29-5-12

MUCPP Clinic

Summary

We began with a lecture in the van covering nutritional supplementation, growth charts, Prevention of Mother to Child Transmission (PMTCT), the referral system, the baby friendly initiative, and controversial issues all with respects to the township population.  We then proceed to MUCPP to tour the facility.  After our day was over I toured UFS’s incredible anatomy museum and anatomy laboratory followed by a guest speaker about egg consumption.

Detailed Account

Today was a bit more of a lecture day than an ‘in your face’ township experience.  We met in front of the nutrition building and jumped in the van.  We drove to a nearby parking lot and began our lecture in the laid back van atmosphere.  The topics we covered were nutritional supplementation, growth charts, Prevention of Mother to Child Transmission (PMTCT), the referral system, the baby friendly initiative, and controversial issues all with respects to the township population.

The Department of Health is in charge of the Nutritional Supplementation Policy (NSP) and determines the entry and exit requirements one must people to obtain supplements.  When residents visit the clinics they bring their growth charts/cards and there growth/BMI is assessed.  Supplements are given if an adult/child is below the 10^th percentile.  Once the adult/child passes the 10^th percentile and remains above it for three months they are taken off the supplements, but must return monthly to be weighed.

Growth charts are a vital resource for the dieticians, regarding children below the age of five.  Children’s growth progression is plotted on the charts, many are below average but not severe enough to hospitalize.  The growth charts also contain important information about the child’s immunizations, PMTCT and HIV information, vitamin A supplementations and deworming, as well as any notes doctors or nurses may have and health education messages.

The Prevention of Mother to Child Transmission (PMTCT) is a growing program in the poor areas of South Africa.  The main focuses are currently providing medication and education to families.  When a mother is 7 months pregnant she is given a medication that she must take right when contractions begin.  It is important to educate them about this because some will take it instead when they are 7 months pregnant if they are unsure.  This medication helps to protect the baby when blood is shared between the mother and child during birth.  All mothers also receive Antiretroviral (ARV) treatments, which is the primary treatment for HIV.  If a mother is HIV+ the child will also receive ARV treatments.

Prior to this year all the PMTCT provided milk supplementations to all babies and encouraged mothers to supplement rather than breastfeed.   It was found that when mothers used these milk supplementations more babies died from secondary means such as, supplement preparation and the lack of clean water.  The child’s immune system was also compromised resulting in more deaths as well.  Research shows that even in HIV+ situations it is better for the mother to breastfeed for 6 months after the child is born since ARV treatment is available.  It is difficult to convince many of these mothers that this is a safer way to raise their child because they have it ingrained that breastfeeding if they have HIV will be detrimental to the child.  ARV treatment is also much cheaper for the government to provide than milk supplementation.  In rare cases supplementation may be prescribed for example if the mother has a chronic disease or is mentally unstable or if the child is an orphan.

In order to be a patient at MUCPP you must first have and identification card.  If a person is sick they must visit the clinic closest to their home (there are roughly 26 small clinics in the area).  Only nurses work at these primary health care clinics and they are allowed to issue drugs of the essential drug list (EDL).  The EDL is composed of about 15 drugs that treat the common diseases.  If the patient is still not improving they will be referred to the secondary clinic (there are 5 in the Free State), like MUCPP.  This is a bigger clinic, containing a pharmacy, three doctors, and about 16 nurses.  If a patient is still unresponsive they are sent to a district hospital followed by an academic hospital.  If they visit a hospital and have a referral everything is free but if they do not want to wait at clinics then they must pay the bill of their hospital visits.

The Baby Friendly Initiative partners with Kangaroo Care and is promoted within the hospital.  It is focused on lowering the stress levels of new-born children by close contact with mothers.  They emphasize skin to skin contact.  Incubators are not used due to increased sounds and separation from the mother.  If a baby is not breastfeeding well it will be cup fed and lap up milk much like an animal would.  It is found that a pacifier or bottle teaches the child to suck which is different from suckling the nipple and therefore not promoted.

Many traditions and beliefs make providing the best care extremely difficult for patients, especially concerning children.  Women have been told how dangerous breastfeeding can be if the mother is HIV+ but now it is known that is untrue.  Convincing these women is difficult and it is usually more difficult to convince the elder women of the family to let her daughter breastfeed.  Also traditions state that women should not eat eggs during pregnancy but we know they contain important amounts of protein, lutein, choline, folate, and other vitamins and minerals vital for healthy babies.  These traditions make the dieticians role increasingly challenging as they try and educate the current generation.

Once the lecture was complete and I received hand-outs to read this evening we headed to MUCPP to tour the clinic.  MUCPP was established in 1991 after the Kellogg Foundation of the US invited all universities in South Africa (ZA) to propose partnership-concepts in the community.  The proposal from the University of the Free State won the competition and the MUCPP Clinic was built in partnership with the University of the Free State (UFS).  Departments from all areas of the UFS use MUCPP including medical, nursing, nutrition, economics, agriculture, construction, education, sport, recreation, youth, culture, administration, and theology.  Out of all the departments the nutrition is the only one that actually walks through the streets of the township and is engrossed in their living conditions.  Unfortunately a few years ago the funding for the MUCPP program was pulled and they have been struggling ever since.

The clinic was much bigger than I imagined but it was heart wrenching is some aspects.  We walked through desolate isles that could not be used because of insufficient funds.  We would then come to waiting rooms that could seat 500 and all chairs would be filled with people waiting.  Some hallways were packed of parents and children; every now and then I would hasten my walk and hold my breath through some overly occupied areas.

We stopped by the maternity ward and visited two mothers who had healthy babies earlier that day.  Our lecturer chatted with the nurses about the growth charts and we quizzed the mothers on how long they would breast feed for.  A great deal of the nutrition program is to educate the people on healthier lifestyles and the majority of the time they were eager to learn more.  We learned that the hospital had been out of growth charts for over two months and they had been copying them to give them to the mothers, which was illegal but the best they could do.

At the end of the day many people are turned away after waiting all day to be seen.  They arrive early in the mornings but are not guaranteed treatment or medication.  The TB and HIV area and supplementation pick up areas are always overflowing with patients.  Although the patients must go through a great deal of hassle to come to the clinic and are not always treated fondly they still continue to come, and I am so thankful for that.  I am extremely excited to work there tomorrow and I’m sure I’ll have lots of stories to report!

We finished up early today so the other nutrition student and I stopped by her father’s office, who is a doctor and lecturer on campus.  He allowed us to visit the anatomy museum before he took us to lunch and the anatomy lab following.  The museum was incredible, there were more organs and body parts than I have ever seen.  There was usually a normal organ followed by an organ affected by almost every disease I could imagine.  It was incredible to see the effects of everything from a malignant kidney tumor to a brain haemorrhage to atherosclerosis of the coronary arteries and all in actual humans.  Lunch was lovely and getting to know her father was a real treat.  We then visited the lab and it was the most educational place I’ve been to.  I dreamed of having a place like that to study while I was taking anatomy.  They had cross sections of real bodies you could touch and put together, along with every organ imaginable.  They had cadaver to dissect and plastic models of the full body you could take apart and put back together.  It was by far the most impressive anatomy laboratory I have ever seen.

A Kidney!! and one of the only appropriate pictures I could add from an Anatomy Museum and Lab

At 2 o’clock we met for a lecture about egg consumption.  A researcher from Las Vegas educated us all on the importance of eggs for all people and in all stages of life.  The majority of countries and organizations have always stated that people should eat no more than 3 eggs per week.  There has never been any research to prove this and research since proves that eggs are extremely beneficial to the body.  The World Health Organization, Australian and New Zealand Food Organizations, as well as the UK, Irish, and American Organizations have all removed the egg stipulations and now encourage everyone to eat roughly 6-7 eggs per week.  It was an intriguing talk and made me understand the value and importance of this easy to make, single serving food.