Nutrition Mission: an education for everyone, by Natasha Mir

Our volunteer dietician Natasha Mir writes about the Nutrition Mission in Ethiopia, on which she trained around 70 Ethiopian health workers and learned about the challenges they face when it comes to working with babies who have cleft lip and palate.

I went to Ethiopia with Project Harar to deliver some training to Project Harar’s staff and the local Health Extension Workers on good nutrition and measurement. Having never been to Ethiopia before, and not knowing how much the local health workers already knew, I was a little apprehensive about the teaching I was delivering, but in the end the mission proved to be a huge success.

One the first day we were based at a village high school. We were in quite a rural location in Ker’sa district, and travelled on some very long, bumpy and dusty roads! On the second and third days we were at a health centre closer to Harar.

I was so impressed with the ladies involved in the training, as they were really enthusiastic. They all sat at the desks and were very attentive and engaged. Everyone understood very well that improving nutrition could really improve the wellbeing of the patients that they see, and they all had good knowledge of the causes and consequences of malnutrition. We had sessions demonstrating measuring height, weight, and making nourishing food that could be given to babies with cleft.

Listening to the challenges faced by the health extension workers I began to understand the complexity of their jobs. The biggest challenges they faced were things like a lack of food, water or resources; lack of awareness among mothers that malnutrition exists, or that nutrition is important; and a lack of knowledge of how to prepare meals in a balanced and hygienic way. They all discussed having a hands-on approach in their villages, and we agreed that changing attitudes can take a long time.

The training gave us a great opportunity to discuss how Project Harar works, and how it can help people with cleft return to a normal life. The health workers all seemed shocked by the information we were providing them with - many had thought that cleft surgery involved removing muscle from legs and arms. We were able to give them reassurance about the surgery, which is information they can now pass on to the parents of children with cleft.

Nearly everyone was aware and able to identify cleft lip, but far fewer were aware of cleft palate. We also told them that a baby had to reach a weight of 8kg to be ready for cleft surgery. The health workers said this was really useful, as they had not known this previously. One lady in particular told us she had seen a child in her village with cleft lip. He was currently 5kg, and she hadn’t understood why he couldn’t have surgery. Now, knowing the weight referral criteria and the increased risk of complications post-surgery if a child is undernourished, she can work hard with his family to improve his nutrition, so that he can be ready for surgery sooner.

It filled me with confidence that by passing on this knowledge we will get more referrals, but more importantly we will get referrals who are nutritionally in a better position and able to have surgery. Raising awareness of this and highlighting that there is treatment for cleft has been so vital. One lady over lunch told us that about 6 months ago there had been a baby girl born in her village with cleft. She saw the baby for a few weeks, but sadly in recent months the baby has not been seen. She explained to us with the knowledge that she had gained from Project Harar she could now confidently intervene and help families get treatment for their children.

Overall we all learned a lot, and the training has highlighted that raising awareness is key. We got really positive feedback from the zonal officials, and I feel if it is possible it would be great to be able to extend the training to different areas of Ethiopia.

Our Ethiopian Program Lead, Biniyam, was a fantastic help and can now take the training to other zones himself. On the request of the International Medical Corps and to promote the teaching even further we have also developed a leaflet highlighting the key learning points, which will be distributed to a wider range of areas. With this training we are hopeful that we will continue to improve the quality of the work we are doing!


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