I will start this blog with a thank you from Kagando Hospital’s Medical Director & Consultant Paediatrician Dr Mary Munyagwa “We thank the people who generously contributed to the cause. We have been able to treat the malnourished children and we have also been able to do food preparation demonstrations to teach the caretakers how to manage the children after discharge. However malnutrition still remains a significant problem. Going forward we need to design community interventions that address the issue of food security.”
On my very first visit to Kagando in 2010 I met a lovely young girl called Mary. She had been admitted to the hospital because of severe malnutrition. I can never forget the sense of hopelessness and helplessness that I experienced that day, as over the years I was sadly to meet many more like Mary and those feelings never change. On the contrary, with each malnourished child comes also self questioning: why in this day and age does this still happen, what can be done, who can help, what can I do?
Towards the end of March 2020 Uganda, like many other countries worldwide, went into lockdown . Due to the restrictions, a large number of people in the area of Kagando found themselves without any form of income and with each day that passed their hunger increased. Then on 7th May 2020 devastating floods hit Kasese district which Kagando Hospital, is part of.
Dr Mary wrote to me saying “Covid-19 has disrupted peoples’ livelihoods, worsening the already poor socio-economic status. With the additional floods that we have experienced in Kasese, thousands of families have been displaced, and gardens (arable land) washed away. This has left the people helpless with nothing to feed on. Already on the paediatric unit, half the patients admitted are suffering from malnutrition. With this double disaster we expect many more cases and there are even more out there who cannot reach the hospital.”
Sr Laheri and the Rwenzori Women for Health team (RWFH) were also messaging me with stories of malnourished children they were encountering in the community. It emerged very quickly that there was an urgent need to assist Kagando Hospital, to address the rising prevalence of malnutrition in children and its distressing impact this was having on the mothers and the community at large.
Markers of malnutrition: pale wispy hair, swollen hands feet, swollen belly probably due to worms; 
Sr Laheri very concerned for this child 
Nurse Joshua screening for malnutrition: assesses mid-arm circumference
The need was two-fold 1. Practical 2. Therapeutic
Practical :The nutritional ward could be reinstated but it had been neglected over the years. The kitchen (vital in the preparation of nutritional feeds), store, and toilets were in a poor state and some basic maintenance was required in order to have the unit fully functioning as soon as possible. The unit would still need total refurbishment in the longer-term.
The Kitchen in need of some TLC! 
Therapeutic: Management of the malnourished child includes daily milk intake. The hospital has cows but their yield is poor, so milk has to be sourced from elsewhere; unfortunately this is not always financially possible. Also the children require additional food supplement, particularly post-discharge, called RUTF (Ready to Use Therapeutic Food) The hospital obtains a small supply of this monthly (free of charge)if available, which is not always guaranteed and the supply is never near enough. The team applied for urgent supplies but were told it was out of stock.
Aside from that immediate crisis, rural women living in poverty have a very poor understanding of nutrition and the typical daily diet consists of food that can satisfy hunger (short term) e.g potatoes, rice or posho (made from millet or sorghum flour, sometimes mixed with cassava flour to make a dough).
Over the years RWFH has been addressing this problem by holding Nutrition Demonstration Classes twice monthly These classes are for mums whose children have been admitted to hospital ,because of malnutrition and/or HIV. The class starts with a talk on nutrition and hygiene, followed by food preparation, with ingredients sourced at the local market. Cooking is done in a traditional oven situated in the Rainbow Room. After it’s cooked the mums and their children enjoy the food that they’ve prepared.
Nutrition Demonstration Classes at the RainbowRoom 
Nurse Jonis heads Nutrition Classes together with Ruth RainbowRoom Co-Ordinator & Sr Laheri Nurse Lead RWFH 
Food Preparation 
In the RainbowRoom Oven 
Preparing the food to go into the oven
Once again Astraia Foundation, now Voice of Women Foundation, gave RWFH a significant donation for immediate help with challenging malnutrition. Thanks to this generosity:
—The necessary refurbishment of the ward could be carried out. —Nutrition demonstration classes now run weekly. The RWFH team are able to visit the children post discharge. This is vital,not only to monitor the child and provide nutritional supplements because mums may need emotional support as well. It is already devastating for the mother not to be able to provide food for her child but if a child is hospitalised that can impact on her relationship with her husband:money will be needed and the child is then seen as a liability. I have personally seen fathers abandoning mum and child in hospital because of the financial issue, leaving the mother destitute.
As to RUTF the nutritional supplement: the RWFH team did not give up; after further enquiries it was found not only that the supplement is produced in Kasese but that there was plenty in supply and importantly it could be purchased directly from the factory. What a blessing! The Team were able to purchase 24 boxes, each containing 150 sachets at a cost of 6m Ugandan Schillings
Precious Boxes of RUTF heading for Kagando Hospital 
The amount of RUTF each child requires depends on age and weight
Malnutrition is ever present; the incredible efforts of the hospital staff and RWFH team have made a real difference and continue to do so. However, the donation was for a ‘one off’ initiative: the RUTF supply is nearly finished, demonstration classes may have to return to being twice monthly. RWFH will also be unable to continue their follow-up visits in the community.
Since June last year there were 110 children admitted with a diagnosis of malnutrition of which very sadly 10 of these children died and 62 are still being monitored..
Any support for the continuation of this initiative, as well as the survival of the Rwenzori Women for Health Project, would be most gratefully welcomed.
Once again, heartfelt thanks to all donors during these difficult times when hunger and thirst are daily realities. I have also been thanked on several occasions, for the Feed 100 Appeal without your generosity this could not happen
Rita x
Rita in Africa 