Summer 2017

What’s a Dietitian to Do?

Challenges lead to hope in Malawi’s first R.D. training program.

By Julie Flaherty

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A children’s ward at a hospital in Lilongwe, Malawi. Photo: Eva-Lotta Jansson/Alamy

The first thing that struck Molly Uebele, N12, about the hospitals in Malawi was the crowding. During the height of malaria season in February and March, she would see three of four children in one bed, parents and extended family on the floors and in the hallways, and still more patients in beds outside. But the thing that really shocked her was how little food the hospitals had for their many malnourished patients. Some could provide beans, cabbage or a little beef; others relied on the patients’ families to supply food, which many could not. And the available food was rarely what a dietitian would prescribe—no formula for infants, no renal diet for patients with kidney failure. Patients die because the hospitals can’t feed them.

That was the reality Uebele faced when she moved to Malawi in April 2015 to start the country’s first dietetics program, a project of the Friedman School’s Nutrition Innovation Lab. As with most African countries, dietitians are practically unknown in Malawi, save for a few NGO workers who trained in other countries. Uebele’s mission, which was funded by USAID, was to create from scratch an accredited nutrition program to train Malawians who could work alongside doctors and nurses.

Uebele, a former clinical dietitian at Tufts Medical Center, knew the science and skills she wanted to teach, and worked with two local universities to create the curriculum, consulting with Tufts faculty through weekly Skype calls. And the the need was clear: Hunger, malaria and HIV are constant in Malawi, while hypertension is rapidly increasing—nearly one in three Malawians have high blood pressure. But at first, Uebele didn’t see how the program could succeed without enough food to go around. “You can’t have dietitians without food,” she said. “It’s like a doctor without medicine.”

She found hope in the six health-care workers who signed on for her first class, future dietitians who could advocate for the right food in the country. “The Malawians believe that if we have people there asking for it, then it will come,” Uebele said. “They are the ones who know their country and how it is going to evolve.”

In the meantime, Uebele and her students worked together with what they had. “I would say, ‘This is how we do it in the U.S. How do you think we could do it here?’ ” Uebele recalled. In class, they brainstormed alternatives for, say, the nutritional shake she would feed to a patient with throat cancer if she were working in a U.S. hospital. The idea of the exercise was to use “whatever foods were available that season they could pound up really well and make into a slurry: pumpkin, peanut flour, soya flour, banana, sometimes a little fish,” she said. “That’s how we had to think.”

And the first time Uebele saw her students do a nutrition consultation with patients, she knew the program could work, too. Her heart lifted when she heard several patients say how well the students listened to their concerns and how valuable their nutrition recommendations were.

One of Uebele’s students, Doris Cement Nanga, said the coursework, especially the biochemistry, was harder than she expected. But she said Uebele inspired her to keep at it, because she was experienced, motivated and clearly proud to be a dietitian. “She groomed us to feel the same,” she said.

When Uebele learned that she was this year’s recipient of the Friedman School Alumni Association’s Leah Horowitz Humanitarian Award, she demurred—she wasn’t on the front lines saving lives. Then again, she thought, that was what she and the Nutrition Innovation Lab had set in motion, a slow process that she believes “will allow Malawi to eventually take care of its own.”

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