From: steve collins <steveatconcern1.demon.co.uk>

Subject: Therapeutic feeding in Port of Prince and UNICEF decision to stop supplying milk

Date: Mon, 29 Dec 1997 13:16:07 -0000

Dear NGO-nuts

On a recent visit to Haiti I was shocked at the conditions in the nutrition unit of the teaching hospital in Port of Prince. The standard treatment for Kwashiorkor appeared to be a dextrose-saline drip despite the reasonable knowledge base of the medical staff who knew that this was not appropriate. The result was that the staff reported a mortality rate amongst Kwashiorkor cases of >70%, translating into about 4 deaths per week. The immediate cause of this horrendous situation was that UNICEF had decided to stop supplying the hospital with Nutriset and there was no other source food available to the staff. Whilst I'm sure that with a little imagination they could have done better that treat Kwashiorkor with Dextrose-saline infusions.....(doing nothing for example and I suggested this to them) the decision by UNICEF to stop giving them milk appeared very strange. I went to see UNICEF to follow this up and was told that the decision to withdraw the milk was a political because they wanted to be more "developmental" and not because they had had any problems with the use of the milk in the hospital. In fact in the hospital the mortality rate amongst the Kwashiorkor cases was very low when they had the Nutriset as the staff knew what to do with it.

How could UNICEF leave the only teaching hospital on the island with out means to treat malnutrition, thereby producing a generation of new doctors totally unprepared for treating the most common cause of childhood morbidity and mortality in the island, and call this developmental? I actually saw a teaching round in the ward, presumably learning how to put up dextrose - saline drips on children with Kwashiorkor.

I don't know if any of you have any influence over UNICEF but if you do a little pressure to restart a small donation of therapeutic milk to the hospital would save many lives. The UNICEF head of mission was called Gnilane Senghor I think, unfortunately I only managed to meet his deputy.

happy new year

steve

steve collins

Date: Mon, 29 Dec 1997 11:25:43 -0600

From: Benjamin Torun btorunatnsem.incap.org.gt

Subject: Re: Therapeutic feeding in Port of Prince and UNICEF decision to stop supplying milk

The infortunate situation described by Steve Collins in Haiti reinforces the importance of using locally avalailable foods in the treatment of severe malnutrition, whether kwashiorkor or marasmus. There is no doubt that "optimal" diets can be carefully formulated and prepared to provide a maximum of digestibility and an ideal balance of macro- and micronutrients.

But when such diets become unavailable, health personnel with poor training in nutrition are at a loss and may start making the fatal errors pointed out by Steve. The same is true when therapeutic measures are based only on a basic ingredient, usually powdered milk, that may suddenly disappear, and no one has bothered to recommend other options.

It is therefore ESSENTIAL that all local health personnel, NGOs and other entities involved in nutritional rehabilitation acquire knowledge on:

a) The basic --and not so complex-- principles of dietary treatment of severe malnutrition, including the "safe" amounts of macro- and micronutrients, and when and how to give them; and,

b) The sources of such nutrients, including not only the foods provided by international agencies and NGOs, but also the foods that are or can be locally available at different times of the year. Although some of the latter may not have the best nutritional characteristics in terms of digestibility, protein quality, energy density or nutrient balance, with reasonable knowledge and ingenuity they can be used to prevent many deaths.

Well-meaning efforts may lead to disaster if the beneficiaries become solely dependent on such efforts, and are not taught how to deal with the situation when something --in this case, the food supply-- goes wrong.

A meaningful contribution would be the inclusion in all manuals and guidelines for the treatment and rehabilitation of malnourished children and adults, of simple, practical recipes for the preparation of therapeutic diets with locally available and culturally acceptable products. I, for one, would welcome obtaining such recipes from different parts of the world where they have been shown to save the lives of malnourished children.

Ben Torun

Benjamin Torun, M.D., Ph.D.

Head, Human Nutrition Unit, Institute of Nutrition of Central America and Panama INCAP -- Apartado Postal 1188

Guatemala, Guatemala

Tel: [502] 472-3762, 471-5655, 471-9913, Fax: [502] 473-6529

e-mail: btorunatincap.org.gt

Date: Mon, 29 Dec 1997 10:49:07 -0500

From: jcseteathqfaus01.unicef.org (Joanne Csete)

Subject: Re: Therapeutic feeding in Port of Prince and UNICEF decision

Dear fellow networkers,

We appreciate Steve's bringing this matter to our attention (and that of others). I have spoken with our office in Haiti, and we will be addressing this situation as a matter of urgency.

We are always glad to have the observations of visiting NGO and other agency staff to help us keep track of things that may go awry.

Best wishes for the new year to all.

Joanne Csete

Nutrition Section, UNICEF-NY