Monday, July 23, 2012

Taking my Knowledge to New Extremes!

From June 4 through June 25, I set out on another Haiti adventure. The first week of my trip, I led my first mission team on an unforgettable experience to Haiti. All 11 team members were young adults between the ages of 20 and 30 years old... all with such giving and open hearts. It was such a unique experience to be able to share third world poverty with people my age.. people I have grown up with, people I have worked with, and people I had just met. Even though I had been designated the leader of the team, I felt as though each member on my team helped challenge me to become a stronger leader, friend, and member of our global community. Each person brought forth their gifts, talents, and expertise that helped me to see more clearly the beauty of community... and how the value of positive and supportive relationships can aid in creating a more just world. Each team member served and led the team in ways I had not anticipated... offering up ways that we can have an impact on the world, challenging each other "to go deeper", and encouraging each other not to become complacent upon the return home from this encounter with 3rd world poverty.
My beautiful team! 

Bringing clean, free water to the people of Cite Soleil

The slums of Cite Soleil

Playing with the kids at Gertrude's orphanage for special needs and handicapped kids.  

We took a few hours out of our week of service to see the hope and potential for Haiti!! 

Most of the team came as strangers, but all left as friends!!

After this wonderful week of cultivating new relationships and sharpening my leadership skills, I said goodbye to my team at the airport and headed up to Grace Village Orphanage in Titanyen to use my nutrition skills to strengthen and support the children sponsored by Healing Haiti. Grace Village is currently the home to 62 children between the ages of 20 months and 17 years old. Within the walls of the community, there is a boys dormitory, a girls dormitory, a feeding center (my "office"), and the largest playground in Haiti. The village is currently in the process of building a talapia farm and a school, but also has plans to build a church, a soccer field, and a medical facility. While Grace Village remains a gated community within the town of Titanyen, it opens its doors to the people within the surrounding community during worship hours (specifically Sunday morning and weekly evenings). Many of the children, in their best worship clothes, run up the hill to the village to join our orphans and delight in the service facilitated by our Haitian Pastor. Following the Sunday worship, the kids are all given a small loaf of bread with butter (or peanut butter) and allowed to play on the playground. As Grace Village continues to expand and grow, it will continue to serve the community of Titanyen in many more beautiful ways beyond worship and play.

Grace Village Orphanage 

The kids' at their morning activities!! 

My trip to Grace Village was originally planned to be a one week trip in which I would obtain follow-up nutrition assessments on all of the children, preform a 3-day diet analysis at the Feeding Center, and make recommendations to enhance the meals served by the Haitian staff. Several days before my departure from Haiti, I decided that the week had not been enough. I did not feel confident leaving knowing that there was still a lot of work left to be done. I contacted my mom in the U.S. and had her help me adjust my airfare in order to spend an unexpected, extra week in Haiti. It was a long, stressful two weeks at Grace Village.... being challenged in ways I had not expected. 

My first day at Grace Village, I immediately began my nutrition assessments on the children. I gathered heights and weights on all of the boys, and on all of the new kids we welcomed into our community. The new kids were in pretty rough condition; many having extended bellies, gaunt faces, sunken eyes, and irritable/ closed off dispositions. These kids were very malnourished and where just starting to accommodate to the new environment they too would soon call home. It was a never ending experiment trying to figure out how much food intake the new kids' could tolerate; I kept having to adjust.. and readjust.. and adjust... the portion sizes for these kids. Some would seem like they were tolerating the intake and portion sizes well, and then before you knew it... they would be exhibiting physical signs of refeeding syndrome; reporting abdominal pain, 
excessive sweating and dehydration, fatigue, physical weakness. It was a constant back-and-forth battle trying to figure out their individual needs. I spent several day thinking we had conquered the "hump" of refeeding.. then one kid would be complaining of upset stomach pains, and I would find myself at square one again. Not only was it difficult monitoring the portion sizes for the new kids, but I always felt like a "watch-dog" at meal times. There were several of the kids I would catch scarfing down the food leftover on the other kids' plates. Some of the kids' were mentally starving to eat.. even though their bodies were  physically unable to metabolize the large portion of food they had just inhaled. One day, I noticed a new boy sitting on a bench in the feeding center, glistening with sweat, and looking as though he just ran a marathon in the Haitian heat. This was one of the boys I had caught on several occasions scarfing down extreme portions of rice at meals. I sat down with the boy and one of our Haitian translators to see  how he was feeling. The young boy denied being in pain, but through discussion I discovered that he was having trouble running and trouble moving around. He was extremely fatigued. I felt his belly.... it was extended and as hard as a rock. It must of hurt or have been at least uncomfortable. The translator, the boy, and I had a discussion about being careful to not overeat at meals, and helping him to trust that the feeding center will always have more meals and snacks for him. He won't ever go hungry again... unfortunately, the psychological damage of food insecurity has already been done and it will take some time, trust, and counseling to help him understand that there will always be 3 meals served to him daily at Grace Village.

Extended bellies... 

Some unexpected stress!

Measuring waist circumference. 

There was another child that I had to monitor her portion sizes and food intake more closely. She was strictly on a low carbohydrate, moderate protein, and high fat diet due to her severe state of wasting, malnutrition, and parasitic infections. She was my most complicated case of malnutrition, yet. Once we were able to get her to tolerate frequent feedings, we boosted her caloric intake and had her consuming well-portioned meals/snacks every 2-3 hours. Her diet consisting mainly of avocados, eggs, small portions of bread/rice/noodles, fruit, peanut butter, yogurt, and supplements of ensure and medika mamba. The rational for her intake ratio of fat to protein to carbohydrate was directly related to the metabolic state her body was currently in; to feed her a normal to high carbohydrate diet would put her body in a state of shock... eventually leading to death. The ingestion of carbohydrate 
causes a surge of insulin release in the body, and under normal conditions the cells of the body will take-up insulin and glucose (the most simple form of carbohydrate). With individuals that are extremely wasted (lacking adipose cells) and malnourished, the body is not able to adjust to the insulin rush and clear insulin from the blood. The body shifts states of metabolism from using body tissue, such as fat and protein, to now using extraneous glucose sources. This drastic shift in metabolic sources of energy leads to catastrophic conditions for the individual. Thus, from a dietary perspective, it is of most importance to 1. ensure that the individual is properly hydrate and in a state of electrolyte balance and 2. fed small feedings of predominantly high fat and high protein foods to allow the body to "recognize" the molecular composition of the food source and to be able to metabolize the extraneous sources in a similar fashion as during the malnourished state. Once the body has adjusted to the frequent, small feedings, and weight restoration has begun, carbohydrate intake can be increased within the diet and caloric intake can be increased to further initiate weight restoration. (for more information on refeeding syndrome, I have found this resource to be a fairly easy read to better understand the complex issue: Without using biochemical feedback and blood samples, combating malnutrition can become very complex and has to become a purely observational and intuitive process.

Avocado and eggs were the base of my most critical case's diet for a few days. 

As you can probably assume, my skills as a new dietitian were greatly challenged during the process of refeeding our most critical case. Not only was I dealing with a compromised state of malnutrition, but I was also in a third world country with minimal resources. To further complicate the experience, we were without Internet at our orphanage for 5 days so I had limited references and resources to rely on; there was a riot in the city around us so we were unable to leave the walls of our compound, which impacted our ability to go to the market to purchase fresh produce. Thankfully, we had an emergency food supply of canned goods and Feed My Starving Children Food in the feeding center, however, trying to refeed a malnourished child on a restrictive diet became very challenging. These drastic conditions made me realize the many things we take for granted in the United States... access to safe and reliable food, having shelters that can provide food to those who struggle with food insecurity, and the everyday conveniences of many Americans have in our daily lives (going to caribou, enjoying a meal at a fine restaurant, basic food security). 
This is a picture of the early stages of the riot in our town. People were burning tires on the main road. 
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This is one of my "mamba boys" .. he has gained over 10 pounds in the past 6 months and is starting to look like a teenager! Don't mind his "tough boy" face in the second picture... the boys were supposed to be helping me get pictures of all the kids at the orphanage. They got pictures of all of them, but were having fun with my camera not realizing the pictures were for research purposes! This mamba boys is actually a really big sweetheart and not the "tough-boy" he appears to be!! 

In addition to closely monitoring, assessing, and reassessing all of the new children, I was also working closely with our feeding center and our Haitian staff to enhance the meals provided at the feeding center. I spent hours in the kitchen observing the staff hard at work to prepare enough food for 100+ people. (Not only do we provide enough food for 62 children, every lunch we provide 10 hot meals to elderly within the community through our "meals-on-wheels" program, and for the staff working in the kitchen, as part of security, and on the construction). It was wonderful to be able to spend time with the Haitian ladies and to help teach them ways to increase the nutritional value of meals they provide to the kids. I worked closely with our Haitian feeding center director (who is a phenomenal young lady that speaks English, is wonderful with the kids and staff, and is eager to learn new things). I taught her about food groups, went to the market with her to show her what produce would be great to have at the feeding center, and showed her simple ways to help meet the kids' dietary needs. We worked on increasing the ratio of beans to rice (beans were often lacking) to help increase the amount of protein in the children's diet. We also worked on incorporating more whole fruits and vegetables for vitamins, minerals, and fiber. 
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This is one of the days from my 3-day diet analysis at the feeding center.


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We worked on eliminating the juice and replacing it with whole mangos, slices of watermelon, and fresh pineapple! 

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The staff made that dish above that day after I showed them how to use whole vegetables... they did it without me even being in the kitchen or asking them to do it!! I was so proud of them!!

I went many days on only 4 hours of sleep, as I stayed up late reassessing the cases of malnutrition, planning out the next days' feeding regimens, and plotting about how I would use the limited resources I had available to enhance the lives of these beautiful children. It was an intense 2 weeks of work, but my passion for my mission was fuel for my fire. I was determined to leave knowing I had done enough "damage" that the changes would be implemented long after I was gone.. and that the kids on supplements would continue weight restoration. Besides just "work"... I always made some time for play! I enjoyed listening to the kids sing and praise, dancing with them on the courtyard of their dorm rooms, eating meals with them, and tucking them into bed each night! 

The girls LOVED being ballerinas with me!!

So what is next for me..... I am heading to Haiti again this fall and will be there for two months (September 24- November 19) to continue improving the quality of life for the people we serve in Haiti through good nutrition.

 I appreciate all of you that have been following and supporting me along this journey.... it means so much to me!!!

1 comment:

  1. hi kristina! i came across your blog somehow through google- im a junior in dietetics at the university of MD at College Park and also have the same passion as you for nutrition on the missions field. I've been going to Guatemala every summer for the past 11 years to serve at a children's home. My ultimate goal is to one day work for WHO or a similar organization where i can get paid to do it :-) but for now i am praying for connections and opportunities that will lead to something once i've become an official RD. Anyways, your blog is inspiring and I'm so happy to find someone with the same passion as me! May I ask what if any educational steps did you take to prepare for specifically treating malnourished children? Because that is not a major focus at all at my school in dietetics. I would love to know what you did to prepare and gain knowledge in this area! Thanks!