FARNed

Since I last posted in February, I’ve been fairly busy. First, I gave a workshop to 20 nurses from different parts of the district regarding nutrition and a specific model the Peace Corps uses to help stop malnutrition in villages. It’s an interesting problem- the Minister of Health has said that the care of moderately malnourished children is the responsibility of the community and not the responsibility of the state- different from the previous protocol. Also, the current practice of giving children Plumpy Sup/ Plumpy Nut: a peanut butter like substance that comes in a shiny package and everyone calls “chocolate” isn’t working in my village. So the MCD (medecin chef de district- head doctor of the district)used something I had said during a presentation I gave to another doctor within our district, and set up a training to teach other nurses how to do it with the expectation that they would implement the model in their villages. The pilot for this program was to be conducted in three villages: Poa, Kokologo and, Sabou. The model is called a HEARTH in English and a FARN in French- means the same thing though. So the district supplied the materials, and I supplied the know-how and things were good.

The HEARTH model is built off of the philosophy that people learn best by doing and doesn’t take anything for granted. Every day for 12 days a group of 10-15 mothers meets at a central location and make an enriched porridge and talk about a health subject. Our model was going to use 3 groups of 5 mothers in different locations. The first 6 days are led by the group leader while the last 6 are led by the participants themselves. It’s a way for them to show what they learned during the first 6 days. Each day the mothers feed their children the enriched porridge and they start to see what the child likes and what they don’t like. The porridge is actually pretty easy to make. It’s made up of some type of flour (corn, millet, etc.), some type of protein (peanut butter, beans, dried fish, etc.), oil, sugar or salt, and some fruit if it’s available. While there are recipes it’s really easy to mix and match which makes the entire process a lot easier.

When we got back to site, things became a little more difficult. The district had arranged to pay the participants and while that served as a strong motivator to sign up, it didn’t assure that all the mothers would go everyday and it didn’t promote sustainability. So we found the mothers whom we identified as “positive deviants”- women who live at the same socio-economic level as the majority of the village, but rather than having malnourished, sick kids- they have kids who are well nourished and generally healthy. We were essentially looking for people who don’t leave their kid alone at home for long periods of time, know what to feed their kids, know when to go to the health center for treatment, and know/implement healthy behaviors. And then we identified women who have moderately malnourished children and would benefit from this project. We also told them we would be paying them. Of course, they said yes.

After that we informed our community health agents that they were going to go to each of the houses and observe the practices of the mothers at their house. This is so we knew what the mothers did well and what they did not do and then we could pick specific health topics that the women needed to know about. Our topics were Malaria, Hygiene, Nutrition, Family Planning, Pre-natal Consultations and, Exclusive Breastfeeding.

While this was happening we told all the women to come to the health center for consultations- there we gave every kid a de-parasiting agent, iron supplements, and vitamin A. We also asked every mother if there was anything wrong with their kids- and if there was, we treated them.

The point of the HEARTH is that it has amazing potential for sustainability and doesn’t need a Peace Corps volunteer for the implementation. It’s made using locally available ingredients, the education is all about things nurses are supposed to teach people about anyway, and it’s a way to make the community better starting from the base of the community. However, my village seemed almost afraid of doing something without me. So, we would sit down and talk about what we had to do, we’d make a schedule and then if I left for two days to deal with something else I would come back and it wouldn’t be done. So, that was slightly frustrating and more than slightly confusing. This slight issue made it so we had to start after the other two villages had already finished- not the worst thing ever but also not sending a good signal to the district.

Finally, after all the waiting, trying to schedule and, planning we were ready to go. I was fortunate to have Christina, another health volunteer come to my site for the two weeks of the HEARTH which made things a lot easier. As day 1 arrived, we got ready to weigh all the kids. The midwives were going to go to each group and weigh all the kids. However, we did not anticipate that the women would get to the courtyard early, and thus finish early. So, even though we had left earlier than the start time we still got to one group after the kids had already eaten and because of that- couldn’t weigh them. We decided to weigh them the second day instead. Aside from that, the first day went pretty well. Christina and I decided to go to 1 group per day, meaning that we could visit each group 4 times and we would have a chance to bond (in moore because none of the mothers spoke French)with the mothers and the kids. Predictably, some of the kids were scared to the point of tears, and others just screamed, turned and ran as fast as their legs could carry them. Some regarded us with indifference (though those were primarily the malnourished ones).

And for 12 days that was our schedule. Wake up super early, head to a courtyard, hang out with moms and kids, take some pictures, give health advice, leave- and then watch Dexter or Castle (both pretty decent shows). Every other afternoon we had a meeting with the leaders explaining the recipes and sensibilization topics for the next two days.

We also found time to plan a mural and tell a guy to cement a wall (picture a condom saying “make it so” with the insignia from Star Trek: The Next Generation), to try to plant trees (we showed up but no one else did), and to try and start a correspondence program between herbal medicine doctors in the states and those here in Burkina Faso.

At the end of the 12 days, we weighed all the kids again and after reviewing the data we found that, on average kids gained 513 grams (roughly a pound). Which means that, mathematically, it was a complete success.

I was recently asked to see if we were going to do the project again- because the peace corps wants to video the whole thing. I would like to do it again, I just don’t know if people will want to be paid again. I certainly hope not because 1) I disagree with paying someone to get involved in their own betterment and 2) Where is the money going to come from?