An update for Sara

So today we had a pretty ideal day in the field: enrolled quite a few children, not to many fat babies to waste our time, mixed antibiotics with no issue, pretty short drive (around an hour or so) etc.

We did, however, see the sickest kid I've seen thus far. He was an eight year old with full blown marasmic kwashiorkor (deathly skinny with huge, puffy feet and skin breakdown). Kwash past the age of 4ish is pretty rare and this child had already been treated for malnutrition at the hospital (and he was HIV negative) so it looked like something else was going on: an incredibly bad tapeworm, leukemia- something. He was incredibly listless and his eyes were pretty much blank as his mother carried him to the table.

We took him to the hospital again and recommended other tests but in truth I'm not sure how well this guy will do. My coworker said she saw him two weeks ago and he was already pretty bad. They tried to give him the therapy food but he was apathetic and refused to eat. His older brother was trying to help and kept waving money in his face trying to entice him to eat but the kid just stared into space. It's pretty heartbreaking.

We do see children that simply don't recover despite weeks of therapeutic foods and trips to the hospital. Many of these children are HIV positive and others have congenital issues that will never be fixed in a country like Malawi. Last week there was a child who had been through more than twelve weeks of RUTF therapy but was still wasted (severely skinny) because he had a heart condition. We simply had to stop feeding him knowing that he will most likely not survive. It's hard to be the one to circle "finisher" (code for child who fails therapy and does not graduate to a healthy weight) but it's important to remember that RUTF will not save these kids. Still, it's not easy and it makes it hard to joke and laugh on the car ride home when you have a mental picture of a child who you can't save.

While these children are heartbreaking, however,  they are not the norm. Most children do excellently on a regime of RUTF and gain weight quite rapidly. It's very gratifying to groan under the weight of a child only to look at their card and realize that they started out severely malnourished and now are luxuriating under rolls of adorable chub.