South Sudan

Whatever it takes to reach children in need

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“Hunger makes everyone suffer, but malnutrition haunts the children,” says Robert, Action Against Hunger Nutrition Officer

By: Susan Martinez

In the last year, extreme flooding in South Sudan has impacted more than one million people – displacing families, isolating communities, and washing away roads and crops. By some accounts, it has been the worst flooding in decades.

But flooding has not stopped Action Against Hunger’s team from getting malnourished children the care they need. In Paguir, a remote area of Jonglei State, floods cut thousands of families off from the rest of the world.

"With these floods, many villages have been displaced. These communities migrate to islands even if there are no houses there," says Robert, Action Against Hunger Nutrition Officer. "Some of the areas are cut off by water so mothers can't come [to our center] unless by canoe. Hiring canoes is too expensive, so it makes things more difficult. "

Action Against Hunger is the only organization in Paguir providing medical assistance, but for some in this vast region, the Stabilization Center is still a long and challenging journey. A mother may not be able to make the difficult trip to our center, where her child could receive lifesaving treatment. That’s why, now, our outreach team goes to them to ensure that no child is left behind.

"It is very difficult for us mothers," explains Nyatey, mother of 18-month-old Nyasebit, who lives in Puyai, a remote village in Paguir. "How could I not know that my child was malnourished? I feel sad that I didn't know. But now, Nyasebit will get better thanks to the outreach team."

People living in the areas closest to the Stabilization Center have seen their health and nutrition improving as a result of the services it provides. Today, the most vulnerable families, like Nyatey’s, live farther away from the center, and our teams are finding new ways to reach them.

“We created an outreach team to reach those people who wouldn't be able to access our health services," says Robert.

"Some faraway villages are still in need, that is why we go out with the outreach team. Out there, we find a lot of children to admit to the outpatient treatment program for acute malnutrition, and in serious cases, we refer the child to the Stabilization Center," explains Robert. The outpatient program brings care directly to communities, and the Stabilization Center focuses children with the most severe malnutrition with medical complications.

On a Wednesday morning, the three-person outreach team sets off early. Robert, Peter, and Mawuna travel an hour to Puyai to screen children under five years old for malnutrition. The journey cannot be made on foot because the flood waters are too deep, so the team decides to travel by canoe. They have received information that more people have arrived in Puyai seeking refuge from the floods. Many children could need their assistance.

"A mother could walk 2 to 3 hours to bring a child to the outpatient treatment program here. They might not come at all. So, it's on us now to go to them with the supplies," says Robert.

An hour later, canoeing through grass and bush-covered areas, the team arrives in Puyai with packets of Plumpy’Nut, the nutrient-rich peanut paste used to treat acutely malnourished.

With a clear strategy, the team sets up a screening area and uses a color-coded measuring band to check the nutrition status of the children in the community. Robert measures, Peter collects the numbers and identifying data, and Mawuna distributes Plumpy’Nut to the mothers with malnourished children.

Within the group of mothers, a child has been identified as too sick to be treated in the field - it's Nyatey's daughter, Nyasebit.

"My child had stomach pain and fever. She also developed diarrhea. So, I knew I should bring my child to the Stabilization Center, when the outreach team found me here with my child," explains Nyatey. "As mothers, we have a challenge of transporting children to the center. We normally bring them by use of a basin, so it's a good thing when the outreach team brings us with canoes to get treated."

"We advise the mother when her child is too malnourished and needs to be stabilized. Once she agrees, we travel with the mother and child on a canoe because we are moving in deep water. We take care of them in that canoe until we put them in the hands of the doctor at the Stabilization Center. Once the doctor receives them - only then is our job done," says Robert.

After a long journey, Nyatey, her daughter, and the outreach team finally arrive back to the Stabilization Center. Nyasebit is admitted by Dr. Paulino, who will stabilize and treat the 18-month-old until she recovers from acute malnutrition.

"A child could definitely die if the nutrition outreach team didn't come to us," says Nyatey, who joined a group of other mothers whose children have also been admitted to the health center. During their stay, the women have become good friends.

"I'm really happy with the outreach team and the Stabilization Center, because they treated my daughter and she is now getting healthy. And they are also treating all the children around Paguir. So, I would suggest if this center can be expanded to accommodate more children, that would be good," says Nyatey.

For the outreach team, the goal has been accomplished: another mother and child were brought to safety. Next time they go out, they will revisit a village to follow up on the children in their nutrition program, or perhaps reach out to a village farther away where even more children need attention.

"We have to move, if there's no canoe we have to move by foot. We are working for our community. Now, during these floods, we have to go sometimes even without carrying food with us. We go the whole day without taking lunch, because the outreach can take the whole day. So, that is a sacrifice, we are sacrificing ourselves for the sake of our community," explains Robert, 26, has been working for three years to help his community.

Born and raised in Paguir, Robert was a member of Action Against Hunger’s original emergency team deployed to this area in 2017, before the Stabilization Center was built, when the number of malnourished children was even higher and there was an urgent need for assistance. After three years of Action Against Hunger's work in Paguir, Robert has seen a big change:

"Back then, there were so many severe malnutrition cases, very severe. We used to admit 10 severely malnourished children within a week because people were really suffering here. Now we have 10 severe malnutrition cases in a month. This is a big change."

"This work has changed me, has changed my behavior, the way I see these beneficiaries. I wouldn't be able to tolerate to see these children suffering. Even if those children came late at night, I have to serve those kids, I have to serve them before going home. I wouldn't be able to say, 'It is late now, come back tomorrow,' no. This has made me more committed to my job."