Giving Malnutrition Prevention Better Footing in Haiti
By Hayley Fallon, Children's Nutrition Program of Haiti
Viviane looks at my feet and shakes her head. “This isn’t going to be easy,” she says with a smile and turns away from me.
With sneakers on my feet and flip-flops in my bag, I follow her into the street where we walk to the moto-taxi stand, looking for someone who will drive us an hour into the countryside to visit our colleague, Rachelle.
We work for the Children’s Nutrition Program of Haiti (CNP), a non-profit organization that fights to prevent and treat malnutrition in children under 5, as well as pregnant and breastfeeding mothers. We operate in the Léogâne region of Haiti, and Rachelle is one of our Community Nutrition Workers (we call them “monitrices”) who monitor the growth of dozens of mothers and children in remote zones while providing preventative care and health counseling to families. In the communities we serve, our monitrices are often the only bridge between families and proper healthcare.
A much-needed and much-appreciated donation from KEEN outfitted each of our field workers with KEEN EVOFIT ONE all-terrain sandals.
Viviane, a CNP employee of 19 years, is Rachelle’s supervisor, and every month or two she shadows Rachelle to offer guidance and to help improve the quality of her counseling. Viviane has made this trip dozens of times, and I’ve shadowed several monitrices to take photos and collect stories from our remote beneficiaries, but today is special.
Making Great Strides in KEEN Sandals
Until now, Rachelle walked, climbed, and waded through the long distances in ballet flats or flip-flops. A much-needed and much-appreciated donation from KEEN outfitted each of our field workers with KEEN EVOFIT ONE all-terrain sandals. Today is Rachelle and Viviane’s first day in their KEENs.
Good timing, too; it rained last night. Rachelle used to dread going out on days after the rain. The slopes are more slippery, and the streams she must walk through are stronger, deeper, and dirtier. She risked losing a shoe every time she crossed one.
Our US team was able to haul 60 pairs down on the first try, enough for all of our monitrices, but not yet for our support staff (including me). Here’s hoping there’s a size 9 among the remaining pairs!
After an hour on the back of a motorcycle, Viviane and I arrive at the moto stop at the entrance to the zone we’re visiting today. The "Stop” designation only signifies that most motorcycles don’t dare continue beyond this point. Viviane and I cross our first stream, and she strolls through without hesitation. I’m already looking like the absurd “before” character of a bad infomercial, trying to tiptoe across the smooth river rocks and throwing my arms in the air here and there in a comical attempt to keep my balance. Two more streams and a hasty change of footwear later, we come upon Rachelle, who’s been waiting for us. Kind, sweet Viviane doesn’t tell Rachelle that she could’ve arrived 15 minutes earlier if it weren’t for me.
It’s 9:30, and Rachelle is eager to start the day’s work.
House #1 | Neighbors and Grandmothers
At the first house of the day, we come upon two older women – neighbors – sitting on the porch with their grandchildren: two pre-teen girls, a 5-year-old boy, a 4-year-old boy, and a baby about 13 months old, whose parents have both passed away. One of the women is the baby’s main caregiver. As Rachelle hangs her portable scale, the toddler’s grandmother turns to Viviane and asks, “When are you coming back to see us? We miss making meals together.”
She’s referring to our Hearth Program, a two-week-long community-based project where Rachelle and CNP staff worked with local women to show struggling mothers how to cook inexpensive, balanced meals for their children. The woman and her friends miss the convivial get-togethers around good food. “Nap gade sa,” responds Viviane. We’ll see.
Rachelle weighs and measures the toddler and the 4-year-old and administers their quarterly dose of Vitamin A. The other woman tells Rachelle that the 4-year-old (her grandson) has worms. Rachelle gives him albendazole, which will expel most any worm known to this area.
House #2 | Where The Action Is
House Number Two is a lively hotbed of under-12 activity. Several kids from the neighborhood are playing in the courtyard — running, rolling, and laughing. A kind-faced woman holding a sleepy toddler sits before the threshold of the house supervising the children while another woman tends to a pot over a fire just outside the kitchen hut.
Rachelle screens the toddler and a 4-year-old girl who is grinning from ear to ear after coming by a 25-gourde bill. Rachelle and Viviane then sit the mother down for a discussion about family planning. Part of their job is dispelling myths regarding health behaviors and health interventions that still run rampant in the countryside. They assure the mother that the methods of contraception available to her are safe and effective. She doesn’t want any more children at the moment and agrees to make an appointment at a family planning clinic.
House #3 | Good News and Bad News
After a short jaunt across a stream and up a rocky slope, we arrive at the entrance to Marthe’s land (name changed for privacy).
"Onè,” Rachelle shouts.
“Respè,” calls Marthe from inside.
As we coax Marthe’s shy middle son, Daniel (name changed for privacy), out of his hiding spot, Viviane explains that CNP treated Daniel for severe acute malnutrition two years ago at an ambulatory clinic nearby. Rachelle lifts Daniel up to hang him on the scale and congratulates his mother on his progress. His measurements are well within the normal range for a boy of 4.
Next Rachelle screens Daniel’s seven-month-old brother. Sadly, the baby’s growth is not on track, and Viviane and Rachelle have a long talk with Marthe about what he should be eating. Rachelle is disappointed. This is the cycle she and our team are working tirelessly to break. When one child in a family is treated for malnutrition, the subsequent children have above-average chances of being malnourished; babies under a year old, of course, are the most vulnerable. Nevertheless, if Daniel made it through, his brother can too.
They schedule an appointment for the baby at our nearby ambulatory clinic for the following Monday, and Marthe promises she’ll be there. Rachelle would later hear from a CNP nurse that they did indeed make it to the appointment, and the baby had started treatment.
House # 4: A Pregnant Mother
No children here- other than the two neighbor kids hiding in the bushes, curious about Rachelle’s two friends. When we knock on the door, a pregnant woman answers.
Rachelle takes her mid-upper arm circumference and lets her know it’s within the normal range. The woman, who is now 8 months’ pregnant, has had one appointment at the hospital during this pregnancy. Viviane encourages her to have another before the baby is born. “There’s a reason God made doctors,” she says, and the woman agrees.
Rachelle asks the woman what she knows about breastfeeding, and the woman says she knows she must breastfeed exclusively until the baby is six months old. Rachelle tells her that’s a great start and explains that breast milk has everything an infant needs. She’ll be back when the baby is born to continue educating and supporting her.
Another Day, Another Six Children and Two Mothers Checked Off Our List
At 3:30, we reach a stopping point for the day. While Viviane and I make our way back to the moto-taxi stop, Rachelle runs to buy us mangoes before we leave. She skips across three more streams and up and down paths inundated with mud to visit the mango seller and catch up to us. With more streams to cross and the added benefit of my embarrassing pace, Rachelle easily catches up to us. She’s not used to being able to move so fast, especially with a 10-pound bag of mangoes in tow. We say goodbye and watch her disappear down the unassuming path to her house. After ten minutes of waiting and no available motorcycles to be seen, we wade through the river, which is raging today and reaches our thighs as we cross to the other side to hail a taxi.
As a supervisor of 23 monitrices, Viviane sees all kinds of terrain. In the arid mountains where there is little tree cover, she treks up and down steep, slick hillsides. In the low-lying plains, she sloshes through puddles, streams, and rivers. Even in the urban areas, where the oppressive heat from the blazing Caribbean sun is usually the most challenging factor, she must negotiate makeshift paths and dilapidated roads. This may sound like the least of our topographical challenges, but one of our monitrices recently broke her leg slipping into a pothole. The KEEN EVOFIT ONE sandals have been a game changer for our field staff, who dedicate their days to serving the most vulnerable children of Léogâne.
From all of us here at CNP: Mèsi, KEEN. Thank you.
Since 2003, we've donated more than $18 million in cash and shoe donations to non-profit organizations around the world. We love when we can give pairs of our shoes an even bigger purpose.