First Dietitians in Malawi are Now Employed!

First RD, nutrition expert, in Malawi mixing a formula at bedside

By: Dr. Bernadette Chimera
Clinical Coordinator
Postgraduate Dietetics Program, College of Medicine

Four graduate dietitians, of the first ever dietetics program in Malawi, have been hired to occupy the newly created dietitian positions at a tertiary hospital. As of April 1, 2019, the dietitians are working at Kamuzu Central Hospital, in the capital city of Lilongwe. Kamuzu Central Hospital is an 800-bed tertiary hospital that caters for the central region and part of the northern region districts. This is a challenging responsibility for these new dietitians. However, with the training they received, in this very setting, they take on the challenge without reservation. They bring a new hope to make clinical services in Malawi better.

The Malawi dietetics program was started 2015, with support from USAID, and the collaborative efforts of; Tufts University, Innovation Lab for Nutrition, LUANAR and College of Medicine. In 2017, the very first dietitians graduated from the rigorous 20-month training. The four new clinical dietitians have skills in nutrition assessment and screening, nutrition intervention and education, enteral and parenteral nutrition regimens and drug-nutrient interactions as well as communication and management. 

Jonathan Misolo, one of the newly employed dietitians, shares his experience as one of the first dietitians in a Malawian hospital.  “The current situation is that my skills are highly needed in critical care nutrition.  I am based in the intensive care unit (ICU) and high dependency unit (HDU) which comprises of both adult and pediatric patients. I also attend to patients in the out-patient department on diabetes and hypertension clinic days. I am tasked to evaluate their dietary practices, offer nutrition education and counseling as well as monitor the patients weight trends during each visit. 

My daily work requires providing solutions to a variety of challenges. One of the challenges I face daily is the supervision and monitoring of the kitchen department because most of the feeds that I order the patients are not served on a timely basis and as such patients get starved. On the other hand, the ICU and HDU rely on modified custard porridge; which is only prepared through mass preparation and served luke-warm leading to some loss in nutritional value. Additionally, there are no enteral feeds in stock, therefore, I do dietary modification using the available foods at the kitchen stores.

I find the other health professionals are very friendly and willing to learn new ideas on feeding critically ill patients. There is some occasional resistance and I am planning to make a few presentations on feeding protocols and recommendations on feeding critically ill patients in the Medical HDU and Surgical ICU. I am excited and ready to be part of better service provision in clinical nutrition in Malawi.”

The successful multi-sectoral approach used in the implementation of this dietetics program has resulted in immense support from the Government of Malawi through the establishment of 27 dietitian positions across all tertiary hospitals. This comes as a timely response to the need for clinical nutrition services at the dawn of the rising double burden of malnutrition, characterized by the coexistence of under-nutrition along with overweight and obesity in Malawi. We look forward to the day when all 27 positions are filled with graduates from this Malawi dietetics program.