Nutrition

Work here is so so very different than what I was doing in America. Not only in regards to the type of patients I am encountering but also the pace and methods of how facilities function here.

In America, I spent the last 7 months counseling patients one on one - mostly patients desiring weight loss, most with diabetes, and a few GI complications or underweight patients. I was working alone in an office, seeing one patient after the other, often not enough time to finish lunch or run to the restroom because I would finish with one patient and another was already waiting (that was most days, there was always the few days a month when no one showed up). I was managing other dietitians, attempting to check in daily and make sure they felt cared for and had issues resolved, and hired 4 new dietitians during that 7 month period to fill gaps after others left. I was using clinical skills I learned in school or from inpatient work from the past 2 years and some motivational interviewing skills I learned through watching or reading. I was normally seeing the middle class American who grocery shops, can exercise in their somewhat safe neighborhood, and has at least a basic understanding of what is “healthy” like exercise or vegetables (although that was often quite distorted).

Thousands of miles away in a place where most people make less than $5/day...

Now I am seeing mothers with babies who are very under nourished. Babies that are normally crying, whiny or inconsolable because they are sick and irritable from being sick and underfed for too long. The moms are trying to do what’s best for the child by bringing them to the hospital, asking for help, trying to keep hope that change will happen. To even get to see us at the hospital, there’s a good chance they’ve already been asked for money (bribes) to pay for medical care (such as money for normal saline, meds, Etc) that’s actually FREE in this country. Normally I have the mothers report via my interpretor and their medical chart (which is a notebook they carry around themselves, TBH America: this isn’t a bad idea) that might have the chief complaint for admission in it or it might be empty. It is rare to see a child without a charm around its wrist, neck or stomach - a charm to keep away bad spirits, called a healogy. Never wearing diapers. Rarely with clean clothes. Moms drape the babies on their backs and fasten them on with fabric and walk for miles to get there. Often I wonder why more children aren’t bow legged from their legs being sprawled across their moms back from age infant to three. Kids get fed lots of starches - beans, rice, matooke, posho, porridge, potatoes, bread... often ground nut paste or sauce, sometimes small amounts of vegetables cooked into those items and sometimes meat. But for many in the end - with malaria and poor hygiene and close child spacing and poverty - it’s not enough to ward off malnutrition.

At the hospital, the severely malnourished get formula from the government - created specifically to get kids out of the acute phase of malnutrition and prevent refeeding syndrome. After a week or so (signs of improvement) they upgrade to a weight gain formula and are supposed to sustain this for ~2+ weeks but it’s hard to get anyone to stay for more than 1-2 weeks. Often there is a shortage of these formulas so we transition kids to RUTF or ready to use therapeutic food (thick sweetened peanut butter) as quick as possible and get them discharged.

The nutrition clinic in Nyahuka (below, with Clovis) is for the moderately malnourished. They receive education on proper hygiene, methods of avoiding food insecurity (having a kitchen garden!), importance of eatinga variety of foods, family planning, and more. They hear a bible lesson too - using the 10 gospel truths - and just today one woman shared that her brother was killed and it gave her peace to know that he believed and he is in heaven. They receive ground nut paste with meringa and soy flour to increase calorie intake. And hopefully by the end of the 10 weeks - the child is out of moderate malnutrition category and can be discharged as cured.

This work is hard. In a different way than it was hard to skip bathroom breaks and explain carb counting forfifth time in a day. It’s hard in an emotional, sometimes defeating, sometimes heart breaking way. In a way that brings me to the end of myself and then maybe sometimes a little more. In a way that I feel like God has created me to crave, almost a hankering for high intensity, different than life in America.

If I was here alone, without hope in Jesus’s bigger plan, this work would be impossible. Do I believe Jesus is slowly redeeming this place? Yes. Do I believe he is using me in this process? Yes. Do I believe that he needs me to make change happen here? No! Do I believe in a God that needs me to do things for him? No! He can do this work on his own, but he does delight in bringing us in to His work and growing us during the process. And what a joy and a privilege this work is and continues to be.