Millica is in charge of the Nutrition Rehabilitation Unit (NRU) at Mtunthama
Which area of Malawi were you born in? Tell us a bit about your upbringing.
I was born 16 May 1966 in Chiradzulu, Southern Region. I learnt at Chiradzulu, primary school from standard 1-8 and was selected to Chiradzulu, secondary school form 1-4. After that I failed my Malawi Secondary Certificate of Education, and obtained that in Mtunthama at All Saints Secondary School in 2004. I went at Malingunde training school in Lilongwe in 1998, where I studied Home craft working for six months.
In our family we are 10. Seven sisters and three brothers. I am second born. My father passed away and only my mother is alive. She is staying alone in Neno district, Southern Region.
Can you tell us a bit about your family?
I am married and I have got six children, three boys and three girls. My first born was born in 1986, my second in 1988 and my youngest in 2000, studying at All Saints primary school in standard 7. My first born is working with Madeko Fisheries, my second son is at University and the rest are at secondary school. My husband is working with Pres Agriculture Ltd.
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Tell us about your early career and how you came to be living and working in Mtunthama.
After I finished studying I was working at Neno Hospital in the Southern Region for three years. We moved to Mtunthama because my husband was working here. I started work at St Andrews in 2004.
Have you had any training since you started working here?
Yes I was sent by St Andrews Hospital to study HIV blood testing and counselling in 2007 for three weeks. I test the children on discharge from the Nutrition Centre for the HIV Virus.
Sometimes I dream if I could be trained in nutrition, I wanted to go further and learn more about how you can save the lives of these children if I could fund it. I want to teach my own children first. I am happy to work with these malnourished children. I always try my best to ensure every child who is admitted is alive. When a child passes away it is very sad. When a child comes back for their supplementary feed I am very happy to see they are healthy.
Can you tell me about your normal working day?
When I come here at my working place I first clean, take water and mop and clean the glasses. I assess the children. If I find any with a fever I send them to the clinician. I do the milk calculation according to their weight. After that I finish some cleaning and wait until 9 o clock to give a feed. I continue writing my reports to record what milk we have used. I have a time to check we have enough of everything for my children. If any child has diarrhoea I prepare Re-Sol, a rehydration solution. I check that we have enough medicine and get what we need from the hospital. Lunch is from 12 until 1.30pm. At 2pm we carry out another assessment for the children for their temperature, check how the child is feeling with the caregiver, and how they are passing stools, if they have had three diarrhoeas we send them to the clinician.
We are three working here and if we are all here we share the jobs and take time to discuss and have a small meeting about the NRU. We also have time to go into the kitchen garden with the caretakers to teach them how they can do their own gardens when they go back home so as they have their own green vegetables. I take them around the kitchen and toilet and tell them to clean them and tell them about the importance to do this in their own homes for hygiene’s sake.
We talk to the caregivers about family planning every morning.
Why is this important?
Many of the children are malnourished because of big families. Sometimes nine, ten children in a family and a husband can have two or three wives in the same house, each with seven, eight, nine children.
What do you grow in the kitchen garden?
Tomatoes, beans, rape, chinese cabbage, pumpkin leaves. The caretakers do work there on a Wednesday, laying compost manure.
How can you tell a child is malnourished?
A child first has to go to a clinician at the hospital because their malnutrition can sometimes be caused by anaemia. The clinician will send them to the lab to measure blood level, MPS (malaria parasite) and sugar, and then send them here for an assessment. If their symptoms are caused by malnutrition they are admitted here, if they are caused by anaemia they are admitted to the hospital for a blood transfusion.
I also take time to take them to HIV testing and counselling because that can cause malnutrition. The child and the caretaker (the mother) are all tested.
How many children are admitted every day?
On average four on a daily basis. From December to February we have more children as a lot of the families do not have enough food.
How long until they are discharged?
On average about ten days. Whilst they are here they are given special medicated milk every three hours. At first when they are admitted they are given F75 milk for about three days. This milk brings back appetite. When a child comes in they often refuse to drink because of illness. After a few days they are like ‘give me’ and they have an appetite back. We then give them F75 at 9 o clock plus a packet of RUTF Plumpy’Nut, which is like porridge made with peanuts. So there are some children who refuse that so we give them an alternative, but normally the government prefer us to give Plumpy’Nut.
They can only stay about four-six days after this and we discharge the child if they have a good appetite and no medical problems. We give them a certain amount of RUTF and tell the caretaker to come back in one week with the child to see how the child has responded. Three out of four recover with the RUTF.
When a child is malnourished they have oedema, you can press in on their body and it is swollen, it is pitting. When they first come in it is all over, you can press in their forehead. As they recover it is subsiding. If they come in with 3+ it takes eight-ten days to recover, if it is 2+ it takes five or so days.
How far do people come?
Some people come from very far. Some 15km or some even 20km. Some yesterday who had been discharged a week ago came for their weekly check up from far away and stayed overnight and got up very early to start their journey back. If we discharge them in the afternoon we tell them to wait until the next morning to go.
What would be the biggest things to help you do your job better?
Some of the people do not come because of the long distance for the check up. If we had a vehicle we could do a follow up on them if they fail to come, check up on the children, and even take the supplementary food. We could also go to their homes and see how they are living, see if they have a kitchen garden and have learnt from what we have told them. Sometimes we even hear a child has died because the family had no transport to come here and we feel sympathy. If we had a vehicle we could follow up and encourage them to come back for a check up, take supplementary food. When the transport was there we could go out into the community and teach the whole community about family planning and to have kitchen gardens and to keep their own small amount of food. Some of them sell their food rather than keeping it to feed themselves. The clients do not go back and share what we teach them. We see people from the same communities coming back.
We also have a shortage of F75 milk. This is very powerful to give a child an appetite back. We have a hot plate to heat the water for the milk but often do not have electricity. We cannot provide firewood so the caregivers have to go and collect it ad it can take long to prepare which means sometimes the feeds are late.
There are no beds, only mattresses for the families to sleep on. Sometimes the children fall off the mattresses and it is cold.
What do you do on Saturdays and Sundays?
When I am off duty I stay with my family. I have also got my kitchen garden I work in. On Sundays, I go to church with my whole family. When we come from there we sit inside our house and hear gospel music. I also have time to chat with my friends in the community. I have a place where I grow mushrooms together with four friends. We go there at about 5 o clock when we knock off and manage the garden.
Do you have a favourite place in Malawi?
Blantyre. It is my home area. Nearby we have got a boundary. Many of my brothers and are there.
Millica also wanted to make this statement:
On behalf of my fellow workers I would like to pay my gratitude to the government of Malawi, CHAM, Medic Malawi, All Saints Anglican Mission, Management and Staff of St Andrews Community Hospital, for medical and financial support to the NRU Department.
Furthermore, I would like to thank you Nicola and Steph for the good work you have been doing in our NRU.
Lastly, I would like to salute the administrator of St Andrews Community Hospital and all well wishers, for the daily support they are rendering to our Nutrition Rehabilitation Unit (NRU) Department.
May God Bless you all.