Changewith

KIHEFOAddressing child malnutrition

in Kabale, Uganda

A joint publication by GlobeMed at Wayne State and the Kigezi Healthcare Foundation

Preface The Kigezi Region, located in Southwest Uganda, is home to some of the most arable land that is very fertile and rich. Uganda, in fact, has been called the most fertile country in Af-rica. More than 90% of the population of Kigezi consists of sub-sistence farmers who grow their own food. Although the earth here is very fruitful, this region of Uganda has the highest rates of malnutrition in East Africa.

The issue of malnutrition here stems from multiple sources in-cluding poverty, family structure, and gender roles, among oth-

ers. Most women in the family are day-laborers who till the fields. However, most of the harvest is sold at the local markets instead of being allocated for their hungry children. The men in most rural households do not place any importance on the family’s well-being and assume a superior role, one that has its roots in the local Rukiga culture and British Colonialism.

These factors marginalize women and children, ultimately leading to their poor nutri-tional intake which lack fresh vegetables. This issue hits hardest children under the age of five, who are most vulnerable . This public heath crisis has been approached by the Kigezi Healthcare Foundation that strategically has made efforts to uplift people and their com-munities to live healthy, independent lives.

We hope that this publication will shed light onto the issues of global health and social justice as it concerns individuals, academic institutions, and the global community. Our model of solidarity has demonstrated that long-lasting impacts are possible with trust and understanding held paramount. Our experience in Kabale, Uganda during the GROW In-ternship through GlobeMed has shown us that the single unit of any movement is the power of a human relationship. With this thought, we are committed to improving global health and social justice wherever our endeavors may lead.

Sincerely,

The GlobeMed GROW 2013 Team

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AcknowledgementThe students who had the privilege to participate on the Grassroots On-Site Work Internship (GROW) through GlobeMed during May 2013 wish to express their deepest gratitude to all families, mothers, and children of the Kabale villages for allowing us to speak with you during our interviews and also for your heartfelt kindness and generosity. The efforts of many have contributed to this publication.

- The GlobeMed GROW 2013 Team

&& Shreya Desai

&& Ani Mannari

&& Murtaza Hussein

&& Anita Vasudevan

&& Jaipal Singh

&& Rohan Patel

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Nutrition Rehabilitation Center

Severely malnourished children are referred to the Nutrition Cen-ter by local families and KIHEFO staff in the field. Typically these children will then stay

at the center for three weeks to three months, depending on the severity of their condition. In addition to rehabilitation, mothers are given education on how to prepare balanced diets using foods that are available and affordable.

In addition, KIHEFO hosts a Nutrition Visits where mothers and their children come to the center on the last Saturday of each month to receive nutrition screenings.

Agricultural Inputs & Enterprise Development

When a family is identified with undernourished children, they are provided with agricultural inputs and education on how to prepare balanced diets and how to develop enterprises for in-come generation.

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KIHEFO’s Approach

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EDISA2 When six month-old Edisa arrived at KIHEFO’s

Nutrition & Rehabilitation Centre in Kabale on January 2nd, 2013, she weighed only 3 kg and, in the words of her grandmother, “didn’t even ap-pear human.” Her arms and legs were frail, and her stomach swollen. Her bright eyes bulged from her tiny head.

Edisa’s poor health began as a result of her fam-ily’sstruggle to cope with poverty and disease. Her mother, unable to produce breast milk, was forced tofeed her daughter the only food available to thefamily, porridge made from sorghum, a difficult food for young children to digest. Edisa failed to grow as a healthy child and was taken to Kabale Hos-pital where her mother was told that her daughter was underweight and that she needed to feed her soft and nutritious foods. She had three chil-dren to raise, her husband was not helping to provide, and she was dying from HIV/AIDS; she knew she would not be able to afford the hospital's recommendations. Overwhelmed with the odds against her, she died days later on Christmas Day – leaving Edisa and her two other daughters in the care of her grandmother, Florence.

Desperate for help, Florence brought Edisa to the Christian Canan Chil-dren’s Centre to be prayed for – fearing that her condition was brought on by evil spirits or witchcraft. Their staff was able to identify it as a case of se-vere malnutrition and referred them to the Nutrition & Rehabilitation Cen-tre supported by KIHEFO- a decision that saved her life.

For over a month, Edisa has been rehabilitated at KIHEFO's Nutrition & rehabilitation Centre through a feeding program of soybeans, milk, avo-cado, and other soft nutritious foods. Florence, as her caretaker, has been trained to identify and prepare foods that are local, economical, and rich in

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essential nutrients. “Now you can see that she’s a person” Florence said of Edisa's drastic improvement, explaining that her greatest hope for Edisa was to grow healthy and strong, and one day become a doctor.

Today Florence is also the sole provider for three other young grandchildren, and there-fore, she must travel to and from her village of Nyakambu. She works as a farm laborer on other people’s land, earning a

small income of roughly 7000 – 10,000 Ugandan shillings per plot ($2.50 - $4.00 dollars) so her greatest worry is that she will not be able to provide the same foods she’s learned to prepare at KIHEFO when she and Edisa return home in the coming months.

In the future, KIHEFO will continue to support Edisa and Florence through ongoing follow-up and monthly outreach clinics held at the Nutrition & Rehabilitation Centre, every last Saturday of the month. The Nutrition & Rehabilitation Centre has the space to house and rehabilitate upwards of twenty children; however, KIHEFO is in need of finan-cial support to make this a reality. Your contribution can help save

the lives of severely malnourished children in Kabale, Uganda, and provide necessary edu-cation and counseling to caretakers.

Edisa’s story is one of many – let’s take action together to provide a brighter, healthier fu-ture for children suffering from malnutrition.

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Owamani Bright

3Owamani Bright, true to his name, is a bright-eyed three-year- old living in the rural com-munity of Nangara, located in Kabale district. KIHEFO organized a one-day health out-reach in this village in February 2013 with the assistance of volunteer Canadian dentists and health professionals.

When Owamani and his mother, Bezeranta Sanyu, arrived at the health screening, KI-HEFO immediately identified a case of severe protein malnutrition. Owamani exhibited pronounced symptoms, including a distended belly, swelling, sores around the mouth and on the limbs, and ‘silky hair’ (lightening of the hair).

After a visit to their home, the root causes of Owamani’s severe case became apparent. A lack of understanding about nutritional needs on the part of Owamani’s parents leaves the young boy not undernourished, but severely malnourished, a condition that the parents were not aware of until KIHEFO’s intervention.

The main crops available in the village are plantains, Irish potatoes, and cabbage. These starch-saturated vegetables all lack the a growing child needs, and yet they are the main components of Owamani’s daily diet. Additionally, the family lives in a small mud home with a dirt floor, leaky roof, and no mosquito nets. In his susceptible state, such living con-ditions put Owamani at a high risk of malaria.

After diagnosing Owamani’s condition and identifying lack of awareness as the source of his malnourishment, KIHEFO was quick to refer the young boy and his mother to the Nu-trition & Rehabilitation Center in Kabale-town. During their extended stay in this center, KIHEFO gave medical care and attention to Owamani while teaching Bezeranta how to provide a well-balanced diet with locally available foods.

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KIHEFO has the capacity to support Owamani and his mother thanks to the small dona-tions of compassionate volunteers. However, KIHEFO has identified hundreds of cases like that of Owamani in Kabale district, but a lack of resources hampers the ability to offer the urgent attention and education that these families need.

KIHEFO has the solution to child malnourishment through education and innovation, but funding is essential. Find out more about how you can take action be a part of the solu-tion today!

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Purity & Vanessa

4Rushanga Village is a small agricultural community in the Kisoro District of the Kigezi Region. It was in the Mutorere Hospital of this village where a woman by the name of Ninsima Modo gave birth to twins named Purity Kato and Vanessa Kakuru on Novem-ber 5, 2011. In the local culture, the name of ‘Kakuru’ is given to the elder of the twins, whereas ‘Kato’ is the name for the younger. Un-fortunately, their mother passed away during their birth and the twins were taken by their grandmother Faith Myiramaka and elder sister Maureen Ninsima. Maureen, who is aged seven stays at home with her grandmother and her aunt Annet Orishaba and does not re-ceive any school education.

Like most in the village, this family supports itself with subsistence agriculture on their 2-acre farm. Living in a grass-thatched home, they also earn a living by working on the farms of other owners, but cannot make enough money to feed the new-born twins. Purity and Vanessa were taken by Faith and Maureen to a local church seeking support from the religious elders of the community to help the in-fants. Upon explaining the hardships of caring for the children and their desperate situation, Faith was advised to abandon the twins be-cause the family was too needy to support their well- being.

A bystander by the name of Immaculate Natukunda could not turn a blind eye to the social injustice taking place in front of her from religious leaders to whom the community looked up for help. She of-fered to take care of the twins until she could find them a perma-nent caretaker. Immaculate took the initiative to refer the children to the KIHEFO for treatment at the KIHEFO Nutrition Rehabili-

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tation Centre. After nearly three months of nutrition rehabilitation, Purity gained 4.8 kilo-grams and now weighs 5.0 kg. Vanessa has gained 3.2 kg and now weighs 6.2 kg. Their con-dition is improving and they look forward to a healthier, more fulfilling future. The further progress of these twins will not be possible without passionate involvement from those who believe that health is a human right.

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Christopher5 Around a year after his birth, Christopher stopped receiving

breast milk from his mother, who had abandoned him and left his grandmother, Stella (65 years old), as his sole care-taker. Due to financial situations, she was unable to provide him with nutritious foods and Christopher settled into a state of severe malnutrition. After spending a month in care

at the hospital, the nutritionist did not know whether he would survive due to his malnourished state, so he was referred to KIHEFO.

The Nutrition & Rehabilitation Center did not exist at this time, so Christopher arrived at the KIHEFO Gen-eral Clinic in a very fragile condition; his arms and legs were frail and thin. Stella and her grandson spent only one week at the clinic but were encouraged to come on a regular basis for milk feeding and check-ups. By at-tending the monthly nutrition assessments held monthly at KIHEFO, she began to see improvement in his health and weight development. Stella learned a lot from her time with KIHEFO, mainly to feed foods like avocado that are high in natural fats and nutrients, and mashed beans and greens; she never gives the children ‘cold foods’ (raw)– always cooks the food so children can manage chewing and digesting and getting the maxi-mum nutrients from foods.

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Christopher, age 3, has now grown and developed, though there have been some delays due to his previous malnourished state. He is able to walk, has hand mobility (ability to grab onto things), and is improving thanks to his grandmother’s care and attention.Stella is currently caring for 4 children: 2 grandchildren and 2 other children from a men-tally ill woman living in her village who is unable to care for them. Many families in vil-lages are close knit and care for each other in these situations. So, her greatest challenge is earning enough money to pay for food and all the children’s school fees.

Christmas6Flashback to 2005:

Christmas Phiona was 14 months old, but she looked hardly half that age. Her frail, nearly lifeless state drove her nervous parents to seek help at the Kabale Hospital, where she was diagnosed with

malnourishment. The hospital offered treatment in the Children’s Ward at 35,000 Ugan-dan shillings (approximately $14 US dollars), but this was far out of the family’s range of af-fordability. The husband told Christmas’s mother, Peace Tumuhebwe, to simply “Let the kid die,” much to Peace’s devastation.

On the walk back to Kataraga village through Kabale-town, a market vendor told the par-ents about Dr. Anguyo’s private clinic who said the doctor had a “big heart.” This was be-fore the time of KIHEFO’s Nutrition & Rehabilitation Center, but the family was admit-ted to the general clinic where they received one week of rehabilitation at an affordable price. With ongoing counseling, visits, and treatment over the course of the next year, Christmas’s health improved significantly.

Flash Forward 8 Years – February 2013:

Christmas is now 9 years old, and she is the healthiest she has ever been. She continues to visit the KIHEFO Nutrition & Rehabilitation Clinic once a month for assessments, coun-seling, and advice. Christmas has developmental disabilities and limited mobility and speech because of such severe malnutrition at the tender age of one. As a result, she is fully dependent on her mother and caretakers, which certainly poses some challenges in raising her.

This only speaks to Peace’s strength and resilience as a mother of seven children, four of whom she currently cares for. Her husband had an accident while digging a latrine several years ago, rendering him unable to work in labor jobs, and leaving Peace as the sole bread-11

winner. She rakes in a small income by growing and selling staple crops such as maize, plan-tains (matoke), beans, and sweet potato. There is limited access to protein sources like meat, eggs, and milk, but Peace works hard to make ends meet and keep her family happy and healthy.

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Kebiruryi Prety

7Kebiruryi Prety is an eighteen-year-old mother currently resid-ing in the Muyebe village of the Kabale district, where she lives with her mother and older sister. She was born and brought up as the youngest of six children. Since her father was not present in her life, her mother worked hard to earn income as a subsis-tence farmer, growing sorghum, Irish potato and sweet potato.

Growing up, Prety loved to spend time with her friends, espe-cially playing net ball. Just as she was ready to enter senior two,

however, Prety was forced to grow up all too soon: she became pregnant with her now six- month-old baby Mi-wahereza Clare. Fearing the spread of rumors, she moved to Mbarara.

Clare’s father, who is twenty years old, made promises to support the young family unit by working in town and saving money to build a home. Immediately follow-ing Clare’s birth, he provided some money, but once his own mother became sick, he broke his promise. Now, Clare’s father lives with his mother, and Prety is no longer in contact with him.

A few weeks after Clare was born, Prety found that she was no longer able to produce breast milk. Moreover, Clare was not taking breast milk or sorghum, and was quickly becoming malnourished. Worried, Prety sought help at the Kabale hospital. That is when she found out that both her and her baby are HIV positive.

Her mother and sister were shocked when they learned of her status, but they soon accepted it. Due to the cultural stigma at-tached to HIV, Prety was initially suicidal, and she still has no hope for her life. The ARV medication for HIV is affordable thanks to government subsidy: it costs 5,000 Ugandan

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shillings (approx. 2 USD) to register and is free thereafter. However, the hospital is too far from Mbarara for Prety to regularly go pick up the medicine – if she leaves home at 7AM, she will only be able to return by 5PM. Prety takes the ARV medication every day even though it makes her very dizzy. At first, she would forget occasionally, but now she gets headaches if she does not take it.

KIHEFO volunteer, Annette discovered Prety and her baby on March 27, 2013 at a village outreach where medication was being distributed. Clare was clearly very malnourished, and Prety was referred to KIHEFO’s Nutrition & Rehabilitation Center. Since coming to the center, Prety has learned to grow cabbage and spinach.

She hopes to move back home and help her mother with farming once Clare’s health im-proves, although she does not know how long that will take. Prety is now practicing family planning, because she does not want to have any more children. The birth control medica-tion has some negative side effects, but Prety is determined to devote her attention to Clare and ensuring that her daughter goes to school.

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Arthur & Evalyne

8The Nutrition Center accepted Arthur Nawera when a volunteer spotted him in a church with swollen feet and no appetite. Eva-lyne, his mother, had thought that he had stomach worms and con-tacted a local doctor for some traditional healing herbs, but they didn't work. Now having been at KIHEFO for about one month now, her son is provided with a hot lunch and dinner as well as a soap filled bath, both things that were not available to them con-tinually in their village.

What exactly was the cause of Arthur's mal-nutrition? It is a story similar to many in the Kigezi region of Uganda, yet it is still an ongo-ing problem for the families. Evalyne was raised by only her mother and had no contact with her father; this is the reason she had to help support her family in a young age by helping out on the family subsistence farm. At age 16 she was married off and moved to Kabale with her husband to be near his fam-ily. He makes 10,000 shillings a day driving a boda-boda (motorcycle taxi) and they pay 150,000 for school fees for their three kids, so they have no savings for their future or even present. When Evalyne was a child, a matoke (plantain) branch cost 5,000 shillings, but now it is roughly 15,000 shillings. This hike in the cost of even simple foods such as plantains has been the cause of nutrition problem in households. They are unable to afford the luxury of eating a variety of foods; sometimes eating only starches for weeks, a habit that is detrimental to their health. Ar-

thur was fed a stable diet of only eggs, greens, and sorghum flour with milk, but fell into a sickly state when he was 8 months.

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Since being at KIHEFO, Evalyne now has the knowledge to better take of her kids and ad-vise friends who are faced with similar encounters. Arthur is doing well now: his feet are no longer swollen and his hair has turned back to black. KIHEFO’s Nutrition Rehabilita-tion Centre continues to conduct nutrition assessments to ensure that children like Ar-thur do not fall back into their malnourished state.

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Beckam9

Beckam Nabaa was born in mid-2009 to a teenage couple. He was weak and frail even at birth, because his mother, who was HIV posi-tive, did not take the necessary precautions to prevent transmission of the virus to her baby. After Beckam’s birth, his mother took him to the house of his paternal grandparents (in Uganda, it is customary for the father’s parents to assist in the upbringing of a child). The father of the baby, however, did not want to assume responsibility for the child and

ran away from home, leaving all the care to Beckam’s mother and grandmother. His mother was unable to breastfeed as a result of being infected with HIV, and the first few months of Beckam’s life were marked by many trips to the Kabale hospital.

When Beckam was three months old, his mother was overwhelmed by the demands of surviving with HIV and caring for a baby with HIV, so she ran away, leaving Beckam in the hands of his grandmother. His grandmother continued taking him to the Kabale hospital for care, where he was eventually diagnosed with malnutrition. The hospital did not have enough funding for malnourished kids and Beckam’s grandmother was slowly beginning to

lose hope. When Beckam was enrolled in the children’s ward, the hospi-tal only provided care for the child, and his grandmother did not have the resources to provide food and housing for herself. At this point, Ka-bale hospital referred them to KIHEFO.

Beckam came to KIHEFO’s Nutrition & Rehabilitation Center in April 2010, weighing only 3.5 kg at 9 months old. He was in rehabilita-tion for several months before achieving a stable, healthy weight. As of April 13, he is 10 kg, although his weight keeps fluctuating due to his HIV positive status. He often gets sick with opportunistic diseases, such as pneumonia and flu, for which he receives care from the

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KIHEFO general clinic. Simultaneously, he receives his ARV treatment from the Kabale hospital.

Thanks to a generous benefactor, Beckam’s grandmother receives money for his monthly milk, which has had a huge positive impact on his condition. Beckam has also benefitted from the Canadian organization Change for Children, whose income-generating activities provided his family with a goat. The generosity of individuals in conjunction with local and global organizations has already had a great impact on Beckam’s health, renewing his grandmother’s hope for Beckam’s future.

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GlobeMed at Wayne StateEmail: wsu@globemed.org

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GlobeMed is a network of 50 university chapters across the U.S. that partners students with grassroots health organizations around the world to improve the health of the poor.GlobeMed at Wayne State University partners with KIHEFO to sup-port sustainable, community-based projects that improve nutrition in Kabale, Uganda. GlobeMed educates the university about global health issues and ignites a movement of youth who believe in health for all.

Kigezi Healthcare Foundation is a non-profit organization lo-cated in Kabale, Uganda which seeks to empower communities to fight disease, poverty and ignorance in an integrated and sustainable manner.KIHEFO’s programmes focus on promoting education and aware-ness on HIV/AIDS, TB, other infectious diseases, and economic em-powerment of impoverished households. Using a bottom-up strategy, individual people are given the necessary care to become productive community members. The key is to educate and empower people so they can live a positive, economically productive, and healthy life.

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