00Introduction01Community health centre02Triage03Intensive Care04Acute Care05Discharge


One-year-old Tiemoko is his mother's first-born. Now weighing just 5.5kg, his health deteriorated after a bout of diarrhoea became vomiting, then a fever. That was when his mother consulted her husband's family, and it was agreed to take him to the community health centre.
  • Name : Tiemoko
  • Age : 1 year old
  • Sex : Male
  • Village : Kapala
  • Preliminary diagnosis : Severe acute malnutrition and shock
  • Under Treatment : 9 days +
Tiemoko lives in Kapala village. His mother brought him to the Molobala community health centre (CSCOM), where diagnosis and treatment are free.

Urgent care at the health centre

The staff explain that Tiemoko's life is threatened. He is in shock, his body in semi-shutdown mode to protect his most vital organs. He has lost an extreme amount of fluid, and this is all interlinked with his severe state of acute malnutrition. It will take around two hours to stabilise Tiemoko on IV (intravenous) fluids before he can be moved to Koutiala hospital.
Tiemoko needs to be transfered to a higher level of care in the paediatrics department of Koutiala hospital, 1 hour 40 minutes away.
Tiemoko - Urgent care at the health center
Acute malnutrition can easily and rapidly develop into a medical emergency. As many as 15-30% of malnourished children will require hospitalisation.

Red alert at triage

At admissions Tiemoko's shock classifies him as ‘red', and thus highest priority. He's measured for height, weight, and mid upper arm circumference, or MUAC, to confirm his malnutrition category for admission—also ‘red'. Meanwhile Tiemoko flits between inert and semi-alert states, as the nurses complete a set of blood checks before he goes straight into the emergency room.
Interview with Dr Sagara
from the lab on the various types of shock.

Two-pronged approach to intensive care

Tiemoko has been admitted to intensive care (ICU) via emergency, where the ER doctor has outlined his dual course of medical and nutritional treatment. Tiemoko needs to start therapeutic feeding but is too sick to feed consistently via his mouth. So a tube has been fitted through his nose into his stomach, and his mother has been trained how to give him the milk using a syringe.

Out of ICU for now...

On his second day at Koutiala, Tiemoko has been able to move out of ICU. But he could have to go back there if he doesn't improve. Tiemoko will take longer to re-establish a normal weight compared to some of the other children, as he has started from such a critical baseline. For now, his feeding regimen continues on therapeutic milk.

Gaining strength after a week

Tiemoko has been in hospital for seven days, slowly gaining strength. That said, he's become more alert and, importantly, his body, his neurological system, is functioning better. He's been on antibiotics because of suspected meningitis, and we are possibly starting to see their effect. And the nurses have reported that he has been able to drink via his mouth instead of the tube. He'll continue to be monitored very closely.
“Tiemoko was already somewhat better yesterday and it's good that he has regained his appetite. He's alert, but still not physically strong.”Dr Moussa Karim Diawara, MSF

Turning the corner to recovery

Into his second week, Tiemoko appears outside in the fresh air! Only yesterday the doctor commented that he was still too weak to sit up properly. Yet before he was ill, Tiemoko was just another one-year old, racing around on all fours. The strain has visibly lifted for his mother as they sit together outside the hospital wards, relaxing with some other caregivers and children.

Mother and child get ready for discharge

At last, Tiemoko is much closer to recovery. He's made the transition from milk to therapeutic peanut paste, is breastfeeding as well, and is gaining weight. He can hold his head up, and sit upright— key milestones for Tiemoko. But, he's running a fever, so he needs to stay on antibiotics. All going well he could discharge in two days, to become an outpatient back in Molobala, on the community nutrition program.
”I'm really happy with the treatment that my child received. I didn't think he was going to survive.”Tiemoko's mother