“Eradicate Malnutrition:” Update From the Field (RMF: India)

Now that the training of our Community Nutrition Educators (CNEs) is complete, Real Medicine Foundation Team India has started our field surveys in 500 villages in Southwest Madhya Pradesh.  The CNEs are going door to door to find out about nutrition levels among all children under 5 and ask the thousands of families about livelihoods, access to healthcare and public services, and available food. This is the first time a survey of this size and scope is being conducted in these areas.

Our goal is to gain a better understanding of the level of malnutrition for our interventions and acquire as much information as we can to really understand the underlying causes of malnutrition in the villages. Once our surveys our complete, we will have a comprehensive list of which children are malnourished where, data on pockets where malnutrition is especially prevalent, and some understanding of why malnutrition is particularly bad in these areas. After the surveys, our CNEs, who are really the foot soldiers in RMF’s battle against childhood malnutrition, will know exactly where to focus their efforts and which families are most in need of nutrition education, support, and follow up.

These baseline surveys will also be extremely important for monitoring the success of our program.  Our program includes stringent monitoring and evaluation of the initiative, with our CNEs submitting weekly reports on their activities in the field.  By having a clear picture of where we started, we’ll be able to accurately measure the impact that RMF activities have had in our villages.  This is important not only to prove our effectiveness to our donors, but also to gauge the effectiveness for government and other partners so that our program can be replicated throughout the country.

While in the villages, the Educators are also diagnosing and referring cases of Severe Acute Malnutrition (SAM) to treatment facilities throughout the state. In India, cases of SAM are treated in Nutritional Rehabilitation Centers in district and block hospitals. Over 14 days, the children are given micro-nutrient rich therapeutic food at regular intervals of 2 hours under the close supervision of nurses and doctors. The child’s parent, usually the mother, is also given tips on preparing nutritious food, sanitary preparation of food to prevent illness, and guidance on correct breastfeeding.  So far the CNEs have referred dozens of children to the centers for care.

Over the past week I met with every district team to get a sense of how the surveys are going in the villages.  All of the women were pretty positive, but also shared some of their concerns and difficulties with me, and each other. Actually, I didn’t have that much to say, or much of a chance to say anything at all. By sitting in a room together, and realizing that their peers shared many of the problems they had faced individually, all of the CNEs engaged in problem solving discussions without little guidance. When a problem was raised by one woman that another had faced, and solved, everyone took notes on the new strategies and enthusiastically applied it to their own difficulties. The hardest part of the training process was predicting the nearly infinite local problems that would hamper the surveys, however, team-building exercises such as role-playing gave them some of the tools they would need to handle situations in the field. Combining these skills with on-the ground experience, and conversations about lessons learned with each other, has empowered our CNE’s even more.

Building off of each other, and combining the vast array of talents and backgrounds of our team is the cornerstone of our “Eradicate Malnutrition” program. As we begin the intervention phase of our program we are all confident that we are about to affect some real change in an area deeply in need of it. Our confidence will be tested, however, as the job ahead of us is a daunting one.