Postscript to 'The risks of wet feeding programmes'

We asked Jean Long formerly of CONCERN (currently lecturer in International Health at Trinity College Dublin) to comment on the above article. She had this to say:

This is a very interesting and clear analysis of a nutrition intervention which experienced an unanticipated cholera epidemic. The causal analysis is clearly outlined in the article with issues and implications for emergency workers highlighted. One important issue is the pressure that health personnel are under to implement an immediate response without an adequate preliminary investigation or basic operational facilities. There are many guidelines on preliminary situation assessments which most of us have read. This raises a question, why do we rarely implement these guidelines in emergency practice? What do we need to do in order to implement good practice in situation assessment? Are we prepared to pay the price of inadequate assessment procedures? An implication here is the need to focus on basic hygiene training as part of preliminary nutrition training provided for nutrition staff. As we are also aware effective training requires follow up supervision and regular supplies. Another issue to emerge from this article is that as health professionals we often live within the walls of our ideal well managed nutrition centre without considering, the chaos endured by the relatives of the beneficiaries or the types of behaviour that they are likely to adopt such as, drinking river water or indiscriminate defecation. We provide very poor facilities for these people, although, it was our intervention which encouraged them to congregate. If our interventions encourage temporary camp situations, do we have a responsibility for the provision of basic facilities for these people? The final issue this article raises is the limitation of a single focused intervention, such as, a nutrition response without the capability to respond to other public health issues. Fortunately in this case MSF was able to provide valuable assistance. Oxfam are not alone here as this is a common feature among agencies who specialise in health or nutrition, yet, we all know the theory the interactions between malnutrition and infection are cyclical'. Do health and nutrition agencies need to have a broader public health focus? Finally I admire Oxfam's openness and would like to thank the agency for sharing this experience with us.

View the article that this postscript relates to