Rosemary is 21 months old. Her body is
wasted and she lies motionless on the bed. Her small, lacklustre eyes seek
reassurance from her grandmother, Museuu Gumbo, lying next to her. She
and her twin brother, Previ, lost their mother in August, and are being
raised by Gumbo, who cares for their brother, age four, who plays in a
nearby room. She has brought the sick children to Mpilo Hospital's Therapeutic
Feeding Centre, where hopefully Rosemary and Previ, who suffer from acute
malnutrition, will recover.
Mpilo Hospital lies on the outskirts of Zimbabwe's second largest city Bulawayo and is one of the country's five central hospitals. It is Zimbabwe's major referral hospital containing over 1,000 beds for its patients and serves a large area of North and South Matebeland.
The paediatric wards, which opened in 2001, are housed in an elegant, red brick building constructed with funding from Japan. The facility was intended to treat children suffering from almost any form of disease or complication, but there are not enough trained health staff or essential medicines.
Fighting malnutrition with 'magic milk'
The treatment of acute malnutrition over the last year in Zimbabwe has been radically transformed. The condition was once treated with high-energy milk (HEM), a mixture of milk and eggs, but today medical mixtures containing vitamins and calcium called therapeutic milk are being used successfully throughout the country. This mixture is called "magic milk" by those who have witnessed its success in treating acute malnutrition.
This advanced treatment was introduced into the district level health facilities after it was first adopted by the major hospitals.
UNICEF, with support from the United Kingdom's Department for International Development (DFID) and the European Commission Humanitarian Aid Office (ECHO), has helped train more than 140 nutritionists and health workers in the country.
Tongai Choiziba, 16-months-old, gasps for air, his breathing assisted with the support of plastic tubing linked to an oxygen machine. His wasted body is enclosed in a plastic-like container to protect him. Much of his delicate skin is raw and peeling away, as though he had suffered severe burns. Instead these symptoms are the signs of severe oedema, the result of acute malnutrition. He is tended to by Sister Zulu, a nurse who has been with the health facility since 1991.
Zulu warns that Tongai's condition may be more complicated than just lack of food. This is his fourth day at the Therapeutic Feeding Centre and his condition is not improving. "We still do not know his HIV status. If he is positive, the odds of him responding to treatment are greatly reduced," she says.
In Zimbabwe, where the incidence of mother-to-child transmission of HIV/AIDS is at 12 per cent, many children like Tongai could be HIV-positive, complicating their chances of full recovery and increasing the odds that they will need to be re-admitted to the centre. These children are also the most likely to be brought to hospital suffering from acute malnutrition.
"We encourage the parent or guardian to be counselled and tested as well as the child," explains Doreas Sithole, the senior nurse at the children's ward. "The impact of HIV/AIDS is seriously affecting our work. The challenge of treating HIV-positive children is much greater, as not only are they slower to respond to treatment but [they are] still vulnerable to other opportunistic diseases."
For many parents and guardians like Josephine Chaumbira, whose 22-month-old grandson Romeo is being treated for acute malnutrition, the Therapeutic Feeding Centre serves as a temporary haven. As well as feeding both children and their guardians, the centre also offers daily lessons on nutrition, childcare, and hygiene education.
However, for some families, the centre's distance from their homes can be problematic, and sometimes children are taken out of the programme before they are completely recovered. UNICEF is working closely with the Ministry of Health and Child Welfare, the World Food Programme (WFP), and other non-governmental partners to establish a better referral and follow-up system that will help ensure all malnourished children can be treated.