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How do you assess and treat malnutrition in the field?
The diagnosis of malnutrition can be made several different ways. I will frame it in terms of the admission criteria to our center. To be diagnosed with severe malnutrition you had to have either: 1. peripheral nutritional edema, a.k.a. kwashiorkor; 2. weight for height ratio less than 70% of normal height (this is the gold standard diagnosis for malnutrition); or 3. mid-upper arm circumference (MUAC) of less than 110 millimeters. Admission by any of the three criteria is treated the same way. There are two phases of treatment. The first phase of treatment generally lasts between two days and one week. It begins with a twenty-four-hour intensive medicine therapy, consisting of antibiotics, antiparasitics, a measles vaccine, folate, vitamin A therapy, and malaria treatment if the patient tested positive. During the first phase we administer a specified amount of high-energy milk every three hours around the clock. On day fourteen of treatment, every patient starts receiving iron. This series of interventions is intended to stabilize the system, preparing for the growth that happens in stage two. In the second stage, we slowly begin to substitute milk with high-energy nutritional bars.
Was food security an issue in the camp?
Yes, it was definitely an issue in the camp. Food distributions were very infrequent. Many families did not have any food supply and it was really up to them to find their own food.
The top cause of mortality is often the subject of debate. From your experience, what were the leading causes of mortality in the camp?
I would say that in the early stages when everyone was leaving the villages, it must have been violence. Certainly the violence continued once the IDPs were in the camps, but I don’t think it was any longer a direct, major cause of mortality. The big causes were diarrheal illnesses, malaria, and acute respiratory infections, all of which were exacerbated by malnutrition. This might be changing now; the conflict certainly is not resolving and may be getting worse.
What was the most challenging aspect of your time in Darfur?
I would say that there were two different types of challenges. One was on a professional level: being there and treating kids who were dying for what I perceived as no good reason. This was very frustrating. The other was personal: hearing the stories of people whose family members had been killed, raped, or lost. Almost without exception, everyone you would sit down and have a conversation with would have a story similar to that. Each and every story was worse than anything that had ever happened to anyone I knew back at home. It is so intense that it is difficult to wrap your mind around it when you are there. It was really only once I got home and had time to reflect that it seemed even that much more unbelievable. It was difficult being away from friends and family, even though two months isn’t a long period of time. Being in conditions in which there are random acts of violence and one doesn’t know exactly what is going on is extremely difficult. You don’t communicate with home and friends regularly and it is difficult being out of touch in those sorts of conditions.