Le Foyer d’Apprentissage et de Réhabilitation Nutritionnelle (FARN)

Hearth Model (Community Based Nutrition Education)



Most of you probably wonder what I really do as a health volunteer besides help out at our clinic (CSPS). Well here is one of the programs I have just completed to rehabilitate malnourished children in the village. The program is a community based model to improve the health of the entire family while focusing on children. The original concept of the Positive Deviance (PD) / “Hearth Nutrition Model” (FARN in French) was introduced in the 1980s in Haiti and has since been replicated in countries as various as Vietnam, Bangladesh, Tanzania, Mozambique, Mali, and Guinea. In contrast to traditional nutrition interventions which “tend to look for problems in the community that need to be solved, the PD/Hearth approach looks for the positive behaviors and strengths that exist in the community and can be built upon.” It proves that despite poverty, there are local practices, knowledge, and resources that can be exploited to promote positive health practices. Even in the poorest communities, some mothers are still able to raise healthy, well-nourished children. If those “positive deviant mothers” (Mamans Lumière in French-speaking countries) could pass on their feeding and hygiene practices to other mothers in the community, we would see the problems of malnutrition and other childhood illnesses significantly decrease. Moreover, since the solutions focused on in PD/Hearth come from within the community, thus the behaviors are far more sustainable. These “Mamans Lumières” help lead the Hearth program and provide a real example of someone in the same environment with healthy children.

Positive Deviance Webpages
http://www.positivedeviance.org/
http://en.wikipedia.org/wiki/Positive_Deviance



In practice, the PD/Hearth intervention brings together between six to ten mothers of malnourished children over a two-week period to learn and practice the healthy nutrition behaviors performed by a local positive deviant mother. Led by myself and the “Maman Lumière” from the community, the Hearth group prepares a healthy local recipe and discusses a health issue of concern to the women and their children every day. All the food used in preparing the meals comes from the village and is affordable for all the women in the program. The health issues are discussed with the assistance of one of our local clinic staff. At the end of the 2 weeks, most children gain weight and often exhibit improvements in mood and energy. Furthermore, qualitative studies suggest that the mothers continue to practice the healthy behaviors learned in the Hearth even after the program has come to a close.

Objectives of Hearth (FARN)
Hearth has three main objectives.

1. To rehabilitate malnourished children. Each day, trainers and participants prepare enriched porridge together. Every woman has at least one liter for her child to eat throughout the day, in addition to his usual food. Over a period of 12 days, participating children can gain moderate to significant amounts of weight.

2. To educate the women on basic health issues (i.e. Hygiene, Vaccinations, HIV, Malaria, etc). Each day, the session leaders address a different health topic. Practical, healthy solutions that are accessible to local women are promoted. They facilitate a discussion with the women addressing their questions and dispelling local myths.

3. To demonstrate that raising well-nourished and healthy children is possible even with limited means. By showing that positive change is possible and by teaching women information about their own basic health, women will be inspired to continue positive health behaviors after the training.

This past weekend I completed my second Hearth Model Workshop (FARN) with women from my village. The malnourished children were chosen from information gathered from our clinic at monthly baby weighing. The workshop was held at the “Mama Lumiere’s” courtyard or foyer. At the end of the two weeks all but two children gained substantial weight, one passed away from Malaria, and one decreased after getting over a respiratory infection. At the end of the program each mother received a Moringa sapling that I have been growing in my courtyard. My courtyard has become a mini-nursery and I have been working with my friends from village to incorporate the Moringa in their diets and as a means of reforestation.

http://en.wikipedia.org/wiki/Moringa
http://www.moringagardencircle.org/tree.html
http://www.treesforlife.org/



Remember rural Burkina Faso is poor, really poor. I constantly hear with the “World Food Crisis” that people are complaining about the rising prices of basic goods like rice. Most villagers in Burkina can never even afford to eat rice. They may get a plate of rice a few times a year, and as I found out while teaching last year from my students, they may only get one bottle of Coke a year. So all my recipes used in the 2 week program used village resources. Most were porridges based on sorghum (millet), corn, beans, peanuts, fish, local leaves and mangoes. Every day I ate with the kids to encourage them, and yeah I even gained a little weight myself, which I could use. I am planning on doing other FARNs in the surrounding villages in the months to come.

http://www.bbc.co.uk/worldservice/indepth/080702_food_crisis.shtml

"Ligi ligi" and Pneumonia

Farming Burkina Style

People say the best form of birth control in Burkina Faso is the mass introduction of mechanical farming equipment. Basically tractors equal less need for children. After the past week I have come to understand the exact meaning of this idea. Group farming in Burkina Faso is ridiculously fun and now I understand what it really means to farm by hand. The average family size in Burkina is about 5-8 children per mother, and with polygamy in almost all rural areas, that equals about 3 women per man… around 15-20 children per family. My nearest neighbor and host family has 17 children and 3 wives. Last week I was introduced to Ligi ligi, which means group farming in Jula. I had been cultivating before, but this was a whole new experience. I was told the day before that there might be dolo and beer, along with music. When I got to the field around 10 am the group was well on their way to having a “good time”. I made it there to work just enough for the blisters to form on my hands before the morning porridge break. After that we worked until 2pm and then had lunch with as much Dolo as anyone could handle. Pork was the meat of the day and everyone had their fill of To. Then we worked till around 5pm and my hands, back and neck were a mess. Throughout the entire day the ballafone only stopped for a mere 15 mins, and that was only for the musicians to eat. All and all we weeded about 3 hectares of millet.

Weeding massive fields with a two foot long hoe may seem like a pretty cavemanish idea, and yes I too had similar first impressions. But once you realize how tough and rocky the soil is here, you soon realize after centuries of evolution, it most definitely is the best way to unearth weeds growing in the fields. A longer handle would make sense if the soil was soft, allowing you to stand up right and work in a more relaxing position, but you would get no where and it would not nearly be as efficient. Once you get a new Daba, (Jula for hoe) in your hands and a few liters of dolo in you the work just seems to fly by. The field owners will organize basically a small party in their fields to attract as many able bodies in need of booze fix. They also will kill a goat, sheep or pig for the day. The wives will be busy the few days before preparing local millet beer and enough food to feed the masses, also hard alcohol is bought along with beer depending on the means of the proprietor. Basically it amounts to a massive music filled festival in the fields, with dirt flying and dolo sloshing all day long. It was my first experience seeing this type of group farming and the results were pretty amazing. It motivates others to work harder and longer, while building community relations. The calluses on my hands are coming in nicely and all the villagers are in awe that the white guy CAN work with a Daba and keep up with the young folks… they are proud of their Toubabou (white guy).

On a more serious note, now that the rainy/growing season in full swing, villagers spend most of their time in the fields with their children with them. This colder/wetter season provides a great environment for children to catch colds. This is often overlooked by the importance of completing field work in such a short growing season. The work has to be done, if not the villagers won’t eat next year, so often children are left unattended and not sufficiently protected from the cold.

I watched two kids die last Friday from Pneumonia. They were brought to our clinic after being sick for about a week. When they got there, there was little we could do to help them. Even with prescribed antibiotics and all the meds we could muster, we sat and watched their lungs fill with fluid. We tried to suction as much as we could with the simple tools we had, but in the end it was just an endless battle against time. It was again one of those experiences you really can’t explain. The hardest thing for me was after the children passed away, the mother just attached the child to her back as if it was still alive; the way most African women carry their children, and had to walk the 3 or 4 miles with her dead son on her back. It was a tough day.

Often it’s not appropriate to photograph the experiences that make the biggest difference on me here in Burkina. Most of these I would never want to… and I am sure you would not want to see them. This is not to say that I won’t try to explain them to the best of my abilities. It has been a tough few weeks, but an amazing few weeks. I am starting my second malnourishment program next week in a nearby village. I will explain later and hope to add more photos.

Last night a good friend of mine (Erica) was bitten by a poisonous snake while walking home from dinner in Bobo. She had not seen it in the dark on the path and had stepped on its back. Ben and I killed the snake and brought it back to our office. Her foot swelled up and went numb as she felt the venom migrate up her leg. She was taken to a clinic and within in an hour or so an anti-venom IV was started with anti-biotics. She is fine now but it was a bit of a scare for us all. Never a dull moment.

Malnourished Children

Last week another 3 year old died from malnutrition in our village clinic. Malnutrition is a problem in my region of Burkina Faso. Over the past few months, when we go out on vaccination rounds in the other smaller surrounding villages we weigh the children. This monthly weighing is an easy way to see trends in weight and notify parents of malnourished children. (Ex: 23 months old at 4.400 kg = less than 10 lbs) This is where my work comes in and I will discus with the family better nutritional and hygiene practices, and a demonstration on how to make an enriched porridge with local produce. Over the past four months this child who recently passed away was continually losing weight. His family was warned of the problematic trend. They seemed not to care too much, until this last visit when their child was obviously severely malnourished. I don’t need to attach a photo here; you’ve seen similar kids on TV. He couldn’t walk, distended belly, cracked bleeding lips, chapped and swollen feet and hands, sunken eyes barely open. We took him to the clinic and tried recuperating him with IV’s and feedings. It was just too late. He passed away the next day from complications due to malnutrition. His body systems just basically shut down. You could see in his eyes he was so tired, he just wanted to die; to stop his suffering.

His mother is currently pregnant, and his father has 3 wives and couldn’t afford to pay for all of them to be properly fed. Life is looked at differently here, especially the lives of children. Like I said before he will have no funeral, and no ceremony. The family will just have more children, hoping that the next child with better economic times this will survive. The hardest thing for me to grasp here is the cultural regard to life. It’s hard for me to imagine living a life that is so difficult you have to think of only yourself.

Friends ask me, “Are you making a difference over there?” It’s a question I ask myself a lot. I know I am making a difference, to what extent I will never know. A very similar child to the one above has regained weight is eating well and is healthy. When I first met the little guy he was in bad shape and I thought he would not make it, but after spending a lot of time with the family and mother he was recuperated. So maybe I saved one kid. That makes a difference right? So yeah I am. His mother participated in my Nutrition Project and has now become a role model for other mothers with malnourished children. Last week while we were playing with her now healthy and happy kid, she told me “Awenice”, Merci Beaucoup.

On a way lighter note, I got a new puppy. His name is Kisira, (“Chief of the Courtyard” in Sambla.) Same name as my old dog, just a new language. There are 66 different native languages in Burkina. If he can’t make it home with me, he will be better off than my last one. This ethnic group doesn’t eat dog.

World Food Crisis

It seems like everyone I talk to in Burkina is discussing how “La vie est cher” and how everything here has become more expensive. Everyday on the BBC, I hear of new disasters in the world causing further price increases in everything from gas back home in the states to rice in my tiny village. It seems like this year will one of the hardest for Africans. Sudan, Kenya, Ethiopia, Chad, Malawi, Zimbabwe and even South Africa all have political problems that are constantly in the news. This compounded with the rising food costs should make for a tough next year chez nous. I have obviously not kept up with world news back home as much as I do here in Burkina, but I have this overwhelming sense that the world is really pretty messed up. All I hear about are disasters in Asia, famine in Africa with continual political corruption, war, and even flooding now back home in the Midwest. I wonder how the flooding will effect food production back home on the Iowa farms and resulting market prices. Basically life for the ‘bottom billion’ just got a whole lot worse, and seeing it first hand from the viewpoint of a small West African village makes it all the more powerful. It is interesting how the rising costs of food have affected different classes differently. The upper class people, who buy their own grains and oils, are more affected than those in the lower class, who farm their own crops. So from the village perspective the increase in food price is not as bad for those in the villages. Villagers in my region are so poor that they are almost completely self sufficient and live independently from the markets. Even before the increases in food prices, they couldn’t afford to pay for rice. They only eat To everyday, and even produce their own oil from shea butter. In the long run the rise in food costs will obviously affect all economic aspects, increasing petrol and other needs for the villagers. But today it is evident that the world food crisis is affecting those who don’t cultivate their own food. Strikes and demonstrations against the governments to increase pay are continuing around Africa and I feel that they will not be slowing down until the prices plateau.

Life as a Health Volunteer

Recently I have finished a two week program working with a small group of mothers with malnourished children in my village. Every morning for 2 weeks mothers bring their kids to a designated courtyard and we work together to make an enriched porridge from locally grown and available produce, discussing complete pediatric nutrition. We weigh the children before and after the two weeks and will continue to evaluate their weight gain. Along with this nutritional lesson provided, we incorporate a lesson on local health problems. Topics included basic hygiene, potable drinking water, malaria, HIV/AIDS, proper birth techniques, proper weaning and family planning or birth control. The lessons where taught by myself along with our clinic staff in the local language. It was a great experience and the majority of the children gained considerable weight. Those who didn’t were plagued with malaria, diarrhea or other infectious diseases that undermined the nutritional benefits of the two week program. I am planning on continuing this program with more groups of women in the months to come, as about 30% of the children in my village are malnourished.

Village Life

My new village is tiny. No market, no transport to or from the village, no restaurant. This makes life a little different than my last set up. I am eating more with families and definitely living on a lower level. I have definitely become a real villager. I spend on average about three or four dollars a week in village. That’s for everything. Recently the rains have started and now everyday the village is empty. All the villagers are out in the fields planting their crops; millet, corn, peanuts and cotton mostly. Cotton is their only real cash crop and therefore is associated with the most risk. Based on this years cotton prices fewer people are planting cotton this year. All the farms are plowed and planted by hand. I have not seen a tractor in my region yet. Some of the more prosperous families have cows and plows to work the land, but still most do everything my hand. I again tried my luck at farming. It didn’t last long, about an hour and a half into planting millet my hands blistered and I about passed out in the relentless sun. I ended up sitting in the shade pounding as much water as I could hold while the others kept working for hours. It is remarkable how calloused their hands are and the quantity of land they can seed in a day.
Also, as the growing season has started the village elders have started their ceremonial sacrifices to ensure a good growing season. I have had the rare opportunity to record some of these ceremonies with my camera. I will have to show you all when I get back. Some of the video clips are a bit graphic and too long to upload. Overall things in my new village are going well and I am enjoying my new work, although I do miss teaching and the classroom environment.

As the growing season gets underway, people invest all there money and time in preparing their feilds for the coming rains. Natrually this causes a lot of stress on farmers. Also as the rains come the first new growth sprouts and all the animals who have been basically starving in the dry season eat everything green in sight. This can cause massive problems between farmers and the hearders, usually from different ethnic groups. I heard on the radio last week that an arguement broke out between a group of farmers and hearders. The herders' cows had eaten a large amount of the farmers' new corn. The farmers went and killed a few of the cows in retaliation, this event escilated the situation and it became violent. Overall 15 people were killed in the dispute in southern Burkina. It must not of been a pretty site, axes, hoes and machetes. I am not sure if it made BBC, but was on our local radio from Bobo.

Below is a funeral where villagers dance and play music for days in celebration of a life well lived. The more important and older the person was when he or she died, the bigger the party. Babies and children have no funerals and are just burried, this night was the opposite. He was a pretty big deal.