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Niger: How many children like Haoua will die?

Recently, I visited the northern part of the Diffa region, in the East of Niger towards the Chad border, where we started a new nutrition programme earlier this year. The geographic challenges are tough. In Diffa we see some of the worst malnutrition rates in Niger. To intervene in a semi-desert region means facing enormous logistical and cultural challenges that cannot be overcome without a passion to fight for the well being of all children.

During this visit, we were able to help a little girl, Haoua. At 3 years and 6 months, she weighed only 6 kilograms. The child was completely dehydrated. Her father rode a beautiful horse and her mother, who was cradling cute little Haoua, was on a camel. “It’s their ambulance,” Djibrine, the head nurse of Metimé clinic told me.

We ran into them just as we arrived at the health centre of Metimé for a visit with the head nurse of the centre. Our paths crossing would be serendipity for little Haoua. The travellers stopped next to us, and the camel unfolded his long neck to allow the Haoua’s mother and her sick daughter to dismount.

We found a small girl wrapped in dusty cloth. “Salamleikum,” we greeted the father. Osman, aged 37, replied with a word that sounded like “Kef.”I understood that the parents spoke Arabic. I stammered in my very basic Arabic, “Tamam.”

Osman launched into a rapid explanation and the only Arabic word I recognized was “muskila” which means problem. Just looking at Haoua, it was clear that her health was not good. The nurse began to talk to the father. I told him to consult with the family immediately and forget about our visit.

“This girl is completely dehydrated,” he said to me.

I replied, “Could we take her to the hospital?”

Djibrine responded, “They won’t agree to go to N’Guigmi (the nearest larger town), even if there is nothing we can do for her here.”

“Why?” I asked.

“Because the people here don’t want to go to the hospital. They only treat illnesses when they are at a very critical stage. And for the most part, only in desperate cases,” he said.

I approached Ousman, Haoua’s father. I explained to Ousman the need to send Haoua to the central hospital with a therapeutic nutrition centre that we support. Ousman responded that he would not let his wife to travel alone to N’guigmi.

I immediately replied, “You can both accompany the child.”

Ousman replied, “I cannot leave my animals.”

This conversation continued for about an hour. Another woman came and spoke to Fatma, Haoua’s mother. The chief of the health centre convinced Ousman to entrust the care of his animals with another person so that he could travel with Haoua and Fatma to the N’guigmi Hospital, about 40 km away.

The road, which was basically just the desert, was not kind to us. We got stuck in the sand at least three times. We had to dig the 4×4 out. We had to stop more than five times, as Haoua’s parents were car sick, before continuing on our way to the N’Guigmi Hospital. We arrived at about 7 o’clock in the evening and were greeted by an energetic medical team. Haoua finally received her first medical care 20 days since the start of her illness.

“You know,” the nurse said to me, “these people don’t give any more than a bowl of millet to their children, even when they are sick.”

The next morning, we went to visit Haoua before continuing our planned mission to other health centres in the district. In the treatment room we found Ousman with a big smile on his face, greeting us with words of thanks in Arabic. All I heard from him was “Allah Hamdoulillah…Inshallah, shukran!” Fatma, 26 years, was smiling too. The girl’s health was much better.

I wonder how many children die in the same circumstances? In Niger, 75,000 children die each year before their first birthday. One child in six dies before the age of five. In pastoral areas, it is often the case that girls receive less health care. They are less valued because they don’t participate in taking care of cattle (the main asset of pastoralist people like Haoua’s parents).

Will cultural values, the geographic environment, and the harsh climate be defeated in the fight against under five mortality?

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