Maintaining a nutrition lifeline during the COVID-19 pandemic

Nutritionists in Klaten continue to provide critical services to keep children healthy and nourished

Dessy provides nutrition counseling to Winda Ika Saputri
20 May 2020

KLATEN, Indonesia – Before visiting her patients’ homes in Paseban Village, Dessy Sandra Dewi straps a protective plastic shield over her face and takes a moment to collect herself. As a nutritionist, seeing families to take children’s measurements and provide dietary counselling for parents is usually a standard and routine process.

The COVID-19 pandemic, however, has made it anything but. Like many health workers, Dessy worries that she could become infected by the virus.

“The biggest challenge is to convince ourselves to keep on doing our jobs,” she said. “It’s not easy for us to step away from our fears.”

Midwife Sri Budiyati
Midwife Sri Budiyati in Pandes Village in Klaten, Central Java.

While Indonesia has concentrated its efforts on containing the spread of COVID-19, the need to continue providing nutrition support remains as pressing as ever. A recent survey from 2019 showed that 1 in 3 children – approximately 7 million in total – are stunted, or too short for their age. More than 1 million children are severely wasted, the fourth highest burden in the world, which is unsurprising given that most children between 6 months and 2 years old are not fed food that supports their rapidly growing bodies and brains.

“As families lose income and have limited access to healthy food due to economic disruptions, the already high numbers of malnourished children in Indonesia are likely to increase,” said UNICEF Nutrition Chief Jee Hyun Rah. “This is especially worrying as good food intake and nutrition is essential for strengthening the immunity of individuals to prevent and fight COVID-19.”

At the onset of the crisis, staff at the Bayat community health centre in Central Java struggled to maintain services without clear safety guidance. Movement restrictions have also complicated Dessy’s work, reducing her interactions with patients and often requiring her to travel to their homes to treat more severe cases of malnutrition.

Dessy and her colleagues
Dessy and her colleagues on their way to make a home visit in Paseban Village.

“We need to look after ourselves and our stamina, so we can’t do more than ten visits a day,” she said.

Realizing the urgent need to adapt, she and her colleagues took the initiative and moved much of their work online. The mother’s class, which used to be held at the health centre to educate and counsel pregnant and lactating mothers, is now being done through a WhatsApp group.

“This group enables us to monitor the [mothers] who are at the highest risk,” she explained. “This has proven to be quite effective as a substitute for the class and counselling.”

Patients sit in an indoor waiting lounge at the Bayat Community Health Centre.
Patients sit in an indoor waiting lounge at the Bayat Community Health Centre. The seats are arranged using physical distancing measures to help prevent the spread of COVID-19.

By keeping in touch with mothers virtually, Dessy can provide advice to parents without having to see them in person. If they believe a mother is at high-risk, they follow up to learn more about their conditions and schedule a home visit. With support from UNICEF, she and her team developed a list of standard operating procedures for delivering care.

“First, we make an appointment online and agree to meet outside of their house on the terrace, or inside if the doors are open,” she said. “The health workers wear a mask, a face shield and gloves if we need to touch the patient.”

To further reduce the risk of infection, visits are limited to 15-20 minutes each and counselling is done from at least a metre away. Everyone involved must wash their hands.

Whatsapp group
Face-to-face meetings are limited due to the COVID-19 pandemic, requiring staff to use WhatsApp to counsel pregnant and nursing mothers.

One young mother, Winda Ika Saputri, recently contacted her through the group concerned for her 16-month-old daughter Fariska. After learning that the child had not gained any weight for two straight months, she decided to visit the family and packed her bags with personal protective equipment (PPE), measurement tools and supplementary food.

As they met outside Winda’s home, a metre of space separating them, Dessy noticed Fariska’s pale skin and listless demeanour as she clung to her mother. Winda’s husband previously worked at a tourism site that was closed due to the pandemic, putting the family in a precarious situation. Their daily eating habits have changed as a result, and any staple foods like eggs and fish are prioritized for the children.

With this in mind, Dessy measured Fariska’s weight and recommended that she be fed a diet with more protein. A week later, Winda reported that her child is eating more and appears healthy, easing her concerns in a troubling time.

Nutritionist Dessy Sandra Dewi provides nutrition counseling to Iksan Driyana
Nutritionist Dessy Sandra Dewi provides nutrition counseling to Iksan Driyana for her one-month-old son Hasyim during a home visit in Paseban Village in Klaten, Central Java, Indonesia.

“I’m so happy that Ibu Dessy visited us. It feels like we’re being cared for,” said Winda. “I haven’t worried since she came to help with my daughter.”

As Dessy hears similar updates from mothers in her community, the pervading anxiety that has troubled her since the outbreak began briefly gives way to a sense of hope that helps keep her going.

“It’s like a remedy for us when we see the mothers happy to be supported during a time like this,” she said. “If we’re afraid, who else would deliver the services to them?”

Winda Ika Saputri holding her 16-month-old daughter Fariska.
Winda Ika Saputri holding her 16-month-old daughter Fariska.