Seasonal Malnutrition in Rural Haiti

The SCI team visits the home of a household with high risk factors for malnutrition

The Nutrition Rehabilitation Unit at the hospital has the most severely malnourished children in the region; most of them have been sent to the hospital from the mountain dispensaries in Tienne and Bastien. The surveys by HAS of households of risk factors for malnutrition indicated that the area served by the Tienne dispensary included the highest proportion of high-risk households. This was corroborated by the most recent monthly weigh-ins which showed an inordinately high rate of Low and Very Low Weight for age children.

A community health worker shows off the
normal weight record of a child in a high-risk household

            In order to better understand the actual conditions of households in this region, a team of four members of the SCI team went to Tienne and accompanied animatrices in home visits to selected houses.  In many of these houses, we found children who had been admitted to the hospital's Nutrition Rehabilitation Unit, which validated the survey findings. However, in the locality where my son Edward and I were visiting, we also encountered a number of homes which had high risk factor ratings, but the children's weight charts showed normal growth. This raises the question as to why households with extremely limited resources do not have malnourished children. Part of the answer to this question lies in the concept of Positive Deviance, in which the expected negative conditions are not found. An understanding of the strategies which are deployed to avoid the hazards and health consequences of poverty can help to shape an effective intervention strategy, to help other families to discover approaches to preventing malnutrition and illness.
            Our discussions with the mothers of PD children brought out some of the steps taken by mothers to ensure that their children were well provided for.
            When we complimented one mother on her child's obvious good health, and noted that surely life was difficult in the mountains, she explained "nou pa chita"; we don't sit down. Very animatedly, she told how during that week, she had bought limes from neighbors, loaded them in straw bags on her donkey, and took them down to the Verettes market to sell. She took the money which she earned from the limes, and bought toothpaste and imported foods from the Dominican Republic (which are not available in the mountains) and sold them to her neighbors. With her small profits, she bought rice, which only grows in the irrigated lowlands, for several nutritious meals for her family.
            Her energy and creativity, as well as her concern for her family, combine in the design of her work week to add income to the household and to protect her children.   

The strategic plan for HAS’ nutrition services include the establishment of nutrition rehabilitation services at the two mountain dispensaries, which will reduce the need for the children and mothers to spend several weeks far from home, and will provide a base for community-based education in nutrition. One of the key resources for this effort will be the mothers who have developed strategies to protect their children. These shining examples of Positive Deviance  will be folded into the educational programs as local experts, to share their success stories with their neighbors.

Ian Rawson

A conversation with Carsten Stauf

The patients at the HAS Hanger prosthetics lab have appreciated the gift of new mobility which comes with the prosthetics device. Recently, they have been able to benefit from a new device, the Haiti Knee, which was designed by the Medi corporation in Germany to address the specific needs of Haitian patients. Recently, Rebecca Rawson had the chance to talk in Deschapelles with the engineer who designed the Haiti Knee.

Carsten Stauf shows the Haiti Knee
to HAS Managing Director Ian Rawson

Carsten Stauf is the chief project engineer and inventor of the “Haiti Knee.”  He and his colleagues at Medi, a German company headquartered in Bayreuth, Bavaria, have been providing prostheses to the Hanger Corporation for decades.  When Hanger opened the prosthetics lab at HAS, Medi sent them the first prosthetics systems for Haiti. These have been life-altering for over 500 Haitians.

Carsten developed the “Haiti Knee” to respond to the unique challenges in Haiti, such as the uneven terrain and the gait of the people.  The “Haiti Knee” is lighter and more durable with a titanium head that features greaseless Teflon to make it easy to articulate, and therefore to walk.  The head attaches to 2 carbon rods that can be adjusted to the individual’s height.  It is a neat and efficient system.  Medi has given HAS 300 of these units as well as 300 pairs of shoes, made in Austria, which will cover the hospital’s needs until next summer. 

Long term plans between these collaborators include 2-week rotations at the Hanger lab of Medi-related personnel, such as certified prosthetic orthoticians and physical therapists, to alternate with the Hanger personnel.  Medi is also making a 15-minute documentary by a German film crew that will premiere in Orlando, Florida at the upcoming World Congress meeting of Orthotics and Prostheticians.  It will then be sent all over Europe during the holidays with the aim of creating a registry of doctors, CPOs and physical therapists who would come to volunteer at HAS.

As each patient puts on a new leg at the Hanger Clinic, they may not understand that this prosthesis is the result of an international collaboration which reaches from Germany to the United States to Haiti, but they are overjoyed to have this new mobility, and to be able to look forward to a future which includes the possibility of employment, going to market, and being with family.

Prevention of Water-borne Diseases in Flood Zones

Following the floods in the Deschapelles and neighboring areas earlier this month, volunteer animatrices visited all of the households to which they are assigned to assess the risk factors for disease. A graphic chart was designed to allow the mostly illiterate animatrices to report damage to latrines, well-heads, water storage, or household materials which might contribute to gastrointestinal and other diseases.

More than 1,000 households were surveyed in the three major flood zones, and the results were synthesized in order to identify regions and households where the damage was the most extensive and severe.

I, along with the director of the HAS Wells and Water team, and the senior community relations manager, visited over 50 high-priority households to validate the findings of the survey, and to establish our priorities for reconstruction. We selected three localities with a total of 8 separate households, and over 65 residents in total. In each of these 8 households, we will build a latrine to replace the ones which had been damaged beyond repair. At the same time, we will decontaminate wells and evaluate the need for repair of the well heads.

Work begins Monday on this strategy, with the purchase of cement and hiring a bos mason who will oversee the construction of the latrines at three central sites. Each latrine costs approximately $300, the funds for which have been received from generous and concerned donors.

As the work proceeds on these latrines, we will go to several other nearby localities which have been identified by the surveys to have been seriously damaged. There, our priorities will be latrine construction and well decontamination, plus possible construction of flood-proof wellheads.

In some communities, we have identified the need for biosand water filters; water is accessible through shallow wells, but the water is consistently polluted, so a household water filter will remove coliform bacteria to render the water potable.

The flooding and its aftermath have shown us how vulnerable the local families can be to environmental impacts; as we visit households, we are invited into neighboring courtyards which did not suffer flood damage, but still need latrines, wellheads and water filters. As a result, this work will extend beyond the present urgent state into the near future.

With the encouragement and support of an NGO which is active in the north of Haiti, we will construct several multi-user composting latrines, to be located in several clusters of large compounds of extended families (20 or more residents).

Ian Rawson
Managing Director

Responding to the Deschapelles Floods

Immediately after the floods, volunteers spread out to the most affected households in our region to assist in cleaning and trash removal. By the end of the week, our volunteer community-based workers conducted household visits in these stricken areas to assess other damage from the flooding. They reported on destroyed latrines, contaminated wells, and the loss of animals and property. It was evident that immediate action should be taken to reduce the possible incidence of typhoid, oral-fecal contamination and other water-borne diseases.

The planning team from HAS Integrated Community Services determined that the most important intervention at this time would be to ensure that each household in the most affected areas would have access to a decontaminated well, water filter and a functioning latrine. Each of these involves the construction of the filter, a toilet base and seat, or collar for the well to keep out ground water.

Today, the emergency response team will go to areas where there are clusters of houses with these needs and identify locations where we can set up a small production plant for these items. Because of the weight and the lack of road access, our experience shows that it is easier to set up the fabrication as close as possible to the location where they will be installed.

So far, we have identified 4 priority fabrication sites and we expect that number to increase to 10 sites. Each site will receive 10 latrines at a cost of $3,575 and 10 well covers costing $1,500. We have been assured by World Vision that they will offer food for work support for the people who provide labor at the fabricating sites.

We are fortunate that donors have already made contributions that cover almost all the funds needed for 2 sites. These and other emergency requests that we make are due to extraordinary circumstances and are not covered by our budget. A gift designated for emergency relief will allow us to address this crisis and future ones in a timely and effective manner.

The community is appreciative of the rapid response which HAS has been able to mount in response to this urgent situation, and we are hopeful with your help that the entire program can be funded and implemented by the middle of August.

Ian Rawson, Managing Director