The TFC is the Therapeutic Feeding Center, where severely malnourished patients can be fattened up. This is significantly harder than it sounds since it turns out that human bodies do not take well to severe starvation. As you put in fluids and carbohydrates, the body needs to adjust and deal with the new chemical balances. You can kill a person by feeding them. So the medicine in the TFC is actually a specialty, like urology or proctology, but less icky. Unfortunately for all the malnourished people in Africa, it is also a rare specialty, so we here in Saclepea are just sort of doing our best to run the TFC according to the books the experts in Europe wrote and sent to us. There’s a certain amount of “if it works, don’t change it”, which is OK, but can be dangerous if things aren’t actually working, but you don’t understand what’s happening enough to be able to tell.
Of course, when you have clinically malnourished people in a community you’ve got to first ask the question, “why aren’t they eating?” It’s better to take a public health perspective and solve that problem first, lest 100 more people arrive next week on the verge of death. Of course, there are entire NGO’s organized around that question. When you are writing proposals to the funders, it’s called “food security”. As an aside, making sense of the whole vocabulary of NGO’s is like walking in a house of mirrors with a blindfold on. Like any other essentially political activity, it all changes every decade or so based on the direction of the political winds. There is a sign in a little tiny village on the way to Lepula that says, “Building capacity in maternal mortality and child survival”. This in a village without a school, and a literacy rate that is probably less than 25%. Wouldn’t it be better if the sign said, “Helping mothers and kids to not die”? Or if the money used to pay for the sign was used instead to help mothers and kids to not die? Just a thought.
Anyway, MSF doesn’t do Food Security. We just fix people who are malnourished and hope someone else will make it so that less of them come to us, so we can close down the TFC and get on with more pressing issues, like teaching Quiplu the dog to fetch. (not gonna happen, it seems)
Our TFC has only kids in it. This is a reflection of the current context in Liberia. Children are ending up malnourished in Liberia due to a number of reasons, but rarely is the reason “there’s no food to eat”. This might seem surprising, but consider some other possibilities. A lot of children who are three right now were conceived during the war. I don’t know about you, but the next time I’m in a war, I’m not planning on starting a family. Some of these 3 year olds are the products of rapes, or less violent but still unwanted sex (for instance, sex as a survival strategy, in order to get food, or protection). These children are unwanted, and there is no orphanage system in Liberia to help the mothers deal with them, so some mothers are overwhelmed and de-prioritze the unwanted children among the others who are products of happier times. Another possibility is that these are children of 15 year old orphans, who are missing the family structure of mothers, grandmothers, and aunts who might be able to explain nursing and child rearing to them. It takes a tiny amount of time for a healthy child with diarrhea who stops eating to get malnourished. Also, due to the poor state of health care here, mothers could have an undiagnosed condition that keeps them from producing enough milk, like dehydration and anemia due to low level malaria infection. If we had some Food Security experts here, they could drive up in shiny new Land Cruisers and give us a snazzy PowerPoint presentation explaining which of these factors are at work here. I suppose they are doing that in some UN meeting, but it’s not my problem.
Now that I have you totally depressed, I should get back to the topic: Toys for the TFC. We are working on improving and decentralizing our TFC in order to align our project with the current winds that are blowing through the relief industry. By shifting towards outpatient therapeutic feeding, you can cover many more children with the same amount of money. This is a good thing, but it requires that Susan, our fieldco, figures out what’s currently happening in the TFC and then makes a plan to change it. She started reading the MSF nutrition books and found out that after a child is out of the severe malnutrition phase, it is a good idea to stimulate them with toys. This is actually head-slappingly obvious when you see the TFC, which is a place where the patients and the caretakers sit for 12 hours and basically do two things, eat and wait (the other 12 hours are spent in the night TFC ward, where they do three things: eat, wait, and sleep). The waiting is for the next meal. So clearly this would be a good place to have some toys.
About this time I realized that my mom sent the long balloons you can make balloon animals out of in a care package. (She does weird things like that. Of course, I’m the weird kid who thanked her for the balloons, then asked for a pepper grinder. We clearly deserve each other.) So I made some balloon animals, and they were a big hit. I need to teach the other expats how to do that, so that we can keep a constant supply of balloon animals coming into the TFC. Mom has already airlifted an emergency supply of balloon animals to Geneva, which will arrive when Susan gets back from Geneva.
The problem with the balloon animals is that they pop. So I started thinking about wood toys. On Sunday, my only day off, I try to schedule some work with my hands that is not mind work. Sometimes it is fixing little things that I notice are broken during the week. This weekend, I decided to make wooden toys. I started off with a Land Cruiser pull toy, which was a great success. Then I moved to building blocks, which were too much trouble to cut out of the hard tropical wood we have here using the hand saw. So after only 6 of those, I moved on to blocks with holes and a spindle to stack them on. That went pretty well. So with an afternoon of work, I had three prototypes. We took them in to the TFC on Monday, and they were popular. The MSF Land Cruiser pull toy has not made it’s debut because the paint was still drying. I noticed tonight that it is dry, so Jerome can draw on the MSF logo, and some other details to make it a Land Cruiser. I think the snorkel will have to go on, as it is very distinctive. I put a big HF antenna and tuner on it, which is a trademark of NGO cars here. The HF radios can communicate hundreds of kilometers, even out in the bush, so we use them to stay in touch instead of trying to use VHF repeaters on towers like a fleet of vehicles might do back in the US. The HF antennas are really distinctive, and are easy to model with a little wire. You just strip the insulation off the top part to be the antenna and leave the insulation on the bottom to be the tuner. Et viola!
I just realized that the sticks in the forest next to our compound would make really excellent Lincoln Logs, but I’m not sure that the kids are old enough for that type of toy. Perhaps some sort of coconut-based rattle would be nice. I don’t know how to get a coconut with only water inside. The coconuts here have lots of white flesh, which will rot if I just drain the water. This will take some thinking.
After I exhausted myself making toys with the hand tools our carpenters use all day effortlessly, Hugo mentioned that the construction site has power tools. So this weekend, Hugo and I will set up an assembly line and maybe get Jerome to help us make some more toys for the TFC. It should be a fun weekend project!
One more quick thing. Ever wonder where the big advertising banners go when the campaign is over? Like the kind in Times Square? Well, it turns out they end up in Liberia on top of trucks as tarps. Normally, they are probably inside out, advertising boring stuff like soap to the bags of rice inside. But the other day one caught my eye. Remember the Dove Soap ads with the real women, not stunning supermodels on them? Just a bunch of nice ladies standing around in their bras and panties? Well there is a truck on the road in Nimba with them on it, and the driver chose to put them right side out, so that the Dove women are riding along on top of the truck. Certainly required a doubletake!
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