Good Food

On Tuesday and Wednesday of this week we started up the latest cycle of the BBB nutrition program, an outpatient program designed to provide nutritional support to children with moderate acute malnutrition. I’ve just taken over managing the program (don’t ask me if I’m remotely qualified for this), so this was my first real experience with it beyond the planning stages. The program is based at two small health centers, about 10 minute drives in either direction, where we stage weekly food distributions. Previously, World Harvest had started community based production teams to produce the food we distribute, a g-nut paste similar to peanut butter and a type of soy flour, which we then buy from them and distribute to malnourished children. The idea is to use locally available foods, ones that mothers themselves can make, and to perhaps help create a market locally for the g-nut/soy food (if anyone other than us decides to buy it from the production teams).

 

In any event, this week was screening and enrollment, so I, along with Baguma, an extremely competent young Ugandan man who works on nutrition with us and has become a friend of mine, spent hours weighing kids and measuring their height and MUAC (mid upper arm circumference), which we use as enrollment criteria. Moderate acute malnutrition is defined as being between 70-85% weight for length – that is, children between 70-85% of the weight of a healthy, normally developing child of the same height. Of course, the children who are brought to this distribution are going to be smaller and thinner than average for the population, but it was depressing that, in two days, I saw only one child who was at 100% weight-for-length, and several below 70% (it’s hard to survive for long below that point). Screening the children and deciding who to enroll was both interesting and emotionally taxing work. In a room of 50 kids, all of whom are malnourished to one degree or another, it’s hard to decide who will get the food and who won’t, but lines have to be drawn somewhere, especially when working with limited resources (both financial and manpower). The cutoffs, while not arbitrary, have to be defined, so I was several times faced with kids who met none of the criteria but were clearly malnourished, while other kids qualified but looked pretty healthy. Those situations were difficult, as I felt torn between the need for some sort of system and the desire to help everyone who might need help. Of course, I must remember that my ability to help anyone here is dwarfed by the size of the need, but those hard judgment calls were both stressful and fascinating. I found myself really enjoying the clinical aspect – there I was, evaluating kids and making judgments based on a number of factors, including my own opinion of what sort of shape they were in (pretty scary since I’m not medically trained). That process was an exciting challenge, but was also very heavy, since wrong judgments on my part could have very serious consequences.

 

I was excited to be out in the community doing this screening work, especially when I discovered several kids who were in very bad shape (Kwashiorkor), who I instantly referred to Jennifer at the health center. It felt like very real, hands on work. Toward the end of each session, Baguma gave a demonstration of how to prepare this food we were distributing, followed by a taste test for all of the enrolled kids and their mothers (a few fathers even showed up!). There was something sublimely beautiful, peaceful, and just right about a room full of malnourished kids with their hands and faces covered in food. It felt like the world was a little more the way that it should be, a little more in order. Children who just need to eat, getting the chance to eat some good food – it made my day, both days.

 

It’s easy to romanticize this work and trumpet its importance, when in reality some of these kids won’t improve, some will likely die in the next year, and it can be hard to know what impact it’s really having.  Those are the difficult realities of work and life here. However, there is real joy in the simple act of lending any sort of helping hand to someone in need, and while I can strive to achieve certain outcomes, I only have so much control over them.

 

These enrollments were long days, ending around 7PM both times, and I found myself by turns stressed, excited, exhausted, frustrated, happy, brimming with anger, and laughing both days. But at the end of each day, tired and weary, I was able to look back and see good things happening – kids getting food, mothers learning about nutrition, and, I hope, families getting on a track to a healthier future.