Niger: Kulowa’s impossible decision

Kulowa Don Malam walks into the health centre with her daughter, Zoubeda, seven months old.

From the moment I set eyes on her, it’s clear this child is not doing well. She has an infection in her mouth and her mother tells us she’s been unable to eat.

“It started with me being sick,” Kulowa explains. “I went to the hospital as I had heart pains. It was while I was at the hospital that my daughter got sick as I didn’t have any milk to give her. That was when she started to develop the sores in her mouth.”

Even to my untrained eye, Zoubeda looks badly off. But is she malnourished? That’s what Kulowa has come to find out.

Measured for malnutrition

Zoubeda and Kulowa are made to wait in line with the other women who have come in with their children. It’s hot and the wait seems long – it is Zoubeda’s first time at this centre, so her mother is anxious for an answer.

When Zoubeda’s turn is up, she is placed in the harness to be weighed. She is only 4.3 kilos.

My colleague Adamou, a Save the Children health officer, explains that normally a child of her age and height should weigh around 7kg – a difference of more than a third. It’s a bad sign.

Next, Zoubeda’s mid-upper arm circumference is measured. It’s only 90mm, and the worst is confirmed: Zoubeda is suffering from severe acute malnutrition.

Not the first time

Kulowa is visibly upset, and tells me this is not the first time she has had a child suffer from malnutrition.

Today she has seven children, but she used to have eight.

Kulowa explains that during the last food crisis, her malnourished son became ill with a fever, and he didn’t make it. She says they didn’t even have the time to make it to the clinic before he died.

But for Zoubeda, the fight is far from over. Although she is badly malnourished, there is still time to treat her and prevent her getting worse.

Peanut paste

The next step is to see how she will respond to the high-nutrient peanut paste we give to severely malnourished children.

Adamou tells me that if she manages to eat it, she has a good chance of being able to go home with her mother, who will be given a stock of the peanut paste to feed Zoubeda until their follow-up visit one week later.

We all watch and hope she will take it. But Zoubeda doesn’t eat the peanut paste.

Sitting on a bench outside the health centre, Kulowa is given a packet of the peanut paste to feed her daughter, but because of Zoubeda’s mouth infection, she can’t swallow anything.

Kulowa tries her best, gently cajoling her daughter to eat – but no success.

Doing everything we can

It becomes clear that another solution is needed for Zoubeda: the stabilisation centre. Here she will get 24-hour care and regular treatment to ensure she gets her health back.

As Adamou tells me, “we have to do everything we can to help her”.

Today, Kulowa has a decision to make. Her husband has left their home and village to try to find an income wherever he can – she hasn’t seen him in months.

She has already left her six other children at home without their parents for the morning to bring Zoubeda for screening.

Does she now leave them for what could be days on end, to give Zoubeda the care she needs? Does she leave behind six children, to save her daughter from following the same path as her son?

My heart goes out to her as I realise; it’s an impossible decision.

Please help us reach children like Zoubeda – donate to our West Africa Appeal now

Written by Annie Bodmer-Roy, Media Manager for Save the Children, Niger