On the Front Lines of Malnutrition

An interview with the man in charge of ACF's Stabilization Center in Karamoja, Uganda.
Credit: ACF-Uganda, courtesy T. Frank

Samuel Mbuto, a trained Clinical Officer and graduate of Mbale Medical School in Uganda, joined Action Against Hunger last year to run our new Stabilization Center. Located in the Kaabong Referral Hospital in Karamoja—an isolated region in northeastern Uganda—the facility treats children with severe acute malnutrition and other medical conditions that often accompany near-starvation. Sam sat down with us to talk about managing the Stabilization Center, a child he’ll never forget, and his efforts to train local hospital staff.

What’s a typical day at the Stabilization Center like?

A typical day starts at 8 a.m. I try to arrive early because there’s so much to arrange before the day begins. First, I make sure the daily rations of therapeutic milk and food are available. Then I check that water is being boiled for the children and take care of other routine tasks. Everything can get a bit hectic before we start the ward rounds at 9:30 a.m.

On average, we have about 20 severely malnourished children in the Stabilization Center at a time, so the rounds take us about two hours. It’s a great opportunity to speak to the children’s mothers and teach them about hygiene and nutrition. After the ward rounds, we prepare the children’s next feeding. We give them therapeutic food and milk supplements every three hours, day and night. In the most severe cases, it’s every two hours.

In the afternoon, I teach the nurse how to stock and order drugs from the Ministry of Health so that the local hospital staff can eventually take over from Action Against Hunger once we’ve built up their capacity. Before I leave in the evening, I check on the ward one final time to make sure everything is okay. I’ll review any critical cases again and give the night staff instructions. Then I’ll bring supplies for the night—everything from milk and medicine to paraffin and matches.

The best days are when there are no critical cases or deaths. That’s when I sleep well. But when there’s a critically ill child in the ward, I worry about them after I leave for the night. So when I arrive the next morning and the nurse tells me, “The child is improving,” I feel great. Of course, when the news is bad, it’s very sad, but luckily we’ve had very few fatalities.

Can you tell us about one of the children you’ve treated?

There is one child in particular that I will never forget. Kokoi was two years old when she was brought to the Stabilization Center. She was very sick and severely malnourished—weighing just over 13 pounds. She was literally nothing but skin and bones. She was not eating, not moving, just lying there. She had been coughing a lot, so we suspected she might have tuberculosis, but since there is no x-ray machine in Kaabong, it was difficult to diagnose. We had her on antibiotics and a feeding tube for a few days with no improvement but were very reluctant to prescribe TB medicine because we still couldn’t be sure about her diagnosis.

As her condition continued to deteriorate, I thought about her constantly. Finally, after some time, I told the nurses that we had nothing to lose and to begin her TB treatment immediately. Within a week, she improved drastically and slowly started to move again. Since she hadn’t moved her body for so long, it was as if she were learning to walk for the first time. By the time she was discharged after six weeks in our care, she had more than doubled her weight. We were all unbelievably proud of her.

How does Action Against Hunger identify malnourished children?

We have trained Village Health Team workers at the community level to identify malnourished children and refer them for outpatient treatment, or if the cases are very severe, to the Stabilization Center. In outpatient care, our Clinical Officer and a local nurse give the children rations of therapeutic food and follow up every two weeks until they reach their target weight. After a severely malnourished child has recovered at the Stabilization Center, he or she is admitted to the outpatient therapy program for continued treatment. Finally, the Village Health Team workers continue to check up on them at home. It’s a very practical and cost-effective way of doing things. And training and health education are a critical part of the whole process.

Why is health education such an integral part of the work?

It’s so important that mothers receive health education in order to improve the family’s hygiene and avoid malnutrition and a lot of other diseases. But it’s a gradual process, and sometimes we have to deliver the messages over and over because it’s all new to them. We teach mothers to wash their hands before eating, to use a latrine, to keep their children clean—it’s not an easy thing, and it requires a lot of patience. But time and again I see it working. The mothers’ hygiene improves while they stay with their children at the hospital and the good thing is that most of them maintain these practices after they return home.

Any progress in building local capacity to treat malnutrition?

I think Action Against Hunger has really achieved something here in Karamoja. The Stabilization Center has only been running a year, but we’ve already trained one nurse and two nursing assistants. I’m certain that they are able to manage the Center on their own because they already do when I’m not around. We’ve also maintained an impressive level of professionalism and are really making sure that the children receive quality services. We’ve never skipped a feeding session for any reason – not ever! And this I’m very proud of.

You live in a remote part of Uganda. Do you ever miss city life?

People sometimes wonder why I chose to work here when I could have been in a city like Kampala, having an easier, more comfortable life. I do feel like there are a lot of sacrifices living and working in a place like Karamoja, but what keeps me strong is the feeling that I’m doing something that few other people can do. When I see a child coming in who is critically ill, who then improves because of our care, and who is happy and healthy when discharged—that alone is worth more to me than anything. It’s my greatest joy and makes up for all the sacrifices.