On Wednesday, I accompanied some nutrition colleagues to one of UNICEF's 214 Outpatient Therapeutic Feeding Centres, where there were probably 100 kids and their carers waiting to have their height, weight and MUAC (mid-upper arm circumference) measured. The MUAC is measured with a simple tape measure
If the child's arm measures in the green section then all is well, in the orange or red then there is cause for further treatment. Perhaps it's a good thing that as soon as a child's sleeve was rolled up they started screaming, because it shows that they've had experience with vaccinations. I didn't see a single child who didn't burst into tears when the tape was put around them (this little girl isn't smiling, she's just in between sobs)
If a child is determined to be malnourished they are referred to one of UNICEF's 31 in-patient Stabilisation Centres (Of course there are many other organisations running OTPs and SCs across the country) - these centres are to treat cases of malnutrition where there are also other complications. These complications may have caused the malnutrition, they may be a result of malnutrition, or they may have exacerbated existing malnutrition. Whatever the case, these are very sick children. I visited a stabilisation centre on Wednesday with the film crew and it was by far the hardest thing I've ever had to witness. There were six children in the hospital room, four of whom looked like they were recovering well, and two who were so tiny. One was five months old and weighed just under six pounds (apparently what I weighed as a newborn). The other was almost a year old and didn't weigh much more. We'd arrived at the scheduled feeding time, and the nurse mixed up a jug of high energy/nutrient milk. There are two different strengths; one litre of the first will contain 984 kCal; the second 757 kCal. How much, and how often each child will receive the supplement is calculated depending on a number of factors by a pediatrician. This boy had come in five days earlier with a protruding belly, and was recovering quite well.
I didn't take any photos of the severely malnourished babies as (a) I didn't want to and (b) when my story is published on the website you'll be able to watch a video that explains all this further. But the smallest child had a MUAC of 7cm. That is slightly bigger than my thumb. Just take a second to look at your own thumb and consider what that means.
Once the child's condition has improved to an acceptable level, they are sent home with a week's supply of Ready to Use Therapeutic Food, such as plumpy nut - a sachet of which contains 500 kCal. The child is then taken to an OTP on a weekly basis for a check up and to receive further RUTF.
A vital part of nutrition is exclusive breastfeeding, and we went to a village 'health house' where one of the government's Lady Health Workers was conducting a session on the topic. Again, you'll probably see footage of this in the video that will accompany my story, but there were lots of women and children packed into a small room to hear about the importance of breastfeeding. On their way out of the session they were given some BP5 nutritional biscuits, which can also be boiled in water to make a porridge for babies.
Health, nutrition, water and sanitation are so interconnected that in a situation where all of those sectors (plus of course, poor quality education etc) are in a shambles, the cycle of disease and malnutrition will continue. The flooding has actually given rise to an opportunity to improve the low standards of these sectors that existed before the floods. There is now the chance to use the funding coming in, to not only provide the immediate relief that people need, but also the capacity building and awareness/education of good hygiene practices, of breastfeeding, of hand washing. Simple practices that we take for granted and probably don't realise how effective they are in preventing all sorts of illnesses.
There is still a lot of work to be done in Pakistan, and I have so much admiration for my colleagues who are tackling these issues everyday, in conditions that aren't pleasant, or comfortable, and away from their families. There are many crises in Pakistan, and the need for further funding should not be swayed by corruption in the government, or by terrorism. The simple fact of the matter is that there are millions of people, millions of children, who have done nothing more than survive the biggest natural disaster in modern history. They should not suffer further.