In my interview with Geert Cappelaere of UNICEF, we see the widescale crisis of child health and malnutrition in Yemen. Dr. Rajia Sharhan witnesses this crisis unfold daily as a nutrition specialist for UNICEF Yemen.
UNICEF Nutrition Officer Dr. Rajia Sharhan holds a young child at a therapeutic feeding centre in Sana’a, the Yemeni capital. (UNICEF Yemen/2011/Halldorsson)
Dr. Sharhan works at a health clinic and also trains other medical care workers throughout the country. She recently took time to answer some questions about her work at the clinic. Her insight gives us at least some idea of the challenges facing Yemeni families, and also some solutions.
How far do people travel to the clinic?
It depends on the district distance from their village to the health center. Sometimes they need two hours by car to reach it.
Is accessibility a problem for families trying to get medical care?
Yes it is, especially in the last few months when fuel increased in price so families’ priority was food not health.
What if a medical condition is not able to be treated at your clinic?
The child has to be referred to the therapeutic feeding center and gets medical attention in the same hospital.
Do you see a lot of children who are underweight for their age?
Yes, a lot, around 50%.
What is the most common ailment you see in children at the clinic? Is it something that is preventable?
Many suffer from diarrhoea. It’s preventable by ensuring that the water given to the child is clean and hygiene is promoted.
How much does literacy play a role in how parents care for their children?
It plays a role, as many illiterate mothers don’t know the proper feeding practices and importance of breast feeding and proper complementary feeding. Maybe we use the media (radio) because all mothers everywhere listen to it while cooking, and this may help in increasing the awareness.
Can you describe the use in Yemen of plumpy’nut (the special peanut paste that rescues children from malnutrition).
The volunteers at the village level in Abbs go to identify children with malnutrition. During the regular biweekly work of a volunteer in a village, using Mid Upper Arm Circumference (MUAC), when a child is identified with a MUAC of 11 cm, the volunteer gives a referral card and advises the mother or the caretaker to immediately refer that child the nearest Outpatient Therapeutic Care (OTP) program, which in Abbs is the district rural health center.
The mother has to go there by car so they rent one. The mother and child arrive at the waiting area of the health clinic and give the referral card. Then the child is weighed and the height is measured and if the Z score is -3 standard deviations according to the table chart for malnutrition, the child is admitted to the OTP after an appetite test for plumpy’nut is done to make sure there are no complications (fever, loss of appetite, or any disease causing deterioration of the consciousness of the child).
If the child passes the appetite test then a further clinical checkup is done and the child is given a one-week ration of plumpy’nut which is around 21-28 sachets per week (3 to 4 sachets per day), according to the child’s weight and height. The child then returns to the village but has to go the health center every week to get weighed and to be given the ration of plumpy’nut. Because of the constraints of transportation sometimes the child is given a two-week ration. The volunteers continue their screening and follow up with the children enrolled in the program.
The child is cured after eight weeks.
Child in Yemen opening a packet of plumpy’nut. Around 50 percent of chidren in Yemen are chronically malnourished. (UNICEF Yemen/2009/Brekke).