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A place for Angola's hungry children

© UNICEF Angola/2004/Elder
Nutritional Supervisor Martinho Wimbu holds the hand of the severely malnourished seven-month-year-old Nuria Marcus

By James Elder

For several years UNICEF has been training Angolans in ways of boosting the country’s nutritional status and fighting child mortality. Now, two years after the guns of war fell silent, men such as Martinho Wimbu make up a growing band of trained health workers who are helping to reduce Angola’s awful number of child deaths.

Desperately weak from successive bouts of diarrhoea, followed by malaria, seven-month-old Nuria Marcus lies listlessly in one of Angola’s 24 therapeutic feeding centres. Therapeutic feeding centres (which are for the most severe cases of malnutrition) and supplementary feeding centres are Angola’s front line in stemming one of the world’s worst rates of child mortality.

Nuria, whose mother brought her here just a few days ago, at first glance appears to lack even the energy to cry. Her arms are limp and skeletal, the line from her chest runs in a concave arc to her navel, and her eyes are deeply set and dark. 

The region’s Nutritional Supervisor, 33-year-old Martinho Wimbu, takes Nuria in his arms. After more than a decade diagnosing and treating thousands of malnourished children, Wimbu is well-trained to help the baby girl. “Bright, dynamic and highly motivated,” is how UNICEF Angola’s head of nutrition Dr. Paola Valenti describes Wimbu. “He’s just what Angola needs to fight malnutrition.”

And Nuria seems to sense it, for a genuine smile washes across her face. It will be weeks before Nuria is strong enough to leave, but for now, she, and thousands like her across Angola’s southern coastal province of Benguela, are in good hands.

Martinho Wimbu, who is employed by the provincial Ministry of Health, is the youngest Nutritional Supervisor in Angola. His path led from boyhood dreams of being a doctor, to war-torn years working with non-governmental organizations (NGOs) treating malnutrition, to his current work, with training and supervision from UNICEF. Wimbu is a product of national resurgence mixed with international support (in this case, the funds are from the Swedish Government). He is also one of the clearest examples of Angola’s health system beginning to function on its own.

For more than a decade, the therapeutic and supplementary feeding centres in Angola were run by various NGOs, often with UNICEF support. Expensive and demanding in terms of the human resources required to support them, the centres were nonetheless critical in preventing Angola’s high mortality rates from taking even more children’s lives. Despite the severity of the war in Angola, UNICEF continued to train national health workers to detect, monitor and treat malnutrition, in a constant effort to reduce child mortality and to boost the critically important capacity of Angolan institutions.

The result was that in 2002, following the end of almost three decades of devastating war, Angola’s Ministry of Health took over the running of the feeding centres in Benguela, such as the one where Nuria is staying. Today, with Martinho Wimbu guiding the work in nutrition and with continued funding of UNICEF’s work from the Swedish Government, Benguela and much of the country is seeing an encouraging drop in numbers of malnourished children. In 2001 there were 5000 severely malnourished children admitted each month to the feeding centres; today that figure is down to 1000.

“During the war it was not unusual to have 20 or 30 admissions of severely malnourished children each day in just one feeding centre,” says Wimbu, from the spartan room he shares with six other colleagues. “It was exhausting work, sometimes terribly sad. But today, in many places, we have only a few new cases each day.

© UNICEF Angola/2004/Elder
Martinho Wimbu, Nutritional Supervisor in Benguela province, Angola

“This is happening for three main reasons: Firstly, organizations such as UNICEF continue to train many people, allowing the Ministry to expand its reach. Secondly, we then use that training not only to detect cases of malnutrition early, but also to inform communities of critical preventative measures such as breastfeeding. And thirdly, people are gradually becoming more educated about diversifying the crops they plant.”

While local capacities are now improved, serious problems continue to afflict Angolan children. It sounds trite to say that ‘one severely malnourished child is one too many’, but as I walk through Benguela’s therapeutic feeding centre, seeing more than a dozen children clinging to life – all more or less the same age as my own one-year-old son – this is exactly what I think.

Head nurse Amelia, who has worked at the Benguela feeding centre for two decades, says: “I cannot remember a time of only having 25 children here. We can handle 200, and that number is not unusual, so the reduction in numbers is very pleasing. But nonetheless, look at these children – one in ten of them will die.”

Despite the progress, being a child in Angola is still fraught with problems. Malaria continues to infect and kill children, many mothers remain ignorant of simple sanitation practices and of the immense value of breastfeeding, and structural weaknesses remain in the health sector. But things are changing.

“The road to recovery is long,” says UNICEF’s Representative in Angola Mario Ferrari, “but it is very encouraging to see the results of years of work: Boosted local capacity in systems of health and education. Obviously it is our aim that the Ministry of Health runs these feeding centres, but it can only do so if the technical know-how is there. More and more that is now the case and with ever-increasing numbers of trained people, we are seeing falling numbers of severely malnourished children.”

Wimbu concurs. “This is what all those years working directly with malnourished children taught me – the value of training. A single nurse cannot prevent malnutrition from rising, but if that nurse trains 20 people to detect malnutrition early and to then treat it, then that has great impact.”

“Although things are much better than a few years ago, I still wish there were no little ones like Nuria coming in,” says Wimbu. “But while there are, I tell you this: It’s an amazing feeling when you’ve been trained to do a job, and when that job saves a child’s life.”



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