Can you hear him now?
In Niger, periods of drought and food shortages unfortunately are not uncommon and often people will ascribe a period of hardship a name. In the village of Doundayé people are calling the 2004/05 crisis “Seloula” or “Cellular.” Goshi Naruwa, an elderly woman, explained that Seloula is an analogy to cell-phone coverage. She jokingly said, “Seloula: ta shafi kowa,” meaning that it covered (affected) everyone. Another variation on the theme was: “Seloula: ta soulali kowa,” it shriveled everyone (like a steamed vegetable). Although said in jest, sadly, the images of Niger shown to the world last year back up the truths behind these statements.
The images shown by the media led to a large-scale relief mission undertaken by the Government of Niger and the United Nation’s World Food Programme. By the end of the operation in mid-October, CARE--one of many NGOs implicated in the relief effort--had distributed over 20,000 tons to almost 2 million people in Niger.
The acute crisis is over, harvests are in and households once again have food to eat; yet, those left weakened by the crisis continue to feel its aftershocks. CARE distributed food at the height of the crisis and now is helping, post-crisis, communities recover and prepare for the future. In the Tahoua and Zinder regions, CARE, is working to rehabilitate moderately malnourished children under the age of five.
In places like Niger, where household food security is tenuous, caloric and nutrient intake waxes and wanes throughout the year. Children are particularly sensitive to these kinds of fluctuations and predictably move through stages of declining nutrition when adequate calories and/or nutrients are not available—from mild to moderate malnutrition and eventually severe malnutrition. Once severely malnourished, a child risks suffering permanent developmental retardation, and ultimately death. Thankfully, if detected and treated early enough, almost all children can regain the weight and health from periods of malnutrition.
Doundayé, a medium-sized village an hour’s drive west of Konni, is participating in the nutritional rehabilitation project. An initial nutritional screening of the village’s 450 households identified 116 moderately malnourished children under the age of five. These children became the project’s first cohort. Under the project design, mothers of this cohort will receive a monthly ration of food—comprised of millet, cowpeas, and oil—with which to prepare three daily meals for their malnourished child (or children). To ensure that the child receives the full portion, the family also receives an accompanying food ration to supplement the household’s food supply. At the end of every month, the children are re-examined and their progress evaluated (i.e., weight gain or loss and increased or decreased brachial radial measurements). If a child receives two successive “healthy” assessments from the exams, he graduates from the program.
Doundayé's Exemplary Mothers
The project’s success hinges upon the identification and involvement of local Exemplary Mothers (mamans lumières). Who and what are Exemplary Mothers? At the same time that CARE agents identified the cohort of malnourished children, they also identified children that were especially hale and hearty. The mothers of these children were recognized as being “exemplary” in the way they cared for their children and managed their households. As such, they and were recruited to take an active role in the nutritional rehabilitation project. Each Exemplary Mother (EM) is responsible for teaching a group of 15 cohort mothers how to properly prepare the feeding recipes, which have been specially formulated to deliver the appropriate quantity of calories and grams of carbohydrates, proteins, and fats to the malnourished child.
Through this these interactions, it is hoped that an EM will not only transfer the knowledge of how to prepare recipes, but also will assist in behavior modifications that result in better hygiene and an overall improvement in health status. The changes are small, but crucial, such as using clean water to prepare food and keeping children and living areas clean. Amazingly, an EM receives no payment for her involvement in the project, apart from the use of empty oil containers, which they use to carry and store water.
In Doundayé, CARE has identified about a dozen women who meet the requirements to be chosen as Exemplary Mothers. The interesting thing about these women—as well as the women who have malnourished children—is they are a diverse group that resists classification. They are diverse with regard to ethnicity, age and economic standing.
16 years old, mother of one, already an EM
However, in speaking to women from both groups, and by visiting them in their homes, some telling similarities among the groups begin to emerge. Nana, mother to malnourished Ibro, aged 2, embodies many of the traits found across other mothers in her group. Appearance wise, both she and her child are clothed in dirty outfits and flies cover Ibro’s mouth, nose and eyes. Shy and demure, she avoids eye contact and expresses her ideas and thoughts with difficulty. When asked how Ibro became malnourished, Nana recalls that three months ago Ibro suffered from a fever, diarrhea, and was vomiting. She admits that initially she hesitated to take her sick child to the health center, three kilometers away, for treatment. Eventually, she took Ibro there for treatment and in the end she had to make three trips to the health center to buy medicine and receive consultations. The episode left Ibro weak and earned him a spot in the nutritional recovery program. Already, his health is improved, but he is still not totally recovered to his pre-illness health, and he will likely re-enroll in the program after the next monthly examination.
In stark contrast to this portrait, at the other end of the spectrum is Kuluwa, an EM with 5 children, the youngest being 22 months. She has a confident air about her and there is a peacefulness that radiates from her well-kempt home. She can explain 4 ways of being a good mother in Niger. First, she makes sure that her children eat well and that the food itself is high quality. Next, when her kids do get sick, she prevents the sickness from becoming too serious by visiting the nearest health center, 3 kilometers away. Third, Kuluwa stresses that washing and cleanliness are very important. She says sincerely, “You just don’t feel well if you are dirty or are wearing something that is dirty.” And finally, whenever she becomes pregnant, she makes sure to get pre-natal consultations from the health center. In a place like Niger, simple behaviors such as these can save children from diseases like diarrhea and malaria—not to mention the consequences of malnutrition.
The benefits from these behaviors seem obvious, but clearly not everyone shares Kuluwa’s values. How did Kuluwa learn these values? She recalls that health workers came to Doundayé and talked about the importance of going to the health center when kids are sick. Her grandmother, she says, taught her the value of preparing good, healthy food. And, her husband plays a role too. He is a willing ally in the struggle to keep their children healthy who buys nutritious food from the market for his family and pays for their children to go to the health center when they are sick, or for his wife to receive pre-natal consultations.Evidence shows that these values are passed on from one generation to the next. Just as Kuluwa learned the importance of nutrition from her grandmother, Jaimila, Kuluwa’s eldest daughter, appears to have learned a lot from her mother. When CARE began the nutritional screening, Jaimila had her two children tested and both were found to be in good health.
Aicha Shefou, a CARE field agent that works in Doundayé, reports that the nutritional recovery project is working. She stressed that at this early stage in the project, the main focus is to see progress with the kids. Then, in the coming months, the behavior modification aspect of the project and will begin to scale up its activities. Aicha said that during this phase, the project will begin making a stronger connection between overall health and personal hygiene and in doing so help mothers avoid the pitfalls that led their children to malnourished in the first place last year. She hopes the nutritional recovery project will be a vehicle to help transfer these values and help mothers like Nana become more like Kuluwa.
A real handfull!
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This piece was produced for CARE Niger in November 2005. Some of the language regarding background information on the program and effects of malnutrition came from a CARE Niger funding proposal.
This piece was produced for CARE Niger in November 2005. Some of the language regarding background information on the program and effects of malnutrition came from a CARE Niger funding proposal.
