By Zeina Makhoul, PhD, RD
SPOON’s Nutrition Scientist
After seeing positive outcomes in India’s pilot of the Nutrition Screening System, we are ready to take our program to Vietnam. I’m currently in Hanoi gathering information to identify the needs and inform the customization of the system and the nutrition and feeding curriculum. Over the past three days, I have visited two orphanages to learn about mealtime practices. Rice is a main ingredient of food for all Vietnamese people including in the family setting, so rice is a must in every meal. Here at the orphanage, breakfast, lunch and dinner generally consist of different varieties of rice: rice porridge, sticky rice, or steamed rice with a pork broth and a few leafy greens. Fresh fruits, vegetables, meats and fish are not eaten every day. Snacks, other than milk once a day for young children, and candy are not common.
Nutrient supplements like iron, vitamin C, vitamin D, calcium and multivitamins depend on donations. When orphanages receive several bottles of iron syrup, all children, anemic or not, get them. But the supply lasts for only for 4-5 days. One nurse said that the last time they gave children iron was 5 months ago and vitamin D was last winter. The staff report that children get diarrhea 4 -5 times per year. Again, at the mercy of donations, the clinical staff is not able to always give children zinc to reduce the severity and duration of diarrhea. At the two sites I visited, there is no screening for anemia or growth but the staff is excited and eager to learn. While it’s likely that all children need iron supplements, being able to identify children with anemia through the nutrition screening system will allow the nurses to use the limited supplements for the children who need them the most. And, identifying and quantifying the needs of the children through the system can hopefully help directors and staff make decisions about donation priorities.
More to come on some of my observations of feeding practices.
In the third short, free webinar in our new “Bite Sized Tips” series, Dr. Dana Johnson, renowned international adoption physician, walks parents through what nutrition tests to ask for during their child’s first doctor visit. He explains what each test is for and how it is administered.
From 75-91% of children in baby houses and orphanages where SPOON has worked suffer from malnutrition. If you have adopted a child internationally, he or she is at high risk for malnutrition in the form of micronutrient deficiencies, stunting, wasting, or being underweight. In less than 10 minutes, find out why your child is at risk for malnutrition in this informative, free and short recorded webinar by Dr. Dana Johnson of the University of Minnesota International Adoption Clinic:
Do you dread family mealtimes due to your child’s behavior? Do you find yourself in power struggles with your child over trying new foods or having just one more bite? Do you wish your child was more motivated to eat or more interested in the foods the whole family is eating? Or, are you worried your child is eating too much?
If any of the above questions ring true, then this free, short recorded webinar is for you (it’s less than 10 minutes!). Listen to Dr. Katja Rowell’s simple, practical ideas for creating enjoyable mealtimes for the entire family:
Oogaa makes spoons, bowls and plates that are safe, nontoxic, easy to clean, and most importantly–adorable! Check out their plane, train, and tugboat spoons. They donated a whole big box of feeding utensils for us to hand out in orphanages. And they want to share with you, too.
Like both SPOON Foundation and oogaahome on Facebook and you will be entered in a drawing for this plane, train, and bowl set. Be sure to leave a comment on SPOON’s Facebook page that you liked both pages! The drawing will be held this Friday, February 14th. Gotta love that!
Zeina has returned to India, along with Kate, to check up on the roll out of the Nutrition Screening System. While Zeina worked with VCT’s Nutrition Screening team, Kate spent the majority of her first day visiting two foster homes. Here is foster daughter, Ashika, watching mom prepare lunch.
Zeina Makhoul, SPOON’s Nutrition Scientist, recently returned from Haiti where she trained orphanage staff on the implementation of a comprehensive Nutrition Screening System, developed by SPOON in partnership with Holt International Children’s Services. The Nutrition Screening System is designed to identify critical feeding and nutrition needs of children living in orphanages and foster care. Through the Nutrition Screening System, children with feeding and nutrition needs can be identified and treated before they become impacted by malnutrition.
My second trip to Holt Fontana Village in Haiti was absolutely amazing. I was heartbroken saying my goodbyes to the staff and especially to the children. I got to see the children celebrate their Kindergarten graduation J and International Day of the Child. I got to decorate the stage with Miss Rollande, their teacher, where they performed songs and dances to a big crowd of family, friends, and caregivers. I got to dance with them many times as they practiced to the beat of a popular song by a Haitian artist (Dekole by J-Perry. The song has beautiful lyrics and calls on Haiti and Haitians to rise up and take flight (to “dekole”). I bet you can’t help but dance too!). And I got to immerse myself in the culture and get to know the beautiful people of Haiti.
The rest of the time, I was with Supreme (the Village’s manager), Miss Gilles (the Village’s head nurse) and Nicole and Aselène (two nursing interns sponsored by Holt Fontana), in a small but, fortunately, air-conditioned room training on nutrition, the screening tools, feeding children with special needs, anemia, measuring weight, height, hemoglobin, food allergies, low birth weight, severe malnutrition, diarrhea, and more. Did I mention the training was in French?! While Supreme, the only participant who speaks English, did a big part of the translation, I was alone with the nurses for 3 days. Thanks to my French school education (and skills in Pictionary!), we were able to successfully go through the training and have interesting discussions on malnutrition.
After more than 30 hours of training over one week, we started screening the children at the village. The nurses worked efficiently together; while one took weight and height measurements, the second recorded the numbers on the screening form, and the third got ready for hemoglobin measurement. They switched every few children so they all get a turn to practice all procedures. It was nice to finally see the training put to work.
While most people would flinch at the thought of getting their finger pricked, the children at the Village were so excited, comparing their colored bandages. Not a single tear in the house. They’re the bravest kids I’ve met! The staff found that nearly half of the children were anemic. All the children are receiving a multivitamin and a protocol is now in place to supplement those who are anemic with iron and follow-up with future screenings.
The training was definitely well received. I can see the nurses’ confidence increase and their skills improve the more children they screened. Miss Gilles was so happy that she could finally record information on a form instead of a notebook. Also, the electronic database allows her to print a list of dates for routine screenings, future hemoglobin testing, dates of iron supplementation, doctor’s appointments, etc. for all the children with only few clicks. This will facilitate follow-up care.
As for Nicole and Aselène, they are probably the first two nursing students (due to graduate in August!) in Haiti to receive training on the unique nutrition needs of institutionalized children. They can hopefully apply the knowledge and skills they acquired in other child care institutions or in their practice, wherever that might be.
As the pilot phase continues, we will continue to work with the staff at the Village to refine and improve the nutrition screening system so no child has to needlessly endure any form of malnutrition, even if mild.
Until next time, I leave you with my favorite verses from Dekole:
Si-n vle peyi-n avanse If we want our country to advance
Fòk nou mache tèt kole We must walk together
Peyi sa twò rich pou-l pòv This country is too rich to be poor
Dads are part of the magic that makes the world go round for their kids, so this weekend we are celebrating all you dads out there – Happy Fathers’ Day!
On this day, we also can’t help but think of the tens of millions of children around the world without dads of their own.
When you support SPOON in nourishing babies and kids who are living without permanent families, it means the world – and opens a world of opportunities – to these children.
Will you help us to broaden the horizons of hope for little friends across the globe, by making a pledge of $25 per month to SPOON?
Your monthly gift helps us to sustain life-changing programs for the kids who need us most.
With thanks and in celebration,
Cindy and Mishelle