Work: That's what they pay me for

I’ve written about all sorts of adventures, but not much at all about my actual purpose of being here, which is to work. I know – you couldn’t really tell so far, could you?

If you have any interest in what I’m really doing here, read on. If you want to hear more stories about crazy wildlife adventures, skip this entry.

For the past several years I have been working with a particular model of child health program known generally as community-based growth promotion. I worked with this program first in Honduras, and did my Master’s thesis research last summer with a similar project in Guatemala. Personally, I believe that it’s a very promising child health program. But the conditions have to be, if not perfect, then very close for it to work well and show results. First, we must gain the support of the local government body because without their support, the program will not be sustainable. Then we need to work with the local health officials to train the people who will train and then supervise the community volunteers. That’s what I was doing in Arua during my first week. Then the trainers train community volunteers to conduct growth promotion sessions on a monthly basis. This also requires financial, material and human resources, which you don't get unless you get the local government support as well as generous donations from implementing organizations.

Growth Promotion involves a series of steps. All children (ideally) under the age of two are enrolled in the program and weighed every month. Based on their weight and age, their growth is monitored. Each month, there is a goal weight to be reached that is based on their weight the month before. The idea is that, just because a baby is growing doesn’t necessarily mean it is growing well. Maybe the kid gained 2 ounces from last month. Technically he grew, but not at a healthy pace necessarily.

Then, the child and caregiver (usually mom, but sometimes grandmothers or fathers) are counseled by the growth promoter. The counseling messages vary depending on the age of the child and whether the child gained adequate weight or not. The counseling session is used to discuss nutrition, illness, and other health issues. The goal is to negotiate certain behaviors with the caregiver to try during the course of the next month to improve the child’s growth. The idea is for these negotiated actions to be realistic. For example, if I were counseling a mother whose 3 month old child was not gaining weight, and I thought she needed to breastfeed more times a day, but she works away from home all day, I would work on giving her options that were realistic to her individual situation. So I might ask her to try to feed the child more before she left and when she came home at night. The behavior might be as simple as making sure that whoever prepares food is washing their hands adequately or making sure the child's shots are up to date.

It’s something that ends up making caregivers feel empowered. It can be frustrating and scary to have a child who isn’t growing well and is always sick, because it’s not like we are all hard wired to know exactly how to take care of children and make them healthy.

We went to the field last Friday to visit a community in a district north of Kampala. We ended up talking to a mom whose child is involved in a growth promotion program there. She told a trainer (who translated for us) that she likes the program because she now knows that she has all of the resources she needs to feed her child well at home. The problem was that she didn’t know exactly how to use those food resources. Now she does, and her child is healthier for it.

Before you say this is simple and ask why the mom couldn’t figure out how to feed her kid, it’s not as easy as it sounds. There are lots of cultural factors that get in the way of correct feeding practices, for example. Sometimes if a kid is sick, the caregiver doesn’t push food and milk as much as they should. Have you ever tried to get a kid to eat when he or she didn’t want to? It’s not that easy! Also, as I have learned over my years working in public health, breastfeeding isn’t all that easy either. There are all sorts of problems that mom shave which keep the baby from getting enough nourishment. And here especially, AIDS is a problem. HIV can be transmitted through breastmilk. So what do you feed your baby if you can’t breastfeed.

These are the questions thatthe growth promoters try to help answer. So my purpose here is to follow up with three districts whose trainers have been trained and they are ready to start weighing sessions. They are eager to start, and it spurs me on to action and inspires me to continue working. Hopefully by the time I am done with my consultancy in February, I will be able to say that I helped get at least two district programs going, and hopefully in another six month to a year, I will hear good news that kids in these communities are doing better than ever thanks to the work of the devoted supervisors and community volunteers helping them. That’s really all I could hope for.

Did you know?

• That a 2001 poll sponsored by the University of Maryland showed that most Americans think the United States spends about 24 percent of its annual budget on foreign aid.
• That the U.S. foreign-aid budget as a percentage of gross national product (GNP) ranks last among the world’s wealthiest countries (at about 0.1 percent).

We could probably do better...