Ujenzi Trust News

Making Nyakibale Baby Friendly

2014-03-24T03:17:00.000-04:00

In addition to coordinating malnutrition management throughout Rukungiri District, IECM has been working to make Nyakibale Hospital Baby Friendly. Our FANTA Nutrition Fellow has been working with midwives from both ANC and Maternity to draft a Baby Friendly Health Initiative Policy here at the hospital to ensure that babies get the best possible start to life.

To aid in the project the Program Coordinators have been knitting hats to distribute to newborns after delivery. As newborns can easily become hypothermic the goal is to help keep these infants warm and comfortable in their first hours of life while mothers begin breastfeeding. This is particularly important for infants born prematurely due to their smaller size and decreased development.

The hats are not only helping to protect babies from the cold, but are giving mothers a keepsake that can later be passed on to younger siblings. Currently the Program Coordinators have knit 8 hats that are being distributed at the Maternity ward. More to come over the next few months!

Learn more about Ujenzi Trust at www.ujenzi.org

Inpatient Treatment at Kebisoni Health Center IV

2014-02-27T10:07:00.002-05:00

With the help of IECM and three NACS trained staff, Kebisoni Health Center IV has received its first inpatients this week including one referral from Nyakibale Hospital. Before December, Nyakibale used to be the only facility in the District providing care for malnourished patients. Now select Health Center IVs and IIIs are able to provide care free of charge throughout the District.

Irene an eight-month-old severely malnourished, HIV exposed patient arrived at Nyakibale with her mother on Monday. Without money to pay for treatment at Nyakibale the mother did not know her options for treatment. However, now Kebison, Rukungiri, Bugangari, and Buhunga Health Center IVs are trained to treat inpatients free of charge in Rukungiri District. Staff at the Outpatient Department at Nyakibale along with IECM staff determined that Irene lived closest to Kebisoni Health Center IV. All of Irene’s anthropometric measurements were taken and recorded on a referral slip.

That evening her mother brought Irene to Kebisoni. On Tuesday IECM followed up with Kebisoni staff. In addition Irene had taken the allotted two sachets of RUTF. Her cough had subsided and anti-retroviral treatment was planned. Now, Irene is taking six daily rations of F75 high-energy-milk and has gone from 3 kg to 4.2 kg in four days. Thanks to the hard work of government staff trained in NACS in December, coverage of malnutrition treatment services is accessible, affordable, and effective in Rukungiri District.

Learn more about Ujenzi Trust at www.ujenzi.org

Building Local Capacity for Malnutrition Treatment

2014-02-07T03:11:00.000-05:00

Initiative to End Child Malnutrition (IECM) is expanding its inpatient and outpatient services greatly in Rukungiri District by training government health workers at select health centers. With the New Year has come a new approach to providing malnutrition services to the children who need it most in the District. Outside the gates of Nyakibale Hospital, the center of IECM operations, we have been building capacity and carrying out extensive support supervision of the health centers whose staffs were trained in NACS in December 2013. NACS stands for Nutrition Assessment Counseling and Support and is recognized by the Ministry of Health as the standard for treatment and prevention of malnutrition.

Despite providing intensive NACS training for 25 health workers, training alone is not enough to implement NACS at the health centers. Since training, each health center has received essential supplies, assistance in holding on-site trainings, and on the job mentorship. For example, in order to screen patients for malnutrition and determine who qualifies for nutritional support, each received a stadiometer, a scale and MUAC tapes. All children, pregnant or lactating women and any HIV+ clients must be screened for malnutrition. For adults, using the Middle Upper Arm Circumference (MUAC) as an indication of malnutrition is enough but for children under 5 we also check their Weight-for-Height. The stadiometer is used to measure height and this figure is compared to the child’s weight in order to make a diagnosis. In addition to screening tools, the health centers also received reporting tools and were directly involved in compiling weekly and monthly reports. Staffs have also showed initiative by improvising and creating their own forms where NACS does not provide a specific tool. For example, health centers have created their own registers to track screening which is used to calculate the catch-rate at each site. The catch-rate can help assess nutrition needs surrounding each site.

Since only 2-3 health workers per center received NACS training, another important step has been to ensure that they share their knowledge with other health center staff. In order to stop the cycle of malnutrition, nutrition needs to be integrated into all aspects of health care and not just viewed as a problem for young children. For example, nutrition must be addressed on the maternity ward since a malnourished mother will give birth to a low birth weight baby. At least one on-site training has been held at each site to disseminate knowledge. These sessions are also an opportunity for staffs to delegate responsibilities, schedule follow-ups and set-up a system which can work at their center. IECM encourages local ownership of the program by using problem-solving skills to help staff improve their services and find solutions that can work at their specific site.

In addition to large group training, IECM also works one-on-one with staff to answer questions about the treatment protocol and reporting tools. IECM has extensive experience in running outpatient therapeutic care sites and providing high quality care for inpatients that need special attention. It is crucial that we transfer these skills and this knowledge to staff outside of the hospital so that more children can benefit from nutrition support services. Practical training has been the most important since many of these staffs have not treated malnutrition in the past. Questions are often best answered in the context of treating a specific patient. One site has already admitted two inpatients and it has been crucial to visit and help them calculate how much formula the child should receive and how to accurately prepare it.

IECM is making a difference in Rukungiri District by sharing its expertise with health workers. Through these health workers we are reaching further than ever and enabling staff to provide essential nutrition support to more children than before.

Learn more about Ujenzi Trust at www.ujenzi.org

The Story of Shanita: Treating Malnutrition in Children Less Than Six Months

2014-01-30T03:17:00.005-05:00

At Bugangari Health Center IV in rural, Southwestern Uganda, the Initiative to End Childhood Malnutrition (IECM) has run an outpatient therapeutic care (OTC) site since 2011. Bugangari is one of seven outreach sites IECM managed in 2013. The catchment population of Bugangari is similar to that of the entire Southwest region. According to the Ugandan Demographic Health Survey in 2011, the region has the second highest rates of severe and acute malnutrition in the country, second only to the Karamoja region, which is prone to drought and conflict.

In August, a two-month old severely malnourished infant named Shanita came in with her grandmother to the IECM outreach site in Bugangari. At 2.3 kg she was enrolled as an outpatient and started receiving infant formula since her mother had passed away. Over the next few weeks the IECM outreach nurses noticed that Shanita’s condition was not improving. The nurses took the time to explain to the grandmother, Shanita’s caretaker, the necessity of bringing the infant into Nyakibale hospital for inpatient therapeutic care (ITC). ITC is administered on a special malnutrition ward separated from other pediatric patients to avoid transmission of disease since malnourished patients have a depressed immune system. Without proper attention and close monitoring by clinical staff, Shanita’s condition would not improve. While convincing a caretaker to leave her village, family, and farms is difficult, Shanita’s grandmother agreed to travel 18 km to Nyakibale Hospital for inpatient care. She was transported back by IECM’s outreach team in their Rav4 for the forty-minute care ride back to Nyakibale hospital.

Within hours of being admitted to the malnutrition ward, the nurses and our Food and Nutrition Technical Assistance (FANTA) Nutrition Fellow discovered that Shanita’s grandmother was not able to properly prepare formula. In fact, why would she? All of her children and all of her grandchildren had been breastfeed. She was excessively diluting the formula that the IECM outreach team had been providing her on a weekly basis at Bugangari. After observing and teaching her how to prepare the milk, she was able to make it on her own. Over the next twenty days Shanita went from 2.4 kilograms to 3.18 kilograms and was discharged back to our outreach program at Bugangari. Until Shanita was able to start taking solid foods at six months, IECM was able to provide infant formula for her grandmother to prepare.

Without IECM, there would not have been out outpatient site where Shanita’s grandmother could access treatment close to home. Just as importantly, the program provided all outpatient and inpatient treatment free of charge. Without the program Shanita would never have received infant formula. And, with her mother deceased, she would have passed away silently in Bugangari.

IECM has transitioned to following Uganda’s national guidelines for the treatment of malnutrition, namely Integrated Management of Acute Malnutrition (IMAM). For those infants under six months who are not effectively breastfeeding, the guidelines encourage counseling for mothers. However, for those infants who do not have access to breast milk, the guidelines encourage the use of diluted F100 (high energy milk only available through inpatient therapeutic care), or infant formula. However, caretakers must purchase the infant formula, which is not provided free of charge like the F100, F75, and Ready-to-use-therapeutic-food (RUTF). Infant formula can cost approximately 32,000 Ugandan shillings per tin (approximately $13), and many of our caretakers report earnings of between 5,000 and 10,000 shillings per month (about $4). Without IECM, Shanita would never have survived. It is thanks to the generous funding that has made treatment and prevention of malnutrition possible in Bugangari and all of Rukungiri District.

Learn more about Ujenzi Trust at www.ujenzi.org

Thanks From Our Mothers

2013-12-02T05:48:00.003-05:00

Last week IECM staff had a wonderful and uplifting day. We got a notice from the pediatric in-charge that IECM staff were invited to a special event. To our surprise, mothers of children currently being treated for malnutrition at Nyakibale wanted to show their heartfelt appreciation for all that our staff had done for them. These mothers hosted a concert for IECM staff after secretly practicing their songs. Not only did the mothers sing, but they also allowed us to dance along with them!

It was an amazing experience to see these women take time out of their day to personally thank us through song and dance. Knowing that the work you have done is making a difference is truly an incredible feeling.

Learn more about Ujenzi Trust at www.ujenzi.org

Modern Primary School’s Garden is Still Growing Strong!

2013-10-15T08:08:00.003-04:00

In 2011 the Initiative to End Childhood Malnutrition, with the help of Harvard’s Global Hunger Initiative student volunteers, helped construct a school garden at Modern Primary School in Rukungiri town. Over the past year the faculty and staff at Modern have been enthusiastic about the garden not only for the produce, but also as a teaching tool.

The Deputy Head Master invited the IECM Program Coordinators to see the progress of the garden this week. He has hopes to continue expanding the garden and to diversify the number and quantity of green vegetables. This will allow the school to incorporate highly nutritious vegetables into less expensive matooke, potatoes, and beans. Currently, matooke, dodo, beans, spinach, and eggplants are all growing in the garden. The students help with the weeding and cultivation process. Crops from the garden are used for meals for the boarding students. In addition, students are learning about what crops to include in their own gardens and how to maintain it in order to ensure a bountiful harvest.

With the enthusiastic help of the Deputy Head Master and seed contributions from the local NAADS office, Modern’s garden and children are still growing strong!

Learn more about Ujenzi Trust at www.ujenzi.org

IMAM Training

2013-09-03T10:28:00.002-04:00

Nyakibale and IECM staff including two inpatient nurses, two outpatient nurses, our Nutrition Fellow, and the Medical Superintendent were trained in Uganda’s national guidelines for malnutrition prevention and treatment at Mulago Hospital in Kampala. The six-day, private training was held at Mwanamugimu, the Pediatric Malnutrition Unit at Mulago National Referral Hospital. The training will expand the capacity of IECM’s program in several important ways.

First, training in Integrated Management of Acute Malnutrition Guidelines (IMAM) will ensure that our staff can train colleagues at Nyakibale and local health facilities in Rukungiri District. This will allow a large number of health care providers in Rukungiri to carry the knowledge with them throughout their career and throughout the country.

Second, training in IMAM guidelines will allow Nyakibale to start receiving F100 and F75 sachets, which are powdered high-energy milk formulas for inpatient treatment of malnutrition. These sachets are free and require only boiling water. IECM hopes to see a significant reduction in program costs as a result. Ensuring a continued and reliable supply of F100 and F75 sachets is essential.

Third, IECM will have the continued support from the Ministry of Health. Additional benefits coming from the national and international level such as reporting materials, compiled data, and supplies will become available to as a result of IMAM training.

In sum, IMAM training will ensure that the work IECM has started will have a sustainable and long-term presence in Uganda.

Learn more about Ujenzi Trust at www.ujenzi.org

2013-08-09T04:31:00.001-04:00

August 8, 2013

Recently, we had a child admitted to the malnutrition ward with severe Kwashiorkor. The little boy was a child of four but looked to be about 2. He had edema throughout his body and very little appetite. Over the course of a couple days it became apparent that the child would not drink the high energy milk given to him. When given an NG tube the child proceeded to pull it out and continue to refuse the milk. In response IECM’s nutritionist fellow started to make high energy porridge to entice the little boy to eat, yet still he refused.

After continued problem solving the Nutritionist fellow proceeded to create a special diet known as ekitoobero. The child was enrolled in our “meals for mother’s” program and given well balanced meals with a large protein component. Within 2 weeks the child’s edema has disappeared. He has a strong appetite, a lot of energy. The child’s grandmother has been given nutritional counseling and the child is likely to be discharged by next week.

Seeing a child recovering and knowing that you helped is one of the best feelings in the world.

Learn more about Ujenzi Trust at www.ujenzi.org

Training Village Health Care Teams to Identify Cases of Malnutrition in Rukungiri District

2013-07-24T09:46:00.000-04:00

On June 20^th and June 27th the IECM outreach team including our nurses, volunteers, and Nutrition Fellow helped to train 113 VHTs in Ruhinda sub-county. The trainings include education on signs of malnutrition, screening children for malnutrition, and best nutritional practices.

As a follow-up to training, VHTs went out into the community and screened children making referrals for Child’s Days held on July 6^thand July 13th. 184 children were screened, eleven children were admitted to our outpatient treatment program, and four patients were admitted to our inpatient treatment program. Each subsequent visit to our Ruhinda outreach site has increased the volume of children being screened and continued to train VHTs.

It is amazing to see the dedication and hard work our VHTs put in to protect the health of their community members. VHTs are supported by the Ministry of Health in Uganda, but extensive training in malnutrition prevention is not part of their initial five day training program.

IECM has worked with VHTs in communities that receive malnutrition prevention and treatment services from our outreach site. VHTs have been an integral part of our program by helping to identify children deep within the community that are severely and moderately malnourished. The impact that our trained VHTs have holds promising potential for Bikurungu and Murama sub-counties, two of our seven outreach sites that still need VHT training.

Essential Nutrition Actions

2013-07-12T10:45:00.000-04:00

Nyakibale Hospital is home to the Karoli Lwanga School of Nursing and Midwifery. The nursing and midwife students are assigned to work as interns on each ward as part of their education. When students are assigned to the pediatric ward, they are taught how to follow the IECM protocol by IECM program coordinators and GHI interns. These training sessions are valuable, imparting the students with the knowledge of how to care for malnourished patients. Unfortunately, due to time constraints the training is limited to the clinical aspect of treating malnutrition and does not cover in-depth nutritional messaging such as proper feeding practices for young children or how to incorporate important vitamins and minerals into the diet such as iron and vitamin A. In the last weeks, IECM has had the opportunity to fill this gap by holding classroom sessions with nursing and midwife students. The purpose of the sessions was to teach students appropriate nutritional messaging in addition to the counseling skills necessary to effectively communicate the messages to caregivers.

The nutrition education session was led by Esther, a nutrition Fellow, and Alex one of the current student interns. The topic was Essential Nutrition Actions (ENA), nutrition interventions developed by the WHO which target the first 1,000 days of life. Proper nutrition during the first thousand days of life from conception to the child’s second birthday is crucial for normal physical and mental growth and development. Esther and Alex used PowerPoint slides to first teach the 7 ENA’s, often pausing to answer questions from the audience and to use the white board to list foods that include certain nutrients. Some of the topics were familiar to students such as exclusive breastfeeding for infants 0-6months, while other topics needed more attention such as control of iodine deficiency disorders.

After the ENAs were covered, the students were divided into seven groups and each one was assigned one of the essential nutrition actions. Each student group made a poster with instructions to mothers and fathers describing what they can do to help their families receive the proper nutrients. A representative from each group presented their poster to the class. The students were challenged to communicate the nutrition messages in a way that caregivers could understand. This exercise in role play was important since certain words that we use in the English language to explain nutrition are not directly translatable into Runyankore, the local language in Rukungiri. For example, when explaining the importance of iron in preventing anemia, the student-presenter had to clearly define anemia without using words such as “red blood cells” or “hemoglobin”.

Learn more about Ujenzi Trust at www.ujenzi.org

2013-06-26T04:29:00.001-04:00

20-6-13 VHT Trainings

Today Christine, two students and I traveled to Ruhinda Sub-country and trained VHTs (Village Health Teams). When we first got to Ruhinda the group and I were a little disappointed because only eight VHTs had shown up when we were expecting many more. However, by the time training started we had over 20 VHTs involved! Christine, one of our outreach nurses did a fabulous job with the training. She included descriptions of both Marasmus and Kwashikor as well as how to identify each type of malnutrition. In addition, VHTs were trained in how to take a MUAC measurement to determine if a person is severely, moderately or mildly malnourished.

The VHTs were very involved in the trainings as well. Many asked questions, and a few even got up in the front of the class and gave demonstrations on how to take a proper MUAC. It was great to see everyone participating! Each VHT received a child MUAC tape, and 18+ MUAC tape and a laminated chart delineating the measurements for severe, moderate and mild malnutrition by age group. The VHTs were also provided with a per diem and a soda and snack as a thank you from IECM for participating in our training.

All the VHTs showed great interest and expressed thanks to IECM for providing trainings and supplies. We are very excited to be continuing our trainings with VHTs. We will be training the rest of Ruhinda Sub-county this coming Thursday with Child days to follow.

Learn more about Ujenzi Trust at www.ujenzi.org

2013-06-18T13:39:00.004-04:00

Wangari, our IECM cow, has some exciting news. Yesterday, she was inseminated by sperm from a Fresian bull named Thunder. Currently, Wangari is our only cow and she is producing about 12 liters of milk a day for the children on the malnutrition ward. It is our hope that two cows can provide for the daily needs of the children on the ward (around 40 liters of milk). When the calf is born in about nine months, the milk production of Wangari will increase. Her calf will stay with us and looked after by our herdsman until the age of one, when it will be sold. Rearing a calf until age one can fetch the best price, but is also a risk as calves are more susceptible to illness in the first year.

The hope for sustaining the cow program is to maintain two cows and two calves. Money raised from the sale of the calves will be invested back into the program to pay for vet fees, herdsman’s salary, and other miscellaneous expenses. Maintaining cows to produce enough milk for the needs of the pediatric ward have been challenging. Currently, our pasture is being shared with cows from a local convent and the grazing space is not enough for all of the cows and calves. The diet of our cows has been supplemented with matooke and banana leaves. However, the nutritional value is not enough. An imminent solution to increasing the food supply for our cows is essential, especially with a new calf on the way!

Learn more about Ujenzi Trust at www.ujenzi.org

2013-06-18T13:39:00.003-04:00

Learn more about Ujenzi Trust at www.ujenzi.org

2013-06-18T13:39:00.002-04:00

2-week Follow-Up

2013-04-05T13:25:00.001-04:00

Herbert (not his real name) has been on the ward for two weeks now. Not only is he smiling again, but so is his mother Anna (not her real name). Anna happily reports that Herbert's edema is gone and that he is gaining weight, he's doing alright now. His treatment is not yet complete but Herbert has greatly improved in just two short weeks on the ward. Checking his bedside chart I can see the progress he's made, his weight decreased sharply as the edema resolved. Now his weight is rising since he's moved from Phase I to Phase II of the treatment protocol. In Phase II he receives twice the amount of high energy milk, which means twice the calories - this phase is meant for rapid weight gain and it's working for Herbert. His weight dropped to 8.4kg but is now 9.2kg, nearly a 10% weight gain since the edema has gone.

Edema at admission.

2 weeks later: The dent test
is negative, edema has
completely resolved.

Before coming to Nyakibale Anna said that she fed Herbert cassava, yams, and dodo (a variety of spinach) - a diet lacking in protein. From the health education sessions she has learned about a balanced diet and says that she'll add beans, mukene (small silver fish) and avocado to her son's diet - changes that should help prevent relapse of malnutrition.

Anna says "Thank you because you are helping me by treating my child" and also ensures that she will go home and tell others about what she's learned at Nyakibale and the treatment that saved her son.

Learn more about Ujenzi Trust at www.ujenzi.org

Child receives care thanks to neighbors' referrals

2013-03-22T13:48:00.000-04:00

IECM is well known and trusted within the communities it serves. The story of one child who was admitted this week as an inpatient is a testimony to IECM’s reputation in Rukungiri.

Herbert (not his real name) is two and a half years old and clings to his mother’s body, his grip loosens and his swollen and fretful face brightens as his mother shares a chapatti with him, part of the free breakfast she received since being enrolled in the Meals for Mothers program. Herbert’s mother arrived the previous day to Nyakibale after Herbert was diagnosed with marasmus kwashiorkor at one of IECM’s outreach locations. Marasmus kwashiorkor is a severe form of malnutrition caused by a lack of protein and calories in the child’s diet and presents visibly as swelling in the legs, stomach and face with wasting (loss of fat) as well. The swelling, or edema, is diagnosed using the dent test; a health worker presses her finger on the child’s foot for three seconds. If a dent remains after releasing, the child has edema.

Pictorial representation of the dent
test used to check for edema.

Nurse performs the dent test on
Herbert. He is positive for edema;
compare to photo on the left.

Herbert’s mother, Anna (not her real name) attended IECM’s outreach based on the advice of three other mothers, all of who had children who were previously treated at Nyakibale. These mothers recognized the same symptoms in Herbert as they had seen in their own children and recommended that Anna take her child to IECM’s nearest outreach site.

Anna says that she was not worried about coming to the hospital based on the testimonies of these fellow mothers. She wants to stay at the hospital until Herbert is healthy. She understands that the swelling in her child is due to poor feeding but does not yet understand what constitutes a balanced diet.

Thanks to their previous experience with IECM – receiving medical care and nutrition education on the pediatric ward, Anna’s neighbors recognized Herbert’s swollen legs and face as symptoms of malnutrition and referred him to an IECM outreach site. Based on their accounts, she was not fearful of leaving home to bring her child to the hospital. Herbert is now receiving the care he needs and is on his way to recovery.

Learn more about Ujenzi Trust at www.ujenzi.org

Growing healthy at Modern Primary

2013-03-15T16:02:00.001-04:00

Modern Primary's addition to their
school garden.

Another successful community garden started by IECM is found at Modern Primary School located in Rukungiri Town. As another rainy season begins, it is time for planting. This week, we received seeds from NAADS to be used at Nyakibale and at Modern Primary.

The deputy headmaster oversees the garden and a gardener is hired for the heavy clearing, however teachers and students alike do the work of planting, weeding, weeding and harvesting. They have plans to add a fence to the plot and create a path from the school so that it can be more easily reached for teaching, demonstration, and of course gardening.

Today, 19 students ranging from ages seven to thirteen and two teachers skipped their morning tea break in order to visit the garden. The garden is much larger than the plot at IECM with piles of dead branches acting as dividers between the plots to distinguish between the different vegetables being grown.

Students help to plant eggplant.

These same primary students were present last summer when Harvard undergraduate volunteers visited classes to teach about balanced diet and the three food groups. The students were shy but able to answer my questions about healthy diets – however they were much more interested in climbing into the garden and getting their hands dirty planting vegetables.

Learn more about Ujenzi Trust at www.ujenzi.org

Village Health Team Update

2013-03-15T15:33:00.000-04:00

One of IECM's nurses explains the results of the
malnutrition screening to caregivers.

On Monday, the IECM outreach staff returned to Kikarara after having trained 26 VHT members the week before. The VHT members were asked to visit the homes within each of their "cells" (this can range from 15-30 households depending on the distance) and screen for malnutrition while also educating families about proper feeding.

VHT coordinators receive certificates
for attending the malnutrition training session.

The two VHT coordinators from Kikarara joined our staff and received certificates to distribute to the rest
of their team. Ten new patients were referred by the VHT members for screening by IECM. The referrals
were assessed for malnutrition by IECM Outreach nurses. None necessitated therapeutic treatment, but
the mothers received nutrition education for malnutrition prevention.

Caregivers, VHT members and staff pose together for a
photo in Kikarara.

Learn more about Ujenzi Trust at www.ujenzi.org

Engaging the Village Health Team

2013-03-08T13:02:00.003-05:00

One of IECM’s main objectives in Rukungiri is to address the child malnutrition knowledge and skills gap of local health providers. One of the project activities designed to reach this objective is a training program for community-based volunteers. The first level of health care in Uganda is a Health Center I (HCI). This community-based structure was initiated in 2001 as part of Uganda’a Health Sector Strategic Plan. There is no physical building; rather this health center is built of volunteers who have been chosen by their community to promote health and well being of the village. Volunteers within a village are assigned specific households and together form the Village Health Team (VHT).

IECM nurses lead the malnutrition screening and

nutritional education training session in Kikarara Parish.

26 VHT members and one SCORE field officer were in attendance.

The malnutrition-training program for VHT members began in January 2012 and from its genesis has been a collaboration between IECM, Nyakibale Hospital, the District Health Office of Rukungiri and the Ministry of Health. As of this week, we have trained a total of 120 VHT members in four parishes of Bwambara Sub County, our main target area.

A MUAC (Middle Upper Arm Circumference) is a simple tool used to diagnose malnutrition for ages 6 months and above. The MUAC is similar to a tape measure with a slit on one side to accurately measure the circumference

of the subject’s arm. Diagnosis is based on age.

In January 2013, we received approval from the District Health Officer to train all VHTs within our catchment area. Kikarara parish was chosen as the next training site because of the severity of cases that come for treatment, low patient numbers in recent months and our strong collaboration with SCORE (Sustainable COmprehensive REsponse for vulnerable children and their families) a project that works with communities the same catchment area. Our goal is to provide VHT members with the skills and tools needed to identify and refer cases of malnutrition to IECM’s outreach sites as well as malnutrition knowledge to counsel families on proper feeding and prevention practices.

IECM’s outreach team chose March 4th for the training and a SCORE field officer mobilized VHT members while IECM prepared the necessary supplies, including MUACs and malnutrition education handouts for each VHT member.

IECM nurses demonstrate the proper use of a MUAC.

Training is interactive, nurses pose questions and VHT members discuss challenges they’ve faced in the field. Above, two VHT members volunteer to teach the rest of the group what they’ve learned. Fellow trainees are attentive to detail and supportive– during the peer education they point out errors and ask for clarification. The session was closed with a round of applause for everyone involved.

IECM will return to Kikarara on March 11 to follow-up with the VHT coordinators and handout certificates. As VHT members identify cases of malnutrition, they are advised to fill out a referral form and send the patient for further screening at IECM’s closest outreach location. VHT members are a valuable resource, bridging the gap between the formal health system and the households. IECM staff cannot reach individual households themselves but through this VHT training program, we are reaching farther than ever by strengthening the first line of care; the Village Health Team.

Learn more about Ujenzi Trust at www.ujenzi.org

Soy Harvest Part II

2013-03-01T14:10:00.001-05:00

Learn more about Ujenzi Trust at www.ujenzi.org

Caregivers and patients enjoying high energy porridge, a sweet and nutritious treat, on the pediatric ward made from the soya harvest from IECM's nutritional and education garden.

Welcome back. This week the soya we harvested from IECM's nutritional and educational garden has reached malnourished patients on the pediatric ward in the form of high energy porridge. Enough flour remains to present more cooking demonstrations and prepare high energy porridge for patients who refuse to take the therapeutic high energy milk normally used to treat malnutrition.

Soya production is on the rise in Uganda, especially in the Western region, where Rukungiri is located. Processing plants are being built to produce soy-based products in Uganda, such as soy milk, and farmers have more support than ever to grow and market their harvest. While the size of IECM's harvest pales in comparison to large-scale farmers in the area- we worked to maximize our yield by using the harvest as an opportunity to not only to teach caregivers how to prepare a high energy snack for their children but to encourage them to grow soy themselves - preventing malnutrition from the household level.

Day 6: Okuhura and Sorting
After drying the soya in the sun, the next step is okuhura or dehulling (manually) – the basic procedure is to knock the soya beans out of the pods by hitting the dried soya plant with a giant branch. Repeatedly. Turn the pile and repeat. Okuhura is followed by sorting – another manual process though less demanding. And here’s the result (below):

Day 7: At the flour mill

Next, the sorted and dried soya beans are taken to the mill in Rukungiri town for grinding into flour. It cost 800 Uganda Shillings, or the equivalent of 30 cents to grind 4kgs of soya beans. It is also common to grind millet and maize into flour for commercial and personal use.

Day 10: Preparation of High Energy Porridge

Today the soya flour reached the pediatric ward. One of the nurses led a demonstrative cooking session with the help the nursing students. Together they taught the caregivers on the malnutrition ward how to prepare high energy porridge using soya flour, milk, oil and sugar. After the demonstration, each caregiver brought her cup to receive a sample of the porridge. Conversation began naturally between women about the quality of the flour, how to harvest soya and other recipes using soya. The nurse explained how IECM had harvested and processed the soya and answered questions from the caregivers.

Soya Bean Harvest, Part I

2013-02-22T14:58:00.001-05:00

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Please join us...

This week, Initiative to End Child Malnutrition at Nyakibale Hospital invites you to take a step into our garden...

Our nutritional and education garden offers a visual and hands-on learning experience to educate caregivers of our malnourished patients not only what foods build a balanced diet but also how to grow them in their own backyards.

Southwestern Uganda is lush and fertile. Residents here enjoy two rainy seasons, making it possible for anyone with the right knowledge and motivation to grow vegetables in a what is commonly referred as a "backyard garden"

Staffs, students and caregivers work
together to plant the garden just
before the start of the rainy season.
September 2012

This week, soya bean and spinach were harvested from the garden. Spinach is harvested about twice per month but this was the first time to harvest soya bean. The process started last year in September; the gardener, caregivers, nurses, and students alike met at the garden to plant carrots, soya bean, spinach and tomatoes. The vegetables are all regulars in our garden but soya bean was chosen because it replenishes nitrogen into the soil and is rich in protein, a nutrient many of our patients are lacking.

All of the produce harvested from the garden benefits our caregivers. The produce is brought to the canteen and is used to prepare meals for the caregivers in our Meals for Mothers program. Meals for Mothers is an IECM sponsored program for caregivers who are unable to purchase meals for themselves while attending to their children on the pediatric ward.

Spinach can be harvested and eaten the same day, no preparation needed beyond washing and chopping --- soya bean takes much more work before it makes to to the plate....

Day One: Wednesday

Step 1: Uproot the entire plant

Step 2: Tie together bunches with banana fibers and load onto the bike to transport to the hospital canteen.

Step 3: Lay the soya bean on a tarp to dry in the sun. Be sure to keep a close eye on the weather, in case of thunderstorm (very common here), the tarp must be folded up to keep the soya dry during the storm. But don't worry, the day is not lost, the sun can start shining again within an hour!

Day 3: Friday

Bean pods are dry... interested to see the next step? Check back next week!

May 19th, 2012

2012-05-19T13:43:00.002-04:00

I'm sitting in the airport terminal at the Juba airport, preparing to return to the US after my first stint working as a teacher of junior doctors at Juba Teaching Hospital. As I watch expatriate aid workers arrive on the incoming flight from Nairobi, I feel like a seasoned veteran. And yet I've only spent two months here. Sixty days. Barely any time to even get acquainted with a place. Eight short weeks. In some ways, though, it certainly seems like it's been longer.

Working at the Juba Teaching Hospital has been challenging. Lack of essential medications, equipment, and skilled manpower makes taking care of very sick patients even harder than it should be. Certainly, some patients present too late to be saved, even if they were cared for in a first-class institution like Massachusetts General Hospital. But many patients present very sick, yet early enough that they have a chance. Unfortunately, many that should make it do not.

Our goal is not to bring MGH to Juba. That is neither possible nor a good use of time or funds. With diligence, patience, and a cooperative attitude, we hope to raise the level of care to one that is expected of a national referral hospital in Africa. This is feasible. This is necessary. But it won't be easy.

There is so much work to be done. When an elderly patient admitted tp our ward with diarrhea and weakness, unable to care for herself, receives no nursing care for 24 hours, or when a lecture I worked on for several hours is attended by less than half of the junior doctors expected, I feel disheartened. When a patient dies because there is no IV tubing to give medications and fluid, or when a patient with severe anemia fails to get the prescribed blood transfusion because no one walked the 25 meters to the lab and brought the blood to the patient, I feel like the challenges here might be too great after all.

Yet we get up the next morning, and we try again. We encourage the nurses again to clean the patient in need. We work with visiting pharmacists to address the myriad of medication issues plaguing the hospital. We bring in expert nurse instructors to coordinate between the ministry, hospital, and the school of nursing to improve nursing care. And we work side by side with the young physicians that are charged with caring for one of the most impoverished and traumatized people of the world.

Jeff Pierce, MD

Learn more about Ujenzi Trust at www.ujenzi.org

May 3rd, 2012

2012-05-03T03:27:00.002-04:00

Dr Rae Wake teaching on the Emergency Medical Ward, Juba Teaching Hospital

Learn more about Ujenzi Trust at www.ujenzi.org

May 3rd, 2012

2012-05-03T03:21:00.001-04:00

Since starting work as a consultant on the Emergency Medical Ward in January I have had my fair shares of ups and downs. But what makes the inevitable frustrations of working in such a resource limited setting as South Sudan worthwhile, is the hope I see in the people we are here to train and support. In this blog I will try and share some of these day to day stories whether from our ward, the classroom or from the many people we meet every day who are also striving to improve the health care system in this brand new country.

This week I gave blood. There is an unreliable blood supply at Juba Teaching Hospital. A family sized fridge, with a fickle power source supplies blood transfusions for over 500 patients including elective and emergency surgeries, paediatrics and obstetrics – a major need when it comes to emergency transfusions since bleeding in pregnancy is the most common cause of death. MGH has set up a ‘Virtual Blood Bank’ and now over 100 internationals in Juba are signed up to give blood at short notice for patients who do not have family members to donate or to keep a small emergency supply for when every minute counts. Since November, the blood bank has always had enough to supply transfusions for these critical cases. As the lab technician Ahmad set me up for my donation, I asked him how things were before the VBB existed. ‘It was terrible working here before’ he told me ‘there was always a demand I could not meet. I remember once there were 4 children who needed urgent blood at 3 in the morning. I came in, put a needle in my own vein and donated enough blood for them all.’

One of the many big challenges we’ve faced on the emergency ward is a very poor capacity to deal with ‘emergency’ cases such as diabetic ketoacidosis (DKA). This often affects young people, is a life-threatening condition and in well resources settings with adequate nursing care is relatively easy to manage. I can think of four young lives that have been wasted on the ward due to DKA so it’s been a focus of our training sessions with both nurses and junior doctors. Residents Ne and David developed a protocol during their month long rotation which simplifies the management in recognition of the situation – little ability to measure blood sugars, urinary ketones, no fridge to keep insulin in, no nurses capable of managing an insulin infusion etc. And we have started to see the management of DKA turn around. The junior doctors are carrying these protocols around in their back pockets. They stay on the ward until late in the evening making sure patients get the right treatments. There is still a long way to go I realized when the head nurse told me there is no way that drugs can be given hourly on this ward. But today I found a house-officer sitting with this nurse, explaining the protocol and the importance of hourly insulin doses. So much better when it comes from the South Sudanese doctors.

One of the most rewarding groups to teach that I have worked with so far are the Clinical Officer Students. These guys have 3 years training before they work in some of the most isolated areas – often as the only medical personnel in a health facility dealing with every kind of problem imaginable. The students are bright, enthusiastic and super dedicated to the ward – the first ones there in the morning, coming in on their days off to check on patients, coming to all our teaching sessions and asking hundreds of questions. I had a ‘heart-sink’ patient today. An emaciated lady who had travelled from far out of Juba, unable to communicate with anyone on the ward in her local dialect, dehydrated and malnourished with horrible bed sores and no money to pay for any tests or treatments. Godfrey, one of the students stepped in to save the day. ‘She really needs to be washed and have the sore dressed’ he whispered in my ear, ‘I will go and buy her some things’. And off he went, visiting 3 private pharmacies to find the right stuff, refusing to take any money from us, instructing the nurse how to care for her. I can only hope this student keeps this incredible sense of justice and compassion as he enters in to the real world of work in a years time.

- Dr. Rae Wake

Learn more about Ujenzi Trust at www.ujenzi.org

SOUTH SUDAN: Building a blood bank

2012-01-30T23:14:00.004-05:00

JUBA, 25 January 2012 (IRIN) - A small fridge in the corner of Juba Teaching Hospital’s laboratory is the only blood bank in South Sudan, the world’s newest nation with some of the worst health statistics in the world.

Health workers say a lack of blood is the main cause of mortality at the country’s main but extremely under-resourced hospital, and they face the anguish of having to watch patients who could be saved die.

“Sometimes they bleed until they die and we cannot do anything about it,” said Wani Mena, head of the hospital.

“The first cause, the major cause, of maternal mortality in our department is bleeding,” said Chuol Kuma, an obstetrics and gynaecology consultant.

While the rest of the hospital is sometimes left for days without power due to frequent cuts, capacity to keep more blood is hampered by only having a small fridge in the laboratory - the only room with a back-up generator.

“The blood bank we have is a very small refrigerator. It only takes around 50 units of blood. This is not enough,” Kuma said.
A 20-year-old mother of two recently died after suffering complications from a late miscarriage. “She needed an immediate blood transfusion and she needed blood and then she got the blood late and died,” he said. This woman, like many others who enter the hospital, was already anaemic. “The need for blood is so great in this place because of injuries. Anaemia is one of the most common presentations to our hospitals, both of women who are pregnant and for those who have malaria... and sometimes they die from it,” said Mena.

Fight for blood

But most of the time, the small amount of blood in the family-sized fridge cannot be touched even in emergencies, as it has been donated for specific patients due for surgery. “Currently the system that exists is that somebody gets sick, relatives come and donate blood. That is not a good system. We should have a stock of blood that we can give to any patient in need of it, and immediately,” said Mena. Cultural taboos and a lack of awareness about the risk-free benefits of giving blood also mean that getting relatives to give blood to save a life is often a struggle that staff do not win.

“In some tribes, somebody cannot, for example, give blood to his in-law, or somebody cannot receive blood from a foreigner, things like that,” said lab supervisor Charles Stanley Mazinda. Other staff say families avert their eyes or want to know their loved one will make it before committing themselves.

Amin Gerald, a nurse at Torit Hospital, about four hours’ drive from Juba, said he had come to give blood for his wife. He understands the importance of giving blood, but would not do it for a stranger. Gerald says he often comes across people who believe that giving blood will make them ill or weaken them, or that blood should never be mixed as it could kill the patient.
But Mazinda said that when there is an emergency, people rush to the laboratory expecting blood, only to find it cannot be touched.

Photo: Hannah McNeish/IRIN

"There’s just not a lot of cultural education about giving blood and still being healthy"

Fighting fear

Technician Charity Ritti said the laboratory used to divert blood to emergency patients whose relatives promised to donate afterwards, but when they did not come back, staff faced a backlash from donors. “The owners of the blood will come and quarrel and sometimes they even want to beat us,” she said.

Ritti is concerned that often the bank only has one unit of key blood types, such as O-negative, but says changing people’s mindsets to build up reserves is extremely difficult. “They are afraid of donations - we have people coming here from Kenya, Uganda and Khartoum [Sudan] and giving blood... but our people here cannot face free donations,” she said. “Sometimes we screen them, then we say go and have breakfast and they never come back,” she said.

Changing attitudes

Hospital staff say awareness campaigns and better medical education are needed, among the huge challenges facing a nation where only 16 percent are literate and very few have access to health facilities. Even local doctors admit they too are scared to donate.

“There’s just not a lot of cultural education about giving blood and still being healthy. I think in the US and UK and Europe we are very educated about that,” said Matthew Fentress, an American doctor working at Juba Hospital. In addition, Mazinda said getting people to the blood screening stage was a challenge, as people feared finding out they were HIV-positive. “Sometimes we screen some blood donors, and when they are [HIV-]positive, we tell them to go to the VCT centre down the road, but some of them don’t reach there [and flee],” he said.

Bridging the gap

The government is planning to build a national blood bank here this year that will hold up to 200 pints (113 litres). Meanwhile, doctors from the Harvard Initiative in Massachusetts have set up a “virtual blood bank” to try to beat storage and power problems. The bank is made up of a database of pre-screened volunteer donors who are willing to come in and replace a unit of their blood type.

Fentress said this would free up blood for emergencies and when the hospital cannot get blood from patients’ friends and families. “Right now we’re really focused primarily on foreigners, as their attitudes are already changed,” he said. The hospital is advertising on the internet and in community centres, such as churches, until a government campaign hopefully ensures South Sudan’s first “real” blood bank is filled.

“It is just the beginning and I hope it will succeed. But I think they need assistance from the communities. There must be medical education or health education for the communities so that they accept to come and donate freely so that we may have enough blood in our blood bank,” said Kuma.

** Matthew Fentress is a Fellow with Ujenzi Charitable Trust

hm/mw

Theme (s): Conflict, Health & Nutrition,

[This report does not necessarily reflect the views of the United Nations]

Learn more about Ujenzi Trust at www.ujenzi.org