Malnutrition – the silent disaster in Nepal

Malnutrition does not attract the same attention as an earthquake or an Ebola epidemic. It is a quiet everyday disaster, which is the underlying cause of many childhood deaths and diseases in Nepal.

Malnutrition claims victims every day. Malnutrition is the result of a multitude of coinciding issues: major social upheavals, outdated agriculture, poor health services, poverty, broken-down community institutions, traditions and much more. Nepal works nationally to fight malnutrition across sectors, but there is a very long way to go, and there are major gaps in prevention and treatment. The massive earthquake in 2015 was a major setback. Nepal is already one of the world's poorest countries with very bad statistics in terms of life expectancy, malnutrition and general living conditions.

Through our clinic, we help hundreds of children every year to get a good start in life so that they do not suffer from many of the malnutrition's consequences and later side effects.

The life-threatening consequences of malnutrition

Over 41% of children under the age of five in Nepal are malnourished. Many are chronically malnourished, which has fatal consequences.

The World Health Organization (WHO) divides malnutrition into two major categories, "wasting" and "stunting" - both are widespread in Nepal.

"Wasting" or acute malnutrition develops in a relatively short period of time. This condition can be treated and, in case of rapid intervention, does not provide life-long harm.

"Stunting", however, is the result of chronic malnutrition and develops progressively over the first 1000 days of the child´s life. In addition to an abnormally low height, the condition means a loss of both physical and cognitive abilities, which unfortunately are irreversible. The affected children experience learning difficulties for the rest of their lives.

For the untrained eye, the children look quite ordinary. However, their immune system may be very weak due to malnutrition. A weak immune system makes children vulnerable to possible diseases. When a baby with a weak immune system gets diarrhea due to poor hygiene and inadequate access to clean water, the child is weakened. Ear infections are common among the children and are often treated incorrectly, over-treated or not treated at all which can lead to chronic hearing loss.

It is therefore crucial to create awareness about malnutrition in order to act quickly and effectively. If malnutrition is to be stopped, both mother and child need proper nutrition from the start of the pregnancy until the child is about three years of age, i.e. the first 1000 days. It is crucial to get in contact with the mothers from the start of pregnancy.

Our key programmes in the fight against malnutrition

Overcoming malnutrition is complex. Because malnutrition affects so many aspects of a child's life, we address all related issues, from information about healthy nutrition (what is a nourishing meal for a small child) to hygiene, hearing tests and proper treatment of infections, breastfeeding over a long period of time, disability and much more. Our three key programmes in the fight against malnutrition are:

Home Visits - reversing the malnutrition curve
Mother Groups -giving advice and helping mothers help themselves
Outreach Camps - reaching out in the field

1. Home visits - reversing the malnutrition curve

In 2016, Chimalaya Charity established a system of home visits to some of the most vulnerable women. Such a system is necessary in order to reverse the malnutrition curve. For cultural reasons, many women do not leave their homes during the first months of the child´s life. A large number of women, such as the seasonal workers at the carpet and brick factories, also do not have the resources or opportunity to seek out a local health center.
Home visits allow Chimalaya Charity´s staff to follow the children during the first 1000 days of their lives, a crucial period to ensure a healthy child.
In Denmark, nurses and general practitioners see each child on a regular basis during the first years of its life. The child has a record containing essential health information.
In Nepal, there is no such overview of the child´s health status. The doctors at our clinic work to systematize the collection of information on the individual child. The idea is to attach information on weight etc. to the child´s vaccination card, as vaccinations in the area work well.
With proper data, it will be possible to gain information on how to reverse the malnutrition curve most efficiently.
It is difficult for the individual Nepalese to find out which healthcare services are available to them and their children. Some places offer a multitude of services while others offer very few. The government recommends e.g. postnatal visits, but often these do not take place. The local health centers where the women give birth, do not offer advice or postnatal care.
Grith Szuster, Danish health worker, talks about Chimalaya Charity home visits:

2. The first Mother Groups in Nepal

Chimalaya Charity was the first to introduce mother groups in Nepal – giving advice and helping the mothers help themselves.

Having repeatedly seen the many serious health problems in small children at our outreach camps, Chimalaya Charity established the first mother groups in 2014. The format and activities of the groups are adapted to Nepalese needs, e.g. the women do not meet in each other's homes like in Denmark, but at the clinic, which has light, heating and running water unlike most private homes. The main purpose of the groups is to provide mothers with the tools to fight malnutrition. At the same time, our doctors have the opportunity to measure and weigh the children, and obtain important data about their development. Children with signs of acute malnutrition immediately receive food supplements. The Nepalese staff teach important skills such as breastfeeding, correct treatment of middle ear infections, basic hygiene and much more. On the wall of the common room, a local painter has visualized many of these things, as many of the women are illiterate.

Mothers openly share their experiences and problems and are able to pass on their knowledge to other women at the factory or in the village. This exchange of skills and experiences among the women is crucial in spreading the knowledge about malnutrition, as many rarely have access to a clinic. The mother groups have become a great success and we are working on developing and spreading the concept.


3. Outreach Camps – reaching out in the field

Because of Nepal's isolated villages and poor transport and health services, many health professionals in Nepal work with the so-called outreach camps. Typically, the clinic's staff will spend an entire day in a village, factory or school in the area. Being visible in this way enables us to get in contact with people who may not otherwise have heard of us. We often combine medical examinations of individuals with joint training in e.g. hygiene and tooth brushing.

Thousands of women work hard at the local carpet and brick factories. The workers are poor migrants from other parts of Nepal. Their homes are small sheds at the factories with no running water or toilets which makes it difficult for them to maintain good hygiene with the newborns. The lack of sanitation increases the risk of severe diarrhea in infants. Factory workers go back to work shortly after giving birth, which makes breastfeeding a problem.

The clinic's health workers are constantly reaching out to these women to build trust and spread the knowledge of both the clinic and the mother groups. Often women have difficulties getting to a doctor due to the lack of childcare in their absence as their families live in a different region, and there are few means of transportation.

Why is it so important to teach completely basic things like diet and hygiene?

Apart from his work in the clinic, Dr Ram Krishna Chandyo also does research in malnutrition. As he sees it, a considerable amount of basic health information has been lost in Nepal over the last 20 years. During that period, the country has experienced massive changes. During the 10 years from 1996 to 2006, a severe civil war was damaging to institutions as well as everyday life. Politically, the country is still in a very fragile transition phase with political tension.

The move of the population from country to city has also meant that young mothers in the cities do not have the support and advice of the elderly at close hand. Lack of schooling and a weak public health system means that new knowledge of nutrition during pregnancy and in infants has not been widely distributed. Often, traditional, nutritious porridge is replaced with sweet tea and biscuits filled with non-nutrient sugar.

Several old traditions are still kept which are not healthy for the children, according to Dr. Ram, e.g. oiling the ears of the newborn; keeping the children indoors for the first months of their lives, which means that their delicate airways are exposed to strong smoke from the stove. The child does not get fresh air, as many locals believe that being outside causes colds and other infections. At the same time, there is a tendency to use very strong medicine to treat minor ailments. Several studies show that many people in Asia have become immune to certain types of penicillin. Finally, many small communities in Nepal live fairly isolated in the country and in the mountains and only have emergency access to medical care and new knowledge.

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