Days at the District

Alrighty, well yesterday was the definition of bittersweet.
Jaclyn, Allie & I headed to District first thing in the morning and had a full day with the nutritionists. We started out listening to a health talk about the importance of getting test for HIV during pregnancy. It was in Swahili, but they translated the main points to us and we were able to observe the mothers and their babies...too cute. They had a great turnout, thank goodness.
After the talk, we went back to the nutrition office to discuss how they assess cases, diagnose, monitor, follow-up and provide food prescriptions. Like I mentioned in the last post, they have a few different flours to make porridge - they have some for children, adults and pregnant/lactating women, as well as Plumpy Nut PB. If a child is malnourished or vulnerable, they are provided porridge. If this is the case, the parent is given food as well to ensure that they don't eat the children's food.

One of the nutritionists assessing a patient 

Pictures of malnutrition in the office

Our entire day essentially revolved around one case, so I will give you the rundown. It is one of the most heart-wrenching stories I have ever heard about, and to see it firsthand was unreal...it is one of those cases that changes your perspective on life.
The mother is 26 with mental disability, her daughter is 3 and her son is 1 1/2. By measuring their heights, weights and mid-upper arm circumferences, we determined that the daughter was normal, but vulnerable, and the son was -3 severe malnutrition. They were provided US AID porridge, as was the mother. The mother has not been preparing the porridge consistently because she only has one pot and it is not big enough to make a substantial amount. In the past, she has been known to eat it, rather than giving it to the kids as well.
The husband/father works doing manual labor, but before coming home, he stops at the local hotels to eat and drink. After spending his earnings here, he comes home with only 30 shillings worth of flour for the rest of the family to eat (86 shillings = $1.00). We did a home visit and decided that the first step needs to be talking to the father...they were planning to do this sometime this week. Additionally, a neighbor is going to start preparing the porridge because she has more space and larger pots, to ensure the children get the food.
Being at the house was unreal. It was originally part of an NGO setup, but when the project was complete, this family found the tin home and moved in. There is a lot of open area nearby, but they have not been using it to grow fruits and vegetables, which the nutritionist plans to encourage as time goes on. Anyways, the house was literally about as big as a dining room table. Not an exaggeration. There was a "bed" of potato sacks and straw(covered by a mosquito net), a 1 pot heater, a few cups, and a corner full of empty water bottles, which the mother used to sell for extra money. The kids would be left alone with no food or water while she was gone. Thankfully, there were a few neighbors that stepped in to help and have been watching over her and the children.
While we were at the home, the mother began crying because she was hungry and embarrassed. She was holding her malnourished son and began bathing him in a bucket while we were all there. We suspected the son might have malaria, for which there would be no feasible/affordable treatment. The little girl was like a magnet to us. She was hugging my leg even in the office earlier in the day, and here, she fell asleep on our shoulders. She was so beautiful and it is heart breaking to wonder what her life will be like.
The situation is just overwhelming. It is definitely a lot to process.

Home Visit

Inside of the home: bed and kitchen supplies
(I was standing in the doorway, for a little more perspective)

The rest of the day was spent doing rounds and being introduced to each of the wards. Emmanuel, one of the nutritionists, was very proud to have us working with him, but not happy I was leaving this weekend :(  He would give us a rundown of the common nutrition problems encountered in each area. The peds ward was definitely another challenge. We see pictures of kwashiorkor and marasmus in textbooks, but yesterday and today, I saw it with my own eyes and it was worse than I could have ever imagined...
There was a baby girl in the acute peds ward who was 1 year old and weighed 4.4 kg (9.6 lbs). That is birthweight. Her eyes were so sunken, her ribs were protruding - you could count each one, her arms and legs had no fat whatsoever, her whole body was cold and she didn't even have the energy to get out a cry. She was HIV+, a sickler and at risk for hypothermia because she was so small. Her mother had passed away, so her grandma was with her. She is on formula to try to replenish her, but she is so incredibly malnourished that I honestly don't know if she will be able to fight everything that is against her right now, especially being surrounded by all the other kids in the ward and being already immunocompromised. (She has her own bed, but others in the ward share beds with 2-3 other children.) I felt her ribs, arms and legs and it was one of the worst moments I have ever had. It is just something that is so unfair and that you would never wish upon your worst enemy.

Formula calculations in the peds ward

Leaving District was tough because I saw the work I could be doing if I had more time. The nutritionists were so welcoming and were so curious about how we handle nutrition in the US. I feel like we would be able to collaborate and help some of these patients if we had a chance to put our heads together. I think the frustration is the hardest part, because I want to help these kids so incredibly bad. I am not sure what the reason is that I just found about this nutrition program, but I am hoping it exists.

We had a very late lunch yesterday (due to the home visit) and then spent some time at St. Joseph's PT department. It started to rain, so we squeezed in a quick trip to the market, came back, played games in the dark (because the electricity was out again), ate cake that the PT's and their crew literally baked in the sun, made guacamole and hung out.

The PT crew with Kate's sun-baked b-day cake :)

Today, I chose to to back to District with a few kids from our group to soak up as much time as I can before leaving. I pretty much shadowed them as they cleaned wounds, placed IV's, monitored oxygen tanks and checked up on their patients. It is really inspiring to see people who are so passionate about medicine.

Tyler educating a mother in the peds ward

Lorryn, a pediatric patient who our team has been following

After the hospital, we took a total chance and went to the school to see if the kids would be hanging out there to play, but no such luck. Instead, we just took one last trip to the market, hung out at the Gilly (not by choice) and took it easy at the house.
I cannot believe this is our last night here! It is kind of a time-warp because flying into Nairobi feels like ages ago, but at the same time, I don't feel like it's time to leave yet. I definitely wish I could stay longer (may or may not have called the airline to see how much a flight change would be...), but I am excited to see the fam, use a real toilet...with a seat, take a hot shower, sleep in my bed and eat something besides carbs! It has been an incredible experience.

Saying goodbye to Martha, our amazing cook!

Rosie, our adopted (and pregnant) dog

Homestretch for Team Tusker