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Diatician Makuku: Tells of what your body needs

The MidweekSun Admin

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Growing up, Diatician, Keitumetse Makuku of Bonatla Wellness Solutions at AO Clinic was a fussy eater, she admits, she still is.
She recalls her late grandmother carrying a stick at every meal time. Today, she has has made it her life’s mission to educate people on good nutrition.

What made you choose this career path?
Growing up I would line up my mom’s deodorants, colognes and body lotions as my students. I knew that I wanted to teach people and educate them on how to improve their lives. Hence I chose Dietetics, which entails educating people on good nutrition and improves their lives.

What was your diet like growing up?
I was a fussy eater, my late grandmother would always be carrying a stick everytime I had to eat. I am still a fussy eater and don’t eat a lot of foods.

If you could persuade people to change three things about their diet, what would they be?
Eat foods that you enjoy so that you can be consistent with your healthy eating. For example, we know healthy eating entails eating mostly wholegrains, fruits and vegetables, low fat products, low fat dairy products and lean meats like chicken. From the wholegrains group make sure you eat that which you enjoy so that you can be consistent. There are individuals who love eating korong whereas others love eating mosutlhane or both, in this case I should not feel pressured to eat items I don’t like, including brown rice. Some people believe that healthy eating is when you eat fancy foods that entails shopping for expensive vegetables they can’t afford and only eat for a short period of time. Eventually, such people will tell you that they don’t enjoy the food but are just eating it because it’s considered healthy.
Keep it simple, our forefathers were healthy on their traditional foods. Lifestyle modification is a process and it begins with you as the individual. If you want to lose weight do it because you are ready and know and believe that it is the right thing to do, than doing it to impress your peers.

Are there any books, magazines, newsletters, podcasts or websites you would recommend for those who want to become better educated about diet and nutrition?
If you want to know more about good nutrition first and foremost there are professionals in the field, Nutritionists and Dietitians in all the different government hospitals and some are in private practices. They are the right people to give nutrition advise and guide. However, if you want to read about any nutrition facts you need to search peer reviewed articles which have different research findings about nutrition issues. Look for the latest journals as Nutrition is dynamic.

What are some of the most common nutritional mistakes you observe in your clients?
The most common nutritional mistakes I observe made by individuals are that they believe that starchy foods contribute to weight gain. They also believe that starving oneself or skipping meals is helpful in weight loss. They also restrict the intake of important nutrients that can be beneficial to health.

What is a typical day’s breakfast, lunch, and dinner for you?
Breakfast is the most important meal of the day. One cup of oats with a fruit is my favourite, then take in water afterwards. Lunch – one cup of samp and beans with one cup cooked morogo and a piece of lean beef with a bit of gravy and a fruit. Dinner for me could be baked potatoes with one cup of green salad and chicken. I enjoy simple healthy dishes.

There is a lot of hype around intermittent fasting (IF) lately. What are your thoughts about fasting as a dietary technique?
Bear in mind that the amount of food that one eats is dependent on a lot of factors such as physical activity, weight, and basal metabolic rate. Fasting varies according to different religions. Some omit all the food items and use water only, while others omit other food items and remain with a few food items. Therefore, what I can say is that provided you do not have any medical condition you can go through any kind of fasting for religious purposes, however, when you want to lose weight you cannot use fasting because for the body to lose weight it requires to be satisfied first, then that is when it can start shedding off the fat. I do not despute that fasting generally makes one lose weight, but when you want to maintain that weight loss it becomes difficult because your body will start to experience cravings which you would want to curb by overeating.

We are constantly told how ‘bad ’meat is and encouraged to have meatless meals. What’s your take on vegetarianism and veganism?
Meat is not bad, too much high fat meat is high in calories and saturated fat which contributes to weight gain and increases the chances of heart diseases. However, if you eat lean cuts of meat, chicken and fish you also benefit from the nutrients such as iron from red meat, protein, omega 3 and 6 fatty acids from fish. There are however, individuals who opt for vegetarianism for personal, religious reasons. They also benefit from plant proteins which are low in cholesterol, also contain protein. As long as one substitutes the right nutrients then it is acceptable.

What is detoxification and how do you feel about the need for it?
Detoxification as the name implies means getting rid of toxins in the body. What are toxins? High fat foods, high sugary foods, high refined foods, high salty foods. All these become toxins but when you eat healthy i.e wholegrains, low fat products, low fat dairy products, lean cuts of meat, more fruits and vegetables you do not have to detoxify. Eat healthy and avoid having to use the word detoxification.

What kinds of tools and methods do you use to help your clients achieve their goals?
As a Dietitian we are trained to educate, advise and counsel individuals on the right way of eating. We do not impose it to them but we make suggestions. We also give you the risks to unhealthy eating, and allow you to think about what healthy eating can benefit you and your family. We work together with individuals to reach a desired healthy goal.

How important is exercise and how much of it is effective?
Physical activity and not exercise is very important as it promotes good health. Relieves from stress, gives more energy, helps in shedding off fat. However, I always advise that people do what they enjoy most and not exercise because their friend is doing it. You can jog, brisk walk, swim, or anything that you would enjoy so that you can be consistent.

Any words of advice or suggestions for someone considering entering your field?
If you want to study Nutrition and Dietetics you need to have a passion for it.

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Know Your Specialist

Caroline Gartland speaks on Children and Mental Health

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Tell us about yourself and your background
I’m originally from the UK but have been in Botswana for eight years so this is now home! I have a Combined Honours degree in Psychology an MSc in Mental Health and have had a pretty varied career.
I started off working with offenders doing rehabilitation programmes; went on to support the victims of domestic violence then ended up working in Child and Adolescent Mental Health Services for the National Health Service.
I’ve done a lot of work, mainly voluntary, in different fields since being in Botswana but my passion is now Early Childhood Mental Health.

What does your work entail?
Early childhood mental health is mainly working with parents, caregivers and teachers to help them understand how children develop and the best ways to support their mental health and brain development as they grow. It’s about providing training and opportunities for families to bond with their children and introducing new ways of playing and interacting.

What sparked your interest in early childhood mental health?
Quite simply, having my own children! My daughter was born five years ago and I was fascinated watching her develop and grow. It occurred to me that the younger you begin to consider mental health and provide tools for resilience against life’s adversities, the better outcomes you are likely to have.
I began reading everything I could get my hands on, and completed a diploma in Infant Mental Health. I’ve worked down the lifespan but I feel I’m now where I belong, working with babies and young children.

What mental health issues have you observed in children in Botswana?
Mental Health is still stigmatised around the world and Botswana is no exception. Most people immediately think of mental illness, but mental health is about so much more; we all have mental health and some days we are fine and able to deal with life’s challenges and some days we need more support and tools under our belt to help us cope.

Young children can experience mental health problems. Anxiety is a common one, but we are more likely to focus on the behaviour we see rather than how the child is feeling. An anxious child who refuses to go to school may be labelled as ‘difficult’ or ‘naughty’ but what they are expressing is a painful emotion that they need help dealing with.

Describe one thing you find fulfilling and challenging about working in this industry.
Working with children and families is a pleasure and a privilege. To make life a little bit easier for someone is all that matters, you don’t have to be out there saving the world to make a difference.
My major challenge is time. I would love to do more, I’d love to do an MSc in play therapy and a couple of other therapeutic techniques I’ve come across in Europe but that gets put on hold as I focus on my own family and business.

Can you share an anecdote about how mental health consultation works?
I think that education, understanding and connection are the three keys to giving a child the best start in life. Led by that, SensoBaby provides classes in the community for parents and caregivers to connect with their infants.

We offer workshops on parenting and play to foster understanding of child development and wellbeing and we are available to troubleshoot specific problems an individual or agency has with the young children in their care or the systems they have in place. When it comes to individual parents, mostly what they need is to feel heard, supported and guided in their parenting choices.
You can read all the baby books in the world but they won’t give you the answers you need for your child, through responsive parenting and connection, you’ll find you have the solutions you need.

What advice do you have for child-care providers or early childhood teachers who are at their wits’ end over a child’s challenging behaviour but don’t have access to a consultant?
Empathy is an important and undervalued skill – the ability to consider another’s viewpoint. What is that child feeling? Their behaviour might be challenging and hard to deal with but often the root cause is an unmet need. There’s a famous quote from an American Clinical Psychologist, “The children who need love the most, will ask for it in the most unloving ways.”

Does a mother’s mental health affect her foetus? How important would you say is paying attention to women’s well being during pregnancy as with their physical well being?
100% yes. It is so important to support a woman’s wellbeing during pregnancy. As an example, if the mother experiences significant stress and rising levels of cortisol (the stress hormone) during pregnancy, the foetus will be affected and in some cases will be more sensitive to stress in childhood or later in life.

Pregnant women and new families (Dads as well!) deserve nurturing care themselves and shouldn’t be afraid to ask for support. SensoBaby run FREE monthly coffee mornings to support pregnant and new mothers because we understand the importance of maternal wellbeing.

Do smart phones and television make our children mentally ill as is often purported?
I don’t think technology is always the villain it’s made out to be. The key is in the relationship with that technology. Moderate use of TV’s and smart phones are fine, as long as they aren’t a substitute for outdoor play, imaginative play and meaningful interactions. If a child is crying or upset and we hand them a device to keep them quiet then we have missed an important opportunity for connection, helping them process what is going on and supporting them to calm down and settle themselves.

Now, I know you are involved in an exciting programme that helps caregivers and children to bond and get the children off to the best start in life through play. Can you say a little bit about that work and just how you are seeing it play out?
SensoBaby is our baby; a project born from passion and a desire to support families in Botswana. We offer play-based classes for children and their caregivers that are underpinned by the principles of child wellness as well as early foundations for learning.

When you provide developmentally appropriate opportunities to play, you learn so much about your child. That understanding and observation builds strong connections, which will form the basis of that child’s future relationships and self esteem. Play is so much more than ‘a fun activity.’

We offer a number of trainings and workshops for parents, nannies and community stakeholders and hope to increase our offerings this year. Our community partnerships and voluntary programmes have been successful so far and we hope to see more impact in 2018.

We currently serve the Gaborone community but would like to expand throughout Botswana as opportunities arise. The response to SensoBaby has been fantastic so far and we can’t wait to see how far we can go with the concept!

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Know Your Specialist

Terence Mohammed explains intricacies of clinical trials

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What does a lab manager do?
As BHP laboratory manager, I am responsible for providing an oversight in the technical operations of the laboratory, including the clinical trials processing and testing labs. As part of the laboratory management, I also provide leadership in planning, implementing and completion of research activities and to ensure that laboratory operations and data generated is in accordance with Good Clinical Laboratory Practice. The lab manager is also expected to provide an oversight on the laboratory quality management system and laboratory expenditure.

Describe your career trajectory. How did you get to where you are now?
I joined BHP in 2007 as a laboratory research assistant. I worked for two years in various BHP clinical trials for diagnosing and monitoring of HIV/AIDS in clinical trials participants. In 2009, I got transitioned to the BHP research laboratory to work as a research fellow where I got assigned to work on various basic science projects. In 2014, I worked as a research laboratory coordinator where I was mainly involved in day to day routine management of the research laboratory activities including; conduct of research projects, preparation of education activities and mentoring of new research fellows, students and interns. In 2015, I got promoted to the position of deputy laboratory manager where I assisted the lab manager in overseeing the technical operations of the lab. In 2017, I got promoted to the position of lab manager.

What’s a typical day/week at the Botswana Harvard Partnership (BHP) for you?
I participate in a lot of weekly meetings; laboratory management and departmental meetings. I am also expected to attend meetings for the various clinical trials which we provide laboratory services to. These include local site meetings and international conference calls with study principal investigators and sponsors. I also review and authorise laboratory orders ensuring continuous operation of laboratory work and within allocated budgets. In addition, I also allocate time to walk around the different laboratory departments on a regular basis in order to interact with staff and learn more about their challenges. This facilitates discussions on how to improve our laboratory operations and working environment.

What are the main health and safety issues for lab technologists?
Exposure to blood, bodily fluids and tissues, which may contain infectious agents and also exposure to ultra-cold materials such as liquid nitrogen and dry ice. However, all necessary laboratory safety trainings are mandatory and staff has access to personal protective equipment including lab coats and gloves which are a requirement for certain tasks.

What aspects of your role do you enjoy the most?
I enjoy the daily interaction with researchers in the field of HIV/AIDS, both locally and internationally. It makes me proud to be part of a team that is working towards ending the HIV/AIDS pandemic in our region as it has decimated the population for over two decades now. With our work, I hope Batswana become increasingly cognisant of the task ahead of us and unify to bring an end to the pandemic.

What would you say the biggest challenge in your field is? Discuss one thing in particular?
Supply of laboratory reagents and consumables can be challenging as sometimes we experience supply stock-out and delays in delivery.

On a basic level, what skills does your job demand?
A lab manager should be able to organise and run effective meetings. It is important to set up an effective meeting agenda and be able to assign key action items to staff
-To be able to communicate effectively and create a positive atmosphere in the working environment. It is also important for the lab manager to be able to motivate staff and also be approachable to staff whenever required.
-A lab manager is expected to have leadership skills in order to provide direction to team members and ensure that the institution goals are effectively met.
-To be able to manage budgets and always be alert to ensure that the laboratory current spend does not exceed target spend.

You have done some research on HIV-1c gp120 in recently and chronically infected individuals in Botswana. For starters what is HIV-1c gp120? A brief background on the research and what the findings were?
Gp 120 stands for glycoprotein 120. This is a protein found on the outer surface of HIV and it used by the virus to enter human cells thereby causing infection. Previous research has shown that gp120 characteristics and properties could be susceptible to change overtime during the progression of the disease. Therefore, we used two groups of study participants at various stages of disease progression (i.e. recently and chronically infected) to see if there are changes in structure and properties of gp120 during the course of the disease. This research highlighted the need to further investigate gp120 in order to get information that maybe useful in the development and designing of an effective vaccine

What advice would you give someone interested in becoming a research fellow?
I would advise them to read a lot in their field of interest and also be aggressive enough to seek opportunities of attachment to a relevant institution. Furthermore, they should seek to interact with experts in the field in order to keep themselves in the loop should a research fellowship become available.

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