Reflections from the Medical Director

Here is what I’ve learned in my 5 months in the fight against child malnutrition in Haiti:

Malnutrition – to many in the outside world malnutrition is pictured as severe muscle wasting and swollen bellies. However, there are other significant signs of malnutrition and sometimes there aren’t noticeable weight loss, yet there are subtle signs such as the colour and texture of a person’s hair, skin appearance, swelling in the body!

The 2 types of malnutrition we see in children who pass though our center are Marasmus and kwashiorkor. Big words! I remember marasmus = muscle wasting “same first letter”. Marasmus is caused from a lack of multiple key nutrients in a person’s diet. In Kwashiorkor there is mild to severe swelling in the body due to the lack of protein in a person’s diet.

Although most of malnutrition portrayed in TV commercials are the skeleton looking children (marasmus), kwashiorkor does not get the attention it should. It’s very easy to diagnose and with kwashiorkor malnutrition, the swelling starts in the feet and works its way up the body. I call kwashiorkor malnutrition the silent but highly lethal condition. The swelling puts so much stress on the body’s organs especially the heart. We treat kwashiorkor malnutrition with 72 hours of F-75 which helps reduce the amount of fluid in the body. I assist our Haitian doctor and nurses with a lot of wound care from splitting skin due to swelling. Once the swelling reaches the face it takes the child’s emergent care to a critical state. The risks we struggle with are children going into shock from reducing the fluid in the body too fast, prolonged strain on body organs if we reduce the swelling or we run the risk of swelling reaching the brain.

Finally, while juggling all the many balances in the body such as fluids, electrolytes and nutrients we do run the risk of Refeeding Syndrome which simply is the metabolic disturbances that take place when re-introducing nutrition into a child’s diet who are starving. The initial first 4 or 7 days Refeeding Syndrome can occur and the complications are of this are cardiac, respiratory, and or neurological symptoms.

We may not be able to change Haiti’s malnutrition crisis today or tomorrow, the majority caused by economically circumstance, but we can impact one child’s life at a time while raising awareness of malnutrition such as spotting it early and treating immediately and teaching malnutrition prevention are the golden keys in the fight against malnutrition in Haiti.


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