Dear all:
I don't know how many of you have been following the situation in Niger. Michael Wines of the NY
Times has put out a series of articles & you can go to the NYTimes website & catch a video of
Maradi, a town I visited many many times. I have many friends among the Health Care
Professionals that work there & I can guarantee you, despite some of the comments about the
Nigerien professionals in at least one of the articles, these invididuals responded very well to a
quality assurance program that enabled them to take charge of developing solutions to some of
the long term problems. The articles are being written from the perspective of the emeregency
refugee aid workers with little of the perspective of the local health care professionals.
One of my Manhattan colleagues asked if breastfeeding would have saved these children.
Unfortunately, the answer is no. Breastfeeding has probably protected many of these children
from dying sooner than they would have had they not breastfed. I cringe at the thought of the
death rates given that scenario. Fortunately, only the very wealthy (of which there are few) would
even consider formula. I don't even think I ever saw it there. Sometimes they will use goats milk
or camels milk. Given the livestock stituation, I would think even that is severely stressed at this
point in time. While at least one organization is using the peanut biscuits, this is a short-term
solution to a problem that has been growing over time. The long-term solutions are out there,
but often more money gets put into the emergency solutions and these emergency operations get
more press.
One of the most frustrating items for me is that one of the aid organizations is targetting the aid
only to the most severely malnourished children. This is extremely short-sighted because once
those children tip back into moderate malnutrition, they may still die - especially from other
causes for which malnutrition is the underlying cause --- such as diarrhea, respiratory diseases,
vitamin A deficiency (rapid death!!), etc. This sort of triaging is not going to make a dent in the
long-term mortality rates. Everyone there is probably starving and suffering from increased
mortality rates.
If you are the type of person who donate to such causes, I would investigate the following about
the organization you wish to donate to:
1) Does the organization include a component of their nutritional program that adheres to the
standards for breastfeeding in emergency refugee conditions? This is critical because every drop
of breast milk counts in these situations.
2) Is the organization donating food that contains at least the following nutrients that are
extremely critical in this environment:
a) vitamin A - even the livestock have been found to be deficient in Niger. Emergency food
without vitamin A included can speed up the metabolism and the vitamin A deficiency can actually
get worse. Xerophthalmia, the most severe form of the disease has a mortality rate of 2/3 of
those who get it.
b) niacin - the diet in Niger is millet-based and pellagra has been known to occur. Again, this can
exacerbate the death rates.
c) vitamin C - often left out of the emergency refugee situation. Again, scruvy can kill too. What
long term plans to ensure a source of vitamin C if they don't have a present source they are
distributing?
Included in the above would be mechanisms for local trading so that the local population can use
some of the donated food to have access to these critical micronutrient-rich foods that are also
essential for reducing the death rates.
2) Does the organization include sustainable programs that continue after the emergency refugee
efforts including one or more of the following:
a) nutritional programs do more than just target the worst off children. The children that are mild
and moderatetly malnourished may just tip back into the severely malnourished category. These
are the children that are more likely to survive if they do get some help. These children are
suffering highly increased rates of death as well.
b) nutritional programs that include a component to improve accessiblity of food after the crisis
wanes.
3) Does the organization have a long-term presence in Niger? These are the organizations that
are more likely to understand the cultural and political structure in ways that will help rebuild the
infrastructure rather than set up alternative structures that disappear after the crisis.
4) Does the organization include a sustainable development component? Do they do more than
just dump food ---- do they have gardening programs? microenterprise development for
women? water programs (that include women in the decision-making process which is key to
success?
I could go on and on. Inform yourself before donating so that you $$$$ count for more than just
today's crisis - and so that you preserve the breastfeeding.
Best regards, Susan E. Burger, MHS, PhD, IBCLC
PS. I was once locked in a bathroom for 1.5 hours in Maradi (see the NYTimes video) when the
temperatures were in the 114 degree range. There were 100+ health care workers (including
myself) staying in one compound with 2 bathrooms. I went into the less used bathroom which
was less used for a reason - the water didn't run in that bathroom. The door handle fell off on the
inside when I figured that out & tried to leave.
The people there are not just media images to me - they were my colleagues and friends. I still
remember one of the Land Rover drivers. I swear he knew more about how to cook clean and
nourishing complementary feeding porridges than most newbie "emergency refugee junkies" as
we called them.
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