Alleviating Food Crisis
Long-Term Strategy Essential

TODAY, food problem has become grave in many countries, especially in the developing ones. For this reason, many countries are enrolling their names in the list of importers of food, forgetting that they were once self-sufficient.

There are significant differences among countries, having a more varied and balanced diet. Even where food supplies are adequate at the national level, access to sufficient supplies of safe and good quality food is a serious problem in many countries.

The sub-Saharan Africa and South Asia, which were once exporters of food, face food deficits.

Zaire, a net exporter of food a few decades ago, now spends millions of dollars for procuring food.

In recent years, Nigeria has managed to increase its food production of the desired pace meeting the demand of the population which is increasing at a whopping rate.

While India has managed to keep food production growing faster than its population over the past few decades, China has given food production the highest priority.

In Nepal, crop production has not kept pace with population growth. This is testified by the fact that from 1961 to 1981 the production of major food crops was less than two and half per cent whereas the population increased by about sixty per cent.

No doubt, the introduction of improved varieties of paddy, wheat and maize from the mid 1960s contributed greatly to their increased production. Their yield nearly doubled initially but declined later because most farmers faced the need for cash to buy chemical fertilisers and other agricultural inputs in order to keep the crops production level.

Since crop yields have been stagnant in our country, an increase in food production has been obtained by expanding the farmland area and the number of crops per annum.

Surplus food production in the Tarai is usually transported to India rather than to food deficit areas because of difficult terrain. It is not unusual for Nepal to be exporting a surplus from the Tarai while Kathmandu valley suffers from a food crisis.

Actually, food shortages in the Middle Mountains have resulted in great government intervention in the movement and marketing of food grains.

The government has been purchasing rice from both the eastern and western Tarai. This rice, which is shipped through India by rail, is brought in Kathmandu by road.

There is small movement of foodgrains within the middle Himalayan area from the surplus of deficit areas.

In reality, agricultural output growth in the Tarai will not solve the food deficit problems in the mountains because of high transport cost and the lack of purchasing power of the needy there.

Women play a vital role in reducing food crisis. However, the extra time spent in collecting firewood and other for its products takes time away from agriculture, which results in less output.

In fact, Nepalese women encounter an increasing workload due to deforestation which lends to alleviate their overall labour input in agriculture. Consequently, there has been a further decrease in the already low agriculture productivity.

Till now for the rural people there are no feasible firewood substitutes. If firewood is not available, more and more rural people will burn crop residue and cow-dung, depriving the crops of an important source of fertilizer and deprive the soil of needed organic matter. This will have a negative impact on food production.

During the last few decades, planning and development activities have been based on only rough estimates of land use. No endeavours have been made to attempt a complete inventory of land resources or to produce a comprehensive land use map in the country in order to formulate and implement plans and projects pertaining to agricultural production growth.

Actually, the final decision on land use is always a political one even though this decision is taken in regard to the existing ecological, economic and social factors.

Although land reform efforts were made in 1964 placing limits on land ownership, little land has been distributed to poor farmers, and ownership remains spewed.

The poorest half of our population, who own an average of 0.1 hectare per household, owns less than seven per cent of the cultivated land. Even if the population was not increasing, small lanholders would need more land to grow adequate food for their families.

Experiments conducted under the Integrated Cereals Project provide some grounds for optimism for food production growth. This project suggests that increase in agricultural yields is possible using the package approach devised by the projects itself which aims at increasing the total annual productivity of different crops. This approach has a special validity where crops and animals productions are interdependent. Apart from this, factors considered in this approach include crop combination, different varieties, cultivation practices and fertiliser application as well.

Although potential increase in food production with improved seeds is possible and the number of crops grown each year can be augmented, in order to increase food production, there should be a proper land distribution system. Aside from this, policies for alleviating food crisis must include a long range strategy for the efficient and equitable distribution of food for the needy.

Challenges Of Neonatal Illness

By Dr. Iswar Chandra Ghimire

NEONATAL health care the fundamental basic human right of life of every neonates is a social and national responsibility. Neonate is a continuum of fetal life and a very important and vulnerable link in the chain of events from conception to adulthood although it encompasses only the first 4 weeks of life. The quality of life of neonate depends on the proper management of the transition period from maternal dependence to independent existence and of the physiommunologic handicaps of the perinatal period. The morbity rate is high during this period and mortality surpasses deaths among all age groups except those in genetic age.

The neonate patient presents with a series of unique challenges which is not encountered in childhood & adult illness. The challenges of neonate illness ranges from intrauterine problems of growth retardation, Congenital malformations of different organs and systems like VACTERAL association (Vertebral, Anorectal, Cardiac, Tracheoesophageal Renal and limb abnormalities) and others lip cleft and palate, pyloric stenosis, duodenal stenosis atresia intestinal alresia, meconium ileum, diaphragmatic hernia, aganglioric colonic segments, hydrohephrosis of kidney due to pelviureteric function, urine outflow obstruction, undesceded testes omphalocele, gostroschisis. omphalomesenteric duct congenital hernia and turmous in organs in the different sites of body from head to pelvis.

Magnitude of the problem

The situation is worse in least developing countries like Nepal where 40,000 neonates die within their first months of life due to different medical and surgical illness. The neonatal mortality ratio remains almost unchanged irrespective of the infant mortality rate, emphasising once again that at any given point of time and state of the art of the medical care system the neonate is more prone to have disease, disability and death. This age alone provides an enormous variety in physiologic,disease entites and technical problems special anatonmical and physiommunological differences in neonates require a special attention in detail for their care.

Surgical illness is more complicated in neonates than medical illness because there is anatomical defect or deformity in different organs as gastrointestinal tract diaphrangmatic hernia and malrotation of gut congenital heart disease, incomplete development of the abdomimal wall as omphalocele gastroschisis, imporforate anus and recto vesical or rectovestibular fistula etc.

These surgical illness affects respiration, feeding circulation and excretion of meconium & urine and retention in their tract and backward pressure causes complicated pathophysiology.

Future Prospectives

The functional need of survival in these critically ill neonates are influenced by the provision of timely and appropriate (accurate) diagnosis and definitive care. This care includes a broad spectrum of services from early identification of problems, thorough prehospital hospital and rehabilitative care. Emergency medical services for neonates must therefore be integrated into emergency medical services systems at state, regional & local levels.

To save life, to prevent disability and maintaing an adequate fruitful quality of life is the goal of not only medical (Doctors, Nurses Paramedics) but also the common responsibility of social, political as well as government sectors. To obtain optimal results neonatal surgery is best practiced by fully trained pediatric surgeons working in large specialists centers. The concentration of clinical material in such centers offers experiences in the management of a wide variety of congenital abnormalities and facilitates the organisation of training programme. Support should be provided for a special training expertise in Nursing care, Neonatal anacsthesia, Neonatal Surgery, Neonatal radiology, Neonatal Pathology, Biochemistry of the body fluids and gases in the blood as well as nutrition and medical management in these special field of pediatrics.

Conclusion

Health care delivery system is a common responsibility from policy making and resources allocation level of government and parliament, monitoring and management of manpower training and deputation from Ministry of Health and Logistic Support from Department of Health Services. The health care delivery system should focus on proper utilisation of manpower and materials within the institutes for the betterment and satisfaction to achieve the optimum goal of service to mankind and humanity. It should also strive to give consent and cooperation to the medical professionals (Doctors, Nurses & Paramedics) for the care of their kids by parents & guardian. Social support by NGO, INGOs is the helpless and very poor patients should be rendered as needed. Publicity of the role, responsibilities limitation and duties of the different sectors in a evidence-based manner and the evaluation of out-come of investments and efforts of the different sectors as feed back for better improvement in futures should be carried out.