May 31, two World Bank consultants came to Santa Rosa to see
one of Caritas’s projects which works with mothers with infants under two in
almost two hundred villages in the department of Copán. The program,
administered through the Santa Rosa Caritas office is financed by the World
Bank and Catholic Relief Services, cooperating with the national and regional
Ministry of Health offices.
The program has hired workers, the promoters, who train and
oversee volunteers in villages, called monitors, who work with mothers and
pregnant women, to document the growth of infants and to help prevent
malnutrition and infant deaths. Besides visits to houses, the monitors get
together with the mothers each month for a talk by a promoter after which the
monitors weigh the infants, check on their progress, and offer advice to the
mothers on how to continue to help the child grow or, if the child is
underweight, how to improve the health and weight of the child. If needed, the
monitors arrange a visit to the mother’s house a few days later or even refer
the mothers to a local health clinic.
There is also a local “Grupo de Apoyo,” the Helping Group, that also provides some assistance, in some
cases preparing special foods for the mothers to show them how to provide more
nutritional meals for the children able to eat solid or semi-solid food.
(Breast-feeding is encouraged for the younger infants.)
The work here in Copán has gone well. Their recent evaluation gave them 97 out of 100 points. Much of this is due to the dedication of the coordinators of the program and the promoters who often live out in very poor communities during the week, away from their families. But the work at the base is very important.
The two consultants from the World Bank – one woman from Canada
who works on nutrition and the other who works on technological collection of
data – with the Honduran doctor in charge of Nutrition in the Honduran Ministry
of Health as well as some other local and national officials to the site in El
Carmen, in the municipality of San Nicolás here in Copán.
Marie Chantal from the World Bank speaks with one of the volunteer monitors |
I’ve gone to other sites and this is by far the best site
I’ve seen. It is also more easily accessible than many. See my blog entry on the
project site almost on the Guatemalan border.
Usually the mothers in El Carmen meet the 10th
day of each month but to accommodate the visitors, an extra meeting was added.
Many of the mothers showed up but only one infant and mother were attended.
After weighing the child the data is registered in the
infant’s card as well as in the site’s papers. The child was one-tenth of a
pound under the expected growth – though still in the range of a healthy baby.
The volunteer monitor noted this and explained that it was ten days short of a
month since the last weighing and the child would surely attain the expected
weight by then.
After this the mother talked with the monitor who counsels
the women about how to improve the lives and health of their children.
I was not the only one amazed at the professionalism of
these three campesina women,
especially the woman who did the counseling. She did a splendid job.
The monitor advises a mother on how to improve the infant's weight gain. |
Speaking with one of the women I found out that the women had been involved in the community health community before the program began more than two years ago and that they had been volunteering with this program since it began in 2010.
After this we went to a house where the Grupo de apoyo, the Helping Group, was preparing some fortified
tortillas, tortillas with carrots and some greens. I have no idea how these will
go over or whether the mothers will make them at home.
Fortified tortillas |
There was a man who had come to the meeting with his wife.
It is not common to see a father involved in this process. He rents a bit of
land – about one quarter of a manzana [0.42
acres] – for corn and beans and occasionally finds job as an albañil, a trained construction worker. He is also
involved in the Catholic church in the village. Would that there were more men like
him who take so much interest in the health of their children!
Both the father and the mother of the little boy are involved in the program |
All this was very impressive, but not all is well. One infant in the community has been consistently under weight. Why? The mother also in malnourished because the husband has a hard time finding work and so they do to have enough food.
After we left the village we went to the city hall to meet
with the mayor who is in the third year of his third term in office.
The mayor, the vice-mayor, and Maria Fernanda from the World Bank. |
He strikes me as a very different type of mayor. This might
be because he was trained as a primary school teacher and taught for a few
years. He has a commitment to the children and youth of the municipality.
He spoke of how his administration has helped the
infant-mother’s project and other projects. He really is cooperating with this
project and helping where needed. He has obtained scholarships for any volunteer
monitor who wants to go to school for nursing. He has distributed special food
baskets for mothers with children at risk.
It is good to see a mayor cooperating with this project and
also promoting alternative education programs, latrines, ecological stoves, and
improved floors and roofs for people’s homes.
It was for me – as well as for the visitors from the World
Bank and the Ministry of Health – a very good visit. We left with a sense that
something is being done to improve the lives of mothers and infants.
I believe the program is good, but there are some serious
limitations.
There is, in my opinion, way too much bureaucratic paper
work. Also, the evaluation process seems very picky and the monitors seem to
take an adversarial role.
But the real serious limitations are connected with the nature of the project.
If you want to reduce malnutrition and infant mortality so
that infants thrive, is it enough to monitor their growth and offer advice and
refer people to the local health clinic?
First of all, the health clinic might be hours away and the
people might not have enough money to pay for transportation, if there is any.
Then, some of the health clinics do not have sufficient medicine.
But a very real problem, as many of us have noted, is that
to reduce malnutrition you need to feed the children well. For this you need to
improve production of basic grains as well as other food items.
There was at least one volunteer monitor who admitted to the
Caritas promoter that she didn’t have enough food to feed her own children.
This was remedied, but the answer is not just giving people food.
Serious efforts to improve farming are desperately needed.
Caritas and CRS have worked to try to get other agencies to help in this and
about 15 communities will be helped by a US AID (agency for International
Development) project.
But this is not enough since many people don’t have land and
have to rent land at high prices. The problem of inequity in land ownership is
a serious impediment to any long-range solution to the problem of malnutrition.
There is another possible problem. Is this program
sustainable? Now there are hired promoters who work with the monitors in the
communities. When the grants run out, what will happen? Will the monitors continue
and will they get the support they need from the government public health
agencies?
That’s a real problem.
This was made real to me when talking with the general
director of the Copán program. The program ended one phase in January but was
not begun anew until March. In January the chronic malnutrition rate was about
15%; in March it was up to 29% but was reduced to 19% by May. This is not
scientific evidence but only anecdotal. Did the absence of the promoters in the
communities allow this to happen because there was not sustainability built
into the program? This a serious question which I hope all parties involved are
working on.
But at least the lives and health of many mothers and
infants have been improved and the rate of infant mortality has been seriously
cut.
Rosblin didn't want me to leave. |
More is needed, not just programs like this but serious efforts
to improve the unjust distribution of land and wealth that makes Honduras the
second poorest country in the Americas.
4 comments:
Talking with Edgar, who is the director of the project in the department of Copán, he noted another reason why the percentage of chronic malnutrition rose from January to March, as noted above.
The coffee harvest is a major - if not the only - source of income for many rural families in Copán. In some cases, both parents and older children go to harvest coffee and leave the smaller children at home. Thus the children do not get enough to eat - at times, only tortillas. This, of course, recalls again the factor of poverty as another cause of malnutrition.
Would the church consider purchasing a plot of ground for a community garden? It might be cheaper in the long run to do so than to continually buy food to meet current need.
I don't know if you have heard of Plumpy'nut. Partners in Health might be able to advise.
In the parish of Dulce Nombre where I help, there is a parish project which promotes better basic grain production as well as vegetable gardens in the areas around homes. The parish is also hoping to use a plot it bought a while ago for some vegetable production; there was an idea to plant coffee but it is at an elevation which might be too high for good coffee.
The project actually did use some thing like Plumpy'nut for the worst cases of malnutrition.
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