Wednesday, March 30, 2011

The Smallest Superheroes

Any kind of meaningful experience should shift your perception of things, so perhaps that's why I am worse than I've ever been at guessing a child's age. When kids come to the TTL safehome, it's usually (ok, never) because their home situation and health status are great--quite the opposite, hence TTL's entire purpose. So even while we have an amazing success rate in terms of transforming tiny sick babies into chubby happy ones, the pre-TTL time of suffering still leaves a mark on rates of physical development.

Even though I know each safehome child's name, nickname, medications, favorite toys, alarming versus normal fussy cries, and signature spastic movements or other idiosyncrasies, I'm constantly re-checking our med charts to remind myself how old each one is; it's the one detail that my brain cannot seem to accept into the permanent archives, perhaps because every time I check a kid's age it seems like a surprise (we have a four month old who is stronger and almost as big as a two year old, for example). In almost all cases, our kids are much smaller than, say, their American counterparts.

It's no exaggeration to say that at first glance many of our kids or any of the many, many malnourished children in the rural areas surrounding TTL look months or even years younger than what my previous experiences with healthy, well-fed children would lead me to assume. One of my best friends at home has a baby around maybe five months old who is developing normally according to US standards but when I see pictures and videos she looks to me now through my TTL lens like a freakishly large and incredibly cognitively-gifted mini superhero.

Just last week we admitted two new children to the safehome, both our oldest here currently. Even though they are the most shy and withdrawn of our kids--not at all surprising since they are old enough to perceive the dramatic changes in their circumstances at a deeper level than the infants and thus more likely to struggle with fear and disorientation until they feel secure--we're confident they'll grow into their roles as the new king and queen of the TTL playroom. While initially reported as both being four years old, more research revealed that one is just under three and the other is four and a half. Yet before paperwork surfaced to confirm dates of birth, we were prepared to take initial reports at face value because in there is no reliable norm for kids who are that sick and malnourished.

Thankfully, TTL's focus on kids age 0-5 allows us to target kids in the most vulnerable early developmental stages and give them the best shot at making up lost ground. Between the safehome and our vast outreach network, we are able to reach hundreds of kids facing nutritional challenges, usually on top of other health conditions such as HIV or respiratory infections. Our safehome kids eat five times a day--three meals, two snacks or, for infants, as much bottle feeding as needed--and the frequency, quantity, and variety of foods they get is in no way the norm in Lesotho. On outreach, we commonly supply staples (such as corn meal and sorghum) as well as lots and lots of formula for babies whose mothers cannot breastfeed for a variety of reasons (sickness, death, disappearance, and the mother's own nutritional deficiencies are the most common).

While food security isn't necessarily at the heart of TTL's work, it's definitely a critical component of our work. Every mouthful helps these kids get one step closer to being back on track, and in their own way they are all turning out to be mini-superheroes.

Wednesday, March 16, 2011

Two Steps Forward...

Here we are in the middle of March and I’ve yet to update our loyal readers on the happening here in Mokhotlong--my apologies!

One of the problems with letting almost a month go by without a blog post is that so much happens, it’s hard to pick out just one incident to highlight. On the staff and volunteer side of things, the past few weeks have seen six volunteers come and go. Among this crowd was a four person medical team (led by TTLF Medical Director Dr. Amy Hutton from Chelan, WA) that spent two weeks interacting with babies in the safehome, assisting on outreach, and conducting some staff trainings on topics that our safehome coordinator identified as things that our caregivers encounter on a regular basis (these included hand-washing, vomiting, diarrhea, oral thrush, cough, TB, and rescue breathing). Then, this past weekend we welcomed two fourth year medical students from Cornell who are spending their last six weeks of med school doing an elective at the Mokhotlong Hospital located adjacent to the TTL campus just as my co-fellow departed for two weeks, giving me (and my boss) the chance to see how capable I really am here on my own.

The safehome has remained relatively full at eleven babies as of today. We bid farewell to one baby and one toddler at the end of February (some of you may have already seen pictures of baby boy Neo returning home to his mother and Nthabiseng’s last morning here on the TTLF Facebook page). Nthabiseng was the biggest and oldest child in the safehome while she was here, and she had a correspondingly large personality. Seeing her go was definitely bittersweet since so many of the staff had grown attached to her but transitioning a child back home is always a happy occasion as it marks incredible, undeniable improvement.

The outreach team will continue to provide her and her family with support and track her progress--something I have to remind myself of every time I think of the last hospital check-up I took Nthabiseng to for her final assessment with us, during which the nurses quite directly ordered me to adopt her because letting her go home meant letting her return to the same situation in which she became so sick to begin with.

Given the number of sick and malnourished babies that come through those hospital doors on a daily basis, I could definitely sympathize with the nurses’ skepticism. What I didn’t have time to add to the conversation was the fact that TTL clients have the unique advantage of long-term support through our dedicated outreach team. Caring for our clients is multi-stage process that goes beyond the most acute treatment phase; it involves a partnership between TTL and each child’s caregivers, who receive both supplies and education to help ensure the child’s health continues to improve.

For the most part, this model works, but it can’t guarantee 100% success. While Dr. Hutton’s medical team was here and working at the hospital, a mother came in with a baby who was suffering from advanced malnourishment. It’s not clear whether anything could have been done for the baby given the severity of his condition by the time he got to the hospital, but even after he arrived it took many hours for him to be seen by a doctor. The next day, he passed away lying next to his mother on a gurney in the pediatric ward. Adding to the tragedy is the fact that this child was a former TTL client who had graduated, meaning that his health was so stable for so long after we’d initially encountered him that he no longer needed the regular support of our outreach team. How a child can go from being so healthy to so very sick without intervention is not only perplexing but heartbreaking. Even though this kind of incident is rare, and even though it’s nearly impossible to pin down the exact place where things started to go wrong, it’s not acceptable. Thankfully there is no indication that Nthabiseng or any of our other clients are at risk for this kind of situation, but the reality is that things can go very wrong very quickly.

“One child at a time” is a fitting motto for TTL in so many ways, and if TTL wasn’t here there’s a good chance no one would be. Yet sometimes it’s still difficult to swallow the fact that no one can be there for every child every time.