Southern Free State

This past week, Monday through today, I have been in the Southern Free State traveling around from city to city giving presentations in clinics. Here is in detail what I have been doing:

Monday: On Monday morning at 7:00am I was picked up by two of the dietetic students here, Yvonne and Sarah, and we drove about an hour an a half to Edenburg where we met with a dietician, Marli, who works in the city's health clinic. During our time there we discussed what we were going to be doing during the week and the presentations that we were going to be giving. Marli was very nice, and tried to talk in English for the most part. That afternoon I attended a KMC presentation (Kangaroo Mother Care) with Marli. The women talking is a nurse (but here they call the nurses "sisters," and it took awhile for me to catch onto that). It was a very interesting talk and presented an idea to me that was very new because I had never heard of Kangaroo Mother Care before. At first, when I agreed to go to the discussion, I thought it was about carrying your children in the cloth pouches wrapped around you as opposed to using a stroller. However, I was wrong. Kangaroo Mother Care is when you use a cloth (tied around you) in order to keep the child close, and you are not supposed to wear clothes on your top half in order for the child to be close to your heart. The nurse highly suggested that people use this for premature infants, as opposed to putting them in an incubater away from their mother.The nurse used me as an example to show how to tie the cloth (but of course, I was not naked). The nurse also discussed a lot about breast feeding. In class in the US, we learned that if you have given birth and are HIV positive the virus can be passed through the breast milk so if you have access to clean water in order to mix with the formula you are not supposed to breast feed. Here, the nurse, dietician, and students have told me that they still suggest breast feeding as the better option. The reasons for this are that breast feeding is overall better for the child, regardless of HIV status (as I have learned), and that as long as both the mother and child are on ARVs (anti retrovirals) the chance of passing the virus through the breast milk is very low. Also, I have learned that for awhile the government had been giving out formula to new parents, but just recently they changed to strictly enforcing breast feeding, because they found a lot of the time that the parents would use the formula for cooking and various other things, as opposed to feeding their newborn baby. The KMC discussion that I attended was about three hours long. Afterwards, Yvonne, Sarah, and I drove about 45 minutes to Philippolis, which is a very small town in the Southern Free State. The entirety of the Southern Free State, from what I saw, appeared to be rural farm lands and spread out small towns. We checked into our Bed and Breakfast, which was a beautiful little home (we each got our own bedroom and bathroom! And electric blankets as well!) That night we prepared our two presentations for the following day, which were going to be on breast feeding and preparing food.

Tuesday: On Tuesday morning, at 7:15am we began our journey from Philippolis to Edenburg. We arrived at about 8:00am and went into the health clinic to meet with Marli. We discussed where we were going and the presentations that we had prepared. We drove to Nelson Mandela Clinic and gave a presentation on breast feeding to about 50 of the people that lived in a township there. They did not speak much English, so it was hard for me to give the presentation, but I did my best. My part of the presentation was to discuss the benefits of breast feeding, such as it being the best food for your baby because your body makes it and it is natural, that it is free, that it can protect the baby from diseases and sickness, and it promotes bonding between the mother and child. I also discussed the benefits for the mother, such as losing your pregnancy weight quicker and having a lesser chance of getting cancer. One thing that I found interesting was that I needed to call diabetes the "sugar disease," because the people that we were presenting to were not fully educated and would not know what diabetes is. Also, "high blood" is hypertension. I am now used to these name changes! After we gave the presentation (which was in total about 30 minutes long), we went through how to check on the clinic's distribution of nutritional supplements with Marli. She has a long check sheet (about 4 pages long) of things to check. She mostly looks at the records which each clinic kept in a big binder. We were supposed to check things such as the stock of the supplements, who they were being distributed to and in what amount, whether or not people had been returning to pick up their supplements, etc. In addition to checking on these things, we were also supposed to check whether or not the scales in the clinic worked, and if the children were being weighed with or without their diaper (nappy) on (they are not supposed to be wearing it when being weighed). After we finished our job in the clinic, we went to the township's school and gave a presentation to many of the parents there about food preparation. Although I had prepared a section to speak about (I was supposed to talk about grilling or roasting instead of frying, cutting the fat off of meat before one prepares it, and the "haybox," which is a cooking method. One is supposed to take a wooden box with a lid and fill it with some kind of insulation, such as paper or wood. Then, one is to heat up a pot or pan over a fire, place their food in the pot or pan, and place it into the box. The point of this is so that one can cook their food over a long period of time while they go about their day and do other things), I was unable to do so because nobody in the audience (with the exception of maybe one or two people) could speak English. After the presentation was given, we did a small tour of the school. The children were very cute and excited to see us! Their classrooms were full of posters and bright colors, which I had not originally expected. It was a great experience overall, especially seeing the children. After we finished touring the school, we were done for the day and were able to head back to Edenburg to drop Marli off and then to Philippolis. Once in Philippolis, we began to prepare our presentation for the following day, which was on perishable foods.

Wednesday: On Wednesday morning, again at 7:15am we drove to Edenburg. From Edenburg, we drove about an hour and a half to Springfield, which is a small town about an hour and a half away from Edenburg. Once in Springfield, we went to the hospital there and walked to the kitchen. Our job there was to give a presentation to the kitchen staff (which totalled about 3 people, one person was absent that day) on perishable foods. Before we began our presentation, we worked with Marli to complete a checklist of the foods in the hospital. We checked for things such as whether or not the milk was pasteurized, that the kitchenware was clean, that the meals were delivered to the patients correctly, that the meat was stored at a proper temperature, etc. Marli told us that the last time she checked on this hospital she left very angry and disappointed with the job that they had been doing, and that this time they had significantly improved! At about 10:30am we gave the presentation to the kitchen staff. I introduced us and talked about how to make sure that the bread, eggs, and diary products are safe to feed the patients. The milk that the staff had been using was not pasteurized, so I had to strongly emphasize that it needs to be pasteurized because people are in the hospital to get better and they have a chance of getting sick if the milk is not pasteurized because there might be bacteria and diseases in it (it is bad for an HIV positive patient to have non-pasteurized milk). We also discussed how to check that the bread they are receiving is fortified, and where to look for the fortification label. I had not seen a South African fortification label before so it was also new for me. The people were very attentive and appreciative of our presentation! It made me feel very good because I felt like I was really making a difference. After our presentation was done in the hospital, we drove the clinic in the town. Here, we went through the same check sheet that we had done in the Nelson Mandela Clinic, but this time Yvonne, Sarah, and I did it without Marli's help. It was difficult and extremely extensive, but we finished nonetheless! We were also supposed to drive to Springfontein and give a presentation on malnutrition to the nurses, but too many of the nurses were on leave so Marli decided to reschedule that presentation for Monday. After finishing the check sheet, we drove back to Edenburg to discuss what we were going to do today (presenting in a clinic about hypertension), and then drove back to Philippolis. Once in Philippolis, Yvonne, Sarah, and I made posters for the hypertension talk because we would not have a projector screen (on Tuesday we had posters, on Wednesday we had a projector screen, and today we had posters).

Thursday (today): Today, at about 8:15am we drove to Edenburg (per usual) and met with Marli, who informed us that she would not be able to attend the presentation with us today so we were on our own. We made copies of a hand out about hypertension that we were going to give out to the people in the clinic (not the same clinic as the Nelson Mandela Clinic), I said goodbye to Marli because I will not see her again, and we drove the clinic. The clinic was completely filled with people; there was a sign that said it was a two hour wait to see a nurse. I saw many children and I heard a lot of coughing, which Sarah told me was probably from the TB, which I found to be very sad. The head nurse told us that instead of presenting in a room we should give the presentation in front of all of the people that were waiting (about 100 people!). We asked if they could speak English and they could not, so I help up the posters, walked around with our flashcards of food examples (healthy and not healthy), and handed out the handouts at the end. So many people wanted the handouts and had high blood that we ran out. At the end of the presentation one woman came up to us and was asking for more information. Although I could not entirely understand her, it made us all feel like we were appreciated and doing a good thing. We then drove to Bloemfontein and now here I am! (with Internet and the ability to blog!)

6/7/12: I just received a copy of the schedule of what I did during my time in the Southern Free State. I am going to type a copy of it onto this post because I have to give it back to the students tomorrow. I have edited it a bit because some of the activities were canceled and/or changed.

28 MAY 2012
Orientation

29 MAY 2012 EDENBURG
Health day at the Edenhoogte Primary School

9:00: Students give a talk to parents on the following:
-Breast feeding
-Healthy eating on a limited budget (please be creative & practical)
-Discuss recipes (cheap recipes like pumpkin peel stew, etc.)
-Discuss healthy preparation of food
-What is best to buy?
-Healthy snack box for children

Talk should be at least 30 minutes.
Please be creative!
Days should be fun at interesting.

30 MAY 2012 SMITHFIELD

10:00: Stoffel Coetzee Hospital
Students:
-Do Foodservice training on the Perishable foods (I will provide you with the information to be discussed).
     -Students to do training.
     -Provide foodservice with summary of training info.
-Do Foodservice monitoring with me.

31 MAY 2012 SPRINGFONTEIN

10:00: Students to give hypertension talk at Sehularo Tau clinic.
     Discuss:
          -Pathophysiology of hypertension (VERY BASIC)
          -Dietary guidelines