Zeynaba and Kerima are two young sisters who came perilously close to dying of starvation. They live in the West Hararghe zone of Ethiopia, located in the country’s south-central Oromiya region – an area plagued by rising malnutrition rates, hunger, disease and water shortages due to sporadic rainfall and drought. Lack of rainfall ruined this year’s most recent harvest, leaving the family with very little to eat. By late May, the two sisters were very ill and suffering from severe malnutrition.
Both five-year-old Zeynaba and two-year-old Kerima are now on the road to recovery, thanks to an innovative, community-based approach to treating acute malnutrition implemented by International Medical Corps in June 2004. Known as Community-based Therapeutic Care (CTC), the program involves the active participation of communities in finding and treating cases of malnutrition before they become severe.
Unlike more conventional ways of dealing with malnutrition – where individuals are removed from their home setting and cared for in an isolated, specialized unit (a therapeutic feeding center or TFC) – the CTC model recognizes that inpatient care is unnecessary for the vast majority of malnourished children. The CTC approach empowers communities to provide care primarily within an individual family’s own home, thus supporting one of International Medical Corps’ key objectives: to build local capacity and promote self-reliance in the communities it serves.
In Ethiopia, where TFCs have proven expensive, difficult to set up, and heavily dependent on external support, International Medical Corps found the CTC model a much more viable option. CTC programs incorporate the following three modes of care and treatment, all aimed at supporting community participation: Supplementary Feeding Programs (SFPs); Outpatient Therapeutic Programs (OTPs); and Stabilization Centers (SCs). Each of these services incorporates educational efforts addressing the causes of malnutrition, including hygiene, public health and food security issues.
Treatment of moderate and severe acute malnutrition without medical complications is provided at SFPs and OTPs. SFP treatment consists of home-based care, assistance from trained outreach workers, and supplemental dry, take-home food rations. OTP care, while also home-based, involves prescribed, specially formulated energy-dense mineral/vitamin-enriched food, as well as medical treatment and follow-up care on either a weekly or bi-weekly basis at the local community health center. In cases of acute malnutrition with medical complications, children are admitted to inpatient Stabilization Centers. Whenever possible, existing community infrastructures are utilized to serve as SCs.
International Medical Corps has developed CTC programs in two regions of Ethiopia – the Oromiya Region (where Zeynaba and Kerima live) and the Southern Nations and Nationalities Peoples Region (SNNPR). Through these programs, International Medical Corps has trained more than 500 community volunteers and 300 Ministry of Health (MOH) staff in community-based therapeutic care. More than 2,700 malnourished children have received treatment at International Medical Corps’ 42 CTC sites.
When Zeynaba and Kerima’s mother, Kedija, brought her two daughters to the local CTC site in Chiro, West Hararghe last May, both had swollen legs and faces – a classic symptom of severe malnutrition known as oedema. Along with those symptoms, the girls were apathetic, miserable, irritable and lacked appetites. They were immediately admitted to International Medical Corps’ Chiro Stabilization Center where they received 24 hour-a-day care including medical treatment and therapeutic feeding for one week. During that time, the oedema disappeared and the girls began to lose weight because the dangerous fluid concentrated under their skin gradually disappeared. After one week of treatment, Zeynaba and Kerima were smiling and well enough to return to their village with their mother. They were discharged to the local OTP near their village for further follow-up treatment, where they continue to receive weekly check-ups and therapeutic food rations.
When Kedija first brought her daughters in for treatment, she had given up hope that her children would survive. Local healing practices had failed to help the girls, and Kedija believed they were suffering from some kind of a local curse.
While the girls underwent treatment, however, Kedija received basic health and nutrition education. She quickly learned the facts about malnutrition and how to recognize its symptoms. With her newfound knowledge, Kedija was determined to help others in her community learn from her experience.
“Thanks to International Medical Corps, I brought bodies of my daughters and now they are smiling again!” Kedija exclaimed. “I came hopeless and I go back hopeful. When I go back to my village I will assist the community volunteers and tell the mothers to bring their children to International Medical Corps centers rather than taking them to local healers.”
Like thousands of other children in Ethiopia, Zeynaba and Kerima have reaped the benefits of International Medical Corps’ community-based approach to fighting malnutrition. By involving community members, MoH staff and individual families in program management, International Medical Corps is helping promote the long-term sustainability and success of the CTC approach.