Under 5 Clinics

Monday morning is quite busy. Not going to lie, sometimes I dread Monday morning Under 5 Clinics. Not that I don't enjoy my work or meeting new people - it's the energy at the hospital. It's busy and overwhelming and completely opposite of the vibe of Malawi. 

Some background info:

Every person has what is called a Health Passport. It's the size and shape of a passport, but inside are blank pages used to document diseases, treatments and monitor growth (for children). The idea is to catch when a child is underweight before too long so we can start him or her in the Nutrition Rehabilitation Unit, if necessary. There is a graph where we chart the weight of the child each month. Some mothers are very diligent and bring their child every month to be weighed (especially first-time mothers and mothers of under 1 children). Some mothers bring their child only when he or she is sick (maybe because the hospital is too far away, maybe they just don't see the importance of weighing babies) and so I have to go through and count off the months where the mother did not feed her child and then let her know that she needs to come more often - once a month, please.

Ideally, when it's slow enough (Tuesday - Thursday, which are not clinics, but mothers can weigh their children anyway), I greet the mother. She greets me back with a smile, hands me her child's health passport, she throws her child from her back to the front and lifts him or her off with her tied chitenge to hang on the hanging scale. I look at the weight, tell the mother it looks good, she smiles, we slide her baby off the scale, I document in the health passport and then again in the hospital register. The mother gets the book back after the clinic.

This baby weighing utopia is hardly what happens on Mondays. On Mondays, I arrive by 9am to find women are lining the hospital walkways up to the scale; waiting for me to weigh their baby and write it in their book. They are often impatient, pushy and demanding. I think it's because there are so many women waiting, they are afraid I won't weigh their child.

I can promise you, Ama, I have nothing better going on. I will weigh babies until I am tired, hungry, the cows come home - it doesn't matter. Nothing will come between me and the weighing of your infant.

Unfortunately, I don't have the language skills for that, so mostly I greet, tell people to slow down, tell people I only know how to speak some Chitonga, tell people to move into the other room for the clinic.

While suspended mid-air, babies scream and kick (espcially with one look at my scary white face) which makes it hard to read the scale. Sometimes babies get so scared hanging by a cloth, that they pee - sometimes on people sitting to close to the scale. Sometimes children are kicking so bad that they come loose out of the chitenge and start falling toward the cement (I always keep an arm outstretched for such occasions). Sometimes women yell at me - I don't know what they are saying, which may be a good thing as I don't care to be yelled at first thing in the morning.

After their child is weighed, the women go to the waiting area where sometimes their child will receive a vaccine or vitamin drops. The HSAs go down the line of women, who pull up the pant leg of their child to be vaccinated or open the mouth of their child for the vitamins. While waiting, someone (it should be me, but I don't yet know the lyrics) will lead the women in songs about family planning and keeping your children healthy. The songs are sung in Chichewa and Chitonga and often have fun hand movements and dances. I like to dance, so it works out well. After about 20 minutes of singing, someone in the community will give a health talk on a topic - maybe malaria prevention, nutrition education, HIV, etc. The health talk usually lasts 30 minutes or so and then the clinic is over.

If a child is severely malnourished, I have to reprimand the woman (my Tonga skills are still lacking, so I let hospital staff know that there is someone who needs Nutrition Rehab) and she is usually asked a series of questions regarding the child's eating habits and what is going on at home. The child is then measured using MUAC, which looks at the height and weight of the baby and also the circumference of his or her arm. If it is within a certain range, the child is admitted to NRU, if the mother agrees. I have had mothers say no to NRU because they are "too tired", "don't feel like it", "maybe next time" and this is where the truth comes out: If you don't get your child help, he/she will certainly die. The mother usually obliges. We will either admit the child to NRU (where I will proceed to feed the babies every 3 hours with nutrient-packed milk) or we will give the mother the supplement to feed her child at home. It's preferred if the mother will stay at the hospital so we can monitor her child's health. Underweight babies are not VERY common, but common enough to have a ward at the hospital especially for them.

Easy enough?

In theory, yes. But I can't tell you how many times I have left the clinic close to tears from the screaming babies, pushy mothers and people who just won't do what's best for their child. Frustrating, but also rewarding when a mother smiles and says thanks.