Malnutrition Ward

 Monday June 19 

Today I was in the malnutrition ward. I’d heard it was slow with only one patient in previous weeks but today there were 6 patients who were admitted from the Friday weekly malnutrition clinic. 

Most malnourished children have underlying issues, and when they’re in poor households, the families don’t get the care they need. So, most kids in this unit come into the ER or outpatient with other things (diarrhea, TB, malaria, really anything) and then get admitted to the malnutrition unit when they have certain measurements: weight, arm circumference, etc.

They do a lipid test to see if the child is well enough to send them home with the feeding formula (to avoid them unnecessarily being exposed to other illness here) but if they can’t tolerate the formula well enough they are admitted. Malnutrition can make it hard for them to digest things so it is common for them to throw up the formula. They do a milk-based formula that has different dilution levels based on the patient. There is am equation they use to determine that and how often to feed. Dehydration is common but some malnourished kids have edema (fluid swelling in the abdomen) so they have to be careful of what rehydration to use and use a specific mix of salts to not make the swelling worse.

We went on the initial rounds with the resident doctor who is from the Korle-Bu teaching hospital. She showed us how she taps on the stomach to tell if fluid is in the abdomen. 

There is one patient in the ward who has been there for a month and is severely malnourished; the patient looks like just skeleton and skin. The patient also has TB and HIV so the doctors are having to be careful about when to start medications for all those because she hasn’t been gaining much weight. The other cases are not as severe.

One young boy was found abandoned and was brought to an orphanage so they don’t know how old he is exactly but from his frontal lobe being closed they know he’s over 18 months. 

They do not have as robust of a welfare program/CPS as we do in the US, but they do have a social welfare program as part of the ministry of health that will cover costs that insurance doesn’t for some families. Additionally, one mother brought her baby in but refused treatments for him so social welfare took him into their custody so he could get treatment in the hospital and they are paying for his yogurt foods. So, they do have a similar thing to CPS, but still, if a family is struggling, they are pretty much on their own (no food stamps etc) and turning the child over to an orphanage is their main option for help.

The dietician came and we followed him on his rounds. He also went into the ER with us to assess a patient that may be admitted. One patient in the ER had red hair (with black skin) which they think might actually be from undernourishment and not getting enough vitamins to support melanin production. 

There were students from the U of Ghana medical school so it got a bit crowded at times but we spent a lot of time sitting at the dietitian’s desk as he typed up charts.

The ward is mainly metal cots and they do have a little play area but most of the kids are so apathetic they don’t engage with anyone or play. 

We then grabbed lunch and went back home. 

I went to the post office with a peer, this time a smaller and closer post office. Each postcard needed 10 stamps on it! And the stamps weren’t sticky, you had to dip them in water then press them on. 

I then went to the gym (this is the view from the top) then the smoothie place next door, then had leftover pizza for dinner. 

  

Today we had fresh bananas cut from a tree outside our house. They were tiny but really sweet and creamy and somewhat tart!