In March 2009, the pilot Community-Based Therapeutic Care (CTC) program for child malnutrition was launched by Nick Cuneo, ’08-’09 Global Health Fellow.  Through a partnership with Meds & Foods for Kids (MFK) St. Joseph’s Clinic has been prescribing a locally produced Ready-to-Use Therapeutic Food (RUTF) called Medika Mamba to children that present at the clinic with severe malnutrition.

Last Friday, Dr. Casseus was seeing patients as usual when a mother brought her one-year-old daughter in to see him because she had the flu. He immediately saw that the little girl was severely malnourished, noting that both of her little feet were swollen to almost twice the normal size (edema caused by protein deficiency). Immediately, she was referred to Ms. Solane, the nurse in charge of the Medika Mamba program. Ms. Solane confirmed that she was eligible for the program because she had a weight-for-height score three standard deviations below the median WHO child growth standards.

Ms. Solane ran through the normal intake procedures. She sat down with the mother and explained to her the requirements of the program, including weekly visits to the clinic to check up on her daughter’s progress. After the mother agreed to participate in the program, Ms. Solane counseled her one-on-one and explained how best to administer the Medika Mamba to the little girl each day. She also explained the Boutey Soley (Solar Disinfection) system to the mother, explaining to her the importance of point-of-use water treatment and proper hygiene for keeping her daughter healthy. Ms. Solane concluded the counseling session by explaining to the mother how to store the Medika Mamba and reiterating how important it is to come back each week for her appointments. The mother walked out of the session not only with two bags of nutritious food, but also with the knowledge and tools necessary to rescue her child from severe malnourishment and keep her healthy in the years to come.

This is how the course of Medika Mamba treatment is started for most of the children enrolled in our program. To date, we have fully cured 35 children and we are currently treating 8 more. In the beginning, there were a few hiccups in the implementation of this program, as might be expected for any pilot project. As a result, we have treated fewer children than we expected. However, we have corrected the errors that led to these problems and at the moment we are very confident that the program will prove to be very successful in treating our patients that come to us with severe malnutrition. We meet every week with Dr. Mondesir, the director of the program, to review all new cases and those that have been discharged. Through this additional oversight, we have been able to track the progress of all our patients to ensure that discharge procedures are properly followed and examine why some might drop out of care.

Dr. Mondesir relates that the therapy is incredibly effective in bringing children up to an appropriate weight. He sees that the children not only gain a significant amount of weight during the program but also their overall health improves as a result of better nutrition. When implemented properly, there were no non-responders to the therapy. In addition, the families expressed interest and appreciation for the program. Many people commented on the importance of addressing malnutrition in Thomassique and are extremely grateful that we have taken the initiative to begin a program for such a pressing need in the community.

Look for more updates as we work to turn this exciting pilot project into a permanent program at St. Joseph's Clinic!