Ascaris Lumbricoides

In Peace Corps they tell you to celebrate the small victories, so allow me to gloat. Last Monday I correctly identified a case of worms.

Every Monday morning between ten and twenty malnourished children and their mothers come into the clinic for Out Patient Therapeutic Treatment. My counterpart, the health center nutritionist, and I weigh the children (who are generally between six months and five years of age) to check for progress and give out Plumpynut. Plumpynut is a Ready to Use Therapeutic Food (RUTF). A highly nutritious food bar, sort of like a Slim Fast bar except instead of overweight American adults eating it to lose weight; malnourished African children eat it to gain weight.

Mondays are both heartbreaking and incredibly inspiring. To say these kids are adorable doesn’t even begin to describe it. Now that I’m relatively established none of the kids cry when they see me. In fact, some even run to greet and hug me when they arrive at the health center!

Generally speaking, there are two general types of malnutrition: chronic and acute. Acute malnutrition is generally more temporary and if quickly addressed, ramifications are not severe. Children with acute malnutrition often have swollen cheeks and bellies. Chronic malnutrition is a result of long-term malnutrition. It causes stunting, hair loss, and generally slows the development of children. Eventually your body loses the ability to absorb nutrients so treatment is more complicated and can require years of medical attention. (To my friends who studied nutrition or are in med school-- please forgive this dumb-ed down explanation).

Both types of malnutrition affect your body’s ability to fight off foreign bacteria and viruses, which is particularly problematic for small children living in environments with very poor hygiene.

Surrounded by malnourished children on a daily basis, I am slowly learning to identify the warning signs and characteristics of the various levels. So, last Monday when I saw a very upset four-year-old girl with a particularly swollen stomach, but normally sized ankles, wrists, and cheeks I knew something was wrong. After consulting with my counterpart I took my small friend to the lab and where the technicians identified the intestinal parasite causing her pain and weight loss.

I feel a little embarrassed to admit I did take advantage of my umuzungu status to break protocol, insurance procedures, and lines in order to get the diagnosis and the drugs to cure her. I do not plan to act in this manner for the next two years, but I’m not losing any sleep about it this time. At a health center that serves over 12,000 people staffed with only ten nurses (no doctors) there are times people rush and patients get overlooked.

I am hoping that as my language skills improve and health center staff trusts me more, I will be able to help address more of these types of issues. Plumpynut will not cure malnutrition in a child with worms just like ibuprofen will not kill the tuberculosis virus misdiagnosed as a common cold.

While I personally cannot positively diagnose any of it or provide care to cure it, I can work on making it easier and more effective for those who do.