Mwana Mugimu breathes life into hopeless children

By Joseph Ssemutooke

As part of its annual series, Ugandans Making a Difference, New Vision will, until October 3, publish articles on individuals and organisations that have dedicated their efforts to fighting malnutrition in the country. The articles will highlight the causes, discuss solutions and recognise the efforts of those working to avert the problem that affects up to 54% of children under the age of 18 years in Uganda

The bright yellow walls exude warmth and the cartoons and animal paintings on the walls bring life into everything around. From the glistening floor tiles, to the spotless white apparels of the beds, and warm faces of the people around, both the attendants and the patients, the environment is immaculate.

If your idea of a hospital is one of doom and gloom, you will be pleasantly shocked when at Mulago Hospital’s Mwana Mugimu Nutrition Unit. Through a small gate, along the spotless concrete floor adorned with pockets of green vegetation, the ambience is a marvel. The only thing to remind you that you are in a hospital is the sight of cannulas hanging on the children’s thin hands, the white gowns flying in the corridors, and the array of beds carefully arranged in rows, with the attendants seated on the floor between the beds.

Breathing life into the hopeless

Located on the northern side of Mulago National Referral Hospital, of which it is part, Mwana Mugimu Nutrition Unit is Uganda’s prime centre that medically handles nutrition complications in children. Having existed since 1964, the centre is the largest and oldest health unit in Uganda dedicated to child nutrition. It has more staff, handles more cases and offers a wider range of child nutrition services than any other child nutrition facility in the country.

Complications resulting from malnutrition are currently widespread in Uganda, affecting about 54% of children, about 15 million of the country’s 25 million children. The incidence is even higher among the under five-year-olds, with one out of three children stunted.

Being the national referral centre for all acute malnutrition cases means that Mwana Mugimu (with about 60 health workers who include doctors, clinical officers, nurses and administrative staff) deals with urgent cases that cannot be handled by other facilities that do not primarily focus on nutrition. as something to do with nutrition. Others are general referral cases referred by health workers at health units elsewhere, in any part of the country, after assessing the severity of the problem.”

A duty, a commitment

Babirekere says: “When we receive a malnourished child at the unit, we examine him to determine whether the situation warrants an admission or it can be treated on an out-patient basis.

“Once it has been determined that the child requires admission, we take the child through three treatment phases.”

Babirekere explains that the first phase involves admitting the child to the resuscitation ward, also known as the Critical Care Unit. Here, the child goes through the urgently-needed first steps to resuscitation.

Children here are treated for infections and fed on a special type of milk fortified with nutrients and drugs to revive their digestive and general body systems.

It is here that sometimes patients are put on oxygen. The section is also called the Giraffe Ward. The children are normally very thin and most of them stay here for about three weeks before they improve. However, some improve faster, while others take as long as six weeks.

From the resuscitation ward, children whose condition has improved from ‘very acute’ and ‘life-threatening’ to ‘quite stable’ are moved to the transitional unit, also known as Zebra Ward. Here, the children are fed on nutrient-fortified milk every three hours and also re-introduced to solid foods.

From the Zebra Ward, children whose condition has stabilised are moved to the Elephant Ward, where the job is primarily to buttress the gains made in the first two wards. Here, focus is as much on nutrition as it is on educating the parents/caretakers on how best to feed the children when they go back home.

true
A baby being fed at Mwana Mugimu Unit

Holistic treatment

Babirekere says the purpose of teaching the caretakers how to care for the children is to avoid a relapse. The parents and caretakers participate in the preparation of their children’s food to give them hands-on proper food preparation methods. They are taught how to balance the children’s meals, what types of food to give, in what quantities and at what intervals.

Julie Wamala, another nutritionist at the unit, says: “We aim to give a holistic treatment, so beyond feeding the children and teaching their caretakers how to properly feed them, we want to help ward off the trauma caused by their sickness. We have a facility where they go to play, relax and learn.”

After realising that poverty was one of the commonest reasons why malnutrition was affecting children, recently Mwana Mugimu also began to teach parents how to undertake and succeed at income-generating activities. They, especially, teach and support poor parents so that when they return home, they can have food to give their children.

Out-patient and research services

For those children whose condition does not require hospitalisation at the unit (the majority), Mwana Mugimu offers treatment and advisory services on an out-patient basis.

Babirekere says Mwana Mugimu has also made its nutrition services available in 17 clinics in Wakiso and Kampala, where, in cases that are not severe, medical and advisory services can be accessed without going to Mulago.

However, the reach of the unit’s services seems limited considering that more than half of all children in Ugandan suffer some form of malnutrition and require either Mwana Mugimu’s treatment or advice.

Dr. Elizabeth Kiboneka, the head of the unit, says they would like to see Mwana Mugimu extend its services to a much wider expanse, perhaps even across the country. For now, their capacity cannot allow unless they get support. The unit is currently funded entirely under the Mulago budget, and the only other support is of therapeutic feeds given in kind by the United Nations International Children’s Emergency Fund.

Besides treatment and advisory services, Mwana Mugimu is also a centre for research on issues about child nutrition. Kiboneka says a lot of research — medical, demographic studies and public health — is carried out at the unit.

Do you know any individual or organisation focusing efforts on improving nutrition in communities? Write to the Features Editor, P.O. Box 9815 Kampala

or e-mail features@newvision.co.ug giving name, telephone contact of nominee and reasons for nomination. Type food, the nominee’s name and SMS to 8338