Letter on nappy (diaper) use in emergencies, by Maggs Mac Guinness

Nappies !!

The UN official was back as usual to collect the "mortality figures". I gazed into the therapeutic feeding tents as he approached - toddler's bodies, wet and naked lined up side by side. Those strong enough, fingered faecal fluid off their neighbour's body; others, too weak to lift their heads, lay half drowning in pools of diarrhoea welling unnoticed on the uneven surface of the groundsheets.

It was Day 8 at the Centre for Unaccompanied Rwandan Children, Katale Refugee Camp, Zaire, July 1994.

Overcome by a surreal dementia, I turned to our unsuspecting visitor and verbally blasted him; "Look at these kids - they're dying overnight of hypothermia because they are wet! We cannot control cross infection because we cannot contain this diarrhoea. We can't keep track of the body count every morning there's 600 children under five years here now and truckloads arrive every day. Can you find us 15,000 disposable nappies to get us through this week and then we'll talk statistics
The utterance of those very words sent shivers down my spine...disposable nappies - so culturally alien, so environmentally unsound. The Rwandan (Centre for Unaccompanied Children) CUC Co-ordinator in desperation, endorsed the request.

A consignment of nappies arrived the very next day. A quick demonstration and each tent mother was adept and delighted at the prospect of being able to cope with her charge of thirty or so children.

The following morning, the children were still warm, huddled together. Upper body and clothing had remained mostly dry.

The mortality rate approximately halved overnight, levelled out over the next two weeks, then began its decline.

As anticipated, problems arose:

• Nappy disposal (eventually collected by hygiene team and buried in pits);
• Skin excoriation;
• Tent mothers reluctance to revert back to traditional methods once feeding centres were established.

Feedback was recorded from a general staff meeting on
the 'short term'nappy episode; firstly, the staff felt able to cope better as they could concentrate on other aspects of care; secondly they felt the children were more comfortable and drier.

My questions are:
Did the nappies really work? - or were we simply witnessing the turning point of an epidemic curve? Experiential evidence suggests the former.

Considering the pros and cons - is there a case for 'starter pack' disposable nappy supplies in phase one emergency kits to reducecross infection and control body temperature?

This situation may well be unique given the volume of unaccompanied children and initial dearth of available healthy carers at that time.

Any thoughts, ideas or similar experiences to share?

Yours, etc,
Maggs Mac Guinness.

Dear reader,

This is yet another way you can get involved, and for those of you who are up to your eyes, with your sleeves rolled up, probably the simplest. The letters section is the 'anything goes' part of the newsletter. If you have useful tips, or want to air specific frustrations we want to hear about them.

You can also share your impressions, opinions, scepticism or reservations about much broader issues to do with emergencies. You can comment on this issue's contributions: support or refute impressions or findings based on your own experience. Remember do let us know your area of work, and if you want a prompt response, a contact address is useful. Now you know the score so post, phone, fax, E-mail, a grubby postcard or note in a floating bottle will do.

Looking forward to hearing from you,

The editors