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!

Friday Community Engagement Project & MUCPP Day 1


On Friday, Aubrey, the medical students, and I all went to a place that served a very similar to our soup kitchens. It was our "Community Engagement Project" scheduled for Friday. We had a tour of the facility by one of the women that works there, she showed us the kitchen, the playground for the children, and the clothing storage. The playground was very nice and colorful! When we viewed the clothing storage section she explained to us that although they had a decent amount of clothes, it definitely was not enough for all of the people, and that they did not have any warm clothes (and it was very cold that day). That afternoon, we watched as she and a few other women passed out packages filled with food to the people in need in the community. They would come to pick them up, but she explained to us that because it was so cold and rainy that day that most people did not want to leave their houses to pick up their food. The food consisted of fresh fruit, a loaf of bread, and various other things. They were very nice to us there!

Today, my first day at MUCPP, was certainly a different setting than what I am used to. I began the day by walking to the nutrition building and finding the big red van I was supposed to travel around in. After finding the van (which was a bit harder than I thought it would be because I was on the wrong side of the building and a student had to come find me), we set off for the day!

The red van!

We arrived at the township and picked up two people: Elizabeth (the translator for when someone did not speak English or Afrikaans), and a body guard. We drove around and every time we would see a child we would stop to see if the parents would talk to us. The first child we saw was playing next to a group of adults that were making the traditional home made beer. We approached them and they informed us that the child was not one of theirs and that she lived down the street. They did, however, let me smell the traditional beer. It smelled just like bread!

We then walked to the house next door because there were some people sitting out on the front lawn (there were no children though). One of the women was a traditional African healer. She was very nice and put on her outfit for me!

The traditional African healer!

The healing house where she works!

The traditional African healer and the people that she was on the lawn with directed us to a house directly in front of theirs where a girl with a baby were living. We went over to her and she let us inside of the home. She was living with her grandmother and other siblings, and because she was still attending school (she was 17 years old) she would sometimes drop the baby off at the baby's father's house and he would look after her. We checked the baby's growth charts, and the baby appeared to be doing very well. She kept smiling and making faces! We asked the girl many questions about the people living there and who was the provider for the household.Although the majority of the discussion was in Afrikaans I could still pick up certain things. The girl was very nice and let me take a picture of her and her child after we were finished talking!

The girl and her baby girl!

The next household we went to also served as a shop. They had a sign out front listing the things they sold, such as soda, telephone calls, and Russians (very similar to sausage). We talked to the women there and her son, who was a student at the University of the Free State! We asked them the same questions that we had asked in the first household, and in addition to this we also asked questions about their dietary intake and went through a list of the food groups and good food choices. The food groups were split into three different basic groups: the energy foods (carbohydrates and such), the building foods (proteins, milk, eggs and such), and protection foods (fruits and vegetables).

When we left that household, we drove down the street and a man waved at us and stopped us to ask if we could check his children. We followed the little boy he was with to their home and asked the grandmother if we could come inside because she was the adult present. She allowed us to and we weighed both the child that we followed to the home and another child present. We checked their growth charts and they were both doing very well! We gave them balloons for being so good and while Susan (the dietician in charge) and Elizabeth talked with the grandmother about the eating happens, Yvonne (a UFS student) and I played balloon toss with the children. It was very fun and the children really enjoyed it (and so did I)!

The little boys that we played balloon toss with!

Last, we stopped at the final residence and met with a girl that was probably just a bit older than me (she was the only one home). We all sat outside her home because it had warmed up by then and discussed the household's daily intake. Because she spoke English I was able to go through the three basic food groups with her! She seemed very appreciative. Today was a very interesting and eye-opening day!

Medi-Clinic Day 4

Today I began my day doing rounds with Vandghie Badenhorst, who is the main dietician and one of the women at the morning meeting on day one. We began by going into the NICU (Neonatal Intensive Care Unit) and checking on the premature babies. Vandghie taught me the risks of giving formula feed to premature babies as opposed to breast milk. Premature babies are at a greater risk for developing Nectrotizing Enterocolitis; when a child is born prematurely, the blood primarily goes to the more essential organs, such as the heart and the liver. The stomach can sometimes be bypassed, and this results in the low oxygenation of the digestive system. If this is prolonged, part of your gut can die, thus resulting in Nectrotizing Enterocolitis. If this happens, the formula feed should not be given to an infant because it is much harder to digest than breast milk. I also learned about Short Bowl Syndrome, which is when part of the digestive system is removed because it has died, which can result in the digestive system no longer being long enough. This can cause malabsorption. After being in the NICU, we went into the pediatric care unit and checked on some patients there.
After finishing rounds with Vandghie, I met with Anna-Marie and checked on the women I have been checking on for the past few days now (the women with the leaking TPN), who had finally been moved to the Medi-Clinic. She was awake and seemed to be doing very well. She showed us the injection site of the tube, which was pretty interesting to see!
We then drove to one of the out patient facilities and met with a new patient. The patient was diagnosed with HIV and TB. He was very weak and we had to help him up so that he could stand on the scale to be weighed. He has been losing weight rapidly, so Anna-Marie put him on a regular solid foods diet with extra protein at each meal.

We concluded the day by going to the private sector of the Universitas Hospital and seeing the patient (the man with renal failure) that we have been visiting this past week. We checked on him quickly and he seemed to be doing fine and the nurses have been following his feeding plan. I never did actually speak to him, though, because every time I saw him he was asleep. The Medi-Clinic was awesome and I am very sad that today marked the halfway point of my internship :(

Medi-Clinic Day 3

Today I began my day in the practice that Anna-Marie works in as opposed to the Medi-Clinic. We met with a young girl, about my age, who had been losing a lot of weight. She had lost the weight by changing her diet and exercise, and lost the weight at a very good pace (about two to three pounds every one or two weeks). The problem was that she was becoming worried that she had lost too much weight and was becoming obsessed with it. I thought it was very admirable that she had recognized this issue and decided to receive help about it before it became a real problem. Anna-Marie is going to make her a diet plan that will help her to stabilize her current weight and maybe add a few pounds back on. Her BMI is about 19, which is not underweight just yet (18.5 is underweight), but it is still on the lower end of normal, and if she was to lose anymore weight she could become underweight.
After this we drove to the public hospital and checked on the adult patient in the ICU that we saw yesterday (the man in the private sector with renal failure). Anna-Marie changed his feeding plan slightly and added a bit more protein. We also went into the public sector of the hospital and met with two other patients there, who were not under anesthesia, and talked to them about changing their diets after surgery (both were patients with kidney problems).
We then drove to the Medi-Clinic to see the women who I have seen the past two days (with the TPN problems), but she had not been moved from the out-patient facility yet. Anna-Marie was very unhappy about that.
We ended the day by going back to the practice and meeting with the women who we met with the first day who had tried many diets and had always gained the weight back. We went through the diet plan that Anna-Marie had created for her and discussed how to follow it and the specifics of it. I am very glad I was able to see the follow-up appointment! It was good to see both parts of the job: the meeting and history collecting of the patient and the follow-up appointment when the actual diet is discussed. The women scheduled another follow up appointment, but unfortunately I will not be around for it.

Medi-Clinic Day 2

Today was my second day in the Medi-Clinic. The dietician that I was supposed to shadow today was out sick so I shadowed Anna-Marie again. We began our day by doing a round through the hospital checking in on certain patients; we visited the pre-mature baby area, the ICU, and the pediatric unit. I saw some of the same patients that I saw yesterday. We then drove to one of the out-patient facilities and checked on some of the patients there (pretty much the same thing that we did yesterday). In addition to the patients that we met with the day before, we also met with an elderly woman who was malnourished and refusing to eat. She did not want to talk to us when we visited her. Her file stated that she showed signs of depression, which was probably contributing to her lack of eating and unwillingness to talk with us. Meeting with her was a learning experience for me because it helped me to realize that some patients can be difficult, discouraging, and show a lack of interest in getting better, but it is important to do everything that you can and continue on with your day and your other patients.
My favorite part of today, though, was when we came back from the out-patient facility. We went into the private sector of the Universitas Hospital and into the adult ICU to check on a patient there. The patient was a old man who had renal failure. He appeared to be very malnourished and his blood pressure was extremely low. We were in the ICU for a very long time calculating his dietary needs and picking out the right type of feed for his condition. It was all so interesting to me! I loved being there. Even though I could not help out as much as I would have liked because I not have the proper training, Anna-Marie's presence there seemed very important in my eyes. I think that a clinical dietician is the kind of dietician that I would like to be!

Medi-Clinic Day 1

Today was my first day in the Medi-Clinic. I began my day by sitting in a meeting that discussed Pedia-sure and En-sure and why one should use those supplements. These supplements are supposed to be given people that are not meeting their basic dietary needs through regular eating. The meeting focused mainly on premature babies and elderly patients and why these two groups of people should use these supplements. After the meeting I went with two dieticians that were at the meeting (Anna-Marie and another woman) around different parts of the hospital to check on patients. The first place we went was where the premature babies are, but I had to just peer in because they do not want too many people in there at one time to stop the spread of disease. We also went to the ICU. I talked to them about supplements and TPN feeding (Total Parenteral Nutrition), which is feeding through the veins. These two activities (the meeting and walking around the hospital) were both very quick and did not take up much of the day. I spent the remainder of the day shadowing Anna-Marie, who needed to go to two step-down facilities to check on certain patients. We drove to the first step-down facility and I met one patient who had been in a very bad car accident and had significant brain damage. He was only fifteen years old. We also met with another patient who had diabetes. She was very old and Anna-Marie suspected that she was not following her instructions for how to control her diabetes because her blood glucose levels would go from extremely high to extremely low very quickly. After meeting with that patient, we drove to the second facility. At the second facility we said hello to some patients that Anna-Marie knew but was no longer working with. I also got to see the physical therapy room, which was very nice and had a lot of equipment. We met with one patient at this facility, who was an elderly women who was having trouble with her TPN feeding. The TPN feeding tube had not worked properly and had begun leaking so she decided to stop the TPN feeding and try a liquid thickener called "Easy and Thick," which she seemed to like much more. When we left this facility it was 12:00pm (the time that the day is supposed to conclude), but I decided to stay with Anna-Marie and go to her office for an out patient meeting. I am very glad that I chose to do this because this meeting was mostly in English, so I could follow the majority of it. The client was a young woman who had tried a diet that was very similar to the Atkins Diet (very little carbohydrates and fruit, but a lot of meat and protein). She had lost a lot of weight on this diet, and quickly, but she was complaining of gaining the weight back (also very quickly) and wanted to know how to lose the weight and keep it off. Anna-Marie explained to her the science behind these kinds of diets (prolonged limitation of one's carbohydrate intake jumps his or her body into a starvation state) and that it also hurts one's metabolism, which has to do with her gaining the weight back so quickly after not strictly following the diet. Anna-Marie wrote down her regular food intake, and the woman seemed to be very honest and actually want help. She admitted to eating chips, fast food ("take aways"), and skipping lunch. Anna-Marie then weighed her and said that she would create a diet plan for her. She will be given the diet plan on Thursday, and I will attend this meeting as well. Overall I had a very good day; one of my classes, Nutritional Assessment, which I had this past semester, came in very handy today. This is because I had some background information on the practical use of nutrition and dietetics, as opposed to my knowledge being mostly science based (which is the majority of what we have learned thus far). Tomorrow I look forward to spending more of the day in the hospital!

Friday Morning Activity

Today Kalie, Ryland, Aubrey, and I all attended a class with the other dietetic students. In this class there was about an hour lecture discussing how to take a patient's blood pressure, blood glucose level, and urine analysis. Once that hour was over, we all paired up and began to practice these three things! Ryland and I were partners during this activity. We began by taking blood pressure, which she already knew how to do very well because she is an exercise science major. I, however, had a lot of trouble with it, and although I tried many times I could never quite get it right. The instructor ended up letting me use the electronic machine to take Ryland's blood pressure. After taking each other's blood pressure, Ryland and I moved to the blood glucose measuring station. Ryland went first and pricked my finger about three times before she got enough blood to put it into the machine. Luckily, the needle did not hurt. My blood glucose level was 5.1, which is a normal level! Then it was my turn. I had to prick her multiple times as well (twice)! Next we moved on to the urine analysis (actual urine was not used, it was actually tea). We dipped testing sticks into the tea and waited about 20 seconds for different colors to appear on different areas of the stick. The stick measured for things such as glucose, nitrogen, pH, blood in the urine, etc. Because we were measuring tea and not actual urine all of the levels either came out low or negative, depending on what they were. Today was very fun and I learned a lot! I just need to continue practicing how to take blood pressure; it was a lot harder than I thought it would be!