Universitas Day 2 & the Last Day of my Internship!


Today, I began my day in a pediatric ward following around Helane, one of the dieticians at the hospital. We saw a very young patient, about one years old, who was extremely malnourished because he was allergic to so many different foods (mealie meal porridge, wheat, etc.)! They have been trying various different foods to test them, and they had just found out that he could not eat potatoes. Helane told me that the food that he mostly eats is rice porridge, milk, and chicken, because those are the two foods that they have found he is not allergic to. It is worrisome because when he goes home to Lesotho, his family is very poor and will probably not be able to afford the special diet and foods that he needs to stay healthy. The same child also has severe eczema. I also saw another child, who was also very young, that had malaria. The doctors think that the child has malaria because his father is a truck driver and it is possible that on one of his routes a mosquito carrying the disease flew into his truck and came home with him. It was very sad! The child appeared to be very ill. He was also receiving TPN feeding. Another girl I visited, who was about seven, had a severe lung problems, so much so that she is unable to even walk a couple yards away to the bathroom. She was very excited because she had just received a computer and printer from the Reach for a Dream Foundation, which is very much like our Make a Wish Foundation! It was very nice to see such a big smile on her face!
I then followed around another dietician, Monica, for the remainder of the day. I visited the milk kitchen with her, but the workers there had not yet started their day. I tried to go back after my rounds with Monica ended to see how they make the liquids but they still had not yet received the orders, so I was unable to experience this part of the hospital.
We then went into the regular kitchen, and Monica talked to me about "cook freeze." This is how the hospital can feed so many patients; the food is cooked elsewhere, frozen, and brought to the hospital. It would definitely be very hard for the workers to make enough food the feed all the patients without this system! I got to see some of the workers unloading all of the frozen foods into the kitchen.
At the end of my day, we attended a multidisciplinary meeting with various other doctors, nurses, and physiotherapists. We went around the ICU and discussed patients symptoms, diagnoses, and possible treatments for them.
And so concludes my internship! I cannot even begin to explain how life changing my experiences here were for me. I am very sad to go, but I keep reminding myself that I should also be happy that I had this  amazing opportunity and that I was able to learn so much from it! I know that this internship will have a great impact on my future career in dietetics, and my life in general. I fell in love with this country; the people here, the scenery here, the activities here, all came together to form one of the best experiences of my life! I would love to come back to South Africa again, and I will definitely help to promote this study abroad program to other dietetic students when I return home! Thank you so much for everything, Dr. Jones! When I was accepted into this program I was excited, but I had no idea just how incredible it was all going to be!

Sylvia Escott-Stump CNE Workshop

(from left to right) Aubrey, Sylvia Escott-Stump,
Kalie, Me, and Beatriz Dykes at the conference!

Today was awesome! Aubrey, Kalie, and I went to the Sylvia Escott-Stump CNE Workshop. When we first arrived we had no idea how professional it was going to be, but it was actually ended up being a huge conference! So many of the professionals we have worked with were there, so it was awesome to see them one last time before we conclude our internship (tomorrow). The speakers were Sylvia Escott-Stump, who was the prior Academy of Nutrition and Dietetics President (funny that we should meet her in South Africa), Prof. Beatriz Dykes, Prof. Corinna Walsh, and Prof. Edelweiss Wentzel-Viljoen. The talks were on osteoporosis prevention, nutrient profiling, ethics, management in dietetics practice and strategies for dealing with stress, nutrition and genetics, clinical leadership, and prebiotics/probiotics/synbiotics. I loved every minute of it, and cannot believe that I had this amazing opportunity that is so relevant to my major! I am not going to go into every minute of the conference, because it was 8 hours long (8:00am-4:00pm), but I will say that my favorite part was the talk that Sylvia Escott-Stump gave, which was titled "Nutrition and Genetics: the Missing Link." She went into detail talking about how what we eat is very much connected to our genetics, and when a woman is pregnant it is important that she keeps up a healthy diet because the food she eats will have an impact on the child. Some of the diseases discussed were Alzheimer's Disease, which can be linked to a folate deficiency and can be treated or prevented by methyltetrahydrofolate supplementation, autism, which can be linked to an IgA deficiency, etc. The key nutrients discussed were folic acid, vitamin B-12, and vitamin D because they affect gene expression or gene suppression. There will be research opportunities in this area of study in the future!
Today was by far one of my favorite experiences so far in South Africa, and the food was awesome too!

Us, Sylvia Escott-Stump, Beatriz Dykes, and
the UFS dietetic students at the conference!

Us, the UFS dietetic students, and
Beatriz Dykes at the conference!

Aubrey, Kalie, Dr. Lategan, and I at the conference!

After the conference, the four of us and Anna-Marie,
one of the dieticians we worked with (at the Medi-Clinic)
went out for tea to say goodbye!

Universitas Day 1


Today was my first day at the Universitas Hospital, because I was unable to attend yesterday due to being sick. When I arrived, I waited awhile for one of the dieticians, Will, to come get me and show me around and to see his patients. He mainly works with patients that have cardiovascular problems. We ran (yes, we actually almost ran because he walks so fast) around the hospital to his different patients. On these rounds I learned that in South Africa they use either an elemental feed or semi-elemental feed in their feedings tubes, and this means that the feed has amino acids instead of protein and glucose instead of carbohydrates.
One of the patients we met with was a woman who was about to be discharged, so Will explained to her how to make her own TPN feeding to inject into herself because she would no longer have the machine to do it for her. I helped with this demonstration. The powder feed smelled very good, oddly, but I did not taste it. We also visited the kitchen for a bit. During this time I looked around and helped him retrieve the feed bags to give to the same patient that we did the demonstration for. We were going to give them to her to bring home for herself. She would have two weeks worth of feeding and then need to come back after those two weeks to retrieve more.
After being with Will, I met with Marli, another dietician. The two of us, and the other two dietetic students (Sarah and Janke), had a small mini-lecture. During which she talked about many things, most of which were things that the two UFS students would have to know about for an examination they are going to take. I learned quite a bit! One of the things that stuck out to me was her talk about refeeding syndrome. This is when a patient that is malnourished, or something of the sort and along those lines, is reintroduced to food much too quickly. This is the reason why dieticians issue weening bags to certain patients, because these help to slowly reintroduce foods to the patient. In addition to this she also discussed dumping syndrome to us, which is when someone, very soon after gastric surgery, eats too much and their insulin spikes. The symptoms include fever, dizziness, sweats, etc. Things such as meals that are too large, too sugary, and/or having fluid with your meal can cause the dumping syndrome.
After our mini-lecture, we sat in an hour long meeting with some of the doctors and other staff at the hospital. They discussed patients, what their diseases could possibly be, they ways in which they were going to handle them, etc. It was very interesting to listen to, and I was very glad because it was in English! The diseases discussed included cirrhosis, pneumonia, and cancer.
To conclude the day, Marli informed me that on Thursday morning she is going to give me and the other dietetic students a quiz on diseases of the liver and inflammatory bowel disease. I hope I do okay! I need to study because I feel like we have learned some different things from the students here at UFS so I might be a bit behind. Wish me luck!

Presentation Day


Today Aubrey at I had to give our presentations at 8:00 am to the dietetics students and faculty. Although presenting is not exactly my favorite thing in the world, I was very prepared and had practiced several times beforehand. Overall, I think that the presentations that both Aubrey and I gave today went very well!

Aubrey, the dietetic students, and I!

MUCPP Day 4


Today at MUCPP we did basically the same thing we did on Monday, Day 1. We picked up Elizabeth and our body guard and drove around to many houses checking up on people. The way that they pick which houses to go into are based off of whether or not the doors to the house are open (which usually indicates, especially in winter, that we are welcome to come in), and/or if there are people standing outside. Almost the entirety of the day was spent speaking in either Afrikaans or Sotho, so I was not able to communicate with the people like I had done on Day 1. However, I stayed as involved as I possibly could without speaking the language or understanding much. The first house we went to had an elderly couple living in it. The man was diagnosed with TB. We weighed and measured them both and calculated their BMIs. The man was underweight and the women was fine. We gave the man two tins of supplements to use because we knew that the health center was running low.
Another home that we visited had a very sad story. There were many people living in it. The woman that we spoke with in the house told us that she had a sister who passed away from HIV, and had left behind two children for her to care for, one of which was HIV positive. That child qualified for ARVs, but when she had taken the child to the clinic she had been sent away because the child's surname did not match with hers (since she had been married) and she did not have the proper birth certificate for the child because it had  burned when the child's previous house caught on fire. Susan had never heard of this surname rule and was determined to get the child a new copy of the birth certificate and call the clinic to help this child to be put on the proper medication that he deserved. We spent a lot of the day working with this family and making phone calls.
Last, we visited one woman who had an adorable 10 month old baby! The woman was HIV positive, and thus chose to exclusively formula feed her child (even though health care workers strongly suggest breast feeding regardless of HIV status). At this time the child is HIV negative. We took a look at the child's growth charts and she was perfectly placed at all of her check ups on the 50th percentile line, which is great! Although this woman had been to the clinic many times for immunizations and check ups on her child no one had ever explained to her what this chart actually meant, so she was not aware of how well her child was doing. We explained this to her and she was very happy! The baby was making noises and faces almost the entire time that we were there, and it was nice to see such a happy and healthy child!

MUCPP Day 3


Today Susan, Yvonne, and I worked in the Community Health Center. We arrived at about 8:30am and quickly began our day, which consisted of passing out supplements to patients in need. We weighed the patients, measured the patients' height, and calculated their BMIs. For some of the children we would also take down their head circumference to check and make sure that their head is growing correctly. We saw many people, many of which were malnourished; only about two of the BMIs from the entire day were over 18.5 (the cut off point for being normal weight and underweight).

The table where we worked.

Throughout the day, I was mostly in charge of recording the patient's information. I would take a look at the patients' card (an index card with their name, birth date, and past measurements) that was given to them by the Community Health Center if they had come for nutrition support before. I would write down the patients' name, height (taken today if they were a child, and copied from the note card if they were an adult), weight (taken today), and I would calculate their BMI. I would also write down the date and the date of a follow up appointment if necessary. If they either qualified for nutrition support or continued to qualify for nutrition support we would give them supplements; the children would receive three Pediasure tins and adults would receive four Ensure tins. I would also record what they were receiving and ask for their signature.
In addition to recording information, I also learned how to use the measuring equipment. I already knew how to find out the weight and height of adults and the weight of a child, but I had not yet taken the length of a very young child and/or infant. To do so one must stretch the child out on a mat with the centimeters marked. Today was the first time I had done this. The young children and infants did not seem to like it very much!

After seeing about 20-30 people we had seen everyone that was waiting! It took about 4 hours total.

MUCPP Day 2


Today, Susan (the instructor), Yvonne, and I met at 8:30am and drove to the clinic. We had a tour of the clinic where we saw the general waiting room, the occupational therapy room, the TB waiting area, the HIV waiting area, vegetable gardens, and such. There was an overflow of people waiting in each area; the clinic was extremely busy. After touring the clinic, we sat in the van and talked a bit about the health care system in place. Susan informed me of the basic referral system:

1. Small Health Care Clinics 
First, one starts off at the small health care clinics. Mostly nurses work in the health care clinics and they are given an "Essential Medications" list. On this list are the medications that a nurse is able to prescribe without the permission of a doctor.
2. Community Health Centers
If the illness cannot be treated at the small health care clinics one is referred to the community health center (where we were today). There are both doctors and nurses present at these centers.
3. District Hospitals
If the illness cannot be treated at the community health center one is referred to a district hospital, such as the Pelonomi hospital and the National hospital.
4. Universitas Hospital
Finally, if none of these places are able to treat the illness one is referred to Universitas Hospital.

If one follows this system and goes in this order then the health care is free. If one goes out of this order then he or she has to pay (unless they are extremely sick and the nurse or doctor phones the upper level hospitals for the patient).

After having the lecture in the van, we concluded our day and headed back to the University.

The inside of the van. The pamphlets are in English, Afrikaans, and Sotho!