Building on Bright Spots to Achieve a World Without Malnutrition

“Go to the people. Live with them. Learn from them. Love them. Start
with what they know. Build with what they have. But with the best
leaders, when the work is done, the task accomplished, the people will
say ‘We have done this ourselves.” ―Lao Tzu

In 2013, I was working as a nutritionist at a health centre in Kirehe, a district in the Eastern Province of Rwanda. Celestin Senyabutembe, a nurse at the centre, was the only staff member focusing on nutrition services. He was also supposed to work on maternal health and family planning services. Celestin didn’t have time to conduct monthly growth monitoring activities in the community or home visits for families with malnourished children. He also didn’t have time to provide supplementary food and dietary therapy for families.

When I met Celestin, he shared that he learned about nutrition from a training on anthropometric measurements. He gave me some weighing instruments and other materials he was using to diagnose malnutrition, and asked me to take over nutrition services so he could focus on reproductive and sexual health services. I noticed that nutrition was the lowest priority at the health centre, with the fewest number of personnel and the least amount of time dedicated to it. This lack of attention and resources led to an increase in the number of new malnutrition cases in the district, but no one seemed to be paying much attention to nutrition anyway…

In most developing countries, malnutrition remains a public health problem of high importance. According to the Global Nutrition Report 2016, malnutrition is like a hidden virus and it is among the top barriers to a country’s development.

Annual GDP losses from low weight, poor child growth, and micro-nutrient deficiencies average 11 percent in Asia and Africa, greater than the total loss experienced during the 2008–2010 financial crisis. According to Rwanda’s 2010 community-based nutrition protocol, malnutrition drives up mortality rates, causes mental disabilities in children, and leads to poor school performance and poor aptitude to work. If not taken seriously, malnutrition can ruin the future of a country.

Of the 667 million children who are under five years of age worldwide, 159 million are too short for their age (stunted) while 50 million do not weigh enough compared to their height (wasted). UNICEF is supporting countries in Eastern and Southern African to reduce malnutrition through improved infant feeding practices and effective management of severe acute malnutrition. Most of the countries in the above regions have also developed nutrition policies with appropriates strategies to end malnutrition, but we are still seeing high prevalence rates. What can we do to accelerate progress?

Source: UNICEF Rwanda Humanitarian SitRep — Burundi Refugees, May 2015

In Chip and Dan Heath’s book Switch, a section titled “Don’t Solve Problems — Copy Success” tells the inspiring story of Jerry Sternin’s 1990 work on malnutrition with Save the Children in Vietnam. Tasked by the government with improving childhood nutrition outcomes in six months, Sternin was repeatedly told by his colleagues that this task was not possible. Significant improvements would require monumental efforts to end poverty and build sanitation systems, and Sternin had very limited resources.

Sternin ignored these warnings because he had no choice. He traveled to a local village and asked mothers there for their partnership in finding ways to improve nutrition for their kids. Sternin and the mothers went out in teams to weigh and measure all the children in the village. Then, they reviewed the results together and found that some very poor children were bigger and healthier than the typical child. If some kids were healthy despite their disadvantages, Sternin knew that this meant that malnutrition was not inevitable. Sternin honed in on the bright spot and sought to understand and replicate what the mothers of these children. As a result, six months later, 65% of kids in the village reported better nutrition outcomes.

It is possible to transform people’s lives in my country, in your country, in refugee camps, and all over the world. But we need to go in the community and search for bright spots to build on. We need to be committed to the work we are called to do. We need to practice empathy and put ourselves in the place of people we are seeking to lift up. We need to implement what is written in our policies, moving from promises to impact to end malnutrition by 2030.

…we need to go in the community and search for bright spots to build on. We need to be committed to the work we are called to do. We need to practice empathy and put ourselves in the place of people we are seeking to lift up.

Joining the health equity movement through Global Health Corps opened gates for me. I have been honored to be trained as an emerging leader in the the fight for health equity and social justice. I am gaining a new understanding of how the world works and what it will take to transform it, and I invite you to join me.

Jean Claude Habineza is a 2016–2017 Global Health Corps fellow with the Ministry of Health in Rwanda.

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