By Andrew Masinde
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
Agnes Kacho comes from Kengoma village, about eight hours’ walk from Bwindi. At 16 months, she was brought to Bwindi Community Hospital (BCH) with muscle wasting. She weighed 4.7kg, less than half the normal weight of a child her age. Kacho’s body had wounds and abscesses from injections. She was assessed by a team of health workers at the hospital and diagnosed with severe malnutrition, tuberculosis and HIV.
Her mother, who is also HIV-positive, was only 18 years old and had been abandoned by her husband and family members. “We had no hope for survival, but the health workers did all they could to restore our health. They fed us and, indeed, I realised it was lack of food that was going to kill us.” Today Kacho’s wounds have healed and she has gained weight. Mother and daughter were discharged after seven weeks. “The medical team still visits us every month on an outreach site near our home for regular checkup of TB and HIV.
They also give us food. They set up for me a small garden where I was taught how to grow vegetables and fruits and life will never be the same. We are happy the disease was detected early and we were given free drugs and food at the hospital,” Kacho’s mother who preferred anonymity explains. Like Kacho, many people in Bwindi are battling with malnutrition and HIV. Bwindi is a home to some of the poorest, marginalised ethnic groups of the world – the Batwa. They were displaced from Bwindi impenetrable forest when it was gazetted as a national park to protect the endangered mountain gorillas.
The average family in Bwindi has seven children and lives on less than a dollar a day. Bwindi Community Hospital is a community-based organisation operating in Buhoma at the peripheral of Bwindi Impenetrable Rainforest in south-western Uganda. It serves three subcounties of Kayonza, Mpungu and Kanyantogoro and almost all the villages around Kanungu. The hospital serves the most under-privileged population in the area.
The Batwa, a traditional hunter-gather community in Bwindi, are some of the most vulnerable groups in the country. They live in scattered settlements, and with particular health needs, including severe malnutrition. We trained village health promoters (VHP) in different activities for every one of the 200 villages in Bwindi.
They started teaching and screening the residents on behalf of the hospital,” Robert Kamugisha, the head of nursing and midwifery explains. “We discovered over 10% of the children were malnourished.” In Uganda, about 250,000 children under the age of five suffer severe acute malnutrition. About 360 children below five years die daily and nutrition interventions can save at least 120 children.
A mother with a malnourished child talks to Kamugasha
“We had to find ways of preventing malnutrition. We started by teaching households how to grow food and prepare balanced meals,” Kamugisha explains. He adds that the VHPs take records of all the children in the villages; they visit and keep checking onthem every three months.
Those with severe malnutrition are referred to the hospital for special care. With the high rate of referrals, in 2008, the hospital started a child health and nutrition unit to handle the children. The unit provides fortified milk for severely malnourished children for the first three weeks before they start eating foods that boost their immunity.
The milk is from the cows and goats that were given to the hospital under the 3H Rotary grant. During this period, cooking sessions are held at the hospital and parents are taught how to prepare a balanced diet. Grace Byarukunda was displaced from her home to give way to the establishment of the park.
Together with her son, Byarukunda is benefiting from the hospital’s nutrition programme. “Since we were displaced from our home in the forest, I have never seen my husband, I was left with no home, no land and no relative,” Byarukunda recalls. She says she had a twoyear- old boy, and due to lack of food they became sickly.
The community health team visits the areas around the hospital three days a week to teach people the importance of proper nutrition and how to achieve it. The community team and the village health promoters form the core of the BCH prevention strategy in combating preventable diseases and malnutrition in the area.
The hospital team also trained parish child protection committees in Bujengwe, Ngaara, Muramba, Mpungu, Buremba and Mukono parishes and 60 children’s rights advocates were trained.
These are charged with the responsibility of identifying children whose rights are abused, making reports and reporting to the BCH and all other authorities. “Many of the malnourished children were also found to have suffered some form of physical abusem, while others were neglected.
To a large extent, malnutrition and child abuse are linked and should be fought together,” Kamugasha says. The hospital also has specialist clinics every week for children with long-term illnesses. “We work with health organisations like Organisation Useful Rehabilitation Service (OURS) and Comprehensive Rehabilitation Services in Uganda (CoRSU), which offer additional services such as physical rehabilitation and repair of congenital defects,” Kamugasha says. He adds that every month they see more than 500 children at the outpatient department and admit more than 100.
Joseline Ninsiima, the BCH communications officer, says outside the ward, the hospital has a children’s play area, a kitchen and a demonstration garden. “Our staff organise practical cooking sessions with the mothers of the admitted children every week. These are always preceded by singing and dancing,” she says.
Children who were previously admitted with severe malnutrition are followed-up after every two weeks to assess their nutritional status. Since hunger was the major cause of malnutrition, BCH patterned with St Francis Hospital Mutolere and Sustain for Life to develop and implement a comprehensive organic agriculture project.
Their purpose was to feed patients and staff and train vulnerable community members, especially the Batwa, in sustainable agriculture. We train communities in sustainable agricultural and low-cost farming practices, nutrition, sanitation and income-generation,” says Birungi Mutahunga, the executive director of the hospital.
The hospital provided over 10 acres of land where local people are trained in vegetable growing over the first three years. The project is to benefit over 5,000 patients and hospital staff and over 8,000 Batwa in the neighbouring communities. BCH is working closely with the community members and Batwa leaders to ensure the success of the project as a model for future interventions.
The hospital, together with the WASH project, also introduced a radio programme to sensitise school children and parents on sanitation by setting up water facilities in homes. “We are happy that the levels of malnutrition in Bwindi have reduced drastically from 10% to 4%. Our target is to eliminate malnutrition from Bwindi and the neighbouring areas of Kanungu,” Kamugasha says.
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 firstname.lastname@example.org giving name, telephone contact of nominee and reasons for nomination. Type food, the nominee’s name and SMS to 8338