Ending childhood malnutrition, one family at a time

December 2020, Phnom Penh: Mao Sukunthea sits on a bed in a plainly furnished ward in Cambodia’s National Pediatric Hospital, tenderly massaging her baby's thin legs. “I do it to warm him up,” she says, forehead creased with concern. “He gets cold because he’s too small.”

Phearith is just six months old, but has already had a lot of troubles in his young life. “We realised after a few months that he wasn't growing and that he was having trouble breathing," Mrs. Mao remembers. She tried to get help in her home town, the coastal town of Sihanoukville, but the local hospitals didn't have sufficient equipment to diagnose his condition, so she and her mother took wrapped Phearith up and  set out on the eight-hour journey by crowded bus to the National Pediatric Hospital in Phnom Penh, Cambodia’s capital city.

“They took him into emergency care right away, and did X Rays and other tests,” Mrs. Mao explains. “As a mother, you can imagine how I worried. Finally, they said the problem was chronic malnutrition. It was a surprise. I have seven other children and they were all big and healthy. But I'm glad I know now and that he can get help."

"A lot of parents come in here believing their children have mystery illnesses," reflects Doctor Un Vuthy, the Chief of the Malnutrition Department at the hospital. "In most cases, malnutrition is at the core of the problem. It isn't just poor families, though, as some people think. Sometimes we get children from wealthy families who are malnourished, too, because they have developmental disabilities or chronic sicknesses. Not many families know how to feed a child with special needs. The important thing is that we are here to help them, no matter what their background is."

Doctor Un has been on the frontline of Cambodia’s battle against malnutrition for 18 years, ever since he first began working at the National Pediatric Hospital. UNICEF and the World Health Organisation (WHO) have been key supporters to his department throughout this entire period. WHO first trained Doctor Un in nutrition, while UNICEF has long supported the hospital through caseworkers, training, and transport support for disadvantaged families.

"A lot has changed since I started," Doctor Un recalls. "Back then, there was so much malnutrition in Cambodia, people didn't have enough food or know how to prepare it hygienically. I would meet a lot of children who were stunted or bloated from malnutrition, and it was painful to see. I wanted to work in this field to help, but sometimes it felt like it was a problem you couldn't solve. Now I think there is better knowledge among the population and we can do more to support them. There are fewer deaths now and it feels like a problem we can solve at last."

Looking to the future, Doctor Un is cautiously optimistic. "COVID-19 has definitely been a problem," he says. "I know some families who live far away didn't continue their treatment because of the pandemic, they were too frightened to travel. The vaccines are going to be very important to getting on with our work. When things are back on track, I want to see even more investment in nutrition services, so that there are more trained staff to support families and greater knowledge about nutrition across the country."

Nurse Chuon Monny is one of the case workers funded by UNICEF at the hospital. Her role is to provide support to the families from the moment a child is diagnosed with malnutrition until the point they are considered recovered. “That can mean calling families up and making sure that they come to appointments, or helping them to pay for travel. But mostly it’s about being really clear with them about what they need to do to help their child. I set them clear targets for weight gain, and tell them the kind of food their child needs and when and how often.”

Like Doctor Un, Nurse Chuon has been delighted by the progress Cambodia has made in reducing malnutrition. “I first came to this hospital in 2005. I remember that at least three or four children would die a month through malnutrition. That was terrible. Now the situation is better because we have more resources to take care of families and follow up with them. But it’s not over. A lot of the problems happen when Cambodian parents are poor and have to work overseas. They leave their children with grandparents, who then struggle to feed them properly. Situations like that are difficult for everyone."

Nurse Chuon works closely with a newer arrival to the hospital, Doctor Sar Sotheavy. "I joined two years ago, and am very proud to work here,” Doctor Sar says. “Hospitals across the whole country refer cases to the National Pediatric Hospital, because they know this is a place where sick children can get well and strong again. We provide the best quality care, and when we do a good job and help a sick child that gives me a happy heart.” 

Little Phearith is only the latest baby to benefit from the team's expert, compassionate care. He has been prescribed antibiotics to deal with his malnutrition-related bronchitis, and is receiving specially-formulated food to help him gain strength. "He's still not very well, but he's getting better bit by bit," says his mother, rocking him gently as he dozes. "He has more energy and wants to play sometimes, and that makes me happy. I'm thankful the hospital could help us. We will get through this as a family. All his brothers and sisters will help.”

"It's just so rewarding to see a child recover," observes Doctor Sar. "You can see the changes as one extra kilogram turns into two and two turns into three. You see the child's brighter skin, the fuller face, the life returning to the eyes. It's a beautiful thing."