Tuesday, October 12, 2010

Today’s Work Frustration

In an effort to remind you that I do primarily spend my time here working, rather than just using my weekend adventures to cover blog updates for the rest of the work week, I figured I should start sharing a few more work stories. Hope this decision doesn’t bore you to death.
Today, as a team, we reviewed a PowerPoint on the success of CCHIPs’ nutrition program. The two people in charge of the program are going to present it tomorrow at a district meeting of NGOs as an example in their discussion of how to eradicate malnutrition in Rwanda once and for all.
Here’s the good thing: I am a huge fan of our nutrition program. By government order, all children under 5 must be weighed and tested for malnutrition/edema once a month. The next step for the government declares that all children who are severely malnourished must receive Plumpy’nut supplements…which is great and all, but they’re usually out of stock and even when they’re in stock, I think we can all acknowledge that Plumpy’nut is a short-term solution to a long-term problem.
CCHIPs foresaw this short-coming and designed a demonstration cooking and demonstration kitchen garden program, in addition to facilitating the national Plumpy’nut program. Mothers (by the insistence of CCHIPs – originally there was an issue because mothers were sending older siblings) of mildly and severely malnourished children come to the health center one day a week for a demonstration cooking. This demo shows them how they can cook a healthier, heartier meal using foods that are readily and cheaply available. The kitchen garden shows them how they can use their plots to grow a greater variety of vegetables. (One huge shortcoming with farming in Rwanda is that people are hesitant to do anything differently than they’ve always done it, and therefore don’t take advantage of the opportunities with multiple rainy seasons.) They then get a hearty meal, plumpy’nut for the road, and some new knowledge to bring home.
Observationally, this program has been wildly successful in decreasing malnutrition and decreasing relapse from children who “graduate” the program. I also love it because it’s sustainable, hopefully prevents future children from becoming malnourished, and empowers mothers to not rely on government hand-outs to feed their children.
Here’s the bad thing: Thanks to national priorities and goals, malnutrition has essentially already been eradicated from Rwanda, at least according to the books. When reviewing the presentation today, we ran into some incredible frustrations that make the CCHIPs program look less successful than it seems to be, and were very torn about what to do about this.
For example, following a government mandated emergency screening of all children under 5 in May 2009, the numbers of malnourished children severely dropped for every health center; but this is more because other health centers stopped monitoring children than the fact that the number of malnourished children actually decreased. And even the data for the CCHIPs health center is hard to interpret because it seems that there was pressure during the emergency screening to over-report malnourished children, (at the time, Plump’nut was widely available and widely sought after) making our data look more suspect as well. And finally, even though I want to have confidence in the CCHIPs data, something just seems fishy when the numbers don’t add up: when the number of children in the program one month, less the number of children that graduate the program, plus the new cases identified…doesn’t equal the number of children in the program the next month. We had to acknowledge that it could just be the case that the poorly educated community health workers combined with the poorly trained-in-Excel nutritionist don’t create the most reliable dataset.
So today’s work frustration consisted mostly of mulling over the nutrition data available and figuring how we could best, accurately portray the success of our nutrition program, especially compared to other health centers who appear to have been more successful at decreasing the number of malnourished children, even without any system or program in place. …and it’s times like these when I really find myself wondering: would I face such problems at a job in the US? Would I spend my days concerned about the accuracy of the raw data to begin with, before even being able to start any analysis? 

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