FARN

I’m sorry I haven’t had the chance to update my blog lately. This entry will make up for it though; bear with me because it’s really long, but I think it’ll be interesting for those of you who are interested in details of the kind of work I do here. It also includes pictures at the end!

For the entire month of October, I was busy in village preparing for what is called Foyer d’Apprentissage et de Rehabilitation Nutritionelle (FARN). I am at a loss for how to translate that title word for word, but essentially it is a program designed to teach mothers how to rehabilitate their malnourished children. The structure of the program is based on the notion that the best way to promote behavior change (on the part of mothers that will help improve their children’s state of health) is to actually practice certain behaviors over the course of the sessions; the idea is that they will gradually become habituated to what we practice and will therefore bring the behaviors and helpful things we do back into their own households – meaning sustainable behavior change.

This was absolutely the largest project I have attempted to undertake since starting my service in village last year. I was motivated to do it by the recognition that there is a large problem of malnutrition where I live. To get rough statistical evidence for my claim, I kept track at our weekly baby weighing sessions of how many malnourished and severely malnourished children came in for a month. To explain to those of you who aren’t familiar with baby weighing, it’s a way of tracking the growth of a child for the first two years of his/her life; mothers are supposed to bring their baby in once a month for weighing, and the weight of the child is plotted on a growth chart supplied by UNICEF, which uses drawn-in lines to demarcate whether the trajectory of the child’s growth is following that of a healthy, malnourished, or severely malnourished child. If a child is identified by this means as one who is not growing at a healthy rate, the mother can be informed as what steps to take to increase the child’s weight.

It seems simple enough, but not long after coming to post, I became aware of and disturbed by the fact that mothers were not always informed about the status of their child’s weight after weighing and – what’s worse – didn’t seem to care for the most part. If babies are weighed and their weight, plotted, but their health status is not understood by their mothers, quite frankly, baby weighing is a useless activity. As our health facility is understaffed (there is only 1 nurse and 1 midwife who serve my village and the 10 small villages surrounding it), I eventually took over the actual process of baby weighing so that the nurse and midwife could do all the vaccinations that occur simultaneously. Although I now tried to take advantage of my new position to explain each child’s status to each mother after weighing, I encountered 3 problems:
1) Sometimes the women come in such great numbers that they are overflowing out of the dispensaire (health center) and there is not enough time for me to carefully explain the growth chart of every child to every mother myself if I also want to weigh every child in a reasonable amount of time. Even though I often try to take time to do so nonetheless, how much important information can you fit in on the spot? Not much.
2) Even if the dispensaire is NOT terribly busy on baby weighing days and I DO have the time to discuss each chart with each mother, often the mother does not understand French, and there is no one available to translate for me. Or what I hate more is – and this is a very cultural thing – I’ll ask if the mother understands French (in local language) and she’ll nod yes, and then feign comprehension as I explain things to her, but really she understands nothing at all.
3) Even if the mother DOES understand French, and I can successfully explain a problem of her child’s growth rate to her and advise her as to how to proceed, she may understand but, more often than not, will not put my advice into practice at home (which is proven by the consistent underweight status of her child in following months).

After keeping track of the number of healthy vs. malnourished babies that came in over the course of a month (which is roughly supposed to represent the number of children in my village, as every one of them is supposed to be brought in once monthly), I calculated that nearly 40% of those children were malnourished to some degree. And those were the ones of parents who actually understood the importance of making use of the local health facility! I could only imagine how many more malnourished babies lived way out in the farms and were never brought in for healthcare purposes.

I decided that the FARN program was a good one to undertake because it would allow me to identify and work solely with mothers of children who had been consistently malnourished for an extended period of time and therefore give them the appropriate amount of necessary information in less time-constrained situations. I was worried, however, because, as many of you know, one of my greatest obstacles over the course of my service has been a lack of motivated counterparts with whom I can work, and FARN was absolutely not a project I could do on my own.

I brought my rough statistical evidence of the problem of malnutrition in the village to the next monthly meeting of the ASCs (Agents de Sante Communautaire) or local health workers (who, quite frankly, are not usually the most motivated people in the world, which is what made me nervous). I gave a general explanation of my idea of the FARN program and asked if anyone would be willing to work with me. I got nods, and so I scheduled a meeting which would give more details for the following week; I asked those who said they were interested to show up (although in my head, I worried that no one actually would – it has happened before).

But the next week, they actually showed up! It ended up being just the first pleasant surprise of many. The ASCs ended up successfully helping me actually locate the mothers of malnourished children that I’d identified during baby weighing sessions (but for whom I only had names and their general “neighborhoods” in the village), collect the fee we’d established that they’d pay for the week of food and activities (we decided on 300 cfa per woman for the entire week; that’s roughly about 75 cents), and then the ASCs themselves actually showed up for the training sessions I arranged for them (again, showing up doesn’t seem like a big deal, but it is)! I was so pleased with the ASCs’ cooperation; I absolutely could not have done everything without them.

Let me explain a little more about the actual FARN program. Normally it’s a program that takes place over the course of 2 weeks or up to a month. Women meet in small groups at someone’s home (they’ll all take turns hosting; the importance of having FARN take place at a home is so as to provide a comfortable environment) once or twice a week for about 2-3 hours each time. Local trained health workers meet with them and lead what we call a sensibilization, or informative session on an important topic (it’s important that local trainers teach these sessions; if it was always just me, this wouldn’t be a sustainable project!). After that session, the women cook together to prepare a nutritious meal for their children; cooking together allows them to actually learn how to prepare such a meal (all the food is bought with the money that each woman contributed before the week started). In addition, there is a maman lumiere present at each session who helps teach and cook. Maman Lumiere stands for “Mother of the Light”, and she’s a very key part because she represents a model mother who is at the same socioeconomic status as the rest of the mothers, but who has at least one healthy baby at the same age; this proves that even if you are poor, you can still find ways to adequately care for your children. If women actually put what they learn into practice, their babies will actually gain weight by the end of the program (FARN is a well-known program that has been used in many underdeveloped countries in the world and has consistently shown positive results).

I had to make a few changes in the program. First of all, I was under a time constraint. Thanks to what I learned last year, I knew that beginning in November, women would be occupied in the fields because November is bean harvest month. And then in December, they’re busy earning money to prepare for the many end-of-the-year holidays, so they’re inaccessible then as well. This meant that I had to finish FARN by the end of October, which left me only a little time to prepare and train the ASCs, and I had to condense the program into one week with daily sessions, which I planned to take place the last week in October. I also didn’t have time to arrange “hosting” houses, so we planned for FARN to take place at the dispensaire. My idea was that this could be a practice FARN of sorts which would address the malnourished cases before the end of the year, and then we could actually do the real thing next year.

I organized a different topic for each day of FARN week. The following is a summary of what we taught the women (Excuse the rough titles; it was hard to translate them directly from French). I’m also including the meal we prepared each day, and pictures from each of the sessions:
Monday – Good Hygiene and Sanitation
The importance of washing your hands with soap, drinking potable water, and covering and protecting your food from flies. This presentation included a demonstration for which I rubbed my hands with fresh ginger and rinsed them with water (which is usually what the Togolese count as “washing your hands”); I showed them how even though my hands looked clean, you could still smell the ginger which proves that there are sometimes things (bacteria) on our hands that we can’t see, and rinsing does not suffice. Only using soap gets rid of the unseen. This was the first subject we taught of the week because we wanted them to understand the importance of and get in the practice of washing their hands with soap before eating/preparing food over the course of the week.
Meal of the Day: Enriched porridge made from corn and soyIn this picture and all the ones you see below similar to it, the people standing up teaching the seated women are my ASCs


Washing hands; by the end of the week, the first thing the women were doing upon their arrival was washing their hands and their kids' hands with soap. I was so proud of them!



Eating the porridge. The kids in these three photos (above) are among the most severely malnourished (with the exception of the kid on the right in the bottom picture; he's a nice fat brother)



Tuesday – Good Nutrition
The importance of breastmilk and well-balanced meals (for children under age 2). In Togo, for simplicity’s sake, development workers teach 3 food groups: Energy foods (i.e. grains and fats), Construction foods (i.e. protein foods), and Protection foods (i.e. fruits and vegetables). I drew a large diagram with pictures of these 3 groups and, after explaining what each group does and that an ideal meal contains at least one food from group, we had the women come up and give us examples of “well-balanced meals”.
Meal of the Day: Enriched porridge made from corn, beans, and peanuts



The ASCs who did a FANTASTIC job on the nutrition section.



My wonderful "Maman Lumiere", Clarisse



Clarisse's kids (above and below)





Wednesday – Good Childcare
How to prevent prevalent illnesses but what to do if your child actually gets sick. The 2 most prevalent illnesses we see among cases of children at this age who are brought into the dispensaire are malaria and diarrhea. We talked about preventative measures but I also did a demonstration with a “thermos baby” (I drew a face on a thermos); I poked a hole in the bottom and patched it up with tape for the first part, for which I showed that when you hydrate the baby (pour water into it), most of the water stays inside. But when the baby is sick with diarrhea (I took the tape off the hole), water comes out fast and if you don’t rehydrate a lot and more frequently, the baby can become “dry” and die. We also taught them how to make a rehydration drink that will stop up diarrhea with clean water, sugar, and salt.
Meal of the Day: pâte (a corn-based dish) with baobab leaf and bean sauce
We always had the mothers help Clarisse prepare the food so that they would learn how to prepare the nutritious meals themselves - in case they didn't already know (we used common meals with local ingredients so many already knew).






Thursday – Good Motherhood
The importance of vaccinating your child, following your child’s weight/growth chart, and practicing family planning (spacing your children). Again, I used more drawings and had the women try to interpret various growth lines. I also brought in physical examples of family planning methods to show the women, who were fascinated and interested by the idea that you can actually do something to prevent getting pregnant all the time; though knowledge of family planning is growing more and more widespread, there are still many cases of women who don’t know anything about it.
Meal of the Day: watchi (rice and beans) with a tomato and fish sauce








My favorite picture of Clarisse and her daughter



Friday – Review
Because most of the information we taught these women this week was new to them, I thought it was important to do a review session of all we had learned. I made up little “question cards” and posted them on our chalkboard, then had the women come up and choose a question that reviewed something we had learned this week (for example: How do you make a rehydration drink if your child has diarrhea?). If they answered the question right, they got a gift of bar soap. I was so impressed and proud of my women; overall, they rattled off the answers with no problem, and I could see that they were happy and proud of themselves for what they had learned. It was amazing.
Meal of the Day: pâte with peanut and okra sauce




The group picture we took at the end of the week. Most of the women wanted to hold up their gifts of soap for the picture - if you look really close you can see the yellow bars.


Overall the project turned out incredibly well. I was absolutely exhausted by the end of it all, but it was so worth it for a number of reasons: I was so encouraged that the ASCs actually pulled through with their part (it gave me hope that they’re not an entirely unmotivated lost cause; I think they became even more motivated too to see the positive results); everything came together thanks to their help. My Maman Lumiere was absolutely fantastic (a couple weeks before, I had been trying to think of who I could use for this role. I thought of this woman who I knew only because she came occasionally to baby weighing and always had such a positive energy and was always interested in the weight increase of her baby, who was always nice and fat. The problem was I didn’t know her name - I only knew her daughter’s first name, and that she sometimes sold oranges and cheap used clothes at the market; using this information, I went out to the street one day, told someone all I knew about her, and this person asked someone else, who asked someone else, and within 10 minutes, this woman was standing by my side. Talk about advantages of a small village, huh?) Her name was Clarisse and she was always in a good mood, always on time, was an incredible facilitator of the food-making, always stayed to clean up, and did all of this out of her own good will – never asking for compensation (which is so rare for a Togolese person). I could not have been more blessed to have her help me. Overall, women came on time (which is incredible); I reinforced that behavior by giving out gifts of enriched porridge flour or bananas to those who came before 7AM (when we started everyday). A lot of participating women also came to baby weighing that week and we already started seeing an increase in weight in their children, which really encouraged them and made them proud. And then I just got a lot of great feedback from the participating mothers, the nurse and midwife at the hospital, and the ASCs about what a great project it turned out to be. It made me feel good, but especially because I saw how they recognized that their participation helped make it a success. That was my greatest reward: to see the people of my village begin to recognize their own capacity. That is the start of sustainable change!

I think of other villages where my peer volunteers are, and I think of how, if this project had taken place there, it wouldn’t have been that outstanding a thing. But every village is different. And for mine, where there has been a constant struggle with getting people to participate and be motivated and actually pull any kind of project together, the success of this project represented a big step in the right direction.



OTHER RANDOM PHOTOS FROM OCTOBER AND NOVEMBER
Me and the gingerbread man Danielle made for me at our "autumn party"


Me and some other Peace Corps friends, Chrissy and Brittney



This picture truly represents the epitomy of my relationship with Danielle



nap time



fabric fall leaves from mom - the closest I get to Autumn around here



The welcome meal Danielle and I made for Danielle's replacement, Michelle, when she came for her post visit. We made homemade tortillas with bean and chicken filling, nacho cheese sauce, fruit salad, and cake with white chocolate and cranberry cookies (thanks to ingredients sent from the States).



I made Michelle a cake; that's her below!




Me and Danielle, sweaty and gross - but it's our last picture together at her house, so I had to put it up.



Kids studying by lamplight in my compound. Every night they use the chalkboard in my compound to study and I like to join them and help them with their homework when I can.




Watermelon that I found in my market! It's a rarety!



Michelle spent one night at my house during her post visit week and my gas ran out so I taught her how to use the charcoal. We made pizza!




Danielle, me, and Michelle (below) at Danielle's goodbye/ Michelle's welcome party




The president of the NGO where Danielle worked gave her a nice going away speech and gift and we took a group picture with everybody she's worked with.




This is a shot of part of the (horrible) road that leads out of my village.



A few weeks ago, an 8 month old baby died, and the cause was determined to be sorcery. The "sorcerers" held accountable were identified, and there were huge meetings that took place with hundreds of spectators to determine what steps should be taken to avoid any further deaths. The consensus was to "dig up the souls of living people that the sorcerers hid" under the palm bush you see in the picture above "to free them before the sorcerers can kill them too". I snuck a picture of the digging process; I unfortunately couldn't fit in the MASS amounts of spectators watching from my compound.



My neighbor boy in his cute overalls


Solim (my little host sister) helping me pick baobab leaves for one of my FARN meals



Small world! Me and Isaac Gross (both from Belmont High's graduating class of 2003); Isaac is working for the Clinton Foundation for a little while in Togo (just arrived last week) and we went out to lunch to catch up.