Look daddy, I can walk!

A girl’s journey from severe acute malnutrition to recovery in eight weeks

By Helene Sandbu Ryeng
Fourteen-month-old Adut William
UNICEF/UN0344853/Wilson
15 October 2019

Aweil, South Sudan – The legs are still shaking a little, but new confidence is gained in every step. With a huge grin on her face, she is making her way around the simple hut made of grass. Eight weeks ago, fourteen-month-old Adut William was not able to walk on her own.

“Her peers are already running around but Adut is refusing to take one step unless someone is holding her hand, or she can hold on to something. She is not even playing with her siblings,” her father William Deng said when we first met him.

Adut is not only struggling with walking, she has fever, diarrhoea, is refusing to eat and is generally weak

“I don’t know what is going on with my child. She used to eat, now she is not. She is weak and skinny.”

“As a father, how does that feel?”

“Sometimes I don’t sleep, I’m just thinking of how I can help Adut. You know, she will be the last one. We have eight children in total and she is the last and that is as special as the first.”

At Gabat, a UNICEF-supported nutrition centre in Aweil, Adut is dressed in a pink chiffon dress suitable for a party, but she is far from dancing. Most of the time, she is sitting on mother Angelina Mayuel’s lap, leaning against her chest. Her eyes are swollen, and her gaze sorrowful. The nutritionist is measuring her mid-upper-arm circumference, 11.5 cm confirms she is suffering from severe acute malnutrition (SAM). Her weight is only 6.5 kg, which is considered normal for a healthy six-month-old, half Adut’s age.

 Adut is checked for acute malnutrition using a MUAC tape at Gabat Nutrition Centre.
UNICEF/UN0344903/Wilson
A nutritionist is measuring Adut's mid-upper-arm circumference with a MUAC tape at Gabat Nutrition Centre in Aweil. Red indicates severe acute malnutrition.

 
Severe acute malnutrition is a very serious condition, which can lead to death because the body doesn’t have the capacity to fight even simple diseases. In 2019 alone, an estimated 260,000 children under five years of age are suffering from the condition in South Sudan.

The severe and prolonged food insecurity in South Sudan is one of the contributors to the large caseload. As of August 2019, 6.35 million people in South Sudan don’t know when and from where they will get their next meal. "This doesn't only affect the quantity but the quality of food that the children are eating." For the young bodies to grow and develop, they need a plethora of minerals and vitamins. When food insecurity is high, you eat what you can get.

Illnesses such as malaria, acute watery diarrhoea and pneumonia are common in South Sudan, and another contributing factor to acute malnutrition. An infection is often the starting point, before a downward spiral unless timely treated.

This is what happened to Adut. She had repeated malaria infections which gave her high fever, reduced her appetite and the little she ate was flushed out of the body through diarrhoea. Her parents were not able to get Adut to eat enough food, and the food the family could afford was limited.

Eight weeks later, Adut has gone from being somewhat indifferent to her surroundings to an active and opinionated girl.
 

Adut and her sister Lydia (12) outside their home in Aweil.
UNICEF/UN0344933/Wilson
Adut and her sister Lydia after Adut is discharged from the nutrition programme.

 
“She even fights with her siblings,” Williams says chuckling, thinking of her youngest ones snatching food from her older sisters and brothers.

Adut is constantly putting her hand in the bowl of peeled peanuts, or ground nuts which they are called locally, disturbing her mother. But the interruptions are more than welcomed by her mother.

“As you can see, her body and her face are now healthy and there is no more sickness. She's really moving on well without any problems,” says Angelina, grabbing Adut and placing a big kiss on the now chubby cheeks.

The little girl’s appetite is also back.

“Last night she woke up but there was no more therapeutic food, so she cried for the rest of the night until 06:30am, so one of the family members had to wake up early to buy some bread and milk for her to eat and keep her quiet.”

Severe acute malnutrition (SAM) is a very serious condition for children, but it is treatable. Ready-to-use therapeutic food (RUTF) gives the children what they need to bounce back to being healthy children in just six to eight weeks. From January till July 2019, UNICEF South Sudan has treated more than 144,000 children with SAM. Over 90 per cent of them have recovered. This tells us that if UNICEF can access the children, most of them will survive and recover.

UNICEF South Sudan is also working to prevent children from becoming malnourished in the first place. Infant and young child feeding counselling is given to parents and caregivers to ensure the children are getting the food they need. The importance of clean water, hygiene and sanitation are also messages UNICEF is spreading to families across the country. Furthermore, UNICEF is working with the water, sanitation and hygiene (WASH) and health sector to ensure access to clean water, sanitation and hygiene, prevention of diseases and access to health care.

“Her sickness is gone, and she now plays, talks and laughs - now that she's healthy she's so playful. She will enter the house and go out again, and you can even send her to go and bring something and she will bring it to you,” Angelina says laughing.
 

Adut is playing with UNICEF nutritionist Jesca Wude Murye in Adut's home.
UNICEF/UN0344939/Wilson
Adut and UNICEF nutritionist Jesca Wude Murye after Adut is discharged from the nutrition programme.

 
“She now keeps running, running, running. Yesterday it rained, and she almost ran into muddy water,” Angelina adds.

A healthy baby also makes it possible for Angelina to work so they can buy enough food for all the children, making sure none of them will suffer like Adut did.

“Yesterday, I had left home to attend to a women's conference where they are designing bed sheets and I went and sat there knowing that Adut was eating at home and was drinking and playing with the other kids. Before, I couldn’t leave the house.”

With Adut healthy it is time to start thinking of the future.

“Someday, she will be a minister, or even prime minister. Why not,” William says laughing. “One day she will be a somebody, I’m sure about that and happy about it.” 
 

UNICEF South Sudan’s nutrition programme is generously supported by the European Civil Protection and Humanitarian Aid Operations, ECHO.