By Rebecca Beauregard
GASHAMO, SOMALI, 15 February 2017 – Mutas does not look at his mother. He is not looking anywhere, rather he lays still, his unfocused pupils covered occasionally by heavy eyelids. While we talk, his mother, Bedra Dek, keeps her eyes entirely on him. Her one-year-old son is suffering from severe acute malnutrition (SAM) and despite the food and water shortage and her two other children, she explains that all her thoughts are focused on him improving.
“When your child is well, spiritually you feel happy. This is what I am waiting and hoping for. Nothing else is in my mind except this,” Bedra speaks softly, her eyes never wavering from her son.
About six months ago, Mutas became sick with a cold. Since then, he has fought that illness and intermittent diarrhoea while they lived in remote rural areas. Living in remote areas means even farther than where we are now, which is over 300 km from the regional capital and 63 km off the paved road through desert sand – no roads. Bedra walked yet another 15 km to the settlement just outside Al-Bahi kebele (sub-district) after hearing that there was a mobile health and nutrition team (MHNT) providing lifesaving services. She knew Mutas was not improving, and indeed, shortly after her arrival, he had become lethargic and largely unresponsive.
At 21-years-old, Bedra has 7- and 4-year-old daughters in addition to Mutas. They are a pastoralist family, living in a rural village and often traveling vast kilometres in search of water and grazing land for their livestock.
While the semi-arid Somali region is often dry, the drought brought on by the negative Indian Ocean Dipole (IOD) in the past few months is beyond anything Bedra has experienced. Her family’s herd of over 200 goats and sheep is now down to four, and their physical appearance is too poor to sell in the market.
Upon arriving in Al Bahi, she went to the MHNT, which has temporarily set up as a static clinic in the site to service the hundreds of families in the area. MHNTs were initially set up over a decade ago in this region as a unique and necessary component of the emergency health service delivery system to reach nomadic families such as Bedra’s. They respond to disease outbreaks, provide routine immunizations and basic healthcare including treatment of common illnesses, conduct screening and manage uncomplicated cases of malnutrition as well as refer to higher levels of care as necessary. Here, the team has encountered high levels of malnutrition and the majority of children have low immunization status. The team is both responding to emergency care needs as well as conducting mass immunization and other preventative measures to ensure that a temporary settlement like this does not create further disease and suffering.
Once a child is diagnosed with SAM, they are provided with ready-to-use-therapeutic-food (RUTF) and medications which should help them to quickly improve. To ensure progress, mothers are instructed to come weekly to have their children checked. We meet Bedra as she waits with Mutas for his weekly check.
UNICEF continues to support the GoE’s MHNTs through vehicle provision, transportation allowances, emergency supplies and technical guidance. UNICEF emergency health and monitoring consultant, Kassim Hussein, was present when Mutas was referred. When asked about his role, he explained how he roves around the region providing technical support. “During emergencies, things may be done in a haste, there may be staffing or technical knowledge gaps, or the situation may reach extreme levels and the team is too busy to report. I make rounds to all the teams, providing technical support and ensuring standards of care and supplies are available at adequate levels. I then report back to UNICEF and the regional health bureau,” explains Kassim.
Now Mutas is being seen by Mohammed Miyir, the team leader of the MHNT in Al-Bahi temporary settlement. Originally, he diagnosed Mutas with SAM; now his condition has developed medical complications, making him unable to receive fluids or medicine. This development signals the need for him to be sent to a stabilization centre (SC) at the Gashamo woreda (district) health centre, where he will receive in-patient advanced care until he reaches a minimal level of improvement in his responsiveness and weight.
Bedra is perplexed. Just minutes before they told her this news, she had said she wanted anything for him to improve. Now that it may happen, a new reality hit her. Her two daughters will need to be left behind – there is no room in the MHNT car. This is often an issue mothers out here face. With husbands caring for the grazing livestock, if they need to go to a SC for further treatment, who will take care of their other children? Some find neighbours to watch their kids, other mothers choose to stay and hope for the best, concerned about finding their children again as people are so mobile.
For Bedra, she has another 10 minutes to decide until the car will be ready for her.