Months after Typhoon Bopha, children in the Philippines at risk of malnutrition

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UNICEF correspondent Marissa Aroy reports on the situation for children in the Philippines affected by Typhoon Bopha - 100 days later

By Pam Pagunsan

It has been estimated that, in the aftermath of Typhoon Bopha, 67,000 children under 5 are at risk of malnutrition. Children like Longlong, in poor, remote areas, are particularly vulnerable.

LAAK, Philippines, 26 March 2013 – Three-year-old Bartolome Mantog is sitting up – the first time he has done so for days. He has just been given a bath, and he is wrapped in a t-shirt and towel. He sits propped against a piece of luggage in the district hospital bed.

The little boy shivers and pulls up the towel to cover his badly swollen and sore legs, picks up a toy truck and makes bulldozer noises.

“He was dying”

After Typhoon Bopha, Longlong, as Bartolome is known, was diagnosed with kwashiorkor, a nutritional oedema affecting his whole body that is one of the signs of severe acute malnutrition (SAM). Longlong also had dermatitis, an inflammation of the skin resulting in discolouration and peeling that usually accompanies the swelling of kwashiorkor.

“His entire face and body was swollen,” says Laak rural health unit nurse Jessica Mahilum. “He was in pain; his skin was dark, peeling and bloody. It looked like he had second-degree burns.

“He was dying,” she adds.

Longlong’s family of seven is from the Dibabawon tribe – one of many tribes that make up the indigenous people’s communities. They live in the remote community of Datu-Davao in a remote, mountainous area bordering Compostela Valley and Agusan del Sur. The area was badly affected by the typhoon, but has, as yet, still received little relief, even months after the disaster devastated its people’s lives and livelihoods.

Pain of loss

“We lost everything, including our house, and the one hectare of land where we grew corn, cassava and sweet potato,” says Longlong’s mother, Maricel. “My children were fine, thankfully – not even a cold or cough, despite the weeks of rain.”

The typhoon swept through largely poor, rural areas, where the nutritional status of children was already of serious concern, with malnutrition rates well above the national average. To make ends meet after the typhoon struck, Maricel would prepare daily meals of rice and sweet potato for herself and her children.

“I noticed Longlong’s feet swelling at the end of December, just two weeks after surviving [the typhoon],” Maricel says. She describes how she had seen a baby with similar symptoms in her village before the typhoon. That baby had died, so she knew Longlong’s illness was serious.

When the swelling became worse, rising up his legs and across his body, she decided to take the 37 km, three-hour journey to the Laak rural health unit. Along a muddy road, Maricel held Longlong on the back of a motorbike, with her husband and other children.

Nurse to the rescue

It was, in part, Ms. Mahilum’s quick thinking that would save Longlong’s life. Just the week before, she had attended training organized by UNICEF and partner Action Contre la Faim on managing malnutrition cases.

“I saw a photo of a child like Longlong, and I immediately sent a picture of Longlong to the doctors who trained us,” she recalls. Longlong was admitted to hospital and supported by Action Contre la Faim Head of Programme, Nutrition and Care Practices Dr. Rosalia Bataclan. Dr. Bataclan has been working to train Philippines medical staff in the globally recognized treatment protocol of malnutrition – integrated management of acute malnutrition (IMAM).

“In this kind of case,” explains Dr. Bataclan, “doctors who are still unfamiliar and untrained on IMAM would still inject an intravenous line into children. But with so much fluid in Longlong, this would have killed him within hours.”

Urgent need to reach remote areas

Past experience suggests that there is an increase in child malnutrition in the aftermath of a disaster of this scale. The Typhoon Emergency Nutrition Cluster, which is composed of government agencies and such development actors as United Nations agencies and NGOs, estimates that 67,000 children under 5 years old are at risk of malnutrition.

Maricel’s community of 44 families is poor and remote. The community does not have latrines, and the villagers draw water from a nearby spring. Only one person has a generator, and a few people have phones. There is no functioning village health station.

“There are serious emerging nutritional issues in remote, badly typhoon-affected areas that are still underserved by relief,” says UNICEF Nutrition Officer Dr. Paul Zambrano. “There’s an urgent need to reach these communities who may not always have the resources, or knowledge to get help.”

“UNICEF and the nutrition cluster is urging the quick roll-out of the malnutrition IMAM protocol by the government so all community health and nutrition workers, nurses, midwives and doctors are trained to identify, treat and save children like Longlong,” adds Dr. Zambrano.

Longlong will soon be ready to be discharged back home to Dutu-Davao. He has been following a course of antibiotics, and Maricel has been given a week’s supply of ready-to-use therapeutic food, a highly nutritious food paste for children with SAM. Longlong’s weekly visits to the rural health unit will be funded by the municipal hospital, where he will continue to be monitored and provided with the therapeutic food until he has fully recovered.