Interview with MSF Sierra Leone project co-ordinator Sweet C,

To begin 2010 our foodblogs got quite a coup - an interview with Sweet C (yes that is her real name and isn't it great?), a Filipino doctor in her early 30s working for MSF in the Gondoma referral centre, Sierra Leone. The Gondoma centre offers inpatient services for women and children, and, relevant to this blog, houses a therapeutic feeding centre.

Malnutrition rates in Sierra Leone are among the highest in the world, and solving this problem has been said to be one of the most neglected areas in Sierra Leone's post-conflict recovery. Such simple and easily solve-able problems as Iodine deficiency may cause over 252,000 Sierra Leonean children to be born with varying degrees of mental retardation over the next five years. Work by charities such as MSF is crucial in bringing down Sierra Leone's sky-high infant mortality rates.

I've done a bit of reading on the subject, and it's claimed that simply sustained investment in nutrition in Sierra Leone could bring about gigantic human and economic benefits in developing the social sector, revitalising Sierra Leone's economy, and attain the poverty reduction goals that have previously been set forth.

Sweet C grew up and studied in the Phillipines as a doctor and is a family medicine specialist. She's very interested in community medicine and public health and has been involved extensively with local NGOs back home. Currently she's the project coordinator for MSF in Bo, Sierra Leone and has been working there for coming up to five years. What follows is an interview we conducted with her by email...

Could you talk me through a typical day for you at the Gondama referral centre?

My typical day starts with the morning endorsements with the CHOs (Clinical Health Officers) and expats (MSF volunteers). After that, I make some announcements and go back to my office where I mostly sign off papers such as food requests, operational advances, leave forms, daily worker payments, etc. Then I go around each ward, talk to the staff and ask for daily statistics and problems in each ward.

Then I go back to my office, which is open to anybody who has questions. I work on writing reports, analysing statistics, looking at our consumptions and making phone calls. On special days I may have meetings with expats or team leaders or the management team. Somedays I do ward rounds to discuss difficult cases and there are also special days for training CHOs on relevant topics.

How did you end up working with MSF? And specifically in Sierra Leone?

I have always liked working in communities and going to far flung areas; doing medical missions or immersions with the local NGO I was involved with (in the Philippines). When I learned about MSF, it was like a door being opened to see the opportunities of working in a different context, to learn from the organization, from other people, to find out what I could contribute as well...

That’s why after my residency training, I decided to pursue a road less travelled by most Filipino doctors. (FYI: Most Filipino doctors go to US/Canada/Australia to look for greener pastures). Sierra Leone was the first mission proposed to me. I only knew of it being the source of conflict diamonds which caused the civil war making it the poorest country in the world. Some people said, 'your country is already poor, why should you leave it and work in another poor country?' Then I realized that working for another poor country doesn’t mean I cannot do anything…Since, I have learned to better appreciate the simple things in life and that there is something I could contribute, however little it may seem to other people.

What's the local food like?

The staple food of most Sierra Leoneans is rice and it's eaten twice a day in most households together with cassava or potato leaves with palm oil. Sometimes it is mixed with fish or meat or beans. In MSF houses, we eat rice or potato with chicken curry or meat in groundnut soup, sometimes we also have pizza! :-)

How would you identify and how would you care for a child suffering from malnutrition?

You can identify if a child is malnourished by bilateral pitting oedema on both feet or if the weight for height ratio is below the standards set. Malnourished children are given special therapeutic food and milk; things like F75, F100 and Plumpy Nut.

How much difference has Plumpy'nut made in treating malnutrition?

When Plumpy Nut was introduced, it made management of malnutrition a lot easier, especially logistically. Before its introduction, most malnourished children were given supplementary food which was given either as wet or dry rations… meaning a lot of resources were needed. Plumpy Nut has reduced significantly the logistic constraints in treating malnutrition in emergencies and made it much faster and more effective.

How has malnutrition affected Sierra Leone? What's the current situation like?

Malnutrition in Sierra Leone is more of a socio-economic problem coupled with lack of education aggravated by wrong beliefs; rather than just mere lack of food. Moreover, a lot of children become malnourished because of diseases, and the health-seeking behaviour of people is poor. They come to the health facilities only when the traditional treatment does not work.

The recently concluded nutritional survey in November 2009 done by MSF in Bo and Pujehun districts showed that 48.2% of children had chronic malnutrition. At the Gondama Referral Centre, the number of malnourished children comprise more than 20% of the total admissions. MSF is working in the Bo and Pujehun districts but only 28% of our Therapeutic Feeding Centre admissions are from the target population; the rest are coming from outside our catchment areas. This indicates that there is clearly a lack of access to health care in other areas.

What do you think of Sierra Leone's long term prospects in curbing the malnutrition problem?

I think the main cause of malnutrition among children in Sierra Leone are macro-economic factors that MSF cannot directly influence, although we can lobby the government and other organizations. MSF can continue to treat malnourished children in our catchment areas but some other actors need to intervene in other areas. We are not a development organization and we cannot stay forever in this country.

Moreover, this country needs a strong agrarian reform program to improve their food production. It’s such a pity that this country with vast land of fertile soil has no irrigation system, no machinery to plough the soil, no support to farmers in terms of fertilizers, seed crops and education on farming. Treating malnutrition will not end the problem if the root cause is not solved.

Photo by Emily Linendoll

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