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!

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