Nutrition Workshop: Bamenda, Kumbo, Bafut and Wum

Nutrition Workshop:  Bamenda, Kumbo, Bafut and Wum

Always a challenge, the topic for this workshop was to be Nutrition for HIV Positive Pregnant and Lactating Mothers and Infants and Children who are HIV Positive.  Observations and learnings went far beyond the course material.   Ten participants were brought in from Bamenda, Kumbo, Bafut and Wum.  It was easier to pay their transport and accommodation then for us to travel and present to four communities.  UNICEF, USAID, WHO and Toronto Public Health have excellent materials that were well used.  Core to the building of the workshop materials were the 30 Counselling Cards developed by UNICEF for field workers. 

 A reporter was designated for the day.  His comments were very detailed.  They were interested in Colostrum, the advantages of this first precious milk for the newborn.  The graphic chart showing 12 feedings per 24 hour period was surprising to them.  They were intrigued by the ‘skin to skin’ recommendation for the newborn, especially the premature or low birth weight baby.  They loved the kangaroo care, looking at the front carrier.  In Cameroon, most babies are carried on the mother’s back.  The changes in breast milk, both during a normal feed from a lighter to a milk with more fat in it;  the adaptation of the breast milk for the premature baby and how the constitution of the breast milk changes almost daily as the infant grows during the early days.  Exclusive breast feeding for the first six months was emphasized.

Mme. Oussematou cautioned the participants in counselling the mothers to allow them the option of infant formula, that formula is good milk and sometimes the only option: for example, when the mother dies and there is no ‘wet nurse’ available.  Lydia had emphasized that it is wrong for formula companies to provide just enough formula to mothers to discourage breast feeding.  All agreed that breast feeding is the best way but sometimes not possible.  The Counselling Card on reasons to choose breast feeding promoted a discussion on how impossible in this environment it is to properly wash and sterilize bottles.  Many children die of diarrhoea caused by contaminated water.

One of the participants talked about how important it is to be tested for HIV and to be on antiretroviral drugs if HIV positive.  She said that HIV is manageable as long as a person addresses the problem early and adheres to the treatment, eating properly and being closely monitored.  She said that removal of the stigma of HIV is very important.  Another participant told us that she herself is HIV positive and is enjoying a healthy and vibrant life.  She said by sharing her story in community of Kumbo, stigmatization has been reduced, people have come forward to be tested and treated when positive.

Emphasis was placed on a balanced diet with greater food requirements for the pregnant and lactating mother as a result of being HIV positive.  The basic diet is corn or rice.   Fufu is made from white corn, often eaten with huckleberry, an excellent vegetable.  But, the need for protein to be added was emphasized with beans and ground nuts (peanuts) being great substitutes for chicken, fish and meat.  Another common family meal is rice and beans.  Adding pumpkin, tomato, pepper or carrot would help the need for Vitamin A in the diet.

A discussion that almost stumped me was on the need for iodization of salt. In Canada, we try to minimize the use of salt.  Here in the market, salt in large open bags is cheap but not iodized.  Goiter is a major problem.  Never would I have thought, as a person trained in nutrition, that I would be advising people to use salt!  So Oussematou’s advice to them was spend the 600cf (a little over a dollar Canadian) and buy a box iodized salt to be used sparingly.

Milk here is not a common food.  At the hotel, we are served heated reconstituted skim milk powder with our morning coffee.  Rickets (bowed legs and knocked knees) is too common here.  All those pictures from the nutrition text books come to life here.  Especially sad to see children hardly able to walk because of rickets.

USAID, WHO and UNICEF all point to the Cameroon as having a major problem with Vitamin A deficiency.  Blindness and eye problems result.  It is uncommon to emphasize vegetables in meal planning in the Cameroon.  Often farmers sell the vegetables at the market to obtain much needed money for the family, depriving the family of good vegetables. 

Mmn. Oussematou summarized the history of breastfeeding and HIV positive mothers.  Initially, HIV positive mothers were advised not to breastfeed because of the possibility of transmission but in time, it was determined that threat to the infant mortality was greater when not breastfeeding and, with good antiretroviral follow through, proper nutrition and care, that breastfeeding should be recommended.  One participant cautioned about sores on the nipple bleeding and the blood ingested by the infant allowing for transfer of the HIV virus.

Another concern I voiced was seeing people washing dishes in cold, dirty water,then placing them in the dirt.  One participant said this could not be helped.  Breast feeding allows for sterilized milk at just the right temperature!

One thing that I feel should be addressed by government is the need for Vitamin B enrichment.  Iron and folic acid are available as supplements to the pregnant woman coming to the clinic.  Rice and flour should be enriched with Vitamin B and iron.  Maybe Vitamin B enriched beer would be helpful to some.  There are sure a lot of big beer trucks on the road.  Not recommended for pregnant and lactating women!   I feel the increase in ‘crazy people’ (as they put it) during dry season is nutritionally related to malnutrition, Vitamin B deficiency in particular.

Never before, despite the years racked up teaching Nutrition, have I seen the need so great for basic good basic nutrition.