Atak and his mother at Majoknoon Mobile Outpatient Clinic
**Armed hostilities erupted in South Sudan on December 15 and have continued into the new year. On December 23, ACF evacuated all staff out of the country due to security concerns. We immediately set up remote management out of Nairobi, Kenya. The story of Atak and his mother Nyaman comes from before the crisis broke out. Stories like this one serve to emphasize the importance of our work in countries like South Sudan. We continue to do everything we can to return to Juba and proceed with operations in a safe and secure manner.**
Post by Abigael Nyukuri, Nutrition Programme Manager in South Sudan
On 16 October 2013, Atak Majok Deng was admitted to an ACF mobile clinic in Wunrok, South Sudan. Atak hails from Malwalgon, a village just a few kilometers from the ACF Outpatient Treatment Clinic in the Majoknoon site. There was no doubt about it: Atak was suffering from severe acute malnutrition.
ACF team members quickly undertook simple but effective assessments to determine Atak’s condition. At 9.5 months old, he weighed just 7.9 pounds. To bring this into perspective an average, healthy, nine-month-old boy weighs approximately 20 pounds. He also displayed other alarming signs of severe acute malnutrition. We used one of our main measurement tools, the Mid Upper Arm Circumference Measurement, and found that Atak’s arm circumference measurement was a mere 7.3 cm; a healthy measurement is 13.5 cm or more. This is called wasting: a condition characterized by a massive loss of body fat and muscle tissue. Children who are severely wasted look almost elderly and their bodies are extremely thin and skeletal. Atak’s height, another important indicator, was also far too low for his age at one foot 10 inches, compared to a healthy two feet, four inches. This is known as stunting, a chronic condition resulting from long-term nutritional deficiencies.
Severely malnourished and dehydrated, Atak was inactive, quiet and did not display any kind of emotion. He was also unable to take any food orally.
All of these conditions painted a dire picture for Atak. He was far away from being a healthy, playful, nourished baby – the things every parent wants and deserves for their child.
After learning more about the child’s medical history, the nurse discovered that Atak’s mother had been admitted to Turalei Health Facility when Atak was just 5 months old. During that period Atak was unable to breastfeed and was left at home under the care of his aunt, a teenager who had no idea how to feed or take care of a young baby. Atak was given the normal family ration, which was not suitable for a baby who had been previously breastfeeding. His nutrition status deteriorated quickly and by the time the mother was discharged from hospital, Atak was already severely malnourished.
Atak’s mother, Nyaman Matwic Majok took him to the ACF Majoknoon mobile clinic after she realized her child needed help. Atak was admitted to the Majoknoon clinic on October 9th where he was given RUTF, or Ready-to-use Therapeutic Foods. RUTF’s are peanut butter-based pastes and biscuits that are very nutrient-rich and highly concentrated with protein and energy. RUTFs do not require refrigeration or water to be eaten so they greatly reduce exposure to water-borne bacteria and can be stored anywhere.
After one week, Atak was referred to a bigger clinic for inpatient care as his condition was worsening and he stopped consuming the RUTF.
Fortunately, this dire moment was also a turning point for Atak.
At this hospital, Atak was given a therapeutic milk formula intravenously, as he wasn’t able to take anything orally.
Meanwhile, his mother Nyaman was given health and nutrition education on how to care for a young child. The Nurse Aid helped Nyaman stimulate her milk production when Atak’s condition stabilized and he was able to suckle milk.
By November 1, the third week after being admitted, Atak was discharged. His weight at the time of discharge already showed improvement: he weighed 9.5 pounds, but his arm circumference was still only 7.3 cm.
He had no medical complications and was able to suckle with no difficulty. Thus he was referred to the Majoknoon Mobile Outpatient Clinic to continue with therapeutic treatment.
On 21st November 2013, the South Sudan Nutrition Programme Manager for ACF, Abigael Nyukuri, visited the Majoknoon Outpatient Clinic to follow up on Atak’s condition. At the site with Nyaman, Atak looked healthier and could even afford a smile. His arm circumference had increased to 10.5cm and he weighed 11 pounds.
The tide had turned. Atak was on the road to health.
Nyaman relayed her appreciation to ACF staff for saving the life of her child. She admitted she had nearly lost hope for her son after she returned from the hospital to find him so sick and malnourished.
Nyaman had been afraid the treatment centre couldn’t help Atak, but she didn’t give up. Her effort and commitment to her child, bringing him to the treatment centre and caring for him through the therapy, literally saved his life.
Teamwork, through the combined efforts of ACF staff and community health care workers, was a powerful part of the puzzle. In addition to the Nurse Aid, the Programme Manager and other ACF team members, Nyaman was supported by the Community Health Workers who regularly visited her home, providing education on Infant and Young Child Feeding practices and checking on Atak’s progress.
Since this experience, Nyaman is determined to help other mothers so that more children can be saved from the trauma and potential death of severe acute malnutrition. She has since helped educate other mothers in her community and urged those with undernourished children to visit the Outpatient mobile clinic.
This teamwork continues to spare more children from hunger, and help the children and families of South Sudan go on to have healthy, happy lives.