Kindness the best medicine
Doctors go beyond duty to fight malnutrition
WHEN doctors Jeroen van Lobenstein and Vanessa Comley saw increasing numbers of children being admitted to their hospital with severe acute malnutrition, they could not pinpoint why.
Sometimes they saw the same child more than once, joining hundreds of others who walked through the doors of Stanger Hospital in KwaDukuza, north of Durban.
The situation was so bad the hospital was rated one of the country’s top 10 with the highest rates of malnutrition in children.
“Malnutrition is part of the poverty trap in our communities. Parents, especially mothers, for financial reasons were not able to provide the nutrition needed,” Van Lobenstein said.
“We also heard of instances where, for some reason, mothers were incorrectly told not to breast-feed their babies. Breast-feeding is the best form of nutrition,” he added.
The hospital started by enforcing the guidelines as set out by the World Health Organisation on the handling of patients with malnutrition. It started working on a programme, under the direction of the KZN Guidelines on the Integrated Management of Acute Malnutrition, and set out to create the best conditions for treatment at the hospital, and then impart information to the families with malnourished children.
Comley said a “mothers’ lodging” facility was created on the hospital premises where they could stay while their children were being treated.
“Having a mom present when a child is sick makes them heal so much faster.”
At the same time, the hospital’s medical experts, such as dietician, physiotherapist and nutritionist, work with the mother to educate her on the best foods for her child, and how to make simple things like a sugar-salt solution for cases of diarrhoea.
“Diarrhoea, tuberculosis and pneumonia are worsened if the child is malnourished,” said Comley. It was important, she noted, to educate the mother on how to care for her child once they left the hospital environment.
For mothers of children with malnutrition, the doctors also taught them about proper stimulation using toys.
“Malnutrition stunts growth and inhibits learning. It is important that the child is stimulated with toys that build cognitive functioning,” she said.
The doctors then started creating toys out of recycled materials such as egg trays and tin cans, to help the children learn. This forms part of the offerings at the children’s play area, also created by the unit to stimulate children.
At present, a group of medical students from the University of Groningen in the Netherlands are working on developing the toys as part of their studies.
However, doctors discovered that despite educating the mothers, the rates of malnourishment were still high.
“We needed to get to the source of the problem. It was a huge undertaking for our hospital to do this, but we felt we needed to,” said Van Lobenstein.
The team of doctors joined forces with community caregivers from the departments of health and social welfare.
“We were now entering a phase of intersectoral approach. We met supervisors of caregivers and taught them how to identify the problems and offer solutions at community level, and for that information to be passed down into the community. We also opened up workshops with the community.
“We are at a point where we sit as a team on a case-by-case basis and identify what assistance a particular family needs in terms of food hampers, social grants applications or assistance with Home Affairs.
“If I have a patient admitted at the hospital, I can call up a caregivers and ask for assistance in locating information about the patient. This is important, for example, if the patient presents with TB, then we can check if there are other family members in the household who would then need to come in to be tested,” said Comley.
The team is also working with the department of agriculture to help families create food gardens to grow their own nutritious food.
“In 2013, we had 423 cases of malnutrition with 61 deaths. Since the programme started in 2015, the latest figures showed a massive improvement. In 2017, there were 137 cases and nine deaths. It’s something we are working on daily, and it’s having a positive effect,” said Van Lobenstein.