Mass MUAC Screening by community nutrition volunteers (CNVs)

For those of you following our blog I, Christine, am managing three nutrition sites that provide curative and prevention services to children under 5 years and all pregnant and lactating women (PLWs) in our catchment area. These nutrition sites are located in 3 of the camps that make up the larger refugee camp with a population currently of over 1 million displaced Rohingya from Myanmar.

Our 3 camps cover a population of over 70,000 people of which close to 20,000 are in our program. In the past year we served over 18,000 children and 4500 PLWs. We are in the process of doing a mass MUAC screening exercise to figure out if we indeed have all the eligible children and PLWs that we should be providing services to actually enrolled in our program. This is what is technically called determining coverage.

The MUAC tape

I'm assuming most of you are not familiar with measuring rates of malnutrition in a population as this is not something that is ever done in the USA or other countries with high levels of development.  The standard method of doing this in a quick and fairly easy way is to do a mass MUAC screening. MUAC stands for mid-upper arm circumference and is a measurement that is used to give an indication of nutritional status. The measurement is done with a glorified measuring tape with color bands on the tape corresponding to nutritional status. The tape is wrapped around the mid point of the upper arm and pulled through the white end where there is a window that displays the centimeter measure and corresponding color.  

Checking for children under 5 years of age

The goal of the mass MUAC screening is to identify and screen every child under the age of 5 and PLWs in the catchment area. Steps in the process involve visiting every household and finding out who is under the age of 5. This is done with a stick and a mark on the stick for 110 cm. Any child under 110 cm is considered under 5 years. 

Checking for edema

Once identified the child is then checked for edema – a common sign of a more serious form of acute malnutrition. This is done by pressing down firmly on the tops of both feet for 3 seconds and then removing one’s fingers. If an indention remains then edema is present. 

Determining where to place the MUAC tape

The third step is to identify the mid way point on the upper arm. The child bends their arm at a right angle and the measurer finds the bone at the top of the shoulder and the bone on the elbow. Then the halfway point between those two points is marked on the side of the child’s arm. 

Wrapping the MUAC tape around the arm to see
nutritional status and tallying it on the form

This is the spot where the tape measure is wrapped around to determine if the child is in the red (acute malnutrition), yellow (moderate malnutrition) or green (healthy) section of the MUAC tape - a quick and easy way to screen children in a community and get what is considered to be a proxy GAM rate (Global Acute Malnutrition) rate. The child's MUAC is recorded on a simple tally sheet. On the top section are all children receiving nutrition services. On the bottom section of the page are children who are identified to not be receiving nutrition services. They are then referred to our nutrition site to be enrolled in our program.

Volunteers with a decorated bamboo measuring stick

This exercise has taken about 10 days in total to complete including the initial training focusing on the forms that needed to be filled out. To get a better sense of the logistics involved we have community nutrition volunteers (CNVs) that are assigned to sub blocks in each of the camps in which we work. All together we currently have 140 CNVs throughout the 3 camps with each one responsible for 60-200+ households. They were paired up to do this exercise and together needed to visit every single one of the households in their own and their partner’s assigned block. The CNVs are quite used to their own areas and visit each of their households monthly. This is just an additional exercise to make sure no households and eligible children or women are being missed. To make sure that children were not afraid of the bamboo measuring sticks as a team we worked one evening to do some decorating!

New volunteers learning to use the MUAC tapes

PLWs in our program are also screened using the MUAC tape. Obviously the bands used for children are different than those used for adults. We had to take on some female volunteers to help us do the MUAC screening of PLWs in our program since men are not allowed to touch women. One of the challenges of doing this with females in this setting is that it is necessary to remove the clothing on the arm to get a good measurement. In our nutrition sites, where this is done when women come on a biweekly basis, we have one whole side of our nutrition site that is female only – that includes curtained cubicles to offer privacy to the women while being measured. In the community this is done privately in people's homes.

This exercise was just completed on Wednesday. Now we need to enter all the data that has been collected and find out our coverage rates (in the humanitarian aid world the standard in a refugee camp should be >90% coverage) as well as our proxy GAM rates. This will give an indication of malnutrition rates. However in the nutrition sites we also measure all children's height and weight which is another measurement looked at to determine malnutrition rates.

WFP (World Food Program) provides all the food commodities that we are distributing to children and women coming to our nutrition sites. They are involved in quite a few other services in the camp. I just found out yesterday that they are sponsoring a program called WFP storytellers. Here is a link to one of the storytellers. 

https://www.youtube.com/watch?v=NWiDmAmW24M#action=share

Praise: 

• The Mass MUAC survey has been completed
• Recent funding has come through from two different organizations for our health and nutrition programs

Prayer:

• For a 2 day refresher training for all 52 nutrition staff on June 23-24
• For refugees around the world. June 20th was World Refugee Day. 

Medair Logs Workshop 2019

In early April we had a Medair Logistics workshop in Dubai. Logisticians from all of the Medair programs around the world came together to discuss different aspects of logistics - from the new procurement software that Medair will be using to negotiation skills. We also talked about a lot of

Medair logisticians from around the world!

nuts and bolts issues such as how to avoid disallowances with donor auditors.

One of the reasons we held it in Dubai is that this is one of the few countries in the world where Afghans can get visas.

It was an amazing group of people! Here are some of the nationalities represented: Kurdish, British, Afghan, Cameroonian, South African, Dutch, Syrian and Bangladeshi (my senior logs officer, Juwel, attended with me – he is in the middle on the other side of the table that I am at). So it was really amazing to interact with such a diverse group of people doing amazing work in all the different countries where Medair works and at headquarters!

Logistics (logs) varies so much from one country to another. The South Sudan program, for instance, is one of the most complicated logistics programs (along with Afghanistan and the Democrat Republic of Congo). South Sudan and Afghanistan are both long-running programs, which means that there are multiple bases in each of these countries. So logs often is buying at a central location (like the capitol city) and then expediting to far flung bases around the country. In South Sudan a lot of that expediting happens by air cargo, which is obviously quite expensive. In Afghanistan there are places in the highlands were all supplies are moved by horses. In comparison, Bangladesh is a pretty simple program. We have one base alone. And we have good enough roads to move all our supplies with trucks and other vehicles.

Simulation NSAG

One aspect of the learning during the workshop was negotiation training. There is, obviously, a lot of negotiation involved in logs. One of the primary procurement principles we live by is “best value for money.” So we are negotiating to get that best value for the money that both donors, and individuals like yourselves, give to the Bangladeshi program. But while we were at the workshop a Cameroonian colleague relayed to me how he had had to negotiate with an armed faction in a neighboring country for the release of a couple of his staff who had been taken hostage. This picture is from the simulation we did during the negotiation training. This simulation had to do with negotiating with Non-State Armed Groups (NSAG). My colleague from Afghanistan played the part well! But the training was really helpful! Negotiations are not something that I would say I am necessarily naturally gifted in. So it was really helpful to learn more about negotiating methods and styles.

The things that we learned at the workshop will definitely help my team to better execute our duties. I am grateful for the learning opportunities!

Prayer points:

1. Pray for Medair logs personnel around the globe: for integrity, for strength and for grace to offer others.
2. Pray for Christine as the UN Food Programme project reporting system weighs on her these days.
3. Pray for Rohingya and Bangladeshi alike as almost all celebrate Eid al Fitr over the next 3 days (https://en.wikipedia.org/wiki/Eid_al-Fitr)

Time recently came out with a great exposé on the Rohingya. Check it out!

http://time.com/longform/rohingya-muslims-exile-bangladesh/

A Rohingya photographer

I just want to quick send out a blog in order to share the following link with you:

https://rohingyavision.com/life-through-the-eyes-of-a-rohingya-photographer/

Our comms guy just shared this link with us today. And I am sharing it with you because it tells of some of the difficulties of being a Rohingya youth in the refugee camps. You have to be highly motivated (like this young man) to continue to learn and to grow.

I recently learned that the average amount of time that a person remains a refugee is 17 years! The Rohingya have been here for 2 years thus far.

What he says about education is true. Beyond pre-school education, little else exists. And so the plight of youth is really dire.

And he highlights the fires as well. Here is a picture that one of our staff took of a fire on the 24th of April. He describes well the challenges that fires pose (because he lives that reality).

I think this gives you a better idea of the reality of Rohingya youth! Thanks for continuing to pray for them!