Dec 15 2010
by Lauren Eppinger
Vanderbilt School of Nursing
As I am nearing the end of my time in Guatemala, I have been wrapping up all of the projects I have been working on here. Cody Bowers has been writing about the Oral Rehydration Solution (ORS) project, so I will let him update about that in a different blog. The project that has been taking most of my time here is the creation and implementation of protocol for the screening and treatment of malnutrition.
After participating in care of children at the clinic, and talking with the clinic staff it was apparent that the solution to the inadequate treatment of these children would need to be multi-disciplinary, to address the problem from multiple angles. The clinic's previous protocol was to do exams, give vitamins, and educate the patients. These are all important things to do for the treatment of malnutrition, but the guidelines were so vague that they were rarely being implemented fully. After looking over the current research and discussing ideas with the directors at the clinic I developed a detailed treatment plan, and set out to identify available resources.
In speaking with patients, it became clear that there was a huge deficit in nutritional knowledge. Most people didn't know the difference between protein and carbohydrates. In order to fulfill the clinic's need for an educational plan, I designed one that could be made into a handout and used as a guideline for discussions in the clinic. I made up a food pyramid that was specific to the needs I saw at the clinic, and I included information about each food group, the functions of the nutrients, effects if deficient, examples of the foods in the group, and daily requirements. The other side of the food pyramid handout has information on malnutrition and hygiene, as well as a table to keep track of the child's weight. The clinic now has a sheet for each malnourished child's chart, and a master spreadsheet to keep track of the patients with malnutrition. The educational materials are now stored in each exam room, and a color laminated copy of the pyramid is on the wall in each room.
Another part of the project involved researching ways to get vitamins to these children. Due to supply issues, the clinic was only getting occasional bottles of B vitamins, but no multi-vitamins, and no iron for anemic children. I checked all of the local pharmacies and found an inexpensive multi-vitamin that we are looking into purchasing for the clinic. At the very least, we can write a prescription for the vitamin, and families can purchase it for $1.60 a bottle. Even if we have to wait on more donations or funding, it was important just to know what the local supply was. Previously, no one at the clinic knew what multi-vitamin was affordable, or even how to dose it. This information is very product-specific, and the foreign volunteers really struggled with it. The same thing was done to research an appetite stimulant.
Last Friday the whole clinic came together for a meeting. One of the most important parts of initiating a change like this is having the support of the people who will be doing the work. I was lucky to have support from the entire clinic. They realized the huge need for a specific treatment program, but didn't have the time or resources to create one on their own. Once everything was complete, we held a training session, where the medical students, volunteers, and medical director (head doctor) all took part in learning about how to institute this treatment protocol.
A major part of the training session was reminding people how to help motivate families to return for follow-up, and to have parents take a part in this process. It's easy for people to think there's an element of neglect involved when the parents do not bring their children in for follow-up, but I think it is much more complex. We have to win the trust of the families, and show them that the child's health is a collaborative process. We don't want to take all of the control, nor do we want to be left out when we are needed. There seems to be a stigma here about malnutrition, and many mothers are anxious to see the child's weight, and know if he is at a healthy weight. Any interventions we have to resolve malnutrition seem to be very well received.
In my last few days at the clinic I will be able to help make sure that the new malnutrition treatment program gets going smoothly. It has been exciting already to see families walking away with their educational information. Education is one of the best tools for health promotion, and I look forward to seeing it put to use in a variety of ways here.