Donath

Donath is just under sixteen months old. He weighs 6.3 kilograms (13.9lbs) and his MUAC (middle upper arm circumference) is 110mm. This makes him a severe, chronically malnourished child. He should be in the hospital. Instead, he is part of the health center’s Outpatient Therapeutic Program I work with every Monday. He has been in and out of OTP for ten months (theoretically, children should be “cured” within six weeks), and his weight has not fluctuated more than 500 grams.

When I first noticed Donath’s lack of weight gain despite the many sachets of Plumpy Nut we gave his mother every week, I mentioned it to my counterpart, Mama Fils. “Yes, he is very sick”, she said. We brought him and his mother into our office and asked her if she would agree to take an HIV/AIDS test. Teary eyed, she agreed. The test came back negative. We counseled her on proper nutrition techniques and hygiene.

Community Health Worker measuring a healthy child's MUAC

Two weeks later, still no change. I mentioned the problem to Mama Fils and again we brought Mama Donath into our office. Between long sighs, quick sobs, and a very shaky voice Mama Donath agreed that she would bring her son to the hospital across the street for intensive care the following day, after she made the necessary preparations. The next day Mama Fils told me Donath would not be coming. “Don’t worry Alma, I talked to his mother,” she assured me after seeing my frustration.

Another three weeks have gone by and on this particular Monday I insist Donath go to the hospital or he could end up dying. So Donath and his mother are back in our office. There are more sobs and head shakings, and this is when I learn why Donath cannot go to the hospital. Donath and his mother live alone, because Donath’s father was a genocide perpetrator and is now in prison.

In Rwanda (and most other countries in Africa) most hospitals provide you a bed and the necessary medications. Patients are generally not admitted unless they come with a family member who will be around to feed, bathe, and generally care for them. If Donath’s mother takes him to the hospital, no one will farm her plots and she will have no food to feed him, so she doesn’t take him to the hospital. Instead, she continues to farm sweet potatoes, and Donath’s body remains too weak and malnourished to absorb any of the nutrients she is able to feed him.

Rwanda is a country making incredible progress on a daily basis. It has been seventeen years since the Rwandan genocide, which means that the children running around my neighborhood were not a part of the horror their parents witnessed. Still, they are far from unaffected.