





I held the smallest 1 year old in my life today. She was a twin, and irritable when she was away from her other half. She was dressed in handmade top that that tied up the middle, though I thought it would be better suited for a doll. Her pale, anemic face was expressive… her eyes narrowed and eyebrows cinched in the center of her face that was no larger than the palm of my hand. She striked a glare at every stranger in the room. Her twin was much more patient with onlookers, and even though she was protective of her sister and herself, she looked even a bit healthier than her counterpart. I guess its true; a happy baby is a healthy baby... even happiness on a small scale.
Millions of kids die each year across the world through complications of
malnutrition… and its something that is so easy to prevent right? Well partly yes, and partly know. It seems quite simple, you just feed a kid and it grows right? All you need to do is feed them… but when I wandered the lab of the largest diarrhea hospital in the world, the hospital where
ORS (oral rehydration therapy) was first promoted on a large scale, along with the
cholera cot invention, I wonder how mothers could let their children get this bad? Wasting away, not able to hold their head, why did mother’s wait so long to seek care?
There are so many reasons to explain why this happens to children in Bangladesh.
• Socio economic status- people are poor, and they either they can’t afford proper nutrition to their children, they breast feed for up to 2 years without feeding anything else because they simple don’t know, or they just think their child is thin and there really isn’t anything wrong… until a mad case of diarrhea wipes the child out to barely nothing.
• Exclusive Breast feeding… is GOOD! But only for 6 months, some of the mothers were feeding the kids solely on breast milk up to 2 years… as you can imagine a 2 year old child looked like a dying 1 year old, completely stunted and wasted for its age.
• Big families… can result in neglect of the other children, and lack of money to feed them and treat them properly
• Child Spacing- one lady was taking care of her two year old who was severely malnourished, and she had to leave ever 2 hours to feed her other infant… talk about a busy mother.
• Young mothers and malnourished mothers- I saw an 18 year old mother holding a dying 2 year old child from severe pneumonia, diarrhea and malnutrition… all the while she was taking care of another infant, and she was anorexic herself. If the mother isn’t healthy, we can’t expect the breast milk of that mother to be healthy.
• Lack of awareness- mothers simple don’t know how to treat the children when they fall sick, they continue to seek traditional care and my the time they resort to a hospital, it sometimes is too late.
• Food insecurity… In Bangladesh with the impacts of global climate change, mothers do not have as many opportunities to get foods to cheap.
• Structural factors- accessibility- there are not the resources in rural Bangladesh where women have to travel across land and sea for days to react the nearest big hospital where they can properly treat malnutrition.
• Sanitation- if the mothers aren’t using clean water, this can result in more acute illnesses, leading to severe dehydration, loss of appetite, and hence malnutrition.
There are so many factors that lead children to acquire severe acute malnutrition… I used to walk through the ward and see these children, and be so overwhelmed and angered that children were so neglected. Maybe that is the case with a few of them, but then I realized that the mothers are not only to blame for such neglect. In fact, it is more the overarching societal structure that cause such horrific things to happen on the grassroots level. The government doesn’t acknowledge the needs of these starving children, public health interventions do not focus enough on this global burden of malnutrition, which leads many of the mothers to continue to be naïve about the issue. After all, mothers can only make good decisions about their children if the options are available and if they know about the problem at hand.
Therefore, the solution is complex! BUT we need support systems from the government and some better educated mothers in order to break out of this continuous cycle of poverty that exists.
I wish I had a photo to show you from my own hospital, but due to ethical reasons I don’t feel comfortable breaking that privacy of my own patients. This photo is from an online search, and just the beginning of what I have been seeing and studying these past weeks. I now realize that treating and taking care of the patient, and also the overarching system in which malnutrition happens is a necessity in Bangladesh and around the globe. Thanks for being interested in this issue.