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Saving Gatluok – Treating Malnutrition in South Sudan A photo story by Nick Owen / MSF

Carrying her son, Gatluok, in her arms 25-year-old Angelina arrives at MSF’s hospital in Leer, Unity state, South Sudan.


Saving Gatluok – Treating Malnutrition in South Sudan A photo story by Nick Owen / MSF Nick Owen documents the case of two-year-old Gatluok, brought into an MSF hospital in South Sudan in a severely malnourished state. Gatluok’s condition reflects the wider crisis of malnutrition in the region as well as MSF’s work in responding to the situation with a programme to save lives. Alarming malnutrition rates are being recorded in parts of South Sudan. In Leer, a town nestled in the swampy marshlands that surround the White Nile River, Médecins Sans Frontières/Doctors Without Borders (MSF) is seeing this problem first hand. “Before the conflict, we used to have around 200 children admitted into the ambulatory therapeutic feeding centre (ATFC) at any one time,” says medical team leader Grace Ayuelu from Kenya, who has been working in Leer hospital for almost a year. “But now, we have over 1,800 children. That is a huge amount.” FLEEING CONFLICT Much has contributed to this situation. After the conflict that erupted in South Sudan in mid-December 2013, many people’s houses in Leer, as well as the MSF hospital, were looted and razed to the ground. To escape the conflict people fled into the bush, going months without anything to eat other than wild roots and whatever else could be gathered from the land. Now, with people returning to Leer, the partially destroyed MSF hospital is up and running again albeit at half the capacity. AMBULATORY FEEDING Today, the busiest area of Leer hospital is the ambulatory therapeutic feeding centre (ATFC). Here, children under five-years-old are brought to the hospital to assess their level of nutrition. Taking measurements of their height, weight and mid-upper arm circumferences (MUAC) the majority of children who come through the ATFC are found to be moderately malnourished. “In these cases,” says Grace, “they are sent home with a week’s supply of a ready-to-use therapeutic food called Plumpy’Nut, a peanut-based paste, and come back the following week to be reassessed.” “At the moment, we are going through 60 boxes of Plumpy’Nut a day. Each box contains 150 sachets, so that’s 9,000 a day. It’s a startling example of the levels of malnutrition we are seeing here in Leer,” she adds. TREATING MALNUTRITION But not all children are able to be sent home. If they measure red on the MUAC test, the most important indicator for malnutrition, children have to be admitted into the intensive therapeutic feeding centre as in-patients. Here, their feeding can be closely monitored and drugs can be prescribed to combat any other complications that can be a factor in recovering from malnutrition.

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After a five-hour walk from her home village, Angelina is seen very quickly by MSF’s Ambulatory Theraputoc Feeding Centre (ATFC) supervisor, John Yonk Both, who recognises that Gatluok’s condition is critical.


Gatluok’s measurements and weight is measured. The sscales show that he weighs just 5.7 kg. The weight of a normal healthy boy his age should be around 14 kg.


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Gatluok is gently lowered onto a measuroing board, his height is recorded at 78 cm.


MSF nurtrition nurse Charles Mpona Kalinde comforts Gatluok as he, very carefully, carries him back to his mother after measurements have been completed.


The all-important mid upper arm circumference test. Gatluock’s MUAC measures just 94mm, well within the red area, indicating that he has severe acute malnutrition.


Gatluok and his mother are given a moment to recover after the measurements have been completed. He reaches for the hand of an MSF clinic oďŹƒcer.


Gatluok is then taken for his consultation with MSF nurse Peter Bitoang Machar. Gatluok’s mother tells Peter of their situation at home, how her house was burned and their food stocks looted, and how they fled into the bush.


During the consultation, MSF nurse Peter Bitoang Machar tests Gatluok’s appetite with some Plumpy’Nut. But, Gatluok will not eat. Machar carries out another test and establishes that Gatulok has malaria and a high fever.

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Despite being unwilling to eat, Gatluok is incredibly thirsty and eagerly drinks a rehydration solution.


Within half an hour of arriving, Gatluok is admitted into MSF’s intensive therapeutic feeding centre. But it will not be easy, his mother has no food and as she is not a patient, MSF cannot provide her with anything to eat. She is also worried about her other child, who she had to leave back in her village in the care of her brother.


One week after Gatluok was first admitted to the MSF medical centre, he has recovered from malaria and has started eating again. It is hoped that within the coming days Gatluok will be well enough to be discharged and will continuebeing cared for in the organisation’s Ambulatory Theraputic Treatment Centre.


Saving Gatluok