“COVID didn't scare me from from coming; my daughter’s life depends on the help”

The importance of continuing life-saving services in the context of COVID-19

Helene Sandbu Ryeng
a girl is sleeping on her mother's shoulder
22 April 2020

JUBA, SOUTH SUDAN – Normally you can’t get a glimpse of the wood the benches are made of as they are filled from start to finish with mothers and their children. Today, there are only two mothers per bench, separated with fabric tied together in a rope to separate them. At the nutrition site inside Gurei Primary Health Care Centre (PHCC), staff are doing what they can to implement the Coronavrus preventive measures while providing quality services- as the children’s lives depend on it.

women are sitting on benches
Mothers are physically separated at the nutrition site to adhere to the preventive COVID-19 measures

People across South Sudan are advised not to go to crowded areas to prevent the spread of COVID-19, but Alice Immeno doesn’t have any choice. She is fully aware of the pandemic but staying at home was no choice. “I’m not scared of COVID, but I was scared of losing her,” she says looking down on her 12- month old daughter.  “Sarah had fever and diarrhoea for four days. I took her here and she tested positive for malaria. Sarah lost her appetite and the wasting continued. I took her back.” At the admission, her mid-upper-arm circumference (MUAC) was 10.8 cm meaning severe acute malnutrition.

Alice was given ready-to-use therapeutic food to give her at home and Sarah improved quickly, and in a few weeks her MUAC was 11.7 cm.

A child with a measuring tape on the upper arm
Alice is measuring Sarah's mid-upper-arm circumference

“Then she got malaria again, and again diarrhoea, fever and she stop eating.” Sarah went down to a MUAC of 10.9 cm. At today’s check-up, her MUAC is 11.3 cm.

“As a mother, I’m happy to see her improving again. It has been a struggle.”

Susan Clement is fiddling with the MUAC tape and trying to wrap it around the upper arm of her daughter Flora. The one-year-old sits surprisingly still while Susan is peeping at the other mothers in the room to check if she’s got it right. The reading from the MUAC is not the official follow-up at Gueir, a nutrition worker will do quality assurance after. The mothers are trained on using the MUAC in case new COVID restrictions are imposed hindering them from coming to the clinic. With the MUAC tape, mothers can keep track of the children’s progress.

A mother measuring a child's upper arm
Susan is measuring Flora's mid-upper-arm circumference

Today is Flora’s second follow up after she was admitted to the UNICEF supported nutrition programme. “She had fever, lost her appetite, so I took her here to find out what was wrong with her,” Susan says.

The health workers at Gurei suspected that there was an underlying condition and therefore referred her to Al-Sabah hospital, the only children’s hospital in South Sudan. There it was established that she was anemic. Flora was enrolled in the nutrition programme while also being treated for anemia. Susan can already see changes in her daughter. “Her appetite is back, and she is more active. Now she is playing, she didn’t do that before we came here.”

A woman holding a poster
Before every screening session, a COVID-19 orientation is given to the mothers.

Before every screening session starts, the nutrition workers are giving the mothers an orientation about the Coronavirus. They talk about what it is, the signs and symptoms and how they can protect themselves and their families. This is where Julia Dodo learned about the virus.  “I was not scared to come here because of COVID-19, because I hadn’t heard about it. It was when I brought my twins here and had the orientation I learned about the disease. They told us that we need to keep our distance and wash our hands to protect ourselves.”

A mother with her child on her lap
Julia with Farida on her lap at Gurei Primary Health Care Centre

Julia has brought her twin daughters Roda and Farida for their first follow-up after they were admitted to the nutrition programme. Diarrhoea, fever and cough made the eight-month-olds lose weight quickly. At Gurei, it was established that Roda was suffering from severe acute malnutrition and Farida from moderate acute malnutrition- both requiring treatment.

“They are already doing better. We were given plumpy’nut [Ready-to-use- therapeutic food] and I give them.” Farida has increased her MUAC from 11.6-11.8 cm in one week, while Roda has increased from 9.7 to 10 cm in the same period.

1.3 million children under five in South Sudan will suffer from acute malnutrition in 2020. Acute malnutrition can be deadly if not treated, as it weakens the body so much that every bacteria and virus have free passage into the body and can put an end to a life that has just started. Therefore, UNICEF and its partners is doing everything possible to continue life-saving services such as screening for and treatment of malnutrition, in a safe way. 

At Gurei, the mothers are also provided with soap as a contribution to a more hygienic home for the family and especially the vulnerable children.

Alice Immeno has been in and out of the nutrition centre for seven weeks with her daughter Sarah and has seen how more and more preventive measures are put in place. All the staff are now wearing masks, and everything used by more than one person is sanitized before use.

“I feel safe, they [the staff at the clinic] know what they are doing. I’m also given an orientation here on what to do to keep myself safe. I am practicing handwashing at home and I’m given soap here, so I have no issues with coming here, but I do hope Sarah will soon recovery fully, so we don’t have to.”

A woman handing out malnutrition medicine
After screening and a consultation with a doctor, the caregiver is given ready-to-use therapeutic food enough for one week, which is medicine number one for malnutrition.


UNICEF's nutrition programmes are generously supported by USAID, the EU and UK Aid