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Young Sok Chea stands testament to malnutrition safety net success

UNICEF Cambodia/2011

By Eamonn Casey

KAMPONG SPEU, June 2011 – From frail, lethargic and desperately malnourished at nine months old to chubby, smiling and bright-eyed now at 16 months, Sok Chea is a local success story for Toul Sala Health Centre, the local community, and the multi-agency programme tackling malnutrition in Cambodia’s Kompong Speu province. As he lives, breathes and walks, Chea is evidence of a safety net that works.

“Before he was so skinny, but now you see he’s fat. If you have food to give him, he is happy to eat it: rice soup, egg, porridge, bread or whatever I can afford to give him,” says his grandmother and carer, Chou Savang, in Thnout village, Toul Sala commune.

“He’s eating the same food as his brother – and even more than him now. Now, you see, he can stand: last year he could only lie down, almost lifeless, and do nothing.”

Having suffered frequent respiratory infections, bouts of diarrhoea and fevers as an infant, Chea became very ill and was only clinging to life by five months, according to his grandmother.

Skinny, frail, listless and uninterested in eating, he scared the life out of health workers, private clinics and the local Toul Sala Health Centre, which initially refused to admit him for fear that he would die within their care. They said he should be treated somewhere else, or in the capital, Phnom Penh, but Chou Savang couldn’t take him. She was also looking after her sick mother, who has since passed away.

Eventually, in October 2010, Village Health Support Group volunteers referred him to the health centre after conducting their first community screening in Kampong Speu. Supplies and training of health centre staff and volunteers for the management of acute malnutrition is supported by the MDG-Fund Joint Programme for Children, Food Security and Nutrition.

Supported by UNICEF and other UN agencies, the programme is implemented by government and specifically aimed at improving the nutritional status of children aged 0-24 months, as well as pregnant and lactating women. Among other things, it plans to promote early and exclusive breastfeeding, adequate complementary feeding and improved maternal nutrition.

The programme also involves efforts to better target high-risk populations, and a comprehensive package of nutrition and food security interventions to reduce under-nutrition and improve food security in these groups. It could have been designed with Chea and his family in mind.

Life dealt Chea a tough start. His mother, who has now left the family home, refused to breastfeed him, as she had his brother Huy Vicheka (now 3 years old), following stories from her friends that breastfeeding leads to the loss of a mother’s beauty.

Despite their grandmother’s protests that breast-milk was important, the young children grew up on formula and rice soup, which didn’t give Chea the start he needed. He was effectively ill from birth and received countless treatments for various ailments from public and private health facilities around Toul Sala commune.

Chea’s mother left the house, returning to her home province of Battambang, when he was one month old, leaving the infant and his brother to the care of their father. But 30 year old Sok Vanny works as a truck driver, only getting home once a month, so the boys’ care has fallen to their grandmother who has already raised six children.

Looking after two boys and her own youngest, while also working in the fields, continues to be a daily struggle, but was especially hard when Chea was sick, and weakening by the day. “Last year I couldn’t do anything. I was just with him all the time,” she says.

In October, when he was screened for malnutrition, Chea weighed 5.5kg, about half the normal weight for his age, and had a mid-upper arm circumference of 11cm. These indicators meant that he had severe acute malnutrition. Immediately, Chea was put on a programme of BP-100, a high-nutrition therapeutic food mix used in the treatment of severely malnourished children and adults. He did well on that, eating according to the directions and gaining weight quickly. After a month, Chea was no longer severely malnourished and moved on to a supplementary corn-soya food product (CSB++) for three months.

Happily, Chea moved out of the moderately malnourished category after four months of treatment, and looked “fresher, fatter and more active,” according to one health worker.

His grandmother’s attention and care for Chea at home was crucial, says Ek Sarun, nurse and chief of Toul Sala Health Centre, who praised her diligence in following food preparation and hygiene instructions, and the effort she made to attend regular check-ups.

Nutrition screening has identified 154 malnourished children in Toul Sala commune: 18 severely and the rest moderately malnourished. According to Ek Sarun, not all receive the attentive care that has helped Chea recover. He was among those eating the food properly, presenting regularly for check-ups and steadily gaining weight.

“We keep encouraging and motivating the caretaker to use the treatment products properly – follow the instructions, prepare the food in a bowl, with the right amounts, using boiling water,” Ek Sarun said. “Chea is one of the success stories – for the health centre, and the community as well.”

Chea’s screening and the nutrition interventions that followed helped save his life, as did the love and care of his family, especially his grandmother, who is much appreciated by his father and the family’s neighbours.

Five months after his treatment finished, Chea is no longer malnourished and has all the appearances of doing well ? playing on the steps of his family home, smiling and joking with his brother.

It’s not an easy life for him and his family. Even now, when Chou Savang has to go to the rice fields, she leaves the two young boys in the care of their 10-year-old uncle, her youngest son, Sok Raksa. But at least now the cloud of worry about Chea’s desperate nutritional state has lifted, and the whole family is thrilled with his recovery.

“This year, after making their breakfast, I can at least go to the fields, come back later to get them lunch, and then go in the afternoon to the fields again,” says Chou Savang.

“Now we can play with him,” says Sok Raksa, laughing. “He looks fatter, and I’m happy he’s stopped being sick.”

Chou Savang has quiet ambitions for Chea and his brother: that they’ll grow up to be healthy and good, with happier marriages than she and her son managed; that they’ll get some education, and might get to work as a truck driver, like their father, or even a teacher. That Chea has that future to shape and dream about means a lot to the family.

“I am really thankful for the health staff and the products that helped my grandson survive,” says Chou Savang. “Otherwise, he would have already died.”



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