Nursing in Somalia: ‘I have saved many lives – that’s what’s important’

Conflict and drought have created desperate conditions for the people of Somalia, forcing thousands to flee their homes and live in makeshift camps. Despite the problems, nurses are leading the way in combating severe malnutrition and other devastating diseases.

Conflict and drought have created desperate conditions for the people of Somalia, forcing thousands to flee their homes and live in makeshift camps. Despite the problems, nurses are leading the way in combating severe malnutrition and other devastating diseases

A mother whose children are being treated for malnutrition
at Burtinle health centre in Somalia. Picture: Paul Wu/DEC

Sada, aged 18 months, is placed into a large plastic washing up bowl to be weighed. Screaming, she tries to get out, but her body is weak. She is suffering from severe acute malnutrition.

She looks up plaintively at her mother Hamsa, then at the nurse who placed her there, Mohamed Bayir, and bursts into tears again. The 33-year-old nutrition specialist, who has seven children himself, explains how she became so ill.  ‘She had fever and diarrhoea, and that led to the malnutrition. But she has no complications.’

He adds with a smile: ‘I expect her to make a good recovery.’

Malnourished Sada is weighed and measured at the mobile health clinic. Picture: Paul Wu/DEC

Somalia is in a desperate state. The conflict-ridden country has been decimated by the failure of six successive seasonal rains over three years, leading to the widespread death of livestock, the only source of income and food for many.

Three million people – a quarter of the population – are regarded as being in a ‘crisis’ or ‘emergency’ situation on the internationally recognized IPC scale (Integrated Food Security Phase Classification). Pockets of the population are at risk of the next, final stage: famine.

Sada is one of an estimated 87,000 children aged under five in the country suffering from severe acute malnutrition, which puts her at a high risk of morbidity and death. But she is one of the luckier ones. She lives with her mother and seven brothers and sisters in Talacaad internally displaced persons camp, near the city of Galkayo in the Mudug region of Somalia.

When the drought killed all their livestock over the border in Ethiopia, leaving them with no income or food, Sada's family, like many others, travelled for over two days to the Talacaad camp to receive assistance.

Innovative approach

Almost 60,000 people live in camps like this in this Mudug region of the country alone, displaced by fighting or the search for food. Usually, they have no access to healthcare. With no income, people have to borrow money to get to the nearest clinic, rely on traditional medicine or go without treatment.

But in an innovative new scheme, five mobile health clinics – comprising nurses, midwives, doctors, pharmacists and an administrator – are visiting eight of these camps, including the Talacaad camp, twice a week. In the first four months of the scheme, more than 16,400 people were seen. The most common conditions are acute watery diarrhoea (see box), malaria, respiratory infections including pneumonia, measles and malnutrition.

Lead nutrition nurse Mohamed Bayir (right) briefs Saleh Saeed, chief executive
of the UK’s Disasters Emergency Committee. Picture: Paul Wu/DEC

In Sada’s case, the team working from the mobile health clinic - a simple corrugated iron structure providing shelter from the burning sun - have joined forces with a specialist nutrition service led by two nurses. After being diagnosed with fever and flagged as a malnutrition case, she is transferred to them for an assessment.

Acute malnutrition

Here Mr Bayir, with the help of his nursing colleague Jamail, weighs Sada and measures her on a wooden scale. She weighs 7kg and is 72cm tall. They then do her MUAC score – the middle upper arm circumference test, which is the key indicator of malnutrition. Sada’s is 11 – in the danger zone.

He prescribes her 21 packets of Plumpy’Nut, a therapeutic paste packed with vitamins and minerals, as well as skimmed milk powder and high-calorie peanuts – a week’s supply. She will receive them until she reaches a heathy weight. She is one of four new severe acute malnutrition cases he has seen today, and 25 ongoing cases.

If there had been complications, Sada would have been referred to a health facility in the nearest town. A number of referrals have been made and Save the Children International, which runs the mobile health clinics with the Ministry of Health, funded by the UK’s Disasters Emergency Committee, also assists the parents with transport and accommodation costs.

Nurses are mainstay

At these stabilisation centres, there are more services and treatments available – formula milk called F75 and F100 for rapid weight gain, as well as zinc sulphate and oral rehydration solution. Again, nurses are the mainstay of the staff.

At the mobile clinic in the camp, the facilities are more minimal. The ‘pharmacy’ is a white plastic round garden table with a few bottles on it, consisting of paracetamol suspension, paracetamol tablets, vitamin A pills and the antibiotic amoxicillin.

But what is lacking in medicines is made up for in community spirit. The nurses train ‘nutrition volunteers’ among the camp residents to look out for malnutrition cases and persuade the parents to bring their children to the clinic.

Nurse Fatima Abdulle Seed makes up special formula milk
 at the Burtinle health centre. Picture: Paul Wu/DEC

There are also hygiene volunteers to teach the importance of handwashing after using the toilet. The residents have recently had access to the first latrines in the camp – previously there was open defecation in the arid wilderness behind their tents.

One issue the nurses have to deal with is persuading the parents, who have so little to feed their other children, not to give them the therapeutic food prescribed for malnourished infants. Sada’s mother Hamsa says her family has one meal a day – either rice and water, or a simple pancake. Mr Bayir says: ‘We tell them not to share the Plumpy’Nut, that it’s for the sick babies. We will get the results when we next weigh them.’

A typical camp in Puntland in northern Somalia, where thousands of people are displaced. Picture: Paul Wu/DEC

Mr Bayir studied for four years to gain a degree in nursing in the capital, Mogadishu, paying the equivalent of $250 per semester in fees with the help of his family. He’s been working here since February, and as a senior nurse employed by the Ministry of Health he earns $372 a month, compared with a doctor’s $460. His junior nursing colleague Jamail earns $270.

Culture of help

'I always wanted to be a nurse,' says Mr Bayir. In the past six months he believes he’s treated 450 children for malnutrition, and estimates that half of them would have died without the treatment.

The Somalia culture is based on people helping each other and the nurses here embody that sentiment. Mr Bayir says: ‘When I see a child who is malnourished get better, I feel very happy. I’ve saved her life – I’ve saved many lives. That’s what’s important.’

He’s grateful for the aid donated by the British people via the Disasters Emergency Committee, which brings together 13 British aid charities. This aid has enabled the provision of mobile clinics and the new latrines. ‘We would like to thank all of you, and ask you to continue. It is really important – we need this support.’

AWD: the two-hour killer

Nurses in Somalia are battling the virulent condition acute watery diarrhoea (AWD), which is spread by contaminated water. There have been an estimated 76,236 cases in Somalia since January 2017, with 65% of them in under-fives. It can kill within two hours.

The 20-bed Burtinle Health Centre in the Nugal region saw cases peak in April but they are now falling following the intervention of World Vision, which has been treating water in community and household tanks to make it safe to drink.

Today, nurse Fatima Abdulle Seed is treating Nuur, a boy aged seven who was admitted barely conscious with AWD. Now, having been treated with intravenous saline, he is awake but still very weak. Next he will be given oral hydration solution, and it is hoped he will be able to leave hospital in a couple of days.

In the neighbouring stabilisation ward, Fatima is treating four children from the same family, all with severe acute malnutrition and bronchitis. Fatima, a mother of seven children, has a nursing diploma and earns $250 a month. She says she chose the profession ‘to help children’.

Jacqui Thornton is a freelance journalist. Her trip to Somalia was enabled by the DEC. To donate to the East Africa Crisis Appeal visit https://www.dec.org.uk/splash/africa  


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