Malnutrition nearly killed little Matthew
by Sister Josephine Keane
The ambulance was just ready to pull away after our regular HIV/AIDS clinic in Naanya neighbourhood when an eleven-year old boy named Joseph cycled up and parked his bicycle by the tree. His little brother, Matthew, not yet two years old, was in a cardboard box on the carrier. The poor little fellow was very ill, suffering from severe malnutrition. Our staff were tired from seeing over one hundred patients that morning and were already on board our ambulance and ready to get home for their break, but they quickly disembarked and brought the baby indoors.
Hospital treatment was needed because little Matthew was so ill. A referral note was written to Kitovu Hospital Nutrition Centre, 50 km away. We gave Joseph money for the transport and the admission fee. He put the baby back in the box on the carrier and cycled home to get an adult to accompany them to the hospital. Matthew was several weeks in the Nutrition Centre at Kitovu before his weight became normal.
During this time his mother was instructed daily on his nutritional requirements. The Social Care Team discussed with her how she could be helped on discharge to ensure that his food energy requirements were met. This entailed the Mobile Clinic providing milk powder and soya over a period of time. Thanks to this good care, little Matthew is thriving today.
Daniel was referred to us by a community worker in our programme. On examination he was diagnosed to have advanced leprosy of both hands and feet. Already he had lost part of his fingers and toes.
We referred him to the leprosy programme at Masaka Government Hospital. On his return home he continued his medication under the supervision of our Mobile Team for two years. Special shoes were provided through the Government programme. We had to make sure he got them, as his home is very far from where they are made. While he will never regain his lost fingers and toes, he has continued to do very well and further loss has been prevented. As a young farmer, with a wife and child to support, he manages to cultivate his small holding and is happy to be well.
Paschal and Pius and their little sister, Maria, missed their mother very much when she left the family. The neighbours said there had been some conflict between her and their father. Then one day their father told them he was going to look for work. When evening came he failed to return. The children spent the evening looking down the road for him to come home. Days passed. The neighbours did what they could to comfort and care for the children. Then a neighbour brought the three children to our Mobile Clinic in Kamakuza, half a mile away. Our team went to the house to verify the situation.
The children were confused because one adult told them to do this, and another that. We listened to them and arranged for one person to come for four hours every day, paid by our programme. She would report on progress on Clinic days every two weeks. Some sense of normality returned for the children. She was a reference person for them and somebody we were able to deal with. She was also very glad to have some steady income to help her own family situation.
After several months the father returned, stayed for a few days and went again. We agreed to pay the fees for the older boy, Paschal, in primary school. As the others reach that age they, too, will be supported by our programme.
Baby Joanne and her toddler brother, Kagwe, first lost their mother from AIDS. Their father was a witch doctor, and when he died there was no support from the local community. The children were taken by an uncle who already had four children of his own. When we went to see them the orphans were terribly neglected.
We talked to the uncle and his wife and made food available to all the children in the family. We agreed to pay the school fees for their own children and the two orphans. They are visited each month by our Mobile Team and are doing very well now.
One of our community workers referred this family to us for a home visit. When we got there we found them all under a big tree. Immediately we could see the father had severe elephantiasis, with badly swollen legs. The mother was mentally fragile. There were eight children. Four of them, aged 7, 5, 3 and 11 months, were unable to stand up or walk.
It so happened that we had a physician and a physiotherapist from the UK visiting us. We brought them to meet the family. They could find no physiological reason why the four younger children didn't walk. We referred them to the paediatrician in Kitovu who outruled any physical explanation.
Back home, we started giving them exercises. That meant holding them upright, getting them to stand, gradually trying to help them to walk. We employed a person to visit them twice each week to ensure they did their exercises.
The seven-year-old also had a hearing problem. He gained full mobility over three years, ungainly but mobile. The five-year-old can stand up but likes to hold on to someone. For speed, he prefers to creep. The three-year-old has refused to make any effort to date, but we have not given up on him. Because he is not mobile, he is the last to get food and has suffered from severe malnutrition. This had to be treated at Kitovu Nutrition Centre.
The youngest boy responded from the beginning. In fact he initiated everything. I feel he saw me as a potential helper and never lost an opportunity. He now has full balance and walks very well and is ready to start school.
Our nutritionist has arranged supplies of food monthly. She has taught the mother how to cook and supervises their nutrition levels. We employed another person to help the older children cultivate their small piece of land and ensure that they are able to grow their own food.
Health workers have to cover many miles in the course of a week's work. They do home visitation and have a monthly meeting on the last Friday of every month, at which they report to their co-ordinator.
They are key people in our Mobile Programme because they bring to our attention any neglected orphans, children not attending school, people who are sick and unable to attend our clinics, people with chronic or terminal illness who need nursing care or social assistance because of houses in very poor condition, etc.
In Uganda there is no provision for social work of this kind in such remote areas as ours, so these people work as volunteers. Most of them earn their living as farmers, have cottage industries, or are retired teachers or policemen. Their only material recompense is a bicycle and reduced costs if they need medical care themselves. They welcome the chance for education through the training they receive. Their role in the community is greatly appreciated.
As they receive counselling and learn how to be counsellors their social standing is increased and they are highly regarded in their community.