AT FIVE years old, John Carl Nipas was diagnosed with Hirschsprung’s disease, an abnormality that causes difficulty in excreting solid waste due to the absence of ganglion cells, special nerve cells in the intestine involved in moving the stool from the large intestine to the rectum. The disease is curable but since Nipas is malnourished, immediate treatment is remote.
Nipas is only one of the many children suffering from malnutrition in the country.
According to a 2006 report by the United Nations World Food Programme, 19 per cent of all Filipinos are malnourished.
In 2005, the Food and Nutrition Research Institute of the Department of Science and Technology reported that there were 24.6 and 22.8 per cent underweight children in the Philippines, aged zero to five and six to 10, respectively.
According to the institute, malnutrition remains the overriding problem among children aged zero to 10 and thus, needs to be a priority concern.
Dr. Francisco Duque III, chairman of the National Nutrition Council, told the Varsitarian that they are working on the improvement of nutrition of children.
“To fight malnutrition, we came up with projects that promote good nutrition,” he said.
Included in their 2005 to 2010 Philippine plan of action for nutrition are building capabilities of nutrition workers, persuading people to act favorably on nutrition concerns, and identifying more permanent and effective solutions to malnutrition.
In the University, efforts to alleviate the problem of malnutrition are already being undertaken by the UST Hospital Nutrition Rehabilitation Unit, more commonly known as the Malnutrition Ward (Malward), which aims to treat and rehabilitate children like Nipas through special medical and dietary care and rehabilitative measures.
Beginnings
The UST Malward, established in 1975 by Dr. Martina Tirona-Certeza, is one of the first to be put by a private hospital in the country. Inspired by a malnourished patient Certeza cured during a medical mission at Cabadbaran, Agusan del Norte in 1969, she had wanted to establish a Malward in the University, which would rehabilitate children who suffer from the same illness.
Upon going back to Manila, she approached the Dominican priests to persuade them to allow her to set up a Malward in the Clinical Division. At first, due to seemingly time-consuming rehabilitiation, the priests were reluctant to support her endeavor.
“They thought it would entail a lot of time because unlike acute infections such as tonsillitis, pneumonia, diarrhea, malnutrition takes time and is more difficult to cure. But eventually, through my persistence, I was able to convince them,” Certeza said.
Through sponsors and benefactors, who are mostly civilians and international non-government organizations such as Caritas Austria and Agro-Action of Germany, the Malward has been able to sustain itself for the past 33 years.
Today, the Malward claims to be the only private institution in the country with a viable, functional, and responsive nutrition unit. Situated at the third floor of the Clinical Division of the UST Hospital, it can accommodate eight children, mostly at the age range of zero to four years. Attending to their needs are two dieticians and a rotating team of resident doctors, interns, clerks, and nurses.
Righting malnutrition
According to Certeza, rehabilitation in the Malward aims to be holistic.
“We do not end with only treating patients of malnourishment, we believe that they can still be developed in other aspects, such as their mental capacity and their social welfare, while they are being treated,” she said.
The nutritional rehabilitation consists of dietary management, mental feeding, and nutrition training for mothers.
Dietary management involves treating patients with nutritious food based on their food requirement according to their age. The actual food intake and the required food intake is determined to find out how much food is needed to be given to the patient. If the patient cannot tolerate solid food, a nasogastric tube is used to pass the food through the nose to the stomach.
Certeza said that due to innovations in nutritional rehabilitation, treating patients has become easier. “Before, it took us six months to treat a patient. Now, it can only take two weeks,” she said.
Mental feeding, meanwhile, stimulates the child’s mental capacity through toys, books, and educational activities.
According to Certeza, they also teach mothers how to feed their children with foods that are less costly and more nutritious such as green, leafy vegetables and small fishes. They are also taught proper nursing care and livelihood projects, such as crocheting and cooking, to make them more independent.
When a patient is about to be discharged, a social worker visits the patient’s home to assess if it is suitable to live in. If the social worker discovers that the parents are not yet ready to care for the patient due to financial instability, the patient is referred to a shelter while the parents are subjected to counseling.
“We do this to ensure the patient’s welfare because this is a continuous rehabilitation for them. We want them to be healthy citizens,” Certeza said.
A week or two after discharge from the hospital, the patient is required to occasionally visit the out-patient department for check-ups for six months.
According to Certeza, today, there have only been minimal casualties among Malward patients and that the percentage of mortality is not as high as before.
Many of Malward’s former patients have lead normal lives afterwards, she said. Nipas, who was admitted to the Malward last February 2008, has undergone the same kind of rehabilitation prescribed by Certeza and has now improved from his initial weight of nine kilograms to 10.4 kilograms. He will undergo an operation to treat his disease once he reaches his ideal weight.
