Eline Whist is a doctor from Melbourne, Australia on her first mission with Médecins Sans Frontières (MSF). Here, she describes her experiences working in a new MSF nutrition project in Burkina Faso in September 2007.

Burkina Faso, meaning ‘the land of upright people’, was a country I had hardly heard of before I received the phone call from MSF, telling me that was where I would be spending the next 6 months of my life, my first mission with MSF.

Burkina (previously Upper Volta) is a landlocked country with about 15 million inhabitants and one of the poorest countries in West Africa, ranking 172 out of 174 on the United Nations Development program’s human development index. The whole country is affected by malnutrition, but worst affected are the south-western and northern regions, with lots of children suffering from severe acute malnutrition, and it is in the north, in the regions surrounding Yako and Titao (where I am based), that MSF has just started a feeding program to try and combat the crises.

Our team here in Titao consists of the team at the therapeutic feeding clinic, where I’m based (an expat nurse and an expat doctor, in addition to local nutritional staff), and a mobile team that goes out to the health centers of the villages of different areas in the northern region, to ‘find’ the severely malnourished kids in need of treatment. As much as possible the kids are treated as ambulatory or ‘remote out-patients’; they are admitted into the program, receive their first dose a specially designed standard treatment (antibiotics, Vitamin A, anti-worming treatment, folic acid and antimalarial treatment if the rapid-test for falciparum malaria (paracheck) is positive); they then receive a week’s supply of sachets of ready-to-use food (a peanut-based paste, filled with calories, vitamins and minerals, that the kids love) and come back for review and re-weighing one week later. Only the kids who are severely ill are transferred to the feeding clinic in Titao for a more intense and supervised treatment. In this way we can reach and treat a much larger number of kids, than if they were all admitted as in-patients!

As the only doctor here at the feeding centre in the village of Titao I work from early morning till late at night seven days a week, being on-call every night, which means not a whole lot of sleep so far! But it has never been more rewarding going to work, be it day or night time. Some days are worse than others though. Losing the first child was horrible. Losing the second one was even worse. And although some days are incredibly tough and one feels a bit helpless, the majority of the kids do get better, and it is not hard to realize that some of the kids we are now successfully treating would no longer be here had we started up even a week or two later.

The kids have a surprising fighting capacity though. One little boy who I spent many sleepless nights worrying about, is now, after almost two weeks in intensive care and his second blood transfusion, looking so much better, and yesterday he even started eating the ready-to-use food! He has even started to gain some weight and I think he will be difficult to recognize in a week time!

Being part of the start-up of a mission has been both rewarding and challenging. The first week of running the feeding clinic we had not yet received the beds for the intensive care part of the clinic, no mosquito nets, electricity only parts of the day, no running water and no rapid tests for malaria. But we are gradually receiving all the essentials to run a successful program. With almost a hundred children admitted into the program, about twenty hospitalized at the clinic, during the first few days only, it’s not hard to realize that this really is a malnutrition crisis! After the first three weeks of the program we are already treating between five hundred and a thousand children. Some of the kids weigh only half of what is normal for their age, and really look like little old people, and it is really amazing to see how a bit of nourishing milk and some basic medications can completely change a child from emaciated, lethargic and anorexic to a little person regaining appetite, weight and will to live over the course of only a week or two!

Before my mission here in Burkina I had only ever seen one patient with malaria, but here, arriving in peak malaria season, probably around 80 or 90 % of the kids we treat have acute falciparum malaria (the most severe type), which in kids often cause life-threatening anaemia, amongst other problems. The kids are often extremely sick and anorexic, and I have lost count of how many enlarged spleens I have felt so far.

'Intensive care' here has a slightly different meaning to that back home. There are no intubation/ ventilation facilities, no ECG* machine, no fancy monitoring and no routine blood or other laboratory tests. So, with a lack of all the modern investigations one is used to at home, it is all the more about clinical skills, and every single day so far I have learned something new. We will soon also have another doctor here at the feeding centre, a local (Burkinabé), who will be a welcome addition to our little team. Because the locals here really are ‘upright’ and welcoming people and do everything they can to make us feel welcomed; life in this village is definitely one that I will miss when my time here comes to an end.

* ECG stands for electrocardiogram. An ECG machine records the electrical activity of the heart.

(MSF via China.org.cn December 3, 2008)