Malnutrition

This week I was assigned to the malnutrition ward. This ward is what makes PML such a prized facility in Ghana since it is the only malnutrition specializing clinic in all of southern Ghana. The in-patient ward, photographed here, is where severe acutely malnourished children with or without co-infections are kept. Children here more often have infections preventing their proper nutrition like retrovirus infection, tuberculosis, or cerebral palsy. There are several symptoms of malnutrition I have been able to see. The most unusual is blonde hair. When a child is malnourished they do not produce pigment for their hair which results in blonde hair. There is also something called "wasting" when the body breaks down muscle for energy out of amino acids, this is one of the last stages of starvation. It results in the stereotypical image of malnutrition with sagging skin and protruding bones. This ward is also where Dr. Cicely Williams discovered the disease Kwashiorkor. This is when blood albumin protein is low. Albumin is responsible for dissolving hydrophobic compounds in aqueous solution, therefore without it blood osmolarity is increased and this causes severe swelling from fluid retention. Therefore this ward oversees the stabilization of these malnourished children, afterwards the work to gain weight begins.

Getting a child to gain weight is far more complicated that you would expect. Simply force feeding can induce re-feeding syndrome which essentially puts the body into nutrient overload shock. The nutritionists need to stabilize the children with a lower calorie fortified milk. If the child takes it then they can slowly increase the calories per ml milk until the child gains weight at an acceptable rate. Older children (>6 months) are given complementary feeds in the form of fortified peanut butter (called plumpy nut and is pictured) or fortified biscuits. But this is all if the child takes the feeds. If not, an NG tube may be used to introduce stabilizing feeds.

Once a child is gaining weight and other medical conditions are addressed they are discharged. Then they are referred to the malnutrition rehab center which is removed from the ward. This is such that children don't pick up infections in the hospital. Here at this rehab center they are measured and given plumpy nut rations each week. This is also where mothers are educated on providing balanced meals with the fortified foods at the center. The goal is to have kids keep gaining weight but with balanced nutrients. I was able to help with measuring and handing out the rations which was very exciting. There is also a cook who brings her grandson (I think) and he is my newest little friend! He got quite attached to the screen on my apple watch so I had to quickly confiscate it. Otherwise a happy little Ghanaian baby.