My week at the malnutrition ward has been eye opening to a world that is easily forgotten about when you live a privileged life. The mwanamujimu clinic is one of the happiest looking places I’ve been at Mulago. The walls are painted bright yellow with giant murals on the walls, ranging from Disney movies to safari themes. For as cheerful as the walls are, the children are heartbreaking. There are as many causes of malnutrition as there are malnourished children. Some of the children have been orphaned or abandoned, raised now by family members who cannot afford or do not want them. Some of their mothers have inadequate breastmilk and cannot afford adequate formula supplementation. Many mothers are grossly miseducated: they hear that breastmilk is not best for baby, and begin to feed their young infant matoke (plantains), posho (cassava), potatoes, and soda. Additionally, many of the children come to us with underlying conditions that cause acute malnutrition. Sadly, most of these are HIV/AIDS related diagnoses (diarrhea, pneumonia) or TB.
In the malnutrition clinic, the children are initially evaluated. If they meet criteria for inpatient treatment (a Z score of weight for height at -3 standard deviations or less), they are admitted and worked up for any underlying cause of the malnutrition. They are started on refeeding regimens based on whether their malnutrition is edematous (protein deficiency – kwashiorkor) or non-edematous (total caloric – marasmus). Once they start gaining weight and have had their underlying issues addressed, they are moved to a wing where nurses teach the caregivers how to prepare proper meals. It’s such a welcome change to see education being emphasized and done well! The children are then followed for a few months at outpatient clinic, where mothers are provided with PlumpyNut for the child.
It’s hard to believe that in one week I’ll be getting ready to leave Africa! I’ll be spending this next week on the Infectious Disease ward, then it’s off to Barcelona and Stockholm. I’ll try to get in one more blog post before I head off to the next continent. I’ll leave you with a picture from the malnutrition clinic. This young boy had been a patient for over a month, had been abandoned by his mother, and his father had been arrested. He is just the most precious, sweetest little boy and I wish I could just take him home with me! My heart just melts thinking about him!