I have been very busy doing outreach clinics this week. We notify the villagers in advance and they congregate in an open area, such as in the school grounds or under a mango tree. The plan is to check nutritional status by weighing the children, entering the value on a growth chart in their clinic card. If they are not gaining weight, we have a quick consultation to discuss reasons why, such as recent illness or weaning problems.
All children from six months to five years get a massive oral dose of vitamin A, which helps to prevent eye problems. From age twelve months to five years, they also receive five tablets of mebendazole (500mg) to purge them of intestinal worms. Persuading toddlers to take medicine orally is difficult at the best of times. But when one child objects by screaming, the others get frightened and start crying in anticipation of what’s in store for them.
The mothers lie shamelessly to their children, calling the medicine “sweeties”. Older children chew the tablets and wash them down with a drink of water; younger children have the tablets crushed and mixed with water. Getting this suspension down their throats is an art requiring tough love sometimes. Sometimes the children pretend to swallow it, then posset later. I do get quite concerned when the child starts to choke on the medication mixture, but they all seem to pull through.
I wonder about the value of the deworming programme. I have only seen one child with worms in the time I have been here. I want to go back to the villages a few days later and ask the mothers if they have seen any worms in their children’s faeces. But this is not part of the programme.
The children also receive any vaccinations they might have missed. The programme here is very impressive, with hepatitis B given along with diphtheria, tetanus, whooping cough, measles and pneumococcal conjugate injections. Oral polio and rotavirus vaccines are given orally. I rarely see a child older than 12 months who has not been fully immunised. The programme omits mumps and rubella for some reason I don’t understand.