Munnibai walked several kilometres to bring her son, Aman, to this clinic run by MSF in Biraul district of Bihar.

A measure of his upper mid arm confirms Munnibai’s worst fears. Aman is severely malnourished.

She has been through this before. She has already had two of her children treated for severe acute malnutrition at this clinic.

Estimates by UNICEF suggest malnutrition rates in Bihar among children less than five years to be more than 50%.

Medecins Sans Frontieres has been treating severe acute malnutrition in Biraul district of Bihar since 2007.

“MSF is an independent, medical, humanitarian organisation and it bases its work on medical ethics and humanitarian action. In this capacity we came to Bihar in 2007. In 2008 floods we noticed a high prevalence of malnutrition. We did a survey using MUAC and we came up with a prevalence of 4.8”, says Emily Goodwin, MSFs Project Coordinator in Biraul.

Once the child is confirmed to suffer from acute malnutrition, MSF begins their treatment on an outpatient basis. Mothers receive medicines and counselling about feeding practices with a special emphasis on balanced diet.

Shah Jehan, mother of five children, got her youngest daughter successfully treated for malnutrition at the MSF clinic in Biraul. She says her daughter had suddenly started getting weaker. It was then that someone from her village suggested she visit the MSF clinic.

“Inside she was drying, she started becoming weak. She was healthy before, but she started becoming weak. People started saying that go to Pataniya you get medicines for getting healthy so I went there and they gave me medicines”.

“They checked my child and gave me some medicines. And they asked me to come back again next week. And during this time give a lot of food to your child, boil the water and then when it cools down mix the packet and give it to her after washing her hands, and also cut her nails. Give her a lot of rice and dal; also give her a lot of water. Give her medicines, boiled water and the child will be better”.

Mothers bring their children to the clinic once every week to get them checked from a medical professional. The doctor monitors the child’s progress and mothers collect their weekly supply of medicines. This arrangement suits them well as they have other children to look after.

“It was good for my child. There are many children at home so one has to take care of other children as well. There is nobody else who will other children”, adds Shah Jehan.

However, for some coming even once a week is not easy.

“I went there walking. It was very far. It took me three hours to go there", says Mrs Chaupal, a resident of Biraul.

To address this problem, MSF staff visit families to see how children cope up with the treatment. For better results, MSF collaborates with community networks like ASHA’s who often have a wider reach.

In some cases, like that of Mohammad Fiaz, who suffered from additional medical complications, he had to be admitted to MSFs 24 hour stabilisation centre. Here he stays with his mother, Hajra Khatum.

“Here one gets food, the child is looked after 24 hours, they get medicines. Everything is very good here. The children are kept clean. Also the mother gets good food”.

MSF has cured around 4,000 patients since February 2009 to date.

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