Médecins Sans Frontières (MSF) is working in Madaoua, a small town in the centre of Niger, to prevent and treat child malnutrition. MSF supports several health centres in the district where outpatient treatment to children suffering from severe acute malnutrition is offered and works in the Madaoua hospital where malnourished children suffering from complications are admitted. Pascual Caballero is an MSF paediatrician who has just arrived in Madaoua. Since 5 July, the Madaoua hospital has become Pascual’s second home. He talks about his experience in this interview.  

What did you come across when you arrived in Madaoua?

I came across a national hospital with very few resources. MSF is in charge of paediatrics and an intensive feeding centre for malnourished children. These children are suffering from some other complications and are admitted due to their fragile condition. I came across a very high demand for care for these children.

Can you describe you work for the next few months?

My job is to improve the quality of the care provided by the national medical team in the hospital. Right now we have six young general practitioners from Niger. They have to cover all the shifts to be able to provide care to the 300 children admitted 24 hours a day. We are recruiting more national doctors but it is not easy as there are not many in the country. I have to train these doctors in paediatrics, build up their technical capacities and support them while we get more staff.

What is the situation now?

An emergency is in the making as severe acute malnutrition as well as malaria cases are increasing. Currently there are 300 children admitted and the number is on the rise. Last week, we admitted between 50 and 80 children every day. Around 35 per cent of them were admitted in the intensive feeding centre and the rest, in the paediatric ward, most of them due to malaria. For this reason, we are adjusting our capacity to the needs. This week the logistical team set up the tents and we have already put dozens of children there. We still need to set up more tents. We will set up as many tents as needed to treat children in need.

What are the main pathologies treated?

Most children admitted to the hospital suffer from severe acute malnutrition associated with pneumonia, gastroenteritis, intestinal parasites, anaemia, skin lesions, and so on. Moreover we also have to deal with many bacterial meningitis cases during the dry season and malaria during the rainy season, which is starting now.

What is the most difficult part of your work now?

Knowing that Niger is a country with very few resources and that MSF has a limited action capacity. As a doctor you treat a child suffering from diarrhoea but then he returns home and there is no drinking water available. The family lives on a subsistence from their agricultural activities, which depends on the presence or absence of rain. I have to accept that the social and economic conditions in this country make a mid and long term approach difficult. In this state of affairs, MSF adopts a medical emergency approach trying to address the most basic needs of most of the children in the area.  

What are the challenges for the coming months?

Despite the difficulties we are facing, the work is paying off. The entire team strives to identify the different health problems of this population and work to resolve them. In the coming weeks, we are going to inform the population about malaria prevention and give early treatment to patients in order to decrease the impact of the epidemic. And in the long term, we want to train local doctors in paediatric knowledge and increase the quality of care and the access to healthcare for this population.