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Conquering Malnutrition Together

Indonesia, August 15, 2005

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Roaring laughter and cheerful chuckles filled the stuffy conference room on a warm afternoon in mid July. A group of mostly women - sitting in a half circle arrangement - did not seem to mind the heat reflected by the glass windows or blindingly bright sun rays. They were all captivated by the action going on in the middle of the room that day.

It was the last day of an eight-day training session about a community-based malnutrition rehabilitation program in Jakarta facilitated by the training and mentoring team of Mercy Corps Indonesia’s SENYUM program.

The handing out of certificates to 24 participants amidst amusement and jokes moderated by Erlyn Sulistyaningsih, Mercy Corps Indonesia’s Senior Urban Health and Nutrition Coordinator, marked the training’s completion. The event was concluded by a simple ceremony to symbolize ‘passing on the knowledge’ to people who will, in turn, share that knowledge with their communities.

Suddenly, the previously noisy room became silent. All participants, now standing in a circle holding their lit candles became solemn as if to convey their profound understanding of the long road that lays ahead: the journey to better health for their people in fighting malnutrition.

During the months of June and July, well-known national television stations in Jakarta have dedicated special reports to discuss and expose the problem of malnutrition. They highlighted how malnutrition is not only a problem in Jakarta, but other provinces in Indonesia as well. In West Nusa Tenggara province, for example, 65,000 children under five were diagnosed with malnutrition in June.

The long-standing problem of malnutrition - which has been mostly ignored in the past - has recently been among the hot topics covered by local media in Indonesia as well.

“Part of the problem is the lack of understanding in feeding children nutritious foods,” said Minister for Women’s Empowerment, Meutia Hatta during a recent interview. “We can, however, fight this with proper education for them (mothers).”

Mercy Corps is working to provide just that.

The current Health and Nutrition Program of Mercy Corps Indonesia, called SENYUM - literally meaning “smile” in Indonesian - has long been involved not only in recognizing factors causing malnutrition in urban Jakarta and working with communities through a methodology called Hearth.

The Hearth component was originally added in July 2002 to Mercy Corps’ and food security for the Jakarta metropolitan area, called Transitional Assistance Program (TAP). The Hearth methodology uses an approach to identify households with healthy children defined by their good nutrition status despite having the same limited resources as their neighbors with malnourished children. This approach is called Positive Deviance (PD).

“Discovering how families in the same community keep children healthy enables families to not only improve their children’s weight, but to maintain the improved nutritional status at home,” said Vanessa Dickey, Mercy Corps Indonesia’s Positive Deviance and Health Specialist.

In this approach, two-week community rehabilitation sessions - called Hearths or Nutrition Education and Rehabilitation Sessions (NERS) - take place in a community volunteer’s house. During these sessions, caretakers contribute food, cook together, active feeding to their children, discuss health messages and examine best health practices found in families with healthy children. Health volunteers subsequently visit the participating families’ homes to reinforce the health messages and discuss their children’s health.

“Former trainees have expressed their joy in experiencing new learning methods through these trainings,” said Erlyn. “People are truly practicing what they learned during the training sessions.”

In fact, the Indonesian government has requested Mercy Corps’ assistance to facilitating education about Positive Deviance and the Hearth methodology.

“Mercy Corps’ extensive experience with this approach has proven successful in reducing malnutrition from 36% to 16.7% in areas in Jakarta,” said Dickey

As for the methodologies being used in current and future areas and their communities, the local government was certainly not bashful to show its fondness. “Consumption is not the only culprit when there is a malnutrition problem.” said Theresia Kasi, nutritionist of the North Jakarta district’s Health Department. “I had been wishing for some kind of training that might effectively address and affect long-term behaviors and the Hearth approach offers that chance.”

It seems that, while challenging at times, all parties involved in combating malnutrition have a clear understanding that they must act together if we are to achieve healthier lives for our children.

Working together, malnutrition shall be conquered!