The Nutrition Center

Though I had originally planned to spend this past week rotating with a surgical team, circumstances changed and I chose to spend my time working in a pediatric nutrition center. There were about 40 children being treated in the center, almost all between the ages of 6 months-5 years. To get admitted to the center, a child must have one of these 3 signs of severe malnutrition, 1) an upper arm circumference of less than 11 centimeters, 2) swelling in both feet, or 3) 70% of a normal height-to-weight ratio. In other words, these kids really look sick when they come to the center, and usually present either severely emaciated or completely swollen to the point where their skin breaks down. They also commonly have infections because their immune systems are not functioning well, or are actually malnourished secondary to already having an infection. The WHO estimates that malnutrition contributes to greater than 50% of the mortality for children under 5 years old globally. Though this is a very serious, common illness, it is amazing how proper feeding and antibiotic treatment can transform most kids from being on the verge of dying to laughing and playing again in a matter of a few weeks. Once the kids are discharged, they receive a two weeks supply of "plumpy'nut," which is like a peanut butter paste with some extra fat, sugar and vitamins mixed into it. The idea behind this paste is that it's cheap (about $15 for a months supply), high in calories (about 500 for a spoonful serving), and requires no preparation at home. The kids come back every two weeks for follow up, and then given another 2 weeks free supply of plumpy'nut until they reach 85% of a normal height-to-weight ratio, which is deemed "cured."

There are many causes of malnutrition, and they range from the level of society to the family to the individual. Two reasons commonly given by the center's staff are that a family doesn't have enough food or that parents are not educated on how best to use the food around them to properly provide for their children. One of the most painfully obvious exacerbating factors leading to the high prevalence of malnutrition in Uganda is the country's fertility rate, with an average of greater than 6 births per woman. I met a mother of one our patient's who had 10 children by the age of 33. Not only does she not have the resources to care for all these kids, having pregnancies so close together harms the nutritional status of both the mother and the growing fetus, leading to further health problems in the future. Another common problem with inappropriate child spacing (under 18 months apart) is that mothers will stop breastfeeding their infants out of fear that it will harm the new child inside of them. We had several infants in the nutrition center who were admitted secondary to this phenomenon. The staff members all believe that family planning methods are essential for combating malnutrition, but these efforts are not allowed by the hospital, which as a Catholic institution can only promote calendar and abstinence based methods. In a community where rape has been used as a tool of war for so many years, and women still suffer to have autonomy and authority within a family, these methods seem neither realistic or practical. In order for women to receive education and resources for family planning, they must go elsewhere in the city. Lacor hospital is so well-run, and has social justice written all over it, but it seems like a tragic missed opportunity to intervene for both the sake of the children and their mothers. As if I were back in my Catholic school days, I have found myself engaged again in long conversations with some of the missionary staff on site about the Church as a motivating force in social reform, and its responsibilities in doing so. No agreements have been reached yet, but I'm looking forward to continuing these conversations when I return next month.