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About the editors

  • Ruth Spencer (EJC)
    Ruth Spencer is a journalist, Editor, producer and hails from Montreal, Canada. She has worked for the European Journalism Centre since September 2008 and has edited all three rounds of TH!NK ABOUT IT. She has production experience in print media, theatre and broadcast television. She tweets via @thinkteam and is currently based in Toronto.
  • Guy Degen
    Guy Degen is an Australian freelance journalist and is based in Germany. He travels widely contributing stories to international broadcasters and is regularly commissioned by UN agencies as a multimedia producer. Guy writes for the Frontline Club blog and tweets via @fieldreports. Guy also trains journalists in multimedia skills and mobile journalism.


Filming malnutrition in a paradox of plenty

Published 27th May 2010 - 5 comments - 4483 views -

I'm back from Mali, remembering to take Malarone for a few more days, and gradually clearing away camera equipment, bags and travel debris dumped on my living room floor.

Fine red dust has permeated through just about everything.

Flicking through my grubby, sweat stained notebook, the first pages are simply a long list of statistics.

I find I need to physically write these facts and figures down before beginning to work. Slowly they permeate through my head and somehow in the creative process of filming I try to find people, places and scenes that can bring these sometimes very abstract points to life and tell a story.

One of my main assignments was to travel south towards Sikasso, near the border with Burkina Faso, and film how regional health services are trying to deal with malnutrition.

I've covered food crises and malnutrition before in nearby countries such as Niger. In the south of Niger, near Maradi, the landscape looks like what you might expect from a region where children are malnourished and dying. It's a desert. Arid land baked dry by the sun, farmers struggle with drought and seasonal onslaughts of locusts.   

Sikasso is a complete contrast. It's the agricultural bread basket of Mali. I saw the local market offering plenty of staple grains, vegetables, and meat. Mango trees everywhere were heaving with ripe fruit. I even poked my head into backyards to see processing of cassava roots.  And in the fields, patches of corn were ripening and teenagers doing back breaking work by hand seemed strong and healthy.

It just didn't seem to me as if I was in the right place for filming scenes on child malnutrition. I was reading my notes wondering why do more than 15% of children under 5 in Sikasso suffer from malnutrition?  A rate on par with the arid north up Timbuktu way and beyond? And the international alert rate for malnutrition is 10%.



It was only after I visited a health clinic specialising in monitoring children for malnutrition did I begin to see and hear how precarious life actually is for many children and families in the region. Markets may have produce to offer, but prices for many foods have gone up. The local price of rice for example has increased by 40% in recent years. The cost of farming supplies such as fertilizer is also on the rise. Families struggling in the face of extreme poverty are being forced to make difficult choices about what to buy and who to feed.

Monitoring for malnutrition comes down to weighing children, measuring their height and other physical indicators such as size of their forearms. These figures are checked against tables and plotted on colour coded graphs to give health workers and parents a picture of a child's development.

Depending on their condition a malnourished child may be provided with vitamin and mineral supplements and complementary foods to take home or referred to a hospital for treatment and recovery. Last year health services in Sikasso recorded around 38,000 cases of children suffering from some form of acute malnutrition.

As I waited one morning to watch a typical malnutrition screening session for children get underway, the doctor in charge was pleased with the turn out of mothers on that day and said it was a good opportunity for a quick lesson on feeding and sanitation. The message was really simple: mums, breastfeed your children; wash your hands after going to the toilet; wash your hands and your baby's hands before feeding to avoid illnesses such as diarrhea; and if you're child is ill, bring them to a health clinic for treatment as soon as you can.

I guess I was impressed by the way he was trying to reach out to the mums. Just very human and personable. Though I also think he liked being the centre of attention of about 40 women!

But perhaps what really brought home to me the problem of malnutrition in this region was speaking with a woman called Salimate.

Salimate is a mother of four children and brought her four month old twins Wassa and Lanzemi to a hospital in Sikasso specialising in treating child malnutrition. Both infants were suffering from acute malnutrition and are now receiving complementary foods to breast milk. Other slightly older children in the ward were eating enriched ready to eat food such as Plumpy'nut.

Salimate told me she is from a large family and one of several wives. Her husband is a farmer and they live about 15 km from Sikasso. When the children fell ill, her husband had no money for medicine. They first tried traditional remedies. That didn't work and Salimate also began having trouble breastfeeding. She said the children were becoming thinner, they weren't moving, and their eyes seemed to be retracting deep into their eye-sockets.

Finally she brought them to the hospital for examination. Salimate said if she hadn't brought the children to the hospital they would have died.

Salimate said life in her village is a daily struggle. There's not enough money to meet the needs of her children for food, housing and clothing. She's worried about the future of her children.

I was very grateful for Salimate's patience. She had seen me bound in and out of her ward several times over the course of three or four days. At first she was reluctant to talk much, but late one afternoon when the ward was quiet and nursing staff were resting she told me her story. One thing she is determined to do is to tell other women in her village what to do if their children fall ill and begin showing signs of malnutrition.


Malnutrition is one of those conditions that often only becomes evident once it is serious. And serious it is, especially for children at the start of the lives. Even moderate malnutrition in early childhood can affect children for the rest of their lives.

International donors such as the EU, which is contributing more than 6-million euros to tackling malnutrition in Mali, point out that malnutrition affects the educational performance of children and affects the physical abilities of individuals, which in turn has an adverse effect on socio-economic development and Mali's progress to achieving Millennium Development Goals.



  • Hanna Clarys on 31st May 2010:

    It’s more shocking to see poverty and hunger in regions where actually there is enough for everyone to lead a ‘good’ life. Things are often different than they seem.

    By the way: these are amazing photo’s.

  • Aventures on 31st May 2010:

    Very powerful photos!

  • Bart Knols on 01st June 2010:

    Needless to add, a well-nourished child is better capable of surviving the onslaught of diseases. This is why malaria can end the live of a child so quickly. There is simply no reserves to stage anything like an immune response to battle the infection. Sad, very sad.

  • Guy Degen on 02nd June 2010:

    MSF has launched a new website for a campaign about malnutrition:

    In collaboration with photographers from VII agency.

  • Guy Degen on 02nd June 2010:

    @Hanna, @aventures thanks for the feedback on photos. All produced rather quickly I might add. To give you an insight, not all are photos. A couple are stills from video - middle three. I’ve been experimenting with the Plastic Bullet app on my iPhone. All “images” were uploaded to the iPhone, run through one of the filters generated by Plastic Bullet, then downloaded back to my Mac. By all means could have worked on them much more. I usually use LightRoom.

    @Bart On one of my visits to the health clinic screening children I noted mosquito nets being issued. And it wasn’t for the cameras.

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