Malnourishment is one of the biggest causes for child mortality in Haiti. For Bobbi, it was almost too late, but the nutrition specialists at NPH St. Damien Pediatric Hospital gave the 2-year-old a fighting chance. May 24, 2021 - Haiti
Nurse treating a young child in the Malnutrition Unit.
Child malnutrition remains one of the greatest development challenges in Haiti. Inadequate infant and young child feeding practices is one of the biggest causes. However, there are also infectious diseases, a lack of proper care, and poor access to water, health and sanitation services to contend with. All of which link to one universal factor: extreme poverty.
According to a report in 2017 by the Demographic and Health Surveys conducted through USAID, the population of Haiti was 10.8 million, 1.2 million of which were under 5-years-old. Nutritional data in the report also found that 22% of the child population suffered from stunting, 10% were underweight and 66% suffered from anemia – a condition caused by iron and vitamin deficiencies. Since then the Haitian population has risen to almost 11.2 million with little data regarding the children’s health status. But with civil unrest, political crises and COVID-19 continuing to stifle the development of the country, the dilemmas caused by malnutrition are unlikely to have improved.
Therefore, the need for the Malnutrition Unit at the NPH St. Damien Pediatric Hospital has never been more vital for children throughout Haiti.
One of those children is Bobbi, who recently celebrated his second birthday, although Doctor Marc Alexandre Dervil, the physician in charge of the Malnutrition Unit at St. Damien, says he is lucky to be alive. “We have professional staff and we do our best to treat the children who come to us. But malnutrition is a major cause for child mortality in Haiti. We are pleased that Bobbi is still with us.”
Bobbi’s mother is Carmite. She is 42-years-old, a mother of three, and runs a vegetable market stall on the sidewalks of Martissant, a neighborhood on the outskirts of Port-au-Prince, where she also lives. She says it was once a paradise, but now it has been taken over by gangs and is known as a ‘no-go’ area throughout the Haitian capital. “On a good day, I earn 1,000 gourdes [US$15.80], but that is rare, especially with the problems affecting the area.”
Carmite’s financial problems exacerbated when her husband’s coal business folded. Despite his best efforts to find steady work, it has proved difficult. On occasions, she has had to borrow money from family and friends to put food on the table, which makes her feel ashamed, as she knows she will struggle to pay them back, and they too have their own financial worries. Living in an area where poverty is rife, with a population of 293,041, making up almost quarter of the capital’s overall population, living conditions are fraught, especially having to avoid the gang activity on a daily basis. The disorder prevents Carmite from having a fixed position to sell her produce.
She sometimes takes refuge with relatives or friends as she cannot pay rent on her small house, which is 10,000 gourdes a year [US$158]. With great emotion, she confesses that in times of trouble, her family sometimes endures hunger for several days and the pain of seeing her children constantly cry drains her. It also leaves her unable to sell her vegetables, meaning they putrefy and become unsellable.
“I do my best to feed my three children and give them whatever I can so they can live a healthy life, but it is difficult,” says Carmite.
Five months ago, in the amidst of the COVID-19 pandemic, Carmite began to see a decline in Bobbi’s health. He was 20 months old at the time, when his ankles began to swell and he developed a cough. Her aunty thought it was intestinal worms, and they began to feed Bobbi herbal teas, but his health continued to deteriorate, and he would cry uncontrollably due to abdominal pains. Since malnutrition weakens the immune system, it provokes other illnesses, such as skin and lung infections, including tuberculosis and gastroenteritis.
Panicked, Carmite took Bobbi to a doctor in the neighborhood, who noted he was severely underweight and referred him to the Sisters of Charity clinic. Once there, the physicians diagnosed him with generalized edema, ulcerative sores and a cough syndrome, and quickly referred him to St. Damien Hospital.
“He was 22 months old and weighed 10 kilograms when he came to us, which is extremely underweight,” says Nurse Wilenda Joseph, one of four nurses in the unit, alongside 11 auxiliaries.
On arrival, he was quickly given nutritional stabilization treatment, receiving peanut paste and therapeutic milk (F-100 and F-75). Under the watchful eye of the nutritional specialists, his condition began to improve over two weeks.
“Seeing him in a delicate condition was heart-breaking. The doctors and nurses were so professional taking care of him. They asked lots of difficult questions, which I felt ashamed to answer, but I knew it was for Bobbi’s benefit,” says Carmite.
Malnutrition is badly perceived in Haiti, which causes embarrassment to parents whose children suffer from it. The causes are usually linked to a lack of means and nutritional education. Parents often do not tell doctors the whole truth about what and how frequent they feed their children, either out of shame or because they feel they provide a sufficient diet. Carmite was a rare case; she told the medical staff that she had only been able to feed her children bread and rice when there was no money. The nurses told her that it was miraculous that her older two children were also not showing more signs of malnourishment.
According to Doctor Marc Alexandre Dervil, the Malnutrition Unit at St. Damien serves three areas: the outpatient therapeutic program, additional nutrition and nutritional stabilization. In most cases, they can treat the children, although due to the lack of understanding about malnutrition, parents often bring their children in a very poor condition, making it hard to make a full recovery. In 2019 alone, they received 402 children: an average of eight children-a-week and 34 per month. Within that, the mortality rate ranged from 3.03% to 22.85% at different times of the year.
The unit has 12 beds, which children occupy between two weeks and a month. Once the child is discharged, check-ups and therapy appointments to monitor the child’s health. However, on occasions children treated for malnutrition return with the same condition or worse because parents do not return to the follow-up sessions.
“We do our best to educate and inform, and in most cases the parents listen and their children improve. Nonetheless, there are a number of reasons why parents cannot feed children appropriately, such as unemployment, having several children to care for in the home, low income, early pregnancy, single parent family etc.,” confirms Dr. Marc.
“We are very confident and do our best with the resources we have on-site to treat these malnourished patients and hope that with sustained efforts that the children heal and return home healthy,” he adds.
While Carmite’s economic situation hasn’t yet improved, she is relieved to see Bobbi smiling and playing with his siblings.
"I would never have had enough money to pay for the care of my child. Thank you to St. Damien Hospital, and the doctors and nurses who saved him. He is now in good health,” concludes Carmite.
Names of the children and parents have been changed to protect privacy
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Damarie Egide Voight St. Damien Hospital Communication Officer
You may be only one person in the world, but you may be all the world to one child.
—Fr. William Wasson