Tuesday, 12 June 2012

Southern Free State: Edenburg

Summary

 We began with a Diabetic lecture in Edenburg followed by a few patient consultations.  Marli (the head dietician) proceeded to give a refresher course on malnutrition and the Road to Health Growth Booklets for the sisters at the Nelson Mandela Clinic.  I ended the day with my first traditional braii!

Detailed Account

Chilly is an understatement for the temperature of wooden and concrete houses during the winter in the Southern Free State.  Mornings would involvement getting as put together as possible while still in bed and then immediately making tea or coffee.  Along with being chilly, mornings were also very early since a great deal of time is spent driving to different clinics in the Southern Free State. 

We headed to Trompsburg to fetch Marli at 7:45 a.m. before making our way to Edenburg.  We arrived at the Phekolong Clinic and piled into an office-like room.  We moved the desk and added chairs, which were then filled with six diabetic patients.  Imke explained how the body normally functions as well as the problems faced by diabetics.  She then went through foods that were acceptable and not acceptable for diabetic patients to eat and indulge in.  Much like anywhere in the world some people were receptive and eager to learn while others were stubborn and set in their ways.  Nonetheless I think we made a difference by providing knowledge and hopefully it will help them make better lifestyle choices.

Diabetes Presentation

Before departing from the clinic we did a few nutritional assessments of people from the town, much like I did in the hospital and at the homes in the townships.  We asked what foods they ate and portion sizes.  It seemed that people were proud of their large, unhealthy portion sizes and I truly felt that they did not realize the correlation between portion sizes and their obesity or the problems with being that overweight.  It’s hard for me to see people who are unhealthy and know better but it is a whole other sadness I experience when people are overweight due to a lack of education.

Marli explained how each district has its own supplemental standards.  In her district they had to choose between providing cheaper porridge and reaching more people or providing more nutritious porridge but to less people.  In the long run she chose to feed as many people as possible giving supplements that can be found below.  Underweight children (between ages 1 to 5) are given supplements if they are below the 3^rd percentile.  Children between age 5 and 18 are provided supplements if they have a BMI below the 10^th percentile and adults with a BMI below 18.5 (except any TB patients with a BMI below 22)

Age	Supplement		Amount per month
< 6 months	Pelargon		According to weight
6-8 months	Pelargon		6 tins
9-12 months	Pelargon		4 tins
1-5 years	Philani Yabantwana	Nutri-meil	2 bags	4 tins
5-18 years	Philani		4bags
>18 years	Philani		4 bags

Before leaving the Phekolong Clinic we checked their records concerning seeds, stock control, client registers, and their default lists.  Marli made a list of severely malnourished patients who were given to the home based staff to follow up with them daily in the locations.

We took a quick lunch break and I had my first Vetkoek.  It was a large bread dough thing with meat and cheese inside, interesting but good.  Over lunch Marli told us about the job of the operational manager.  She was employed as a dietician but has taken the responsibilities of the operational manager for the last few months.  Their district is 17 towns/clinics with 3 district hospitals.  They have to order the supplements, do the paperwork, and make sure everyone is doing their jobs.  She is not getting paid extra for this but knows that someone must do it so she has stepped up for the responsibility (did I mention she is 7 months pregnant).  She also thinks that this position will never be filled again because that is the way the government works.

Our next stop was the Nelson Mandela Clinic to give a refresher to the nurses on the "Road to Health” Handbook.  Every parent receives this handbook which they bring each time they visit the clinic in their child’s first 5 years.  There are multiple charts and graphs to fill out and plot to determine the health of the child but many of the sisters (nurses) do not complete these properly and therefore cannot be used to their full benefits.

During the discussion we went over the proper way to take the weight, height/length, mid upper arm circumference and where the immunizations we recorded.  We discussed how to establish if a child was malnourished and what to do as well as important terms the sisters should know (stunted, wasted, underweight, overweight, etc.).  Following we discussed the consequences for children who are underweight and the common malnourishment conditions seen within the clinics (Marasmus, Kwashiorkor, and Marasmus Kwashiorkor).  We began the training and finished the training with the same quiz.  The pre-test portion was sad to see the little knowledge the nurses had on conditions and practices they should be using every day while great improvement was seen with the post test.  It is hard for me to determine if the sisters didn’t know this information previously or if they had and just didn’t care enough to take it seriously and use it on a daily basis.  Often times it seems as the nurses have attitudes and feel they are underpaid for the work they do, yet I usually see them on tea breaks throughout the entirety of the days.  I’m not sure what to think of this situation except the patient’s best interest should always be the most important and often times that does not seem to be the case.

That evening we dropped Marli in Trompsburg before returning to Philippolis.  We decided to have a true South African braai and cooked fresh meat with sandwiches and such, it was wonderful!  Imke and Reggie were becoming like a brother and sister to me and to see them interacting and teasing each other was incredible.  I haven’t been homesick with being so busy here but that sure made me thankful for the wonderful brother I have!

My brother and I!!