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Rick McCharles - what the heck is Plumpy Nut?

Rick McCharles — Fri, 1 Aug 2008 17:46:30 +0000

Part 2 Theraputic. This is where the ‘food’ comes in. Except it not like the typical feeding center you might have seen on TV. In all but the most severe cases, we use what is called a RUTF - or Ready to Use Theraputic Food - called Plumpy Nut. In the past, feeding centers prepared a milk/porridge mixture spiked with vitamins and other nutrients. This is a pain to transport, difficult to store and the quality very much depends on how it is prepared. Plumpy Nut is the solution. It’s a pre-packaged ‘powerbar’ that has the perfect mixture of vitamins, salt, protein, energy and fat needed to bring a child back to full strength and weight. It doesn’t (really) expire, is easy to transport, doesn’t have be cooked in the field and has the exact proportions of nutrients that are needed. Basically, it’s a peanut butter based energy bar…with LOTS of salt. I tried a bit and although its OK, it isn’t a chocolate bar and not something I would actually chose as a “snack”!! Therefore, we don’t just provide food for the children, we provide medicine in the form of a specialized, nutrient rich snack they must eat a couple of times a day. Ambulatory. In most cases, children admitted to the program are given an arm band, the parents are taught how to eat this new and very strange food and the child must eat one sachet in front of the nurse. If all looks well – and the child is willing to eat the ‘medicine’ – they are sent home with enough Plumpy Nut sachets to get them to the next week. Monday is follow up day where all the patients in the program return to the clinic for a checkup and to get their next week’s supply of Plumpy Nut. The nurse re-weight and re-measure the child, check for improvements and look for problems. If the child isn’t gaining weight, they look for possible complications…TB, malaria, an unwilling to eat the medicine, etc. Typically, the parents are required to bring back the empty wrappers to show that all the food is being consumed. In the end, the child is usually given another week’s worth of rations and sent on their way. If not, additional medicine is prescribed (i.e. treatment for malaria) or more training is given to the parents (i.e. do mix the plumpy nut with rice as it just dilutes it and makes it much less effective). Hence the ambulatory therapeutic feeding center. In only the most severe cases (we’ve had less then 10 so far I think), is the child referred to MSFs 24 hour ‘special care’ unit. We only have 1 setup in our largest clinic and it is usually used only for the children too sick to eat the Plumpy nut. They are then put on a specialized milk formula until they are strong enough to start taking Plumpy Nut. Otherwise, the children are only seen once a week and then sent home with their ration for the week. In the first 2 months of the program, we have admitted about 300 children across the 9 sites. Around 60 have been cured, 15 have defaulted (not come back on their scheduled follow up day, for whatever reason) and the rest are still getting their weekly Plumpy Nut rations. As for the medical side of things, we (…Ok, not ME really at all!) are doing somewhere around 1500 medical consultations a week. Mostly malaria, upper respiratory track infections, upset stomachs and typical aches and pains. Any serious cases are referred to the hospital in Khagrachari where they receive care…very poor care but it is a hospital and we simply can’t do everything. Ahhh…but that is a whole different Update. Papa Lima, signing off. (I used to be Foxtrot Lima – Field Log – but was upgrade to Papa Lima once I become the only log in the project. Too bad as Foxtrot Lima has a nice ring to it!)

Rick McCharles - what the heck is Plumpy Nut?

Rick McCharles — Fri, 1 Aug 2008 17:46:11 +0000

Hello All, Wow this month has really flown by! Since my last update, the ‘logistics’ department has shrunk significantly. When I arrived, I was Papa Lima 5 (Project Logistician 5)…in that I was the 5th member of the logistics team to arrive onsite. Since then, my title has been upgraded to Papa Lima 1…or just plain Papa Lima. Yup, the contracts of all the others have finished (…or been finished for him, in one case!) and I’m now the only log in the project. Talk about steep learning curves and lots of responsibility. I am directly responsible for about 15 national staff and EVERYTHING non-medical in the project. In this case, our project is very logistics heavy so that keeps me busy! Still working 12 hour days 6 days a week and struggling to stay out of the office on Fridays, the normal day off here in Bangladesh. But, as per the subject heading, this update isn’t about logistics at all. ATFC stands for Ambulatory Therapeutic Feeding Center and that is what my behind-the-scenes logistics are mostly supporting. In short, we have setup a network of 9 feeding centers spread across a pretty hilly and remote area that are treating children for malnourishment. …I’ll take a step back. Why did the project start? Every 50 years or so, a certain type of bamboo flowers in the Chittagong Hill Tracks of Bangladesh. The flowers are high in protein and are a great source of food for Rats. The rats ate the flowers, had lots of babies and, once this new wave of rats finished off the bamboo flowers, they moved on to the rice and other food crops. This means, in turn, that the last harvest was mostly lost and a population that is already on the edge is facing the real potential for a food shortage… Each location has two basic components…a feeding center to treat malnourished children under 5 and a clinic to provide (very) basic health care. How is a child admitted to the feeding program? It usually starts with our network of 40 community health workers. These are locals who live in the villages in the areas we are work and who have been trained to recognize malnourishment in children. They go house to house and actively seek out potentially malnourished children by measuring the circumference of their upper arm. Yup, there is a pretty direct correlation between malnourishment and the size of your upper arm. Who knew? Its called a MUAC tape, if you want to Google it for more information. When they find a potential case, the child is referred to the nearest clinic for a proper screening. Weight vs. height is measured in the outpost/clinic and if the child is below a certain threshold, they are admitted into our feeding program. All children who come to our clinics for the basic health care are also screened for malnourishment and can then be admitted as well. Ambulatory Theraputic Feeding Center…there are 4 parts and I’ll work backwards. Feeding Center. In this case, it is a simple room in a bamboo building. There is a hanging scale and a height board, a plastic table with a couple of chairs, a hand washing station, a drinking water filter, and a few big metal boxes for medicine / food storage. There is 1 nurse at each location that works this station…they measure the children, explain the program to new mothers and follow up on patients already in the program.

Oliver Blackwell - books - Anthony Daniels UPDATED

Oliver Blackwell — Sun, 27 Jul 2008 15:18:38 +0000

Monrovia Mon Amour is one of my favorite books. For an even better first-person account of the Liberian Civil War, check out Mark Huband's book The Liberian Civil War. The title is a little vanilla but I think you will love it - unlike Daniels, Huband was actually there during the conflict phase of the war, and he writes even more beautifully than Daniels.

Rick Mc - are newspapers dead?

Rick Mc — Tue, 22 Jul 2008 10:59:02 +0000

In this weekend’s newspaper apocalypse round up, Gannett’s quarterly profits were down 36 percent, The Atlanta Constitution cut 8 percent of its workforce, the editor of The Chicago Tribune quit, the publisher of The L.A. Times resigned under pressure and The New York Post and New York Daily News, the Itchy and Scratchy of tabloid rivalry, discussed cooperating on production to cut costs. The Washington Post somehow stayed out of the dreary headlines, for once, but amid declines in circulation and revenues and dramatic staffing cuts, it hasn't much lately. Presiding over the future of The Post in these turbulent times is publisher Katharine Weymouth, the granddaughter of the legendary Katharine Graham. Weymouth has been at The Post front office in various capacities for 12 years but landed this plum job six months ago, smack dab in the middle of the industry’s tailspin. Katharine, welcome to OTM. audicast - http://www.onthemedia.org/transcripts/2008/07/18/...

Rockin' - are newspapers dead?

Rockin' — Tue, 22 Jul 2008 09:28:34 +0000

Go on, McCharles, pelt us Luddites with muck tossed from your cyber-y tower. I agree that journalists are under siege right now and many will be out of work in the coming years, but old reading habits die hard...unless you're some kind of internet cult figure, nomad or circus talent scout. And the population of those is pretty small.