MOUSSORO, Chad (AP) — On the day of their son's surgery, the family woke before dawn. They saddled their horses and set out across the 12-mile-long carpet of sand to the nearest town, where they hoped the reputed doctor would cure their frail, feverish baby.
The neighboring town, almost as poor and isolated as their own, hosts a foreign-run emergency clinic for malnourished children. But that's not where the family headed.
The doctor they chose treats patients behind a mud wall. His operating room is the sand lot that serves as his front yard. His operating table is a plastic mat lying on the dirt. His surgical tools include a screwdriver. And his remedy for malnourished children is the removal, without antiseptic or anesthesia, of their teeth and uvula.
That day, three other children were brought to the same traditional doctor, their parents paying up to $6 for a visit, or more than a week's earnings. Not even a mile away, the UNICEF-funded clinic by contrast admitted just one child for its free service, delivered by trained medical professionals.
The 4:1 ratio that you see in this sandy courtyard on just one day in just one town is a microcosm of what is happening all over Chad, and it helps to explain why, despite an enormous, international intervention, malnutrition continues to soar to scandalous levels throughout the Sahel.
The world poured more than $1 billion into the band of countries just south of Africa's vast Sahara Desert to address hunger this year alone, according to a United Nations database. A third of that money went to Chad, where 15 percent of children are acutely malnourished, says a report by aid group Save the Children. That's among the highest rates in Africa.
There are now 32 clinics equipped with the latest technology to halt starvation, most within a few hours' walk of affected families. If a child makes it to one of these centers in time, the chance of survival is remarkably high.
Yet acute malnutrition is only getting worse in the Sahel, where every year, cemeteries fill up with the bodies of children who wasted away within walking distance of help.
In 2010, 55,000 children were treated for the most acute form of malnutrition in Chad. In 2011, it was 65,000. The expected caseload for 2012 is 127,300, according to the report published in June. Overall, in the eight countries in the Sahel, the number of admissions has doubled in just three years.
One reason is that families simply do not take advantage of the safety net created for them, and cling instead to traditions that can end up killing rather than healing their children.
"We try to tell them the consequences. That these are not good treatments. That if the child has diarrhea, he should go to the hospital," says Laurent Blague, director of child protection at Chad's Ministry of Social Welfare. "Unfortunately, this is tradition."
Eight-month-old Abdallah Lamine had been sick for a month, but it wasn't until he started vomiting that his parents made the trip to the medicine man, Haki Hassane.
The mother rode a red horse, carrying her baby's hot body in her lap. She could feel the fever consuming him even through her clothes.
The remedy the healer prescribes for malnourished children is the removal of the uvula, the tiny ball of flesh that hangs from the back of the throat, which he says "gets in the way of the food." For fever, he prescribes the removal of the child's teeth.
In baby Abdallah's case he prescribed both. He grabbed the baby by one arm, placed him on the mat and pinned him down. As the child began to shriek, he dug the unwashed screwdriver into the baby's pink gums, until four tiny teeth popped out.
The healer wiped down the holes in the child's mouth with a corner of a ratty blanket, stained with the blood of the other children he'd treated that day. Then he handed the petrified, whimpering toddler to his stone-faced mother.
Tooth extraction and the removal of the uvula is common in this part of Chad. Elsewhere, the treatment for diarrhea is burning the child's anus with a rod heated over a fire. Other treatments include draining the "bad blood," a procedure recommended when children's bodies swell, a sign of severe malnutrition.
Similar practices prevailed in Europe and America as late as the 18th century. The advances in world medicine since have made their way to Chad in the form of internationally-run clinics, but they continue to be seen as foreign. More than half of Chad's people still use traditional healers, according to a survey by the Pew Forum on Religion and Public Life in 2010, whose remedies can be effective for some ailments.
Malnutrition is not one of them. Already malnourished children who have their uvula cut can't eat for at least a week, says health official Blague. When the child does eat, the open wound often gets infected. This worsens the malnutrition.
Because the infection can last several weeks, families believe their baby has simply contracted a different ailment. Chad's government has never addressed these harmful practices. The issue remains extremely sensitive, in part because the healers claim their gift came from Allah and in part because many local officials were submitted to such practices themselves when they were children, aid workers say.
Hassane says in 30 years of practice, he's never fielded any complaints from parents whose children became sicker.
"If a child has fever or diarrhea, once he opens his mouth, I can instantly tell. If I put my finger on his gum and feel it, I can tell if it's due to his bad teeth. Once we take out this bad tooth, the diarrhea stops," Hassane says. "And if the child gets sick again, it's because he had some other illnesses in his system."