On the move: mobile clinic helps malnourished children

The sound of a bell rings out to announce that the school day has just finished at Kathebwe Primary School. It’s a hot, sunny day. Children run outside and start to disperse. Some go home to nearby villages, while others start kicking a ball around on the school field. A third group joins their mothers and younger siblings, who are sitting with a hundred or more flood victims in the shade of a large tree. Since the heavy rains and floods of early March, this school has doubled as an evacuation centre.

The weather system that produced the floods in southern Malawi went on to wreak further havoc as Cyclone Idai in Mozambique and Zimbabwe. “After the floods this whole area was underwater,” says Michael Luhanga from the Zomba District Health Office, pointing at what is now earth roads, fields and marshland. “We couldn’t get to the school for several days. It was as if the lake had covered the land.”

To begin with, lessons were cancelled at the school. Then teachers and camp leaders came to an arrangement. During the day, the buildings are used as classrooms, but in the evenings the desks are piled up at one end and women and children lay mats on the floor to sleep. There are around 2,500 people living in the camp, but only a small minority remain at the school during the day.

“Most of the men go out during the day to look for work or rebuild their homes,” Michael explains. “In other schools, teachers have told people to leave, but here they have been allowed to stay. Of course it disrupts the children’s education, but these are people from their own communities and they know they have nowhere else to go.”

Cramped conditions

In camps such as these, people live in cramped, unhygienic conditions, often without enough food to eat. This can lead to malnutrition and the spread of diseases, especially among children and the elderly. Luckily, help is on hand. UNICEF, with support from the UK Department for International Development
(DFID), is providing mobile health clinics that visit the camps daily.

Around midday, a white 4×4 vehicle arrives at Kathebwe camp with a team of eight health professionals and a supply of medicines and equipment. The team includes a clinician, nurse, midwife and three health surveillance assistants (HSAs). A queue of women and children has already formed outside the classroom where the clinic will be held. HSA Chimwemwe Kamvetse starts by checking children for malnutrition. The first in line is 1.5-year-old Alick, who is waiting with his grandmother Gladys. He is crying hard and visibly distressed.

Chemwemwe weighs Alick and measures his arm circumference. The result is red, meaning that he has severe malnutrition. She checks her records. “Alick has been malnourished for the past two months,” she says. “He’s already on RUTF [ready-to-use therapeutic food] but has been losing weight since the floods. He was 6.9 kg when he first came for treatment but now he’s 6.5 kg. I’m going to refer him to the Nutrition Rehabilitation Unit in Zomba. He needs to receive specialist care.”

She adds that although Alick’s condition is not yet life-threatening, it puts him at greater risk of infections that could be. “It’s dangerous for him to be in the camp,” she says. “He’s not getting enough food and he could catch diseases from other evacuees.”

Night of the storm

Under the tree with other evacuees, Alick holds an almost empty packet of ready-to-use therapeutic food (RUTF) as he sits on his grandmother’s lap. Next to them are his mother Vanessa and six-month-old brother Gracias. Together, Gladys and Vanessa recount their experiences during the storm.

“It rained for three days without stopping,” Vanessa recalls. “On the evening of 8 March, I woke to see water coming into the house. We took the children outside where we were rescued by a local fisherman who came in his boat. When I went back later to collect our belongings, the house collapsed. I am so grateful to that fisherman. If he hadn’t found us, I think we would have all died.”

Gladys chips in: “I’m 65 years old and I have never seen so much water in my life. It was scary enough for the adults. The children were terrified.”

The four family members now sleep in one of the school classrooms. They’ve received blankets but no food. “Life is not good here,” Vanessa says. “At home, I wake up every day and make a plan to earn money or do some work in our field. But here there is nothing to do. We just sleep and wait.”

During the day, Vanessa’s husband leaves the camp and goes out to look for work. “Three days ago, he got a day’s work in someone else’s field,” she says. “He was paid 2,000 kwacha [$2.73]. We used the money to buy food. We’ve had nothing since then.”

Despite his continued malnutrition, Gladys says the RUTF has helped Alick. “I’ve seen an improvement in him,” she says. “At first he was very listless and slept most of the time. He wasn’t playing or growing well. Now he’s more alert and has started playing with his friends again.”

“I’m very thankful that the mobile health team is here,” Vanessa adds. “Now if people get sick, they can get the help they need.”

Support from the UK

Following the floods, DFID has provided US $4.5 million to fund the humanitarian response by UNICEF, WFP and Red Cross. This funding is helping UNICEF provide medicines and vaccines for the mobile health clinics, as well as transport for the mobile health workers who are brought in from nearby health centres and hospitals. It is also funding water and sanitation supplies for people living in camps.

“We need to respond to the health needs of people living in camps and ensure that health services are not interrupted,” UNICEF Malawi Health Specialist Steve Macheso says. “The risk of malnutrition and diseases like cholera, measles and malaria is much higher in the camps. The funding from DFID has allowed us to scale up our response and help even more children.”

Although for families like Alick’s, things are not yet improving, other people are starting to get back on their feet. Along the earth road to the school, new houses are beginning to go up. Some are just mud and straw shelters, but others are proper brick houses.

One of these is Jali Sumbuleta, 76, who is rebuilding his home in Mangoli village, with help from two nephews. They clamber across the top of the house, making a wooden frame for a thatched roof. Jali has been living with his wife and 13-year-old granddaughter at the village church since the floods. “It’s expensive to buy housing materials,” he says. “But my nephew has helped me and I’ve borrowed some money from our local MP.”