Malnutrition and other things Tricia combats (no, Tricia isn't malnurished, but her village children are)

--------------Naomi (an orphan) and I at the PD Hearth Program

Malnutrition. Definition: lack of proper nutrition, caused by not having enough to eat, not eating enough of the right things, or being unable to use the food that one does eat. A few months ago, I took three influential people from Jumbo to a workshop about the Positive Deviant (or “PD”) Hearth program. The program focuses on finding basic nutrition in the locally available foods and using it to make children healthier. The positive deviant portion of the program seeks out mothers who are doing a good job nourishing their children. This is my favorite part of the program! The PD mother gets to share with women how they are raising well-nourished children and caring for their children using the same resources available to everyone in the community. How do we find these PD mothers? We have a massive baby weighing! 145 children, all 5 years of age and under, came to the weighing; I was happy with the turnout. With the master Excel skills of Kris, I was able to plot out all of the children on a weight vs. age chart. With some basic math skills, we were then able to calculate the percentage of children in our village who are a healthy weight! Drum roll please… 6%. That leaves 60% low weight, 27% underweight and 7% severely underweight.

What can be done about this? There are several strategies that can be brought forth during the course of the program. The first: family planning! With couples averaging 7 children (and multiple-wife households around 10-15 children), there needs to be a lot of food to go around. Second: education (especially girls and women)! If children are educated, they grow into educated adults who make informed decisions (i.e. how many children do we want and when), and are more knowledgeable about resources available to them (i.e. food that is most nutrient rich). Third: Moringa trees! Also called, “the Miracle Tree,” a single serving of fresh Moringa leaves contains 4 times more calcium than milk, 7 times more vitamin C than oranges, 4 times more potassium than bananas, 4 times more Vitamin A than carrots, and 2 times more protein than yogurt. Unfortunately, goats really like Moringa too; they must sense its nutritional worth and try to bridge their own nutritional gap (nobody feeds them). Finally: have the white lady give money so that you can buy candy and soda and a TV! Okay, maybe that last one isn’t something I think would help.

Here’s what I already do to combat malnutrition in my village. I attend Jumbo’s monthly baby weighings. If I show up, more mothers tend to bring their children (white power—the good kind). At the weighings, I plot each child’s weight on their weight vs. age chart. If the child falls into the severely underweight class I write their name down. I then make a house call to see the child’s home environment. Are there 20 naked children running around eating anything off the ground, moving or otherwise? I talk to the parents and explain why I’m invading their home, and they bring me a chair (white power again). I ask for the child who’s name is in my book, and they bring me the child so I can give them a good look. Numbers aren’t everything, sometimes the child appears mostly healthy, maybe skinny, but maybe just small-framed. Sometimes the child has brown brittle hair, wrinkly skin falling off their bodies and distant uninterested eyes. I describe the last feature as listless, one of the more concerning signs of malnutrition (in my opinion). At this point, the child has either attached itself to my leg or is crying from all the attention. I then talk with the parents about what they farm… not if they farm, unnecessary question in this village. From the list of foods they farm, I point out the ones that that particular child should eat more of, and what they could use less of. We discuss what the child likes to eat and their usual scenario of eating, i.e. shared bowl with 6 bigger siblings, only likes the starchy foods, eats a little then complains of stomach pain… I give them some ideas of how they can get the child to a healthier nutritional status and encourage them to keep trying. I then move to the next house. Generally, I write down about 10 names from each baby weighing, I don’t write down repeats (once I’ve talked to them I only check in with them when they heed my advice and come to the next month’s baby weighing, or if I’m particularly concerned I just star the name and revisit as necessary). I also try to write down at least 1 well-nourished child from each weighing and visit them too, to give them a verbal high five.

In addition, I recently submitted a grant to help pay for bamboo I want to use for fencing. Each clan (there are 12 in Jumbo) would create a fence with the bamboo, near their homes instead of at farm. After the fence is complete, I plan to have them each plant 30-40 Moringa trees in the garden. I’ve already mentioned the benefits of Moringa. If I am successful and the women start using Moringa in their stews and soups, Jumbo will produce massive kids that could give obese American children a run for their money… well, maybe not, these kids do a little more physical activity than American children. In any case, they will be healthier, and parents would have no excuse not to use it, as it is costing them almost no money.

Also, pretty much from day one I have been working to get a small clinic in the village. We’ve completed the work required of the village for getting the clinic and nurse in Jumbo. Very soon I’ll have a nurse to collaborate with on the matter of malnutrition, and I can’t wait! Along with helping reduce malnutrition rates, we’ll have more women utilize family planning methods available at the clinic, and reduce the severe cases and deaths related to malaria and other easily treatable diseases.

May 28th I finished my first PD Hearth Program. Most villages do the program about two times to capture the most malnourished children; unfortunately, I’ll need to do it at least 5 times to reach the most severely underweight children in Jumbo. The program is a nutrition-focused cooking program, lasts for 12 mornings and enrolls 12-15 children (this group included 12 mothers). Each morning mothers of the children selected are shown a nutritious meal to cook, using protein rich food such as ground soya beans, peanuts, fish and Moringa. Then they cook it and feed it to their children. The left-over food is sent home and fed to the child throughout the day.

Our 1st PD with a girl 4 days older than him

Fufu and palmnut soup!

A busy day @ the clinic, baby weighing + PD Hearth Program

Another morning of nutritious food @ Hearth

This first two-week program went well, especially for it being my first try! Most of the women came on most days (I have some ideas for improving attendance in the future). The kids ALL ate the food, and liked it too! Not one child in the group lost weight. Rather, three maintained their weight from the first day and the rest all gained some weight! The child who gained the most weight gained 7.6% of his body weight!! (You try that in 12 days!) In 2 weeks we’ll weigh these children again to check if the mothers are still doing what they’ve learned in the programs while at home.

This is Nakoja, he gained 7.6% of his body weight & was out “biggest gainer”

Tomorrow I’ll start with a second group, this time with 13 children and their mothers. The PD (positive deviant) for the group is a 3.5 year-old girl born into a farming family. As farming is the most common occupation for people living in Jumbo, I was excited to hear how this ordinary (read: very poor) family was able to keep this young girl so well nourished. Their secret? Moringa leaves in her food at least once a day! I’ve been trying to push moringa at any opportunity (baby weighings, community meetings, nonchalant conversation). If I would have been smarter, I would have “planted” this type of mother into conversation much earlier. Regardless, I was given a real-world example of what moringa can do for a child’s nutritional status. The other women in the program are now very excited about moringa, so I told them all to go home and nag their husbands about working a small plot of land so they can use my funding for bamboo to have a moringa garden of their own!This is Jagri, she's the PD for our 2nd group, a very healthy little girl!!

In other news, Kris and I are getting excited about our vacation to the US in less than 2 months! Cheeseburgers…mmm… The rains have arrived, so it’s now cooler, but also more humid, muddy and, well, wet! We no longer have to rely on fetching and pumping our water; we instead collect rainwater from the roof. We are also preparing for a youth camp in June. We are also getting ready host some brand new (less than 7 days in country) Peace Corps Trainees (PCTs). One or two of these PCTs will venture on their own from Accra to our village to see what life is like for a PCV in Ghana. I can’t wait to share insight and advice with the PCTs to help them transition to their new life in Ghana as a Peace Corps Volunteer. Sometime in June I’m co-leading a project that is loosely based on “Take Our Daughter to Work Day.” We’ll take some girls from my village to a bigger town to see women with occupations other than farming. Its intent is to provide girls with positive role models, encourage them to stay in school and to strive for their dreams. We’re also getting ready to say goodbye to PCVs who finish their service starting in July. I guess this will officially make us the “old group.” We’re at the one year mark in our service and can hardly believe how fast the time has gone. A year from now we’ll be busy planning our reentry to life in the U.S. We miss you all, thanks for all your continued prayers, thoughts and support!