Today while visiting the schools in preparation for our mid-line measurements starting next week, my team got a great surprise. My first week in Haiti at one of the schools I spotted a severely malnourished boy. Not only was he extremely stunted (about the same height as a two year old child), his skin was loose and had a ashy color, his energy level was non-existent (what kid doesn’t at least get up for recess?) and he had a fever. All of these are signs of some sort of micronutrient/nutritional problem but put them together and they indicate a possible larger problem of severe micronutrient deficiency.
In other words, this kid was stunted because he didn’t get enough calcium and vitamins a-c-d-k when he was an infant and young child. This could be because his mother stopped breastfeeding before six months or introduced food too early or didn’t watch him eat when he was old enough to eat without assistance or any combination. His skin – the most important barrier in preventing foreign objects like germs, parasites, infection into your body – was poor because he hasn’t had enough vitamin a & c as well as zinc over the years to the point where this barrier is easily broken. Dehydration also impacts the skin. His energy level was low because not only was he not getting enough food, he wasn’t getting enough of the right food such as fruits and vegatables. The Haitian diet is largely made up of rice, corn and beans. Vegetables like carrots, tomatoes, and pumpkin can be bought, but they can get expensive and are not always in the best condition. The fever that he had was most likely due to the fact that he had several infections that hadn’t been treated. These could have come from simple scrapes or mosquito bites or whatever. Your body needs vitamin a and others to fight of infections. When you have little to no vitamin a guess what – you get sick easily.
Besides all of these visible signs that I noticed right away he also likely had others. Diarrhea is common in undernourished children because they are dehydrated, have chronic infections and other illnesses and live in poor living conditions. The water quality in Haiti is also poor – it’s full of ecolli, giardia, amoebas, and other parasites besides dirt, shit and trash. If you drink it, you bet – diarrhea becomes pretty normal. Similarly, sanitation is also more than lacking. The neighborhood this boy lives in is one of the poorest in Cap-Haitien. Many families don’t have latrines (pit toilets you squat to use) and in fact share a common block toilet. (Imagine sharing two or three toilets with your fellow neighbors up and down the street. Now imagine you all have diarrhea and still can only use those latrines. Think they are adequate? They’re not.
So why the digression from nutrition to water and sanitation? Well, they’re intimately connected. You could be the most well-nourished person in the world but if you get diarrhea and don’t treat it, all those vitamins and minerals go out the um, well you know...back end. So while it’s important to be well-nourished, getting enough vitamin a,b’s, c, d,k and minerals like iron and zinc into your system, it’s just as important to be able to ensure they get used by your body and not flushed out.
An over-simplification of micronutrients, but hopefully you understand the complexity of this boy’s situation. He’s been chronically undernourished his whole life and his living conditions are setting him up for chronic illnesses that prevent him from absorbing the things he needs to get better. So he’s sick. And when I spotted him, the team realized that we needed to do something.
While part of the study is to monitor attendance and the health of the participants, there is also a line which we cross if a child is particularly in need of attention. For example, a child misses two days of school because he has a bad stomach ache. We make a note of it but we don’t call all hands on deck. However, a child has shown signs of malaria and has been absent for two weeks. That is more likely to get our attention and we’ll act by taking him to the hospital one way or another (either our nursing team will, school staff, parents, etc). This kid fell into the latter category – he needed to be seen by a doctor and treated right away. So the very next week, one of our fabulous and amazing nurses took him to the hospital where he was diagnosed as malnourished (he was in the 2% for children age 3. This child happened to be SIX YEARS OLD. That malnourished.) as well as having severe infections. He was given antibiotics and his parents were instructed to feed him a specific diet which included meat, dairy products, eggs, and vegetables.
Chances are, the whole family is undernourished. He has three older brothers at the same school as well as four younger siblings. It’s a lot of mouths to feed no matter what country you live in. In Haiti, getting adequate amounts and qualities of food is especially challenging. So, educating parents as well as kids is important. That’s what our nurse did. She talked with the parents and told them what the boy needed in order to get better. And although the parents have hardly any disposable income (really, none at all) they began sending 10 Gourd to school with the boys to buy snacks while at school.
Since these boys are already in the study and are receiving the fortified peanut butter (one of the experimental groups if you remember a previous post) this money can be spent on additional snack food. The nurse in charge of this school – being proactive and diligent noticed this and pulled the oldest brother aside to instruct him what to buy. 5 Gourd is to be spent on bread so that they can put the peanut butter on it (making it more filling) and the remaining 5 Gourd is spent on frozen milk or something similar which is mostly eaten by the youngest brother (the malnourished one). This happened within my first two weeks of being in Haiti.
Having been here for over a month now, I have gotten pretty busy and the little boy, though never completely out of mind has been pushed aside for other things. But today, as I was visiting the school early in the morning before it started I could see three boys running late. I yelled for them to hurry up and as they got to the school I noticed that it was the little boy and two of his brothers. Quelle surprise! The boy was running! A normal thing for a kid to do, but for a little boy who two weeks ago didn’t even get up for recess but preferred to sit this was a sight to see. His whole demeanor was different – he was smiling, talking and engaged.
It was so good to see and got me and my two colleagues pumped up for the rest of the day. Granted, we didn’t do much for him besides get him to the hospital, the fact that he has changed since going to the hospital is encouraging. The school staff, especially the director has been supportive of our project and has begun improvement to the school such as purchasing a water pump and filter for drinking and handwashing (with clean water!), the parents are sending extra money for a mid-day snack for their kids, the nurse is ensuring that he eats the whole peanut butter packet – all of these things are giving him a chance to get better. I can’t wait to see him again.
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