Department of Nutrition, Toward Independence
Nutrition Campaign and the Establishment of Nutrition Counseling Room

College student volunteers promoting the importance of nutrition at the venue

As a part of Nutrition and Diet management Project (NDMP), FIDR has supported the establishment of a diet management system at the National Pediatric Hospital (NPH) since 2006 and the implementation of a nutrition management system since 2014. This project was completed in March 2019.
Today, we introduce an episode related to “Nutrition Campaign,” which was held as a closing event of NDMP on January 18th, 2019. It was the first event that the Department of Nutrition (DN) at NPH independently planned and implemented.

Last year, we received a request from DN staffs, “we would like to conduct a campaign for patients’ family in order to raise their awareness of nutrition and advisory service at NPH.” We agreed with the idea and decided to support the campaign as a closing event of NDMP.
After that, however, the NPH director suggested a plan to conduct the nutrition campaign with another event planned by the Nursing Section. If the nutrition campaign becomes a part of another event, less effort would be required for preparation while DN’s own activities could be limited. We asked DN staffs what they would like to do and left a decision up to them.

Next day, Dr. Daney, a leader of DN, came to us and told, “We understand that event preparation requires a lot of work, but we would like to gain confidence in getting DN recognized in NPH and working independently. We also would like to take this challenge to pursue our own purpose of the nutrition campaign. We have already convinced the NPH director to support DN’s decision.”
Her comment inspired FIDR staffs, and we decided to advance the plan for DN’s conducting the campaign independently.
Kyoto Morning Rotary Club supporting NDMP since 2007 provided financial supports on the campaign, and their supports greatly encouraged DN staffs. FIDR helped DN prepare the campaign on demand while respecting their independence.

On January 18th, 2019, the day of the event. Nutrition Campaign was a great success with about 180 participants from inside and outside of NPH. In the opening ceremony, three doctors of DN explained about diet and nutrition management and nutrition counseling to the hospital staff and patients’ family.
The three doctors got very nervous before the ceremony, but they successfully made the presentation. We felt that the role of NDMP was over while being very proud of them and their confidence.

In addition, the NPH director told the importance of nutrition in each hospital room. A variety of booths opened, which provided free nutrition counseling and games about nutrition, distributed samples of hospital meals, and introduced nutritious snacks.

Dr. Daney of DN presenting nutrition management at the opening ceremony

Commemorative photo taken after the ceremony. All NPH staff got united and led the campaign to success

NPH (right in front) director and hospital staffs distributing brochures and educating patients’family

An outside booth for tasting hospital meals. Participants asking with an interest, “what kind of meals are provided while staying in the hospital?”

On the same day, the ribbon cutting ceremony of the “Nutrition Counseling Room” was held. NPH became the first national hospital in Cambodia that had a department specialized in providing advice for nutrition. Japanese nutrition experts dispatched by FIDR have trained DN’s staff for starting the counseling service so far.
From now on, they have to gain extensive experience by facing and dealing with many complex cases. This ceremony became the beginning of a new path for DN’s staff.

Mr. Yoshinobu Nishimura, the President of Kyoto Morning Rotary Club, cutting a ribbon at the opening ceremony for Nutrition Counseling Room

First patient visiting Nutrition Counseling Room

※Nutrition Campaign was broadcasted on TV in Cambodia.
(Click here for the video）

Planning Hospital Meal Menu Based on Cambodian first RDA

The development of first Cambodian Recommended Dietary Allowances (RDA) we, FIDR, have worked on 2014 has been completed through various processes and certified by Cambodian Ministry of Health in November 2017 as introduced on the page of “Cambodia Nutrition Education and Promotion Project.”
(In April 2017, the development of RDA became a part of Cambodia Nutrition Education and Promotion Project.)

RDA developed in the project indicates the daily amount of energy and each nutrient for sustaining our healthy life. In Japan, the Ministry of Health, Labour and Welfare (MHLW) conducts National Health and Nutrition Survey annually and revises RDA every five years based on results of the survey. Nutritionists and nutrition specialists plan a menu for schools or hospitals in order to meet RDA as much as possible.
When we started Hospital Diet Assistant Project, the previous project of Nutrition and Diet Management Project, at National Pediatric Hospital (NPH) in Phnom Penh, Cambodia, in 2006, the problem that nutrition specialists from Japan faced was that there was no RDA in Cambodia.
Therefore, we started the project by planning a meal menu referring to RDAs of other ASEAN member states. Now, Cambodia has its own RDA, and we began to plan a meal menu based on Cambodian RDA.

Several years have passed since we devised the meal menu at NPH. While some patients are pleased with the menu, saying that NPH provides good and tasty meals, not all patients are satisfied with the quality and taste.
Furthermore, cooks serving meals to the patients every day and talking in person with them and their parents have made some suggestions for further improvement, such as cooking method, seasoning, ingredients, etc., so that very young patients could eat easily. Referring to the feedback from patients and these proposals from the cooks, Nutrition Department of NPH began to work on revising the meal menu.

First of all, we collected feedback on the meal by interviewing parents who came to NPH with patients.
From now on, this project is proceeding with making prototypes based on proposals from the cooks and adjusting an amount of ingredients by calculating nutritive value. Revising the meal menu requires a long way.
The process includes making prototypes many times and finding a menu that satisfies nutritive value and fitting into budget.

This project reminds us that a lot of work and consideration are made behind providing meals at schools or hospitals, which Japanese people take for granted. These hard work and consideration would be very significant because they contribute to providing better meals for children.

Photo: FIDR staff (right back), cooks at NPH (left), and a doctor of DN (center) are discussing to identify problem areas in meal menus and cooking methods.

Nurses Learned Nutrition Education Method

One of the FIDR project sites in Cambodia, National Pediatric Hospital (NPH) currently rations nutritionally balanced food for patients, and considers it is necessary for their parents to improve their understanding on nutrition to make sure that children continue to eat the balanced food even after they are discharged from the hospital.

FIDR held many discussions with the doctors and nurses of NPH about how to conduct nutrition education for patients’ parents. As a result, we decided that the nurses of inpatient ward instruct the parents on issues such as “balanced food” and “malnutrition and relevant diseases.”

In July, we started training for the head nurses of each ward to nourish their skills to perform instructor of nutrition. At the training, participants listened to a lecture by a Japanese nutrition specialist on the overview of nutrition education and watched a video about examples of failure in practice, followed by discussion among the participants to enhance their understanding.

At the end of the training, it appeared that participants became familiarized with the role of instructors. It will not be long before NPH provides nutrition education for patients on a daily basis.

^※nutrition education: for the purpose of promotion of people's health, to provide knowledge and information about nutrition to increase their awareness and encourage a change in behavior

FIDR is Making the First Cambodia’s Dietary Reference Intakes for Children

FIDR and Ministry of Health have been working together to formulate dietary reference intakes (DRIs) for school-age children. DRIs are the standard of amount of energy and nutrients desirable for promoting the citizens’ health. There has been no such a detailed criteria for meals in Cambodia.

Late in November 2014, FIDR started research to construct the DRIs at randomly-selected 2000 students of 135 public primary, middle, and high schools over the country. The surveyors conducted measurement of height and weight, and oral survey about their foods.

It was the most difficult to collect information about students’ dietary history because it required students to answer exact amount and kinds of food they had eaten on the day before the survey. In order to help students answer the questions, FIDR made a book which contains the real-size pictures of major foodstuffs and menus in Cambodia. Sixteen surveyors joined in the project team to carry out this research, and they are visiting villages all around Cambodia with the book on their hands.

The nationwide survey will be completed in the middle of fiscal year 2015. After analyzing the survey results, the DRIs will be compiled.

Training on Nutrition and Diet Management for an Organization Providing Meals for Children in Poverty

There are many facilities that provide meals to children in Cambodia such as orphanages and schools. We provide support to strengthen meal service management and nutritional management not only to National Pediatric Hospital but also to other organizations that operate those facilities.

Among such organizations, French NGO, Pour un Sourire d'Enfant (PSE) is providing education, vocational training, and meals for children in deprived areas of Phnom Penh. It provides meals for 6,000 children every day at their facilities. PSE wishes to improve their management of meal service in order to provide hygienic and nutritionally balanced meals to children.

Therefore, FIDR has agreed to assist PSE. The first lecture, held for 16 PSE’s staff (cook, doctor, teacher, and babysitter) in early September, started with teaching basic understanding of nutrition focusing on the importance of nourishment and three food groups and their functions. Attendees showed their satisfaction by saying “it is useful both at work and at home”and “understood what was shown on TV and radio.”

Based on the experience through the former project to establish a diet management system at National Pediatric Hospital, FIDR aims to contribute to improve nutrition of even larger number of children in the country.

Aiming at improvement of nutritional status of many patients, we keep working with the nurses to establish nutritional management at NPH. We provide further support for them so that they can put the learnt knowledge into daily practices.

※Photo: The instructor was the Cambodian officer of FIDR who had a nutritionist certification of Japan.

Training to Enhance Understanding on Nutritional Assessment

FIDR started “Nutrition and Diet Management Project” in April in succession to “Hospital Diet Assistance Project” finished in March 2014.

One of the activities of this project is to assist National Pediatric Hospital (NPH) to bring in nutrition management to advance the monitoring and intervention of patients’ nutritive conditions. As the first step, the staff of NPH need to be able to carry out nutrition assessment on all the patients with accuracy.

We conducted training for nurses of each ward to deepen their understanding on nutritional assessment of patients last June. All of the nurses that represented each ward participated in the training actively asking questions and diligently working with a calculator throughout three hours of training. They learned how to measure the height and weight, to calculate BMI (body-mass index), and to read the assessment graphs.

Now the participants need to convey the knowledge they gained to other nurses of their wards and lead them as their model.

Aiming at improvement of nutritional status of many patients, we keep working with the nurses to establish nutritional management at NPH. We provide further support for them so that they can put the learnt knowledge into daily practices.

※Photo: All participants seriously participated and asked many questions.