Nyajima

Two weeks ago Nyajima, a two year old girl, was referred to the Nutrition Program after being assessed and treated in the Doro SIM clinic. Her mother reported a three month history of diarrhea, no walking or playing for about two months and a one month history of refusing all food. She was slumped in her mother's arms: emaciated, weak, dehydrated and weighed about half of what she should at 5.3 kilograms. She was refusing food, having frequent bloody and watery stools, vomiting breast milk and medication, etc.

For the first three days in our care I thought she would die of multi-organ failure due to her severly mal-nourished state. Her mother held her, bathed her and breastfed her but showed little interest in giving her the F-75 milk formula for severe malnutrition which we provided every three hours around the clock. Her bony face held no expression and she would close her mouth when we offered the cup of milk. We provided a syringe and taught the mother how to give the milk slowly. Milliliter by milliliter. Nyajima was so weak her eyelids were making hood like shades over her eyes. However, she would swallow the milk a sip at a time when we put the syringe in her mouth. Her mother still did not seem to understand the necessity of getting calories into her--or perhaps she believed she was going to die and did not have the heart to force the milk. She appeared depressed, never smiling, and she spoke little. We had great difficulty communicating with her as she is from a distant village and speaks neither the tribal language of our staff, nor Arabic. Occasionally a relative would visit and translate for us, but we felt she still did not fully understand our questions, instructions or encouragement.

Nyajima actually lost weight in the first four days of her admission. On day five, after heroic efforts on the part of our staff to get more milk into her with the syringe, her weight began going back up toward her admission weight. However, there was little change in her expression, her energy level, her interest in drinking anything but water--and little change in her mother's outlook.

Last Friday we finally began to see an improvement in her interest in life and her activity level. I painted her fingernails and she surprised me by trying to hold the bottle of polish and later held onto a balloon. This was the first interest I'd seen her take in her surroundings since admission, other than to follow us with her eyes as she had been doing since day two. Her mother began to laugh on this day and interacted with her child in a way she had not until this time--teasing her and smiling at her. I believe she began to believe for the first time that her child might live. She began to work harder to get her to drink the milk and the child began to eat small amounts of Plumpy Nut, a peanut based product mixed with milk powder, oil, sugar and vitamins. On Saturday, nine days after her admission, she finally surpassed her admission weight. On Sunday she actually stretched out her hand and cried for the Plumpy Nut sachet. I almost danced with my excitement! Since Sunday she has been eating two sachets of Plumpy Nut per day--a total of 1000 calories and yesterday she began eating some of the staple food common in this area--the flour made from sorghum grain.

Today has been a beautiful day for her! On her weigh-in this morning she showed that she has gained 0.7 kilograms since admission. This afternoon she took a few steps holding her mother's hand--that is the first time she has walked in at least two months. She continues a slow but heart-touching recovery after her brush with death. Her mother smiles and laughs often now. It is a blessing to celebrate with her.

She has two or three diarrhea stools per day and is still weak, but is making significant progress. Medically we have treated her for Amoebic Dysentery, Campylobacter, Thrush and worms. We have prayed for her daily and communicated with the mother that God is the one who heals. We have provided education, nutrition, encouragement, support and a friendly environment. Only God knows the outcome, but each day I'm more confident that He has a plan into the future for this little one. We had told the mother at the time of admission that we would do what we could with medication, nutrition and care, but that God is the One who heals and that we were praying for her. My hope is that Nyabell, the mother, sees God's hand of mercy and grace in this and that she will some day give Him the glory for the life of Nyajima.

Nyajima at the beginning--emaciated, dehydrated, weak, apathetic

On the day of her discharge--not fat--but getting there, strong, spunky, beautiful. 

Today I visited Roda, one of my young girl friends at her "marriage house". She ran away with a young man about a month ago--that is the traditional way to begin "marriage" here in Mabaan . Now they share a tukul on the property of her family and for about two months the young woman is forced to stay within the house and a small grass enclosure that provides enough space for cooking on the gound, storing some watch containers, a bed and firewood. She isn't permitted to be seen outside that enclosure. She was cooking kisera when we arrived. It is a thin bread cooked over a very hot fire with fermented sorghum flour mixed with water. She allowed me to try my hand at it and we all had a good laugh at the comedy of errors.

Her hands, forearms, feet and ankles were covered with henna.  Her head was uncovered.  Her tukul scented with insense they use when entertaining as newlyweds.  Two days ago they held the "Badida"--one of the many events involved in the months of "marriage" traditions.  She had her hair newly woven and the henna done for that party. She also had bleached the skin of her face and I missed the warmth of her usual dark, dark skin. Many of them believe beauty is to be found in lighter skin. She invited us to eat when we told her it was our curfew and we had to get home. Well, you have to be careful not to offend when offered food so Karissa said we could eat a little bit quickly. Well, a lot of food later we hurried home--after curfew again.  Oops.

I'm warmed by our visit with this beautiful young girl, learning to live as a married woman in this interesting culture that holds her captive for two to three months while her husband comes and goes as he pleases. Her oldest maternal auntie is responsible for training her in cooking, cleaning, mudding, etc and will decide when she can leave the forced secluded life and return to normal village life where she can come and go as she pleases.  (Seclusion isn't the right word--she can recieve female guests.) 

She is in the process of marrying David, a young man who is the son of Tabitha who cooks for some of our missionaries. David is currently working for us by helping build a brick kitchen at the Nutrition Program. Usually buildings of grasses and mud are used for "kitchens" but we decided to make a more permanent building.  He is a hard worker and a blessing to me.  He speaks some English and I've been able to use him to translate a bit with the mothers when my other English speaking staff members were not present. Roda was one of the first people to invite me into her home when I arrived in Doro two years ago. Friendships like ours--though limited in some ways by the barriers of culture, language, age and circumstance--are precious to me.  Hospitality, generosity and acceptance in this culture humble, bless and challenge me.  May I be more open and generous to those in my life...

Roda confidently makes kisera on a giddle over a stick fire just a few inches off the ground. It is so much harder than it looks!