Thursday, August 27, 2015

Nutritional "Negotiations"

As Health Agents here in Benin, our major role is that of an educator. Through sensibilizations (health talks), demonstrations and group activities, our goal is to initiate behavioral change in a community to improve community health. 

This week, we focused on maternal health and nutrition. We started by learning about the benefits of exclusive breastfeeding until 6 months old, the importance of complimentary feeding, proper breastfeeding techniques, nutrition during sickness and how to treat and diagnose malnourished children. The Beninese government follows the guidelines set forth by the Essential Nutrition Actions, which outline the main areas of malnutrition and under nutrition in the country. By honing in on pregnant women and children under 5, we aim to ameliorate the nutrition practices of these groups and ultimately create a healthier population. 

Mark and Leland practice a simulated negotiation for exclusive breastfeeding and latching techniques. These guys are troopers!

In addition to breastfeeding practices, the actions specify supplementation of folic acid, iron (to prevent anemia which is only worsened by malaria), vitamin a and iodide (in the form of iodized salt to prevent goiter). It is also recommended that children under 5 receive deparasite medication biannually to prevent chronic anemia and other illnesses. 

While learning about these actions and how to educate the population on their importance, we learned about several practices that are common in Benin and make it increasingly difficult for us to initiate behavioral change. Forced feeding is fairly common here and can result in the asphyxiation of the enfant. In fact, during our community exercise today, Leland and I had to teach a mother why this was a dangerous practice and what techniques she could use instead, such as active feeding (remember the spoon plane flying into your mouth?). Another issue we faced in the community was the belief that horoscopes dictate what you can and cannot eat. One mother was adamant that neither of her children could eat fruits because of their sign. Despite sharing with her the health benefits and essential vitamins/nutrients in fruits such as bananas and oranges, she still refused to budge on her astrological guidance. 

Educating women on nutrition practices required employing negotiation practices. The negotiation process is crucial to triggering behavioral change because the educator does not discount the learners beliefs, but instead tries to offer them other solutions to their problems. We spent a long time this week practicing our negotiation skills for today's community integration exercise.  We drove out to a small village where 60+ women were waiting for us. In groups of two, plus a translator, we "negotiated" with each woman to ensure that she was practicing proper nutrition, hygiene, malaria prevention, and breastfeeding if she had a child under 2.  Many of the women were very receptive to our guidance and I think the exercise was very successful! We are finally getting used to the complications that arise when working with translators and I am thankful that I'll have Daniel to translate for me when I get to village. 

After telling women all morning that a great way to add nutrients to their children's diets is through enriched bouillie, we finally got to make some this afternoon. Beninese eat bouillie all the time. It is the intermediary of paté, liquid in consistency and generally sweetened with sugar to resemble a proper bowl of cream of wheat. Bouillie can be made of almost any cereal, but in order to enrich it, you can add one part soja (soy bean flour) to three parts other grains (we used sorghum, corn and millet which are all readily available here). Once we boiled the flour mixture, we added peanut butter and bananas, which we mashed in a tradition mortal with a monster pestle. The result was interesting, definitely tastier than plain bouillie! Tomorrow we will finish up our nutrition week with a tomato canning and food preservation lesson. 

We are down to the final three weeks before swear in! Team RCH is staying active (we did group yoga today!) and busy here in Sé. I hope everyone is enjoying the last few weeks of summer and getting ready for fall! 

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