I'm Back! :)

I  made it back from the Southern Free State! (And loved it!)

During my time there, I made the realization that their dietetics program seems to be a mixture between our nutrition and health promotion programs. During our time in the Southern Free State, we traveled around to different schools and clinics and gave presentations on different health topics (healthy eating, brushing your teeth and washing your hands properly, breastfeeding, malnutrition, and diabetes). For the purposes of condensing everything that I saw and did this week, I'm including the notes that we were given and those that I took during each lecture.

Monday, June 4th
Noordmansville Primary School

Do a talk on healthy eating, brushing teeth, and washing hands--should be very basic...the children are on in grades 1 and 2. Make sure that they understand...use posters and pictures. Give anything (like coloring picture or fruit...or anything small to be used in school). Approximately 108 children total.

This was by far my favorite talk...even though I didn't understand what was going on because it was all in Afrikaans. In order to demonstrate the passing of germs, we put glitter on our hands and then gave each of the children a high five. They were confused at first, but were very excited to get to interact with the big people. 


We stressed that it was important to wash their hands and brush their teeth to ensure that they removed all of the germs so that they wouldn't get sick. Just like in America, we suggested that they sing "Happy Birthday" to themselves twice to know how long each activity should take. 


In regards to healthy eating, the presenters started by explaining to the children what energy and base building foods were and then built a framework around that. They stressed the importance of getting enough protein, calcium, and fiber to keep them full and help them to build strong muscles and bones. At the end of the presentation, the children were each given an orange and a picture of dancing fruits that they could color in. 


Tuesday, June 5th
Edenburg Combined School

The group of 100+ students that we presented to. 

Problem: Teenagers tend to skip meals to lose weight and can't concentrate in school.
Talk should include: talk about the importance of healthy eating for teenagers and explain the physiology of why it's better to eat small frequent meals to lose weight instead of skipping meals. Also discuss the importance of eating a variety. The teenagers should understand the physiology and understand what a balanced meal is. Be practical...can maybe give examples of healthy eating meals and healthy alternatives for take-aways.

The most interesting thing about this talk was that in the auditorium, the boys sat on one side and the girls sat on the other. We gave this presentation in English, and so I actually helped to present the healthy meals and snacks. And given my strange and exotic (haha, yeah right) accent, I had their full and undivided attention.


The presentation was given in three parts:
1. Five things to remember (demonstrated on a hand)

• Variety--it is important to eat a variety of foods and not just pap, russians, and other typical South African foods. 
• Fruits and veggies--the South African dietary guidelines suggest "5 a day" (2 fruits, and 3 veggies)
• Sugar--it is very important to keep an eye on the amount of sugar we intake each day...for instance, if your going to reach for a cold drink (aka soda), then it is important to choose something like Coke Light as opposed to its more sugary counterpart. 
• Fat--a lot of foods have hidden fats and it is important that we are aware of which foods contain harmful amounts of fat. For example Russians (aka Polish Sausage) has a lot of hidden fat, but is one of the most commonly eaten meats in South Africa. We encouraged the children to watch their intake of fatty foods. 
• Exercise--it's imperative that we exercise during the day. Luckily, the children's school offers either athletics of physical education type classes, so they are at least doing some type of physical activity during the week. 

2. The Physiology of Starvation

• When you continuously skip meals, your body goes in to starvation mode and doesn't know how to digest your food properly. Therefore, when you do finally eat, your body hoards the nutrients because it doesn't know when your next meal is coming. Hence it's opposing effect on weight loss. Instead of losing weight, instead you tend to gain weight because of the body's hoarding tendencies.

3. Healthy Snacks and Meals (My section)

• Based on guidelines given to me from the UFS students that I was accompanying, I suggested the following healthy snacks to the children as alternatives to their preferred Lay's and Simba chips: 

 Brown bread sandwich with peanut butter

1. Popcorn (it provides fiber and will keep them feeling fuller for longer)
2. Water and diet cold drinks (i.e. coke light) (Given that over 70% of your body is made of water, it is important that we replenish it during the day)
3. Fruits and veggies (provide more vitamins and minerals than chips and other snacks)
4. Peanuts and raisins (mmm....fiber and protein!)
5. Low fat milk (full of protein and calcium and can help to prevent osteoporosis later in life)

• Healthy Meals: 

1. Scrambled/boiled eggs (as opposed to fried) with brown (wheat) bread
2. Reheated pap with vegetables and meat (the re-heated pap lowers the GI and will curb their hunger for longer
3. Stews with beans and lentils and soya mince
4. Vegetable Soup
5. Tinned fish with vegetables and re-heated pap
6. Brown bread sandwich with peanut butter

Those were our two biggest presentations and two of the most important because we were speaking to the children...the future of South Africa. I can only hope that they take what we said to heart.

Wednesday, June 6th
Springfontein Clinic
Ante-natal breasfeeding talk (in Afrikaans/English)

During this talk, we discussed breast feeding recommendation, advantages of breastfeeding, proper attachment, and  proper positioning with four expectant mothers. They seemed very receptive to the information we were giving them and eager to put them in to practice when their babies arrived. 


Wednesday, June 6th
Springfontein Clinic
Information session to Sprinfontein Clinic personnel on identification and management of malnutrition.

I was quite honestly shocked that we were asked to give a presentation on malnutrition in a clinic where it appeared to be so prevalent, but happy that we could try to help in some way. To make this section a little easier, I will just give you an outline of what we talked about. 


Weight/Weighing
Make sure that the scale weighs accurately (It is important to zero the scale every day!)
The scale must be placed on a hard surface (They often place it on the beds)
If the child is <2, use a pediatric scale or tared weight (i.e. zeroed with a person on the scale)
If a child is >2, weigh the child alone if the child will stand still
It is important that the child is completely naked and that all procedures are explained to the mothers


Length/Height (there's a difference!)
Length--child is measured laying down (If a child is <2 years old)
Height--child is measured standing up (If a child is >2 years old)
Measuring tapes and mats are not recommended for taking measurements


Mid Upper Arm Circumference (MUAC)
Should be measured every 3 months and the date of the visit and the measurement should always be recorded
MUAC <11.cm is considered severe acute malnutrition and the child should be referred to a better medical facility IMMEDIATELY. 
MUAC >11.5 cm to <12.5 cm without edema indicates moderate acute malnutrition and the children should be supplemented and managed according to IMCI guidelines. 


Malnutrition
2 causes: decreased food consumption and/or illness 
Consequences: liver and kidney damage/failure, hypothermia, heart damage, gut damage, electrolyte and fluid imbalance in the body
4 main causes of death in children with severe malnutrition: heart failure, hypoglycemia, hypothermia, and infections


Growth Charts
There are 3 different types of growth charts used: weight-for-age, length/height-for-age, and weight-for-length/height. 


Clinical Signs
Marasmus (severe wasting)

• Thin appearance, "old man" face
• Apathy: the child is very quite and does not cry
• The ribs and bones are easily seen
• The skin under the upper arms appears loose
• On the back, the ribs and shoulder bones are easily seen
• In extreme cases of wasting, the skin on the buttocks has a "baggy pants" look
• No bilateral pitting edema 

These children have lost fat and muscle and will weight less than other children of similar height 


Kwashiorkor (bilateral pitting edema)

• "Moon face"
• Dermatosis: flaky skin or patches of abnormally light or dark skin (in severe cases) 
• Apathy, little energy
• Loss of appetite
• Hair changes
• Irritable, cries easily

Marasmic Kwashiorkor

• Bilateral pitting edema and severe wasting

It was sad to witness some of the malnourished children come in to the clinic, but hopefully this presentation will help the Sisters (aka Nurses) to refer them to the bigger hospitals. 

Thursday, June 7th

Edenburg

Our last presentation! This presentation was given to about 20 women who lived in a township and covered sugar disease (aka diabetes). It was given in Afrikaans, so I didn't understand exactly what was going on, but the senior dietitian used food models and pictures to demonstrate and reiterate her point, so I was able to follow along slowly. 

All in all, I'd say that I learned A LOT this week and I'm very thankful that this was part of our program. Hopefully next week in the Universitas Hospital will be as much of a learning experience!