Saturday, November 10, 2007

Malnutrition Rehabilitation Centre (MRC)





http://hiamhealth.org/mrc.aspx

In Timor-Leste, many children with severe malnutrition are referred to Dili National Hospital (DNH), which has only a 38 bed Pediatric Ward. Children with severe malnutrition require hospitalization until their weight-for-height (WFH) reaches an acceptable level, DNH policy is 80% WFH. Unfortunately children with severe malnutrition often have to compete for limited beds with children having other illnesses. This pressure for beds at DNH results in early discharge for some children, who are not yet completely rehabilitated. Furthermore, some parents take their child home early, because s/he is not gaining weight at the expected rate. This may be attributed to missed feeds owing to an inability to provide adequate care because of staffing pressure.

Due to this current situation in Timor-Leste, some patients are discharged from hospital and also referred from Out Patient Department (OPD) to HIAM-Health for monitoring and supplementary feeding when weight-for-height ratio is still below 80% some as low as 62% WFH. These children are still in danger of serious relapse and remain at an increased risk of dying in this rehabilitation stage. In order to improve the care and rehabilitation of children suffering from malnutrition, there is a need to establish a separate and dedicated treatment centre particularly for those children who face long difficult journeys back home to Districts where they may not have access to a health facility.

The present system for treating malnourished infants and children after discharge from DNH follows specific guidelines. Children are referred by the resident Pediatricians to HIAM-Health’s existing program when they are moderately or slightly malnourished. Patients attend the centre fortnightly, if they are local and monthly if from the Districts, for weighing, monitoring and supplementary feeding until their WFH reaches 85%. During this time it is a requirement of HIAM-Health protocols that parents/caregivers attend Health Education and Nutrition for Healthy Life workshops. Unfortunately this is only available to people who can travel back to HIAM-Health’s clinic at regular intervals; parent/caregivers who live too far away, frequently return home to their villages with a child whose WFH is still dangerously low. Furthermore they go without sufficient understanding of their child’s condition or how to care for the child and without support of food/milk supplements, which can severely impede the infant/child’s recovery. They also miss out participating in HIAM-Health’s education programs.

Currently at HIAM-Health actual contact time between a family and the staff can be limited to as little as two hours within a group (workshop) and then a maximum of ten minutes of one-on-one contact with a staff member whilst the child is being weighed, measured and supplementary food given. This is not enough time to re-educate the parent/care-giver adequately, and as a result the malnutrition/poor nutrition cycle is not broken, resulting in the child re-presenting some months later requiring supplementary feeding once more.

Rationale for the Centre

HIAM-Health is already making a real difference in the lives of the children and families that they assist through their current facility in the grounds of Dili National Hospital, but there remains a large void in the system for those children in the 'severe' but stable (not sick) category of malnutrition (62% to 70% WFH), who would normally require hospitalisation) but because of bed constrains at the hospital are handed over to HIAM’s day care system for these children rehabilitation is a long slow process particularly for children who reside outside of Dili and can only attend the centre fortnightly or monthly.

In order to improve the care and rehabilitation of children suffering from malnutrition, to overcome the effects of chronic malnutrition and prevent recurrence of the condition, there is a need to establish a separate and dedicated treatment centre for them. HIAM-Health is currently seeking sponsorship to build an infant/child Malnutrition Rehabilitation Centre (MRC) to address this gap in service provision.

Aims of the Centre

The HIAM-Health MRC will have a dual focus:

  1. To provide care for malnourished children following their discharge or referral from hospital, by offering them a live-in situation with their parent/care-giver. HIAM will take a holistic approach to preventing the reoccurrence of malnutrition, by treating the infant/child and the parent/care-giver together as a family, addressing the problem of poor nutrition at the parent/care-giver level as well as with the person suffering directly from malnutrition. The objective is to significantly educate the parent/care-giver while the infant/child is being rehabilitated, so as to break the cycle of poor nutrition that leads to malnutrition, disease and sickness.
  2. While the child is being rehabilitated the parent/caregiver will receive education on a variety of issues affecting the health of people in East Timor such as poor nutrition, hygiene and sanitation practices, family planning (child spacing) as well as the well-documented and tested survival strategy for Third World families, the Household or Kitchen Garden.

Advantages of a dedicated MRC

A dedicated Malnutrition Rehabilitation Centre has many advantages:

  • The experience of working with a concentration of children with the same problem results in increased efficiency through specialisation and improvement in quality of care by the staff.
  • Having a dedicated Centre increases the ease of providing regular and timely feeds - the children all requiring feeding together are in the same place. (Without regular and timely feeds children with malnutrition may suffer low blood sugar which can result in death.)
  • It reduces the exposure of children with malnutrition to children with other infectious conditions.
  • It increases the support to families by virtue of the fact that parents / families can share experiences and boost one another's morale and participate in educational workshops together.
  • It provides an area for developmental and emotional stimulation for children and their families - the majority of children with severe malnutrition have severe developmental delay. For example, most two-year-old children with severe malnutrition do not walk.
  • The Centre will provide a facility for educating parents/care-givers about nutrition and feeding practices, including how to feed their children and how to prevent malnutrition recurring or occurring in subsequent children; provide sound and culturally-specific nutrition counselling to parents/care-givers of young children and recommend the widest possible use of indigenous foodstuffs that will help ensure local foods are prepared and fed safely in the home. The centre will also support mothers to re-establish their breast milk supply and continue feeding the infant.
  • As nutrition and household gardening are integral components for the reduction of malnutrition in low-income families in East Timor, parents/care-givers will also receive training to develop their knowledge and skills in producing a household garden for all seasons, thus ensuring food security.
  • There is a saying, 'Give the man a fish and feed him for a day; give him a fishing rod and feed him for a life-time'. HIAM-Health's philosophy is to help people to help each other. By establishing a Malnutrition Rehabilitation Centre and providing comprehensive education and support, we can alleviate many unnecessary children's deaths and set a standard of service not just for Dili residents, but for the nation as a whole.

To make a donation

To make a donation or for more information regarding the Malnutrition Rehabilitation Centre please complete the enquiry form. Alternatively please phone HIAM-Health on +670 727 3749.

The following supporting information is available on request:

  1. List of Health & Nutrition Workshop topics held by HIAM-Health
  2. HIAM client/patient list - Dili National Hospital and Dili Sub-District Clinics
  3. Letters of Recommendation and support
  4. Dili National Hospital, statistics for Pediactric Ward
  5. HIAM-Health Protocols
  6. HIAM-Health Organisational Structure
  7. Draft plan of proposed building and quotations
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