Sunday, July 17, 2011

"We have already swallowed the whole cow..."

"We've already swallowed the whole cow, only the tail is remaining. Will we let the tail defeat us?" - Inspirational message from the Food Security Manager to our team.

It has been a whirlwind of work this week, field work starting at 7 am. Monday morning I woke up groggy from little sleep and jetlag, wishing for just a few more minutes of shuteye. We had a long day ahead of us, and I had to be ready for anything.

I am here in Damaturu for just over three weeks as part of an assessment to understand some of the underlying reasons behind such high malnutrition rates in the region. Along with the Food Security manager, we are heading a team of 18 enumerators completing over 400 questionnaires. The questions on the household survey range from food security and livelihoods to breast feeding practices, from food scarcity to water accessibility and sanitation coverage and hygiene. Little work has been done in the country as far as data collection goes, and the little statistics one can find are unreliable and sketchy.

Monday morning had us far away from base in Sassawa Ward. After progressively dropping team members along the way, I was finally able to have my first transect walk, joined by a community member, our translator, and the food security manager. We asked about what crops they produces, what proportion they sold, how far there water source was and seasonality of water. We asked about childcare practices and sanitation (this particular community practiced open defecation, and after some urging, we convinced our guide to show us the area everyone went). An hour's walk to the river, where they would bathe, wash clothes, and water livestock before returning home. We asked a woman is we could ask her some questions, "No," she replied, "I need my husband's permission first." So we casually stood near her house and asked our guide questions, only to find her interrupting to answer correctly. We managed to get quite a bit of information from this originally unwilling woman.

Later in the week, I sat with Fatima as we conducted several Women's Focus Group. Again, our questions focused on food, breastfeeding and childhood diseases and water. Surprisingly, the first group we interviewed, when asked, "What causes diarrhea?", the women told us it was their children playing in the dirt and eating things, as well as flies landing on their food. The other two focus groups were not as informed - "Diarrhea is natural, we don't know how to prevent it," or, "Diarrhea is caused by children teething."

Only after a few days in the field, I am already beginning to see trends in people's approach to water/sanitation/hygiene. Hand washing is virtually non-existent, along with knowledge of germ theory. Water treatment is never done, and soap is unavailable due to financial constraints. Breastfeeding practices are usually more harmful than good - women wait three days before breastfeeding and often give the baby water and solid foods from the start (for those of you who are not mothers, there are essential proteins in breast milk only during the first few hours after birth that protect the child from infection. Without them, the child is at higher risk of infection, with weaker immune systems to fight against the many pathogens in the environment). Understandings of transmission pathways that can lead to fatal diarrhea or malnutrition are absent.

I have two more weeks of field work, but already have found some very simple interventions and health messages that I think will greatly decrease the disease burden in the region. Overall, we are looking for ways to address malnutrition, and it seems education is the one thing that can do it.

Where there is a white person, there are children.

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