An unplanned trip to Illela (Part 2)

9/17/09

So. This morning was the longest time I've spent at the infant malnutrition ward. There are five women staying there right now: Habi (in her 3rd week!) with daughter Samsiya, Salamu with son Abu Zaidi, and three women with their babies from other bush villages. One of the women has eight month old twins; one is a normal weight and well developed. The other, a little boy, has bright eyes and seems alert but weighs less that 2 kilograms. While these women stay at the hospital, they are under the stern but compassionate eye of Nurse Hajara. Hajara administers medicines, weighs the babies every day, tells the mothers when and what to feed them. Depending on the age and ability of the babes, they are fed fortified milk, or a peanut-butter like paste, or a combination of the two. Babies who won't drink are force fed; babies who will eat eventually get fed bits of fish and egg. When they reach a weight and health that Hajara approves, they are allowed to go home. Everything is paid for by the government.

When Habi came with 5-month old Samsiya 2 weeks ago, the top of Samsiya's skull was so sunken in you could have filled it with a half cup of water. She weighed 3.8 kilograms (sorry guys, how much is that in pounds? 8?). Today I got to watch Hajara weigh her again- she is now a whopping 4.0 kilos and will be released when she makes it to 4.3. Hajara said that Habi is the best of all of the mothers at making sure Samsiya is getting better. I was really, really happy to hear that. Salamu was smiling this morning; Abu Zaidi already looks better. She told me today that he had passed out three times yesterday, and she thought he had died. But now he's drinking canned milk and getting a whole smorgasbord of medicines and vitamins. It is too soon so guess at how he will do, but I sure do trust Hajara, and I think she'll know what to do for this babe. Habi and Samsiya will probably be home within the week, and hopefully Salamu and Abu Zaidi won't be far behind.

Some of you who read this blog last year may remember that September, October, and November were hard months for mothers and babies. One difference this year is that women seem more aware of where they can get help. It could be my imagination, but I think that perhaps some of the negative stigma- associated with revealing that your child is malnourished- is fading in my village. I hope so. I'll probably write about this again; I sure think about it a lot.

An unplanned trip to Illela (Part 1)

I wasn't planning on coming to Illela today, although I did want to
come up here sometime soon to visit Habi and Samsiya at the hospital.
What happened was: yesterday evening at about 6, an older lady found
me at Narba's and asked me if I'd take another woman and her son to
the hospital.

I got up to go see what was going on; it turned out the woman and her
baby were already sitting in a truck on the road.  The woman, whom I
recognized but didn't know that well, had tears all down her face and
was holding her son, a tiny bundle on her lap.  Someone handed me a
note from the nearbly clinic; it had "severe malnutrition, admit to
hospital immediately" written on it in French.  People were all around
us, staring at her and watching me to see what I'd do, shouting advice
like "Throw your bike in the back, you can come back in the morning!
You're in charge of things like this, you should go!"

I didn't feel like I could just jump in and go. Maybe if I had had
even 10 minutes to get ready, I could've.  But the driver was revving
his engine, impatient.  What I decided to do was run back to my house,
grab some money for the woman, Salamu, wrap it in paper, run to the
truck and give instructions on where to go when she got to Illela.  We
got Hajiya, the older lady who came to find me, to go with Salamu.
They sped off.

I joined them this morning, via my bicyle.  When I got to the hospital
I found a whole crowd of people from our village: Salamu and her son,
Abu Zaidi, plus Hajiya, and Salamu's husband Sa'idou and one of his
friends, all together with Habi and little Samsiya.  My village is
filling the infant malnutrition ward!  Not exactly something you want
to feel good about.

But.
If it's the truth that there is infant malnutrition,
which it is, then it IS good that the women are getting help.

Green: Generally Food Secure
Yellow: Moderately Food Insecure
Orange Highly Food Insecure
Red: Extremely Food Insecure
Black: Famine
Gray: No Data

Here is the FEWS map for the way things stand in Niger now. Compare it to the map from July and you can see the difference. Foloa is in the yellow zone. Although harvest season is beginning, we now face the most difficult season for infant malnutrition.

FEWS Maps and the hunger season

Nationwide, almost one million people in Niger were considered to be living in “severe food insecurity” with another 1.9 million in “moderate food insecurity”, based on the government’s 2008-2009 assistance plan... In 2008, 39.3 percent of the population was estimated to be chronically malnourished, according to the government. (Source: IRIN News)

It's that time again: hunger season in the Sahel. The maps below indicate food security for the second quarter of 2009, in countries monitored by the USAID/USGS FEWS NETprogram. The Famine Early Warning Systems Network, set up in response to the starvation of close to 1 million Africans in 1985, attempts to analyze and predict climate conditions and food security in 17 sub-Saharan countries, as well as Afghanistan and a handful of countries in central America.

The most vulnerable time will appear on their next set of maps, due soon. "Hunger season" is that time when food supplies have run out and the new season's crops are not ready to harvest, and it can represent the slow onset of famine.

Green: Generally Food Secure
Yellow: Moderately Food Insecure
Orange Highly Food Insecure
Red: Extremely Food Insecure
Black: Famine
Gray: No Data

Faloa lies on the edge between green and yellow. As we approach August, the yellow and orange areas are likely to expand; green areas will shrink.

Where Narba was

11/30/08
You might have noticed that Narba's name wasn't on the list of the women who came to the training, although she is one of the grain bank committee's presidents. The reason she couldn't be there was because her granddaughter died that week. And the reason that her granddaughter died was, to my eyes and my understanding, because of severe dehydration and starvation. It's difficult for me to write about this, and so I haven't written about it to anyone. I haven't written a single letter to anyone for this whole month, because I'm unsure of what words to use to describe what is going on in Faloa and Niger right now. I hate not telling you about it, because it's been part of every day of my life for weeks now. But I also hate telling you about it, because I don't think you will understand. That's not fair of me, so I'm going to try.

The big picture, which is easy to explain: By this time of year, people-- farmers, meaning villagers, meaning my people-- have been working their bodies, hard, for six months straight. They have used their bodies and nothing more than a few handmade hand tools to turn sand into fields of millet, sorghum, and beans; they have battled acres of weeds with their backs bent over in 120° heat, they have spent weeks harvesting giant bundles of heavy stalks of grain, they have clocked hundreds of miles on their feet that are either barefoot or in crappy flipflops, and for a month of this- all September- they did it without food or water, for Ramadan. As the doctors at four of the clinics and hospitals that I have visited in the last month have explained to me, by this time of year, nursing mothers' bodies are exhausted and broken, and they stop producing milk. Babies who weren't weaned yet get weaned abruptly, and babies who weren't ready to be weaned yet get weaned anyway. They are given more water than they would normally drink, which results in higher incidences of diarrhea. And that, for a baby, or a kid even, in this country, is close to a death sentence. I wouldn't have, couldn't have, believed it before coming here. But it's real, and it's been happening all around me this month, and I have never felt more helpless, devastated, or furious.

Narba's granddaughter, Foziya, was about 16 months old. When I left the village in early October to help with Peace Corps training, she had a fever and I put a damp cloth on her hot little body. When I returned at the end of the month, I didn't recognize her, except as a child that I could've seen on the news in a report about famine or war. By then I think she was not entirely conscious. She was just bones in a small, rigid shape on her mother's lap. I sat with her mom, Dela, and Narba, and the other women in the family in their hut- I knew they were there because that's what you do when you are waiting for a person to die. It was confusing and shocking and upsetting, and I didn't know what to do, or if I should do something, or if I could. I told Narba, please let me take her to the doctor, but Narba said that it was in God's hands. Foziya died in the evening, and the wake lasted for the next three days.

So that is why Narba couldn't come to the training. I sat at the wake in the mornings and all evening after the training was over each day. I am a part of this family, and I felt like it, and my presence was never questioned.

I'm not sure what else to tell you about, because Foziya's story is the first in what has become way too many children who have died in this village. I can't just list off these names like that's all they are, names. I don't want to do that. They're a lot more than names, they're babies that I am used to holding and carrying around when their moms are pulling water, they're babies that were learning to sit and walk and talk. It's so messed up, it's not fair, it's the cruelest thing in the world that this is true. My friend Mariama, who is lovely and clever and whose daughter Harira was born the week I moved here, is now walking around without her baby on her back, with her breasts leaking milk. Mariama is healthy- she wasn't weaning Harira and didn't have to, she had plenty of milk- but Harira got diarrhea, and even though Mariama took her to the clinic-- three different clinics, all hours of walking away- they couldn't help her. They didn't help her, and her beautiful baby, whose picture I've taken a hundred times, died in less than a week.

As this has all been happening, I've been struggling to understand it and working to find out what the options are for mothers- where can they take their babies, and what help can they expect to get? The two closest clinics have one person on staff at best, who's not usually there, and who just hands out oral rehydration salts like that's going to fix everything. The clinic in Tajae is better, but gets absolutely flooded with people. I've been there a lot lately-- I've started going with women, because they like it when I come, and I think it makes it easier for them to go. I started going a few days after Foziya died, because one of the kids who is closest to my heart started really going downhill. I know I've told you about him before-- Rahman, Zuera and Salla's son, another grandson of Narba's. He's the kid who always toddles up to me yelling 'habba!' and who squeals when I lift him high in the air.

Rahman is 18 months old, and was still nursing until October, when Zuera's milk dried up. Rahman started getting diarrhea, and throwing up, and he started to refuse to eat or drink. He'd been like this before I got back, and was losing weight and acting listless, limp. Zuera and I went to Tajae, where they gave him antibiotics, but he didn't get better. He lost his baby cheeks, his eyes started sinking farther and farther in his head, and the skin on his legs hung like paper. He just got worse and worse, so we went back. We went on a Wednesday, which is when an Irish NGO called Concern sets up at the clinic and administers a whole lot of help- all for malnourished kids. I'd never seen them in action before, and I was overwhelmed and grateful to the point of tears. I mean, you walk into this big cement building and it's full of hundreds of women holding on to their skinny babies, waiting in lines to have them weighed and measured, and then to get a week's supply of high calorie super-nutrient life-saving food. It takes courage to take your kid, you know? They want, like every mother, their child to be healthy. But it's still hard to get the guts to take them, because everyone sees you and sees your sick baby.

Zuera and I were told that Rahman was "broken", and that if he refused to eat the special food at that instant, they would write him a referral to the Concern Hospital in Tahoua. He wouldn't eat anything, and so Zuera and I returned home with him to ask for Salla's permission to take him to Tahoua that afternoon. And you know, this was really strange and disorienting for me, because I don't have authority over this child, or his parents, and if Salla didn't agree, Rahman wouldn't be going to the hospital. It was painful for Salla to decide- he was surrounded by all of the women in his family, yelling and watching, and there I am, terrified he's going to say no, and then he does, he says no. He said no, because he heard that if your child dies there, the hospital doesn't give you your child's body back. I was devastated, and Zuera started crying (people don't cry here), and the women went crazy...I told him, okay, let me call them and ask them if that is true, because if it is true, I understand. But he really didn't want me to call them, and he excused himself and consulted with some other men, and then he gave us permission.

Relief.

Zuera, Rahman, and Narba ended up spending nine days at the Concern Hospital in Tahoua. The doctors showed them how to force feed him highly nutrified milk, and they were kept on a strict feeding schedule every hour. I visited them there twice, and got to see Rahman get better and better. Everyone in Foloa knew he was there, and constantly asked me if I had any news. When they finally got released, Rahman had his chubby cheeks back and even started smiling every once in a while. He'd been back for four days before I left to come in to Konni for Thanksgiving, and he seemed better each day. He still qualifies for the supplements given out in Tajae every Wednesday, so he and Zuera and I will keep going, along with the other five or so women from Foloa who have started going. Last week, a new mom joined us, Tahira, with her son Aziz. Going with them, and helping to connect them with doctors who can and will help them, makes me feel less helpless. I feel like I finally know where to go, and I'm getting to know the doctors. Best of all, women who felt helpless can see Rahman and how much better he is. And that is what really matters.

Current food situation in Niger: the official word

The map below (from AID sources) illustrates some of the text beneath it (info recently sent to Peace Corps volunteers). 700,000 people may need food aid this year (see #7), which makes it a good year; last year the figure was 2.9 million people in need of aid.
Points #4, #9, #10, and #11 seem especially worrisome.

Estimated food security conditions, 3rd Quarter 2008 (July-September)
US AID /Famine Early Warning Systems

Green: Generally Food Secure
Yellow: Moderately Food Insecure
Orange Highly Food Insecure
Red: Extremely Food Insecure
Black: Famine
Gray: No Data

NIGER FOOD SITUATION LOOKS GOOD, BUT NUTRITIONAL ISSUES PERSIST

1. Summary. All signs indicate that Niger will have a bumper annual harvest of major food staples in September-October 2008,representing an unprecedented fourth consecutive good annual harvest for Niger. Pasture conditions are excellent and no major outbreaks of crop pests have been reported. Crop conditions in Nigeria and other countries in the sub-region also appear to be favorable; therefore, added pressures on Niger food stocks will be minimal.
Niger will not need any emergency food aid over the coming year, but will need help to reconstitute its national food reserves and to continue programs to address food needs of vulnerable groups and chronic child malnutrition. There will also be a need to address the problem of insufficient imported rice for urban consumers.

2. The rainy season has generally been exceptional and, even if rains stopped now, there is enough moisture in the soil in most areas to permit a good harvest of the major food staples (millet, sorghum and cowpeas). If like last year the rains cease in mid-September, the harvest will still be better than the good 2007 harvest. If like in 2006 the rains continue into early October, Niger could have a record harvest. On the other hand, too much rain and continued heavy rainfall will make it difficult to harvest. Already the harvest of millet and sorghum is occurring in a number of places across Niger.

3. Flooding in some areas has caused some crop damage and, as of the end August 2008, the loss of shelter for almost 40,000 people. Pasture conditions throughout Niger are reported as excellent without any major outbreak of crop pests. Niger appears to be on the path to a fourth consecutive good annual harvest. This may be the first time in modern history that Niger has enjoyed four good annual harvests in a row. These good harvests and livestock conditions will make life better for rural inhabitants (85 percent of the population), contribute positively to Niger's GDP growth, and reduce budgetary and political stress on the Government of Niger (GON). Furthermore, full household granaries are the best insurance for the maintenance of peace and stability in the rural zones.

4. The food situation of urban inhabitants, who depend heavily on the consumption of imported rice, is, however, worrisome. The cost of imported rice on the open market is at a record high and stocks of rice are at an all-time low. The GON tried to procure on the international market 10,000 megatons (MT) of rice but was only able to obtain 3,000 MT, which it is selling at a subsidized price (35 percent less than market price) during the holy month of Ramadan that began September 1. Given that Niger consumes about 20,000 MT of rice per month, this is a relatively small quantity of rice. It is an open and troublesome question as to how Niger will obtain enough rice in the coming months to feed its urban population.

5. Related to this rice shortage problem was the receipt on July 21 of an official request from the GON for 60,000 MT of rice and 15,000 MT of wheat over a three-year period, beginning this year. This request was made within the framework of the USDA's Food for Progress program. This request follows the signing of an agreement in September 2006 for the same kind of program. Under this previous Food for Progress program, 12,000 MT of sorghum and 5,000 MT of rice (for monetization) were provided. The 12,000 MT of sorghum was used over the past few months for free distribution to the most vulnerable groups. The 5,000 MT of rice was sold to private traders over a year ago and the proceeds generated are being used for food security activities. Concerned GON authorities will need to satisfy some outstanding reporting and accountability requirements for USDA before tackling another USDA program.

6. It was planned that some rice be provided by the end of the year under three new PL 480, Title II Multi-Year Assistance Programs (MYAPs) that USAID signed in August 2008 with participating U.S. non-governmental organizations. These three- to five-year MYAPs have an estimated value of over US$70 million and cover all regions
of Niger. The main commodity to be monetized under the MYAPs is rice and 7,000 to 9,000 MT of rice were to be shipped to Niger by December, but the first effort to procure rice was has not been successful as not enough rice could be sourced. It is still uncertain when rice will be available for these MYAPs and, when sourced, how much can be procured with existing budgets. Higher rice prices will mean lower quantities of rice for the MYAP programs and it may be some time before FY 2009 funding is available for these programs.

7. Notwithstanding the favorable prospects for good annual harvest in Niger, there remain pockets of low rainfall in Niger and agricultural production growth has difficulty keeping up with Niger's fast annual population growth rate of 3.4 percent (or about 400,000 additional people per year to feed). Niger is reaching the limits of the quantity of food it can produce and in the future, even in a good rainfall year, it will not be able to produce enough to feed its population. Current projections show that up to 700,000 Nigeriens (about 5 percent of Niger's 14 million people) will need food aid to one degree or another over the coming year because of poor harvests in some geographic areas. Nevertheless, this is a huge improvement over last year when 2.9 million people were estimated to be in need of food aid.

8. As of August 27, 2008, Niger's national food reserves contained about 40,000 MT of cereals (down from 77,000 MT last February). If current reserve utilization plans are adhered to, this total stock level will fall to about 3,000 MT by the end of September. In the July to September period, 15,000 MT has been utilized by the GON, with donor concurrence, for free distribution to food vulnerable groups and 15,000 for sale at subsidized prices to those in need. The GON goal is to have 100,000 MT in stock in case of poor annual harvest and, thus, its plan is to begin local purchases of cereals
in October following the harvest to reconstitute its food reserves. It plans to buy on the local market 20,000 MT to 30,000 MT of millet and sorghum in the October 2008 to March 2009 period. Currently, the GON does not have sufficient funds to make these purchases and it will be calling for donor contributions for as much as US$12 million in additional funding for these purchases. These reserves are small compared to Niger's cereals consumption rate of 220,000 MT per month.

9. Niger's child malnutrition levels remains among the worst in the world in spite of four good annual harvests in a row. Niger’s low child nutrition levels are not unrelated to a persistent high poverty levels and a consistent rank among the lowest five countries on the UNDP human development index (HDI). Child feeding practices, including breast-feeding, and dietary diversification need much improvement. A challenge to progress in these areas is low female literacy rate of less than 15 percent.

10. Other sobering development statistics for Niger include facts such as 40 percent of its children are stunted and almost 70 percent of the population is less than 25 years of age. The youthful structure of Niger's population and its fast population growth rate represent daunting development challenges. The population growth rate is out-stripping advances in economic and development growth and will not change unless the high average fertility rate of 7.4 children per woman of child-bearing age is substantially lowered.

11. Nutritional surveys led by UNICEF in the June-July period indicate some slight improvements in child nutrition levels among children under five years of age, but global acute malnutrition (GAM) remains alarmingly high by international standards and in this recent survey the overall average GAM reported was 10.7 percent (versus 11.2 percent a year ago). Extrapolation of survey data indicates that over 260,000 children of this age group suffer from much higher levels of malnutrition. Most alarming are survey results for the Region of Zinder that show an emergency level GAM rate of 15.7 percent. The survey also reports GAM rates much higher for children under three years of age. Also, in the regions of Diffa and Zinder the child mortality rate was over the emergency rate of 2 deaths per 10,000 children per day. This survey also reported that only 4.4 percent of mothers are exclusively breast-feeding their babies during the first six months.

12. Comment. Nothing can be better for Niger and its people than a good harvest, but a good harvest alone does not eliminate hunger and malnutrition nor develop over the long term a country. Much investment is needed in Niger's rural infrastructure and agricultural sector to achieve the food production and household income increases Niger needs to feed its people and to improve its rank on the UNDP HDI list. Investment in irrigation schemes that make Niger more drought proof and less dependent on rainfed agriculture is essential. At the same time more diversified ways of creating wealth need to be found to benefit a much larger segment of the population. As long as the vast majority of Nigeriens remain dependent on subsistence agriculture, sustainable development advances will remain elusive. The main
development aims should target less hunger and higher incomes. High levels of good governance, technical competency, managerial capacity and stability are needed to achieve those aims. ##

Niamey, September 3, 2008

For an update on this post, go here.

Food crisis: Part III

Moringa oleifera

So that brings us back to the pagivolte. There are things that I think could certainly help improve the food security of villagers here, and possibly also of city dwellers. We gave the following suggestions:
1. Try saving-or just not spending- a small amount of money (the equivalent of 50 US cents) each week, so that you can cover the increased price of food. Or try joining a money-saving cooperative; lots of villagers do this: everyone puts in a small bit of money each week, and every few weeks one family gets all of it.
2. Plant moringa in gardens. This is a small tree whose leaves grow fast and are packed with vitamins. It tastes a lot like spinach.
3. Plant vegetables. (Again, not a lot of people do this, but a few do. We'll see.)
4. If you can afford a baby sheep or goat, buy it now to sell for profit later. It's true: livestock here is like banks in America. You invest your money in a sheep and then sell it after Ramadan when people are celebrating the end of their fasts.

Yep. That was what our pagivolte was about. The women were pretty funny--they thought we were very entertaining. They may have taken something to heart; I'm not sure. Deep down, I don't see why they would. We don't know what they go through every year; surely they have strategies for feeding their families. They're here! They've always been here! But then why don't more of them do those things on the list? What do they know that they don't tell us, that they conceal behind their laughter and amusement with us? That's the real question; the facts are that they know about living here, that I don't, and that whatever they do to curb hunger and malnutrition is just enough to make it, even if it means relying on a few bags of millet brought by foreign aid which will not be coming this year. It is infuriating; it is amazing; it is frightening; it is risky; it is brave; it is trusting...and if it means that another 20% of the babies in the country die before their 5th birthday this year, then there is a lot of work to do.

I don't know what my role is in all of this, but I'm here, and I tell you what, I will do what I can...to start, when I get to my village tomorrow, I'm going to plant my moringa saplings in my concession, and start mixing some cow poop into the sand to grow a garden. Yeah! TAKE THAT, FOOD CRISIS!

Wow, well I got pretty intense just then. And now I'm sweating even more, and the sun found me again, and bleached out my shade. So it's time to move on.