Kwashiokor

Today was my second morning at the clinic in B. Yesterday, I told you about my first patient of the day, a 4 year old girl with marasmus. This morning I walked in and my first patient was a 1 year old boy with kwashiokor, another type of protein-energy malnutrition that involves swelling of the legs, arms, and face. It is more complex than marasmus in that children with kwashiokor often have a very poor appetite and it is difficult to coax them to eat, whereas marasmic children are often very hungry and will eat eagerly. I was glad to have Vicki there to help me, since she has had a lot of experience with a feeding center for malnourished children in Zambia. It was a very good learning experience for me. I had never seen a child with kwashiokor before today, expect in the books, and this child had all of the classic signs and symptoms. His story is classic also. He was weaned from the breast very early because of his mother's health problems--very bad news for a child in this setting. The cool thing is that his family is from G., a village nearby where Vicki has been going for both Bible teaching and health teaching. There is a new church plant in this village. I have been planning to join Vicki for this health teaching on Saturdays but until this week circumstances have prevented me from going. This week I'll go along and after the lesson we'll try to visit this boy and his parents to see how he's doing with the medications (to cover a variety of infections that he's likely to have) and the feeding advice we gave them. Hopefully we can get a good idea of what food they have available so that we can give realistic advice and teaching.

Again, I would ask you to keep this little boy in your prayers, along with the little girl from yesterday, whose name is Martina. We were not able to call her back to the clinic today because the clinic staff didn't know her so I'm praying that God will be protecting and healing her over the next few days, until next week when I had asked her father to bring her back. Both of these children are very sick and at high risk of death because of the severity of their malnutrition. If the facilities were available, they would both be hospitalized and receiving intensive treatment and feeding regimes.

We don't think it's any coincidence that we have seen 2 children with marasmus and 1 with kwashiokor in the last 2 weeks. The child malnutrition rate in South Sudan is huge and although most of the children we've seen around here have looked quite well nourished, there are probably a lot more of these severely malnourished children out there in further villages.

Please pray for wisdom for us as we see patients at the clinic. We're finished for this week and will start again on Tuesday. This morning went really well and I enjoyed it. I'm starting to be able to communicate a little in the M. language, asking questions for health assessment and understanding some of the answers back. It's a lot of fun to be able to communicate with the parents, even a little. Aside from that, I had a good translator working with me who helped a lot.

After work, Vicki and I went to the market as usual to have a cold soda and buy bread and were thrilled to find some fresh vegetables for sale! This past week has been the first time we've been able to buy any vegetables here since I've been here. We had okra and maize (corn on the cob but not as sweet and juicy as sweet corn) earlier this week and today we found bundles of greens that the people use to make stews and eggplant! We were very excited.