Saturday, June 02, 2012

Small steps to push back hunger

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.


John (Juancito) Donaghy said...

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.

Charles said...

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.

John (Juancito) Donaghy said...

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.

John (Juancito) Donaghy said...

The project actually did use some thing like Plumpy'nut for the worst cases of malnutrition.