Outreach has been great. As my focus to date has mostly been on the OPD handover to the Ministry of Health, so I only get to go out with the team twice a week, but they are days I seriously looked forward to. 

Outreach for MSF can vary hugely from project to project – from running whole medical clinics, to antenatal services, immunisations, health education – you name it, it’s been done. And there's variation in how you get about too – bike, horse cart, boat, train… Currently in this project we content ourselves with travelling in the rather more prosaic Land Cruiser, with the occasional boat trip.

There is a focus on women health, child delivery, and childhood immunisations, but coupled in with that the team take health education materials out with them, screen for malnourished children and actively refer sick people and pregnant women back to the MSF hospital services.

One week was mental – 233 deliveries & 84 children vaccinated in one morning – I had to dash back to the hospital for more vaccines and whatever snack i had to eat on the go!

Malnutrition screening worldwide for children is done using a simple tool which measures round a child’s arm – Mid Upper Arm Circumference, or MUAC for short. A traffic-light-colour-coded arm band is used; Green = chubby and healthy; Red= refer for urgent inpatient treatment; anything in between is referred to the OPD Ambulatory feeding center. It’s a well-established and astonishingly reliable indicator of nutrition status, as it can be used on any child between the age of six months and five years old. I was told that “Lean" season runs til June/July time. In the hunger gap between crops it’s not unknown for the attendance of the inpatient and ambulatory feeding centers to increase fourfold or higher from then on. 

In that vein however, it was a tad unnerving on my last trip downriver with the outreach team to see a diminutive toddler of no more than 18 months old pottering about amongst the cows tethered in the village, his pudgy form wobbling between the legs and bodies of these comparatively massive beasts while the unconcerned mother sat calmly with her back to him milking another heifer. And I guess I haven’t seen or heard yet of a single cow related injury at the hospital, so I know that child was safe, but it did rather put my heart into my mouth to watch nonetheless!