The good... the sad

I'll start of with a picture of Caitlin in front of a beautiful Methodist church in Ganta. On Saturday Kristen and Tate (American friends) called and asked me if I would like to go to Ganta for the day (the town I was in 2 weeks ago for a bit- where Caitlin lives). Shopping around here is poor, so we went there to buy baskets for Kristen to take back for gifts, sat down and had a cold coke in town (there are no real restaurants in Gbarnga), got some really good fresh baked bread right out of the clay oven, hung out with Caitlin, and drove back. It is about a 3 hour round trip, but it was worth it to get out of Gbarnga for a bit- there isn't too much to do here. But at least now I have some friends!

Speaking of friends, Kristen and Tate had a BBQ on Sunday for all of the Expats in the area. There were about 10-15 people there. The people were from France, Canada, USA, and Lebanon, and all had interesting stories and were doing interesting work here in Liberia. It was a potluck and I enjoyed some good food. The Lebanese people brought tabbouleh and hummus, I made fried plantains (there was another nutrition girl there and that's what we made together- funny how we made the fried food), grilled mangoes, grilled eggplant, and people bought beer and sodas and they also made kabobs. It was incredibly "normal." I didn't feel like I was in Liberia. An oasis for an afternoon! In the first picture is a women who works for Kirsten and Tate, a man who has been here for over 20 years, and the man playing the guitar was an American who came with the peace corps for their trial period in Liberia (I think I mentioned before about how the Peace Corps is just doing a trial run here with people who have already completed at least 2 years in the Corps because Liberia is just becoming stable and they don't want to send new volunteers here- glad I came as a newbie haha).

Our host Tate grilling up some corn, mangoes, kabobs, and eggplant

Kristen and Tate's daughter Maya. She is very cute, creative, fun, and a bit of a ham in front of a camera. Another redhead in Liberia (both her parents have brown hair- I'm not the only one)

Okay- now the sad...
On Tuesday I went to the local hospital, Phebe Hospital, where the area acute nutrition center is. I went to observe a friend Kyla (another one of those Peace Corps people) at the clinic and helped with the weighing/ measuring the children. It was an emotional day for me. I have seen pictures in books regarding severe acute malnutrition, but being there in person is quite different. It was interesting to see some of the "textbook" malnutrition cases. When I first got there, the nurse's aid showed me a case of Kwashiorkor and a case of Marasmus. Kwashiorkor is a form protein energy malnutrition where the child exhibits the characteristics of swollen bellies, lethargy and flaky, peeling skin with sores, and Marasmus is also known as wasting where the child has an "old man" face, saggy loose skin, and discoloration of hair- it turns red.

We then went to the outpatient clinic where they were doing growth monitoring and looking for new cases that needed to be admitted into the nutrition clinic for an extended period. 2 children were identified as being malnourished- one severe and one moderate but borderline. The severe child had Kwashiorkor and was severely stunted. He was about Nolan's (my nephew who is 3 years 9 months) height but was 8 years old. He was very lethargic and had sores on his body (with Kwashiorkor the skin stretches from edema, gets flaky and can break open). The other child was 1 1/2 years old and was very skinny, stunted and only had 2 teeth. He was 75% weight for age, but it was not enough to admit him right away because the UNICEF cut off that they use is less than 70%. His grandmother had brought him because the child's mother was sick and could not breastfeed and she could not feed him properly. We had to advocate a bit to have him admitted because even though he was considered moderate at this time, it was likely that his condition would soon deteriorate because he wasn't eating.


Here is the 8 year old...

It is difficult to tell how severe this child's case is in the picture- except the fact that he is 8 years old and about the size of a 3-4 year old. FYI I am testing his Mid-Upper Arm Circumference (MUAC) in this picture. He had all the signs of Kwashiorkor - swollen belly, legs, arms and face, skin lesions, and lethargy. We tested for edema by pushing down on the feet with our thumbs. If it leaves an imprint on both feet it is called bi-lateral pitting edema, which he had, and it is considered severe. His tummy was swollen but not too bad, but his legs, feet and face were all swollen, and his skin had lesions and was flaky and cracked. The Kwashiorkor is severe acute malnutrition and the stunting is evidence of chronic, or long term, malnutrition. It was sad to see the clinic's response to the stunting. I asked what they would do for him and they said, "it is poverty." Very matter of fact. They had plans to address his acute symptoms of edema, but not the chronic condition which will affect/ has affected his mental capacity and ability to thrive as a child. It really hit me how stunted this child was when I thought about how an 8 year old is a child in approximately 3rd grade in the United States.

These pictures are not great because I did not have the flash on. I was trying not to draw any more attention to this case with a large flash. But, the purpose of this picture is to show the bilateral pitting edema- severely swollen legs.

Me testing the MUAC

The worst case- which I do not have a picture of because it was just too sad- was an 18 month old child who was such bad shape that I had to stop and pray for him with his mother. I don't get that sudden urge like that often, seeing him just hit me really hard emotionally. He was- I would guess- about the size of a 4 month old. His little body was covered with blisters and sores because he originally had edema. The swelling had gone down but the sores had gotten infected and he developed septic shock. He was "awake" but looked almost unconscious. His eyes were rolled back into his head and his breathing was very labored. For any doctors or nurses out there, this country is in severe need of properly trained medical staff. The nurses had not contacted the Dr. yet because they said they would do it when his condition got worse. Worse? If he got any worse he would be dead! Some of the staff said he was eating, some said he wasn't. It did not appear that anyone was monitoring his breathing or heart (something they should definitely be doing with septic shock). He should have also been placed on an IV drip of dextrose and water (sugar water), but had not as of yet. Also, protocol for septic shock according to UNICEF is to place a naso gastric feeding tube for feedings rather than rely on oral intake. They promised they would call the doctor, but just in case Kyla and I decided to alert the Dr. ourselves. The child's name is Daniele. Please pray for him.

One more comment about this countries need for trained, educated medical staff. The nurse told Kyla that the swelling of Kwashiorkor was due to too much sodium in the blood. No! Any medical professional knows that Kwashiorkor is a protein- energy form of malnutrition. It is fluid build up as a result of the child not getting adequate nutrition. Uh! I had to bight my tongue. Kyla said she would write about it in her review of the program. The children in the clinic also had no toys and really nothing to do all day. The children just sat in their beds and stared. Kyla might start a program there for arts and crafts with the children and the mothers to make toys. A possible problem identified with these mothers with malnourished children is that they do not seem to spend enough time with them. Hopefully Kyla can create something to give the children something fun to do while also promoting material- child bonding for love, support and development.

I can't leave this all sad...

A success story! This child has been in the nutrition unit of the hospital for 1 month. When she arrived she was unable to walk, unable to communicate, and was severely wasted (thin). She is now all smiles and very sweet!

Today I was supposed to go out into the field, however, there was a problem with logistics yesterday and they are a day behind (which is really 2 days behind at this point). Also, the driver's child was convulsing last night and they had to take her to the hospital. So, first, pray for her, but this means we have no vehicle to get around. So, office day for me, which is fine, I have work to do. Hopefully tomorrow I will be out in the field for the rest of the week assisting with Village Health Educator training and also observation of meal preparation in the community so I can determine serving sizes and portion distribution to accurately conduct a nutrient analysis on typical Liberian dishes.

Thanks for all your support and nice comments. Adam- thanks for the words of encouragement and sharing your story. Carla, thanks for praying away the spiders! I saw a bunch in my room a couple days in a row, but now I have not seen one for several days. So, thanks!

Love you all lots! Please keep me updated with your lives in the States!

-Nicole