Nutrition scientist for SPOON Foundation, Zeina Makhoul, spent a week training staff in Haiti’s Fontana Village to recognize and treat causes of malnutrition, which is often a deeper and more complicated problem than just making sure a child has enough to eat.
by Billie Loewen, Staff Writer
Late June was a time of celebration at the Holt Fontana Village childcare center in Haiti. Everywhere, children prepared for the festivities of kindergarten graduation — which they traditionally celebrate in a big way — and the International Day of the Child. Boys and girls practiced dances and presentations, dressed in white and tan linen suits and skirts. Some children received haircuts, and many greeted the few American visitors with hugs and games. One of those visitors, Zeina Makhoul, is well known by the children at the village, since she had visited less than a year before.
Zeina is the nutrition scientist for SPOON Foundation, a Portland, Ore., based nonprofit that began in 2007 and now works internationally and domestically to improve the way orphaned, fostered and adopted children are nourished. As a partner of Holt, SPOON works to design and implement a wide range of sustainable and affordable nutrition programs to optimize the health and well-being of children in care overseas.
After forming a partnership last year, Holt and SPOON chose three pilot sites to begin developing a comprehensive nutrition screening system for children in care. These include the Holt Fontana Village in Haiti and Holt’s partner organizations in India, Vathsalya Charitable Trust and Bharatiya Samaj Seva Kendra childcare centers, two of Holt’s legacy partners in the region.
Only six weeks before Zeina’s recent trip to Holt Fontana Village, she trained staff at the two sites in India on nutrition, child nutrition screening tools, and identifying critical feeding and nutrition needs. Together with the staff, she implemented a comprehensive nutrition screening system. She then traveled to Haiti for the second time to do the same.
Around the world, malnutrition is responsible, directly or indirectly, for 60 percent of the 10.9 million child deaths annually in kids under 5. Malnutrition can cause delayed motor and mental developments, reduced resistance to infection and irreversible stunting of growth. In Haiti, one of the poorest developing countries in the Western hemisphere, anemia and Giardia are extremely prevalent. Few social services are available, and a massive earthquake in January 2010 caused devastation to infrastructure that still remains in poor condition in many areas today.
Zeina, along with her Holt partners, are working to change that.
On Zeina’s first visit to Holt Fontana Village in September 2012, she learned that Holt spends a large portion of their budget in Haiti to feed the children who are served there. However, tracking the nutritional value of the meals can be difficult, and identifying and tracking the children’s growth and risk for malnutrition isn’t easy. Zeina worked with executive staff at the village to learn about the demographics of the children, menu planning and the clinical care children receive. She also spoke to local doctors to learn what types of illness are common near the village, and what types of medical supplies and nutritional tracking resources are available — all information that would help Zeina provide the most useful training on her next visit.
From June 24 to July 2, Zeina provided manuals and practical, hands-on workshops to four members of Holt Fontana Village’s staff, including their program manager, Supreme, their head nurse, Miss Giles, as well as nursing interns Nicole and Aselène. In a simple, white-washed room with plastic tables and a white board, the trainees flipped through their French-translated manuals, which are three-ring binders full of diagrams and procedures, charts and graphs. Through the training, the nurses learned how to screen for iron deficiency and anemia using a Hemocue machine that measures hemoglobin in a blood drop collected by a finger prick. The nurses also learned how to interpret hemoglobin values and how to appropriately supplement the children with iron to treat and prevent anemia. They learned to properly measure height, weight, head circumference, and body mass index, and how to track healthy and irregular growth patterns. On the last day, they discussed signs and management of food allergies and intolerances, nutrition and feeding considerations for children who lack the oral motor skills to safely swallow or feed themselves, and how to care for children who have trouble adapting to unfamiliar flavors or textures.
With Zeina’s help, the staff moved far beyond the basics of providing nutrition. Staff learned to identify and care for the nutritional and health needs of children with physical and cognitive development disabilities, including cerebral palsy and congenital heart disease, as well as special nutritional struggles associated with special health care needs like iron deficiency anemia, severe malnutrition and low birth weight.
After more than 30 hours of training in four days, the implementation phase of the nutrition screening system began. It was impressive to see the three nurses finally putting the knowledge and training they received into practice. They 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. Nurses screened all the children at the care center, entering data into trackable and individualized medical charts and then into a simple electronic database so child information is securely stored and easily retrieved. While most people would flinch at the thought of getting their finger pricked, the children at the village were so brave and excited. Not a single tear in the house. The staff found that nearly 50 percent of the children at Holt Fontana Village were anemic, but they also made a plan to turn those numbers around.
“The training was definitely well received,” Zeina says. “I can see the nurses’ confidence increase and their skills improve the more children they screened. Miss Giles was very pleased that she can now record information on a form instead of a notebook and she can easily track the care of the children using the database. As for Nicole and Aselène, they are most likely the first two nursing interns 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.”
To learn more about our work in Haiti, click here.