Beginning RMF’s Malnutrition Eradication Program in India

Starting RMF’s Malnutrition Program in India

Last month sitting comfortably with a cup of coffee and my laptop, I sat on my balcony in Delhi and read a New York Times article by Somini Sengupta titled “As India Growth Soars, Child Hunger Persists” (http://www.nytimes.com/2009/03/13/world/asia/13malnutrition.html. Living in India and considering myself a well-informed hand of the development sector, I knew that malnutrition was one of the nagging problems pulling back at India’s development, but the awesome extent to which malnutrition plagues this country was a shock. With 46% of India’s future threatened by malnutrition, to call the problem India’s “a national shame,” in the words of Prime Minister Manmohan Singh, is just the beginning.

“What is going on? Why isn’t anyone doing anything for malnutrition? What can we do?” I complained next time I spoke to Dr. Fabian Toegel, RMF’s Honorary Country Director in India. In his very German way of breaking down a problem, Fabian rattled off a plan to combat malnutrition without skipping a beat. Fabian not only is a doctor with his MPH, he has also worked in rural India for the past 12 years: He’d clearly been confronting and thinking about how to tackle malnutrition for years.

Based on Fabian’s innovative approach to tackling malnutrition in India, the two of us sat down and devised a strategy and then set up meetings with partners and key stakeholders to determine the need and feasibility of our intervention. We quickly saw that despite the numerous challenges to working in malnutrition in India, the potential for us to make a large impact is enormous, so we brought our idea to Martina Fuchs, RMF’s CEO. “Eradicating Malnutrition in India” was the title in my email and Martina’s response was “this is fantastic, let’s do it.”

And there, with barely an audible pause between words and the enthusiastic faith of Martina, the RMF Malnutrition Eradication program was born.

Our goals are ambitious, the problem is daunting, but we have to do something and we have to start somewhere, so we’re going to start where the problem is the worst, the state of Madhya Pradesh. Our work is cut out for us: 60% of the state’s children less than 5 years old suffer from malnutrition, with an estimated 1.2 million of those suffering from severe acute malnutrition and another 1 million suffering from moderate acute malnutrition. [For more details about the challenge we face and how we plan on tackling it, click here

As soon as we decided to start the program, I left Delhi for 3 weeks to see the ground realities in rural MP to determine where we should focus and what the most urgent requirements of the communities on the ground are. I met with top government officials, NGOs small and large, doctors, caregivers, and UN organization heads in Bhopal, MP’s capital, to get a sense of the local political situation and the NGO landscape in MP, and then went out into the field. I traveled through the northern districts of the state and the tribal areas of the south, visiting the cities in the middle. After many overnight trains, rickshaws, buses, motorcycles, jeeps, and even an elephant, I’ve seen the overwhelming need for our work, especially in the southern tribal districts of the MP.

From the limited amount of this vast state that I have seen so far, the malnutrition rates in Madhya Pradesh are not statistical exaggerations. The faces of the children behind the numbers are haunting: they are the blank bug-eyed stares of children left behind by the system and society, so skinny they can’t sit up to hold the weight of their heads.

The poverty causing malnutrition is as real as the cliché. I met a group of railway orphans who were taken to see “Slumdog Millionaire” by an NGO as a treat, but who didn’t find it at all entertaining because that is their life. I met women who were forced to work the fields and then on their return found they couldn’t breast feed their babies. Dirty water is used for baby formulas. Untreated cases of diarrhea leave children emaciated. Caste bars some state sponsored health workers from entering villages. Naxalite revolution bars health workers from entering others. Frequent migration leads vulnerable populations to alien towns where the food they know to be nutrition in their village is either unavailable or prohibitively expensive. Dangerous misconceptions about nutrition abound from lack of education, such as the village tale that bananas (plentiful, cheap, and nutritious) cause sterility. Mono-crops have limited the nutrition coming from the earth and the productivity of agriculture. The drought this year in southern Madhya Pradesh is only going to exacerbate the dire state of the majority of the rural populations. The future is bleak for most of these children even if they survive childhood.

The poverty in rural MP is compounded by/linked to a number of serious problems within the government and NGO service delivery system. The government has been unable to address rural problems at times, at others complacent, and at worst a counterpart to driving poverty. I’ve seen and heard anecdotes of endemic and systemic corruption, government schemes that never reach the people, NGOs with fake addresses, and empty health facilities. There are many government officials, NGOs, and individuals doing what they can to alleviate poverty and address malnutrition, but there is a lot to be done to fix the system.

Malnutrition in India, like most social, political and cultural problems in this complex and nuanced country, is difficult to wrap your head around. Unlike Africa were malnutrition is mostly caused from the unavailability of food politically or otherwise, in India food scarcity is not the issue. Distribution is certainly a problem, but in a country with the world’s most billionaires, nuclear weapons, and a lunar mission, not to mention the producing the world’s second highest agricultural output, the lack of resources – both money and foodstuffs – is not the issue. From what I’ve seen and heard (backed up by many experts’ opinions), the two predominant causes for malnutrition are the inextricably linked poverty and lack of education. From poverty and lack of education stem the lack of knowledge of nutrition, the inability to treat simple diseases such as diarrhea, dangerous superstitions, indentured labor which forces people to live hand to mouth, and ignorance to public poverty alleviation schemes.

In short, the causes for malnutrition are as multifarious as Indian society and cannot be rooted out in one generation by one NGO one government or by one approach. But is this a reason not to act? Not to work with government for sustainable change? Not to partner with willing NGOs and individuals to affect changes?

Its exciting and scary to start a new program, especially in the complex nexus of politics, science, development, and poverty in which we’re working. There are the days when anything seems possible and when goals seem within reach. Then there is the harsh reality of a system stacked against us, an economic slow-down and donor fatigue.

I’ve had to fight the tears of pity, frustration, and anger a few times. It is at times overwhelming to see the scope of the problems we face and is tempting to give up doing anything because its impossible to do everything.

While pessimism has its place in plan Bs and careful scrutiny of approaches, I think we have many overwhelming reasons to be optimistic that our program will work. Over the few weeks in the field the support we’ve received by government, NGO, UN, and individuals throughout Madhya Pradesh for our program has been encouraging to say the least. From a priest who washes leapers’ feet to a doctor who doesn’t take weekends and visits field sites until 2am, meeting the people already in the field and carrying out inspiring work lets me know that we’re doing the right thing with the right people at the right time. We’re going to work with government officials who really want to affect honest change and with individuals who are willing to take risks in order to do what is right.

We could fail. But we also could save one child’s life. Maybe 2 children.

Maybe a family. Maybe a village. Maybe 10 villages. Can we stretch it to an entire district? We may even be able to save the children in an entire Indian state. We might actually save 1.2 million children. That’s incentive enough to try.

To all the RMF fans out there, we’re going to need your continued support if we’re going to eradicate malnutrition! We encourage your support through sending ideas, sending funds through the website and Facebook page, volunteering your time, and letting friends know about our efforts.

If you have any ideas, suggestions, comments, etc. on how you think we can tackle malnutrition or improve our program, please email me at Caitlin.McQuilling@realmedicinefoundation.org .

The best approaches come through collaboration!