During my 2 weeks in Kenya, I got a unique introduction to the Kenyan health care system. My first experience was 2 days volunteering in Mathare North health clinic located in the Mathare slum, where I followed the work of the local nutritionists.
According to Kenyan law, free health care is provided to all pregnant women and children under the age of 5 years. Preferably pregnant women have 4 checkups during pregnancy. After the child is born they are supposed to come to the clinic once a month for growth monitoring and immunization. As electronic records are not yet a part of the Kenyan health care system all the visits, data and medical consultations are recorded in the purple Mother and Child Health Booklet: http://bit.ly/1HQ0Rrs
In this booklet the clinic note everything down regarding pregnancy, delivery and the child’s health during the first 5 years of life. It is very convenient that all information is gathered in one place, so it is the responsibility of the parents to keep this booklet safe and to bring it to the clinic at every visit. Later in life this booklet is handed over to the child, so they have all their health information from early childhood.
While volunteering I participated in the growth monitoring of the children in the morning and later I observed the nutritionist counseling parents with malnourished children. So I think I have probably weighed and recorded approximately 200 children during my stay and participated in more than 25 nutritionist consultations. In the classroom, everything seems so clear and easy, when you are lecturing on clinical signs of malnutrition and micronutrient deficiencies – but when you suddenly see the symptoms of marasmus, kwashiorkor and stunting in one child, you have to realize that reality is way more complicated than the textbook.
Every time a new family comes into the consultation the nutritionist’s trained eye first scan the child, then the parents and finally she looks at the very limited amount of fortified and therapeutic foods that she has available. The nutritionist has three options in the consultation room; she can counsel the parents on proper feeding practices, she can hand-out fortified maize flower or she can administer “Plumpy’nut” (http://www.nutriset.fr/index.php?id=92). Her dilemma is that every child that enters the consultation would benefit from getting fortified food – at least for a short period – but she must prioritize the most severe cases. So every time she sees a child in her consultation she has to decide if this particular child is one of the most severe case and if this child will benefit from the therapeutic feeding – or if the next child, a child tomorrow or maybe next week will benefit more… How the child benefit from the treatment also depends on the parents/family; if they are willing to follow the recommendations. Therefore, the nutritionist is very firm and strict to the parents and explains very clearly what she expects from them. This is so far away from the supportive and encouraging environment that we would normally try to create in a counseling situation. But as the nutritionist explains: “I have so limited resources available, so if they don’t intend to follow the treatment for the benefit of their child, I would rather give the food to someone who WILL benefit”. She further elaborates that if a child does not show any improvement and she suspect the parents to not follow the treatment plan, the child is immediately removed from the treatment programme to make room for another child. It seems very cold, but it is a hardcore cost-benefit analysis this nutritionist has to make several times a day…
Volunteering for 2 days in Mathare, I really got to experience what global health is truly about. When we are in Denmark discussing therapeutic feeding and nutritional guidelines everything seems so simple and straight forward. But in real life everything becomes a bit more complicated and most often the health professionals have to use their experience to improvise, in order to make the best use of the limited resources available. I wish that all of you could have a hands-on experience like this to really understand what it takes to be a true global health professional.
Featured image. (c) Rohini Das, took from Flickr (http://bit.ly/1DjGsLt). 2015.
This post was written by Susanne Stilling My name is Susanne Stilling and I am an assistant lecturer at GNH. I consider myself to be a global health professional as, I graduated from GNH with the first batch in 2010 and in 20012 I graduated from UCL with a Master’s degree in Global Health and Development. I have worked as a global health professional in Nepal, South Africa, Greenland and Denmark mainly focusing on prevention of malnutrition, smoking and suicides. But now I am happy to be back to share my experience and knowledge with the students at GNH =)