On the steep, rocky path to Degrave, Haiti, pieces of old asphalt collected from a road demolition project many years ago act as makeshift cobblestones.
Like the road to Degrave, families in this poor, rural community in Haiti are skilled at piecing together a life from the difficult realities that surround them: political instability, economic stagnation, rising food prices, declining agricultural yields, lack of government services and infrastructure, and vulnerability to natural disasters like hurricanes and earthquakes.
As I walk this path to one of the weekly child malnutrition clinics MCC has run in this area since July 2017, the nurses tell me about the two children they want me to meet: nearly three-year-old twins, Gabina and Gabison Ossinel.
“They were like threads,” Mennonite Central Committee (MCC) nurse Marius Kerline says, pulling her thumb over her index finger to make an impossibly small representation of how thin their arms were when she first met them. “They were 2 1/2, but they could not walk. They could not hold their plates up themselves to eat. They were so weak and sick, they could not control their defecation. I really thought we might lose them.”
Mentally I prepare myself for what I imagine I will see. Seeing children suffering does not get easier. I struggle not to think about my own daughter, a similar age, living just a couple hours away in Haiti’s capital city of Port-au-Prince.
Under the hot tin roof of the school turned clinic, women and children gather to meet with the team of Haitian nurses MCC has hired. Each patient’s chart is reviewed carefully. The children are weighed, measured and examined for progress.
Severe acute malnutrition brings a nearly 20 percent chance of death for young children who are not treated. For those who survive, life-long consequences can include poor brain development and intellectual disabilities, heart damage, metabolic disorders, autoimmune diseases and physical stunting.
In the Haitian context, for the poorest families in remote villages, accessing hospital-based treatment is extremely difficult. It usually requires several months’ wages just to cover transport, supplies, food and missed work even if the treatment itself is free.
The nurses evaluating the children are comparing their weight, arm circumference and height against both their last measurements and international standards for malnutrition. Children who are failing to make progress or are getting worse are referred to a hospital for more intensive treatment. If they are stalling in progress or have other symptoms (like diarrhea), the nurses act quickly to get them back on track, administering antibiotics, an anti-parasitical or other medication as required.
Meanwhile, parents are taught how to help their children recover and stay healthy. They learn about maximizing nutrition on their meager earnings, how to avoid getting sick and how to keep food and water clean. After each visit, parents are sent home with a nutritionally enriched food supplement for their children, made primarily from peanut butter. The nurses follow up weekly with every child, sometimes in these group clinics and sometimes house to house.
As I talk with one of the mothers, a small girl sits down beside me and giggles. “This is Gabina,” her mother says with a smile. “Doesn’t she look strong?”
I remember reviewing the charts before we left. Only four months ago, Gabina weighed just shy of 12 pounds. For a child her age, that’s literally off the bottom of the growth chart. Her thin arms put her in the severe acute malnutrition category, and given her extremely short stature at the time, it seemed likely that she would be permanently stunted.
Today, Gabina is back on track, having quickly responded to treatment. She is healthy, strong and curious. Her twin brother also is recovering well.
Their mother, Bertha Louisius, laughs as she describes the relief and gratitude she feels every time she sees her twins now. “They were so small, they were so sick. I didn’t know what to do. I had no money, and nothing I was doing worked. I thought they might die, but I didn’t know what I could do. I had given their fate to God when I met these nurses.”
The nurses Louisius is describing ‒ Exaus Andrène, Adeline Sainvilus and Kerline ‒ are part of a pilot project MCC is running in the mountains of the Artibonite Department, where many of MCC’ projects are located. At-risk families are identified through MCC’s wide network of kids’ clubs and farmers’ groups. The nurses evaluate children in these families and enroll those with severe and moderate acute malnutrition for three months of intensive support, followed by at least a year of follow-up.
The pilot project is on track to help 160 children in 2018. So far, 98 percent of the 202 children who have been treated since the beginning of the program have fully recovered at home through the project. Only two percent have had to be referred to a hospital for inpatient care.
Nurse Sainvilus explains why she proposed this pilot project last year.
“These are children in our own community that are suffering, and their families are powerless to help them. They are too poor, and they don’t know what will help their children recover. As Christians we can’t stand by and watch these children get sick and die when we know that we could help, when we know how little it takes to help. As a nurse I know how to help, and now I can. I praise God each day for that.”
Paul Shetler Fast is serving as MCC’s Global Health Coordinator and is based in Port-au-Prince Haiti.