In the afternoon, we drive east from Kankan to Mandiana. It’s 35km as the crow flies to the border with Mali. It is the most remote place I have ever visited. The road is not a road at all. It is a dirt track through the bush, more uneven than any so far. The journey takes two and a half hours in our 4×4. When we arrive, my first question is: why? Why is there a settlement here? I can’t immediately understand the history of the place. There is no river and little vegetation.
The answer: gold. There are artisanal gold mines around Mandiana, which create a primary source of income for the men in the region, who scratch a living panning for the precious metal. We are here because it just about the furthest from Conakry that you can possibly travel, and Unicef nutrition surveys have shown malnutrition in this area is at its worst. We park outside the Centre de Santé, which is full of women and children, and as soon as we’re inside, quite spontaneously a focus group seems to begin. These women are more direct and straightforward than any I have spoken to thus far. They seem less encumbered by shyness or mistrust. They are angry and their problems are urgent.
What is the biggest problem for you here, I ask? Water, they reply. There is no water. The statement is so basic and baldly stated it hits me like a club to the head. Can you talk more about that, we ask? One woman speaks up. There is only one well, it is a long walk from the village, and we only have access to it for certain hours of the day because it is controlled by the military. I don’t need to expand on this. They are deprived of a basic need.
What follows is a demonstration of the methods of screening small children for signs of malnutrition. The first test is relatively simple. A small coloured band, like a bracelet or an ankle belt, is threaded around the left arm of the child, between the elbow and shoulder, to measure the width of their upper arm. If the measurement is in the green zone than all is well, in the yellow or red then there is cause for further treatment as the child is either moderately or severely malnourished. If a child is diagnosed to be malnourished, they are immediately treated by the centre de santé or referred to the local hospital which treats the most severe cases of malnutrition where there are also other complications. These complications may have caused the malnutrition, they may be a result of malnutrition, or they may have exacerbated existing malnutrition. Whatever the case, these are very sick children.
Moderately malnourished children are firstly prescribed with a peanut and protein-based packet of paste, with a consistency like cake icing, which is given to the mother to feed to the child, a certain quantity every day. It also contains essential vitamins and minerals, and the hope is that when the child returns to the health centre in a week or two weeks’ time, it will have increased the child’s level of health. If a child is severely malnourished he will be admitted immediately to the nearest in-patient centre or hospital and prescribed with a treatment of fortified therapeutic feeding milk: F75 and F100 which vary in strength and is given during the two main Phases of treatment. Unicef is responsible for providing and supplying this milk and medical equipment.
The eight-month-old boy that is tested registers on the border of the yellow and the red zones. He’s diagnosed moderately malnourished. And there is no water here. He’s only eight months old. The road ahead of this young boy is unimaginably steep.
We are taken across the village to the hospital in Mandiana. There are twelve beds; four of them reserved specifically for children with malnutrition. We’re introduced to a young mother, eighteen-year-old Alima Diallo and her one-year-old son (her third child) who has been receiving treatment at the hospital for the last two days. He has malaria and he is also severely malnourished. Perhaps the former led to the latter. Alima’s first child died at fourteen months, probably from malaria as well. She lives 9 km from Mandiana, and regularly comes to this hospital: “Here they do good work.” The doctor explains that they provide therapeutic milk firstly, then medicines and antibiotics. They also provide folic acid to improve condition of blood, paracetamol to reduce fever, and tablets to reduce parasites. Multi-vitamins as well. A lot of meds.
The doctor needs to see 15% weight increase before the child can be released, which should take three weeks, after which Alima can go to the health centre which will reassess the child’s health status and could provide the specialized peanut paste.
In this scenario Unicef provides therapeutic peanut paste as well as the training sessions for the doctors on severe acute malnutrition: instructions on new protocol; cooking demonstrations for young mothers; sessions on how to implement support groups for breast-feeding women, formula milk, arm measurement tapes, and weight scales. Unicef provided the equipment and the supplies, but local medical staff save lives.
Alima is very happy about the treatment she’s received and she can see the improvement in her baby. The doctor says it’s likely that Alima only spent three years at school. She thinks she’s doing it right, but the doctor disagrees. Alima thinks she has enough food, when she doesn’t. Alima is a child herself. She’s 18, and has borne three children. She had her first child at the age of fourteen. The child died. Her second is three years’ old. She suspects he has malaria. Her third is malnourished.
As we walk away from the hospital Julien explains that this looks like a case of a young mother not knowing how best to ensure her child has a balanced diet, is protected from water borne diseases and malaria.. She lives far from the health centre, has missed out on a primary school education in general, and specifically in observing and diagnosing the symptoms of ill health. She has probably responded too slowly and too late in seeking medical assistance. Alima has done the best she can with what she has, but has been let down by a lack of education. She is learning, however. She says she won’t be having any more children until her youngest is healthy.
As we drive away from Mandiana, from this hot, barren place, I feel further away from home than ever. I can’t conceive of what life must be like there on a daily basis; and the simple challenges they face to survive. ‘There is no water’. I can’t get it out of my head.