May 2023 trip to Lira, Uganda

20 . 06 . 2023

Name: Laura Flynn

Role: Specialist Head and Neck Oncology Dietitian, Poole Hospital, University Hospitals Dorset

I have always wanted to use my dietetic skills in developing countries and have long had a passion for Africa. So, when I was introduced to the Poole Africa Link by Sarah Currell, a retired paediatric dietitian, who had been twice before, I jumped at the opportunity.

The preparation

Getting ready for this trip involved organising vaccinations, fundraising, and preparing teaching material. I prepared material on both infant and maternal nutrition, basic nutrition concepts, global nutrition and the nutrition transition, nutrition for wound healing, anthropometric tutorials, nutritional biochemistry tutorials and communication skills roleplays.

The trip

University

On arriving at the university, a sign ‘nutrition services offered here’ was hard to miss. I was immediately interested but, despite efforts, I was unable to determine if this service is being delivered.

The students were very engaged and had a good basic understanding of nutrition. To find out more about local foods and cooking practices we asked the students to list foods under each macronutrient.

Main protein sources:

Animal: silver fish, pork, beef, liver, chicken, eggs and insect’s

Plant: beans, cowpeas, ground nuts and boyo seeds.

Main sources of carbohydrate: cassava, millet, matooke, sweet potatoes, maize, yams and rice.

Some of the teaching I delivered:

Introductory nutrition, the nutrition transition and infant feeding, with a focus on breastfeeding, to 3rd year midwifery students. We did an infant feeding quiz before and after the lecture. This proved a great way of engaging the students and seeing how much they had learned during the talk.
Maternal nutrition to 3rd year midwifery students
Supported Peter, consultant neonatologist, in delivering neonatal resuscitation and basic adult life support to 1st and 2nd year nursing and midwifery students
Safe for surgery course: the whole team delivered a Saturday course to 4th year students. I delivered talks on the importance of communication and teamwork in the OR, understanding the need for leadership and paediatric fasting pre op.

Referral Hospital

Seeing the hospital for the first time was overwhelming. A collection of buildings connected by uneven, rocky paths with green spaces filled with people, the relatives of patients.

At the hospital, there is a therapeutic feeding centre. I was very excited to meet the nutritionist, Ann, who works here. On arrival at the reception, I could see MUAC and acute malnutrition classification posters on the wall, along with RUTF dosing charts and a timetable of maternal education topics (breastfeeding, complementary feeding, family planning, malnutrition, malaria control and hygiene).

I spent some time with Ann, learning about her role and the workings of this department. Patients are admitted with either MAM or SAM. Nutrition provision of feeds include F75, F100 and RUTF. Ann mentioned the need for a kettle for clean water to allow feeds to be made up effectively as sometimes they have been left to boil water on firewood outside the hospital.

We were delighted to give the feeding centre a new baby scales, kettle and hand out knitted hats, dresses and blankets to the mothers for their babies.

I met a group of 4th year medical students and went on the very long ward round with them led by the paediatrician. This was an invaluable learning experience for all as I was able to identify possible nutrition problems and solutions. The medical students were very keen for some nutrition training.

Teaching I delivered at the hospital:

To 4th year medical students: dietetic assessment of the paediatric patient, maternal nutrition and breastfeeding practices, nutrition for the sick child, physical signs of nutritional issues and a tutorial on MUAC and head circumference measurements and fluid requirements.
Discussion with Ann, regarding nutrition for renal disease and dialysis, as the hospital have just started delivering dialysis but there are no nutrition services available to optimise this care. I shared some resources with Ann to help bridge this gap.

Adina Foundation rehab centre

Adina work with children that need orthopaedic surgery, which is fully funded including rehabilitation after surgery. I supported Kat, paediatric physiotherapist, who worked with the centre’s physiotherapist to diagnose and treat the different needs of the children. I was able to provide pre-op counselling to some of the children getting ready for their surgery and encourage different physio exercises.

We had planned to go back to Adina another day to deliver teaching however, due to team sickness, this was not possible.

However, there is a real need for nutrition education here as children often present with a risk of malnutrition/ are malnourished with a greater need for certain nutrients due to the nature of their bone/ muscle health. Furthermore, nutrition could optimise the physio work the centre are doing.

I had planned to deliver training to the staff on

How to use MUAC to determine malnutrition risk
Wound healing nutrition
Bone and muscle health nutrition
General nutrition concepts

Nutrition and Dietetic links

Freda, is the head of nutrition at the university, and while Freda was away on outreach projects, we have been in contact regarding the departments plans to set up a dietetics course here!

Robert, a nutritionist working at the university hospital, was unfortunately also away during my trip but we spoke on the phone and have made a link for future PAL trips.

Nutrition education for future trips

Support dietetic course development
Deliver nutrition training to staff at the Adina Foundation
Continue to deliver nutrition education to both students at the referral hospital and university
Support nutritionists at both the referral hospital and university hospital to develop services offered and standard of nutritional care delivered
Explore and support nutrition services offered at new outpatient department at the referral hospital

Conclusion

There is a clear need for dietitians in Lira and I strongly encourage dietetics to continue working with the PAL on their twice-yearly trips. This experience was challenging but overall, the most rewarding thing I have ever done. It has truly been life changing and I cannot yet fully describe the impact the trip has had and will continue to have on my life and my choices.