Malawi Day 2: The malnutrition ward

My brain can't compute what I'm seeing. I'm looking at what appears to be a two month old baby who is sitting upright without support. 





The ward round begins and it's clear that, underneath several layers of oversized clothing, this is a 13 month old baby who is the size of a 2 or 3 month old infant. She was abandoned at 3 weeks of age and never fed properly. Taken in by members of the extended family who did their best, she was fed formula milk, but clearly not enough. In a country where resources are limited, we know that babies on formula often do not get regular feeds and the milk may be overly diluted or made with unclean water.  





The result is severe malnutrition and stunting of her growth. This baby weighs a mere 4.9kg. I regularly see babies of 3 or 4 months of age weighing that much at home. The all-important measurement of mid upper arm circumference (MUAC) is 9.5cm. Severe acute malnutrition is defined as having a MUAC under 11.5cm. If I made a ring with my index finger and thumb I could encircle both her upper arms. 





Not for the first or last time that day I feel a surge of emotion. I'm close to tears for a moment. I take a deep breath and compose myself. I would hate this child's caregiver to feel worse because she thought I was worried. We focus on feeding regimes and I learn about high calorie milk based feed and the comically named Plumpy Nut paste. This is an example of a RUTF (Ready-to-use Therapeutic Food). This, like any other area of medicine, is a world of acronyms. In simple terms this is a sachet of peanut  paste which is very high calorie and well tolerated (it tastes like peanut butter - why wouldn't it be?!).  Interestingly this area of the world does not see peanut allergy, or really any allergy at all for that matter and this momentarily gives me pause for thought about our increasingly allergic population at home.  The good news is that this baby has gained weight in the few days she's been on the ward. If her gut can cope with the transition from high calorie milk to Plumpy Nut, she will be ready for discharge. In the meantime she sits on the bed, still and quiet but keeping constant watch, and I can't help but wonder what those eyes have seen in her short life.  





As is so often the case in my work, we see patients for a brief period in their life, we may get to know a little about how their story began but we hardly ever get to know the ending.  I hope that the wonderful team at Queen Elizabeth Hospital have been able to give this little girl a new start that will lead to a better future.