MSF Blogs: The Silent Cost of Child Malnutrition in DRC

Just as I was about to leave for the day, Steve, one of the nurses, asked me if I could see this one case before going. Beatrice (not her real name) was two years and seven months old when she arrived in our pediatric hospital tent in Kimbi Lulenge, South Kivu, in the Democratic Republic of the Congo (DRC). A quick glance at the prostrate child in the dim circle of light cast by the tent’s single bulb and I guessed she was another malaria case. Steve shook his head. “Non, docteur. C'est un nouveau cas de malnutrition” (“No, doctor. This is a new malnutrition case”).

I quickly felt the child’s feet—icy cold. A careful look at Beatrice showed that all the curves and dimples of a healthy child’s face had shrunk, leaving the forbidding lines of a woodblock print. Beatrice was alert, but silent, which formed an ominous void amid the children crying in the rest of the tent. There was a glint of anxiety in her rheumy eyes that grew dimmer as she seemed to fall into it.

I gently pulled back the cotton wrap. The malnutrition had ravaged her skin, causing it to flake off, leaving behind weeping sores across her arms, legs and chest. There was no healthy protest when a drip was placed in her arm.

The nursing staff went into action. They gave her glucose to prevent low blood sugar, antibiotics through the drip to fight off infection; they advised her mother to keep her warm, as hypothermia takes the lives of many of these children at night. Careful fluid management and gentle refeeding was started: give too little and the child will succumb to dehydration and shock; too much and the child will die of heart failure.

Treating a malnourished child is complex. It is not simply a matter of doling out cups of milk and packets of peanut paste when a child like Beatrice finds her way into our tent, tied to her mother’s back after she has walked a day to get to our hospital or, if she’s lucky, on the back of a relative’s motorbike along the treacherous dirt roads.

Read the rest of Chris Bird’s Blog entry from the field.