Working in Unconventional Settings as an RDN
As an RDN living in Sierra Leone, I tend to know a bit about living unconventionally. After completing my rotations and RDN exam, the Cal Poly SLO Dietetic Internship opened the greatest door I could imagine, a full time job as a Field Research Coordinator doing what I love: working in pediatrics and fighting malnutrition. It may not be the typical Registered Dietitian job, but I wouldn’t trade it for anything in the world. Hopefully this post can provide insight on unconventional jobs and how Registered Dietitian Nutritionists are needed in global health.
As a Dietitian I have many skills that are utilized during my day-to-day encounters. When a child is low in weight and not yet eligible to be a part of our study if less than 6 months of age, I can encourage the mother to breastfeed more to improve supply or recommend proper food supplementation when a child is 4 months. I am also able to assess when a child needs a hospital setting versus being in our program. Often the Sierra Leone hospitals aren’t equipped with the same supplies as a medical facility in the States and sometimes hospital care can be more counterproductive than at-home feedings.
My daily routine consists of waking up early and making sure the clinic boxes are stocked up and ready to go. Once done, I greet the staff, we stop for “Chop” (aka breakfast, most likely cassava leaf and fish) and we take off to one of the many feeding clinics in the two districts I manage. At clinic, we screen for severe and moderate acute malnutrition. If a child is moderately malnourished they will either receive Ready to Use Supplementary Food (RUSF) and/or will be assigned to attend mother support group teachings on how to properly care for their child. Our study is assessing if food supplementation should be given to children at high risk of moderate malnutrition or if traditional mother support group teachings are best. Children who are severely malnourished will receive one of two Ready to Use Therapeutic Foods (RUTF). The two foods given include traditional RUTF versus a 15% less costly oat based RUTF. We are testing to see if the oat based RUTF will be just as effective as the traditional RUTF. Next, we take measurements of all previously enrolled children and assess if they will continue treatment or graduate from our program. Once done, we feed and provide education and then we set out on the bumpy journey back home where I then enter data daily. Other daily tasks include making sure the office is well stocked, scheduling cars and nurses, and lastly, updating my superiors, the district health medical team and other public officials on our progress.
Being responsible for almost 50 direct staff, 45 feeding clinics and over 4,000 children can be overwhelming at times, however my Cal Poly DI prepared me well. Leadership, management and cultural competency skills are put to work daily in order to run clinics efficiently and effectively to make sure the children (or piken dem in our local language, krio) receive proper nourishment.
My leadership skills have allowed me to create strong ties to the staff and public officials. However, sexism is a daily barrier as staff aren’t used to having women in power. This barrier however pushes me to prove my worth as I know how important it is to show how competent women can be in positions of leadership. Management skills like discussing timeliness to staff or making sure all staff members receive the same amount of work days are put to test daily. Lastly, navigating cultural differences can be frustrating at times when lives are put at risk. Country-wide policies like not allowing wet nursing are put into play due to high HIV rates, however the only other option is letting the child starve to death. As a health care provider, I must educate the public on why it is important to test for HIV and how to treat it properly with ART. Then I make sure to follow evidence-based research that is best for each child.
Living in Sierra Leone is difficult. However, the smiling children make it worth it every day. If there’s any advice I could give it’s to ALWAYS investigate new opportunities, keep an open mind to unique jobs and push through when life gives you barriers.
