Trying to Understand Malnourisment at Save a Life!

The Save A Life Clinic was kind enough to host Gillian and I (Johanna) this past week. We were excited to utilize our paediatric assessment skills on several of the admitted patients. One particular case that stood out for us was a small boy that we will call Nawa for the purpose of this blog. He was a severely malnourished patient who looked no more than 6 months old. We were astonished to find out he was actually a child of two years and one month after discussing the patient with Dr. Lisette. We realized it was difficult to guess the age of many of the children because malnourishment can cause severe developmental delays. According to the WHO standards for acute malnutrition, the weight to height ratio of this boy was at -3 SD's which is categorized as severe malnutrition. This level of malnutrition can increase a child's risk for death by 9-fold. Due to Nawa's severely dehydrated status and his inability to drink, he required IV fluids. His deterioration led to an admittance to the hospital as Save A Life did not have adequate equipment. We soon found out supplies were limited at the clinic as the clinic runs on donations and sponsors for their resources. Unfortunately, we were informed the following night that little Nawa had passed away at the hospital. Nobody knew the exact time of death and by the time Dr. Lisette arrived he was already gone. Dr. Lisette had to inform the mother as she was not aware of his death. Many thoughts went through our minds such as, "Would this child be still alive if we had the right supplies? If someone was around the child at the time of death would he have been given another chance? Did we do all we could to save this child?" With the knowledge and abundance of resources we have in Canada, we felt guilty because perhaps this life could have been saved. Unfortunately, this is just an example of many cases of malnutrition throughout Mongu.

         Another part of our week were the home visits regarding outpatient follow ups. The clinic follows each patient and their family for six months after discharge to ensure proper feeding. What we witnessed on these visits was surprising. Even though the mothers are being taught about nutrition and the importance of feeding, there was a disconnect between understanding the teaching and actual feeding practices. A lot of these women were not feeding their children appropriately, such as on a schedule or throughout the day. The mothers seemingly had all the supplies amd resources needed-because the clinic provides teaching and free food-and yet the children were not being fed appropriately. Although this might seem unbelievable, we attributed this to deeply ingrained cultural practices. We found it frustrating to know that some children are not being fed however we realize that in Canada we are fortunate to have loved ones around us to teach us basic life skills such as mothering. We also have a great health care system that supports and educates expecting mothers from the beginning of their pregnancy to post pregnancy. A lot of these mothers are young, such as age 15, and may not have the support or family alive to help teach basic life skills. This was a big culture shock for us as it was hard to not only understand their lifestyle but be compassionate towards it. Mostly we have learned that we take for granted the simple things in life, and not realize that these simple things can have such a big impact. We are feeling especially thankful for our friends and family back home. :)

Dr. Lisette and Gillian assessing Nawa.

A typical scene during the home visits - we would meet outside of their houses that were made of straw or mud.


Doing some teaching on TB while the patients wait in the clinic.