Lost and Found

Things have been somewhat crazy lately, but not in a bad way. Let me try to explain a bit.

I recently (last weekend) finished a project called the "FARN" or "Foyer d'Apprentisage et Rehabilitation Nutritionelle". It's a malnutrition rehabilitation project that follows the theory of positive deviance. Though the theory can be applied to many different aspects of life, the idea, explained in terms of malnutrition, is that in any given community where there is a high percentage of malnourished children, there are bound to be some children who are healthy and well-nourished. If all the people live in the same area (village) and therefore have the same resources, and are basically the same poverty level, what makes some kids flourish, while the majority of the populations children are malnourished?

In doing the FARN, you first find a "positive deviant" family, look at what they do differently, and try to use them as a model and teacher for the other families to follow. You then take a group of no more than 12 women and their malnourished children, and make a different enriched porridge or meal with them every day for 12 consecutive days. You use local ingredients that are easy to find in and around village. Nothing is given to the women by an outside source, the idea being to teach the women (and families) that they can have a healthy and well nourished family without outside aid or assistance; all they have to do is use the resources they already have available but may not be accustomed to using.

While the food is cooking, the mother who has been chosen as the positive deviant, affectionately known as the "maman lumiere", talks about a different health subject every day with the group of women. We started with simple, non-controversial subjects at the beginning of the project, like hygiene, nutrition, signs of malnutrition, etc., and progressed into the harder to talk about subjects like HIV/AIDS, family planning, pre and post natal health, etc by the end of the project. Each afternoon, I trained the maman lumiere in the subject material for the next day so that she could be the one to deliver the message. As everyone knows, hearing information from someone from your group of peers is a lot more effective than hearing it from some sort of outside figure. Then once the food is ready, the kids sit and eat all together as much as they can, and they take the rest home to eat throughout the day as a supplement to their normal meals. By the end of the 12 consecutive days of the kids eating a well balanced meal, the hope is that they'll have already gained some weight, and that they'll take the practices they learned during the twelve days and use them at home.

So how did it go in my village? I would say that my first FARN was a success, but not without its share of frustrations and let downs as well. With 12 straight days of me and my counterparts (the maman lumiere as well as my gerante (pharmacist) from the CSPS, Aguera, who is the only person besides the Nurse and Midwife in my village who speaks french, and thus does pretty much everything with me, as well as functioning as my mother in village), pounding information into the womens heads, there's no way they didn't learn something. The major point we wanted to make was that with very simple changes in practices, like washing hands with soap before eating, and USING all the foods rich in protein and vitamins that can be found around village but are not traditionally used to cook with, you can drastically increase the health of your family. It's a great project because it's sustainable, capacity building, and you can actually see results after the 12 days. I am already being hounded by all the mothers who weren't chosen to participate in the first FARN to put them in the next one, because they've seen the effect it's had on the children and mothers who participated in the first one.

I realize that explaining in too much detail how the FARN was implemented and what i did to prepare for every step of it might be boring, so how about a list of highlights and lowlights from the inaugural FARN, in no particular order:

Highlight 1: one week before start of project, I did a village wide baby weighing day, in which I attempted to weigh every baby in my village and take their height and arm measurements. Usually I weigh babies every friday, but i wanted to hold a special day, where I informed the women that I would be weighing to find the malnourished children, so that I could get a good sampling of kids. I actually got a great turn out of about 200 kids, which was awesome

Lowlight 1: this massive number of people, as awesome as it was, was extremely hard to deal with and a huge mess at times because people don't know how to stand in lines and wait their turn, and i was subsequently pushed all around by the giant scary mob of moms and babies waiting to be weighed. I had to get angry and threaten to take the scales inside and stop weighing babies if people didn't behave themselves, quite a few times. I tried drawing a line in the sand that people were not allowed to cross, until i told them they could, which worked for all of 5 minutes before everyone forgot it was there and continued to close in on me and smack me with their health carnets (little books where we write all of their health information and records) to get my attention to weigh their baby first. Also, for some reason, a lot of the kids are deathly afraid of getting on the scale to be weighed, and kick and scream and scratch and refuse to stay still, so, yea, i know you might be thinking that they're just babies, but in all seriousness, they can be scary. I came away with many a baby weighing injury, but it was ok, because I was glad to see the huge interest by the women who came out.

Lowlight 2: Two of the babies included in my first FARN were a set of twins from my own courtyard, who, to be honest, i should not have included because their situation was too grave for me to deal with in village. They were each about 4 kilos, which is a normal weight for a newborn, but certainly not for kids 16 months old. I had been telling their mom for about 3 months (maybe longer) that she needed to go get help at the hospital, because she claimed that they just didn't accept food, and that they refused to eat. But she refused each time, telling me that there was no money, or giving me other excuses as to why she couldn't go. Twins here are often malnourished, and I've found that people kind of expect it as normal. It's rare to find a set of twins that have both made it to adulthood. Anyway, I discussed with my major whether or not I should put her in the FARN, because I wanted to refer her to the hospital in ouahigouya, but he told me that if I didn't put her in, she wouldn't go to the hospital, so I might as well try helping her in village. So i did. A couple days into the FARN, one of the twins started looking worse and worse. Just looking at her, you could tell she had very little life left in her. At this point, even all the other mothers of malnourished children were telling her to get to the hospital. "This is not a kid anymore", they were saying. And they were right. I finally forced the mom to get on my bike, and i took them all to the hospital myself. On arrival, one of the twins had a temperature above 104 and was now only 3 kilos. She was so dehydrated that if you pinched the little skin she had covering her tiny bones, it stayed in the position you pinched it into. Please excuse the graphic description, but she was like a little sack of bones wrapped in cellophane. As I held her for the doctors to try to find a vein in which to put an IV, I could almost feel the life leaving her. After spending a few hours trying to get both of the twins settled into the hospital, they both ended up with IVs finally being placed into their heads because there were no plausible veins anywhere else, and laying on the floor in the one big room reserved for babies in the hospital. I left and went back to village once things were settled. The next morning, I explained to the father where his kids were in the hospital ( he had heard they were there, but he came to ask me where exactly) and he went to see them. About an hour later, I was sitting with Aguera when she got a call from him that one of the twins had died. I guess i knew she was most likely going to die, and I've known a number of kids who've died in village, but for some reason, i was especially sad about this one, i think because I felt some sense of responsibility for her. And I knew her well, and had played with her many times in the last year. I biked back into OHG the next day to see the mom and the other twin, who were still in the hospital. She seemed surprisingly to be much happier. I think she knew as well that her child was going to die, and she had given up a long time ago. It was more of a relief for her it seemed, that now she just has one baby to take care of (plus her other children, but that's not the same as a baby). I fear that in writing this I'll give the wrong idea about burkinabe, and I don't mean to insinuate that she was uncaring; I don't think that she is a bad mother, and I know that she was upset and mourned the loss of her child, but in general, death is not dealt with in the same way that it is in the United States. The mourning period is much shorter, and people tend to get on with life a lot faster, not because they don't love their family; they just mourn quickly, and move on. It's something that I have become accustomed to to some extent, but I think will remain hard for me, as with my American ways, I tend to want to mourn for longer, and show it more outwardly.

Lowlight 3: This doesn't really have anything to do with the FARN, except that it happened during it, but one night, a kid went missing in village. This had never ever happened in the history of my village, because, well, in the village, all the kids run around everywhere, but they always come back home and it's never been a problem. There's really no need for kidnapping because if you don't have a kid and you want one, all you have to do is ask someone if their kid can live with you, and it's done. It's still kind of a mystery as to how and why this happened, but a baby, not even two years old, disappeared while the mother was taking her bucket bath. She didn't see the child when she got out, but didn't think anything of it, because it's perfectly normal for kids to just wander around everywhere. So she did some other things, and then went to look for her baby around the courtyard. When she still didn't find it, she asked a bunch of people if they had seen the kid around, and none of them had, and it wasn't at the boutique which is where kids tend to hang out, at which point she probably started getting nervous. The entire village ended up spending all night looking for the kid to no avail. I mean, nobody slept. Not a single person. Everyone in the whole village looked all night; in the fields, all around the village, everywhere. The kid was nowhere.

Highlight 2 (continuation of lowlight 3): The next morning, I went to get Aguera to go do the FARN for the day as usual. Every morning, I went and got her at around 530 AM, and we would walk to the woman's courtyard who we were doing it in together. That morning though, her response to me walking into her courtyard was "I don't think we can do it today, since the kid is missing". I told her we'd go and see, and when we got to the courtyard, the 2 women who had actually come on time were saying the same thing, that they didn't think we could hold the FARN today because of the missing child. I reminded them that even in the midst of terrible situations, your own kid still needs to eat, to which they said "oh yeah, that's true" and agreed that we should still hold the FARN. About 10 minutes into the causerie, an old lady stuck her head over the wall of the courtyard, and yelled "THEY FOUND THE KID!" at which point everyone dropped everything and ran to go see. Including me. Because everyone else did. Someone ended up finally finding the baby in a field a couple kilometers away, which was very bizarre because there's no way the baby could have gotten there on its own, since it can barely walk, and it had nothing wrong with it. Wasn't hurt, wasn't even hungry. Everyone thinks that someone took the kid, and then got scared because the entire village was mobilized in trying to find it, so they deposed it in a field. The entire village had to come see the kid to verify its existence. We had a big "we found the kid" party. Solidarity.

Well the list will have to stop there, because a) this posting has gotten too long and i want people to actually read it, and b) it's getting dark and i really should leave the internet and bike back to village.

I'm going on vacation to Mali next week for a few days, so the next issue of cogitations will hopefully be about that!