NATIONAL 3 -(Spotlight Weekly)

Nutrition Education

The National Vitamin A Program has covered 69 out of Nepalís 75 districts, reaching 89 percent of the countryís population.

BY AKSHAY SHARMA In Tatopani

"A child had drowned, but because I was pregnant, I was not able to give the necessary mouth-to-mouth respiration. I asked another person to do it. I was so scared and I told the villagers that he needed to be taken to the hospital. But they thought he had died and he eventually died." says Pema Poudel of Pulping Kathi VDC, Tatopani, describing the scariest moment she has faced.

Training cillagers : For a healthy tomorrow

Pema, a Female Community Health Volunteer (FCHV) participating in a three-day workshop organized by the National Vitamin A Program (NVAP) , said: "I have trained here for three days and I'll teach others at my village what I've learnt. We are focusing on telling people that things like milk, vegetables, eggs they that they sell, they need it for themselves."

Research studies conducted in Nepal show that supplementation of a high dose of Vitamin A capsule could reduce child mortality by 28 percent. His Majestyís Government initiated the NVAP in 1993, which has been designed to virtually eliminate Vitamin A deficiency in Nepal.

"I was interested in medical treatment as a child," Pema told SPOTLIGHT. ìToday we get Rs150 for our work. During the Panchayat era, we used to get Rs 100 during programs like this. Even though my family does not support what I am doing, we have managed to create awareness," Pema says. A member of the part of the Ama Samuha, Pema pledges to work to make life in the village better. "There are 12 volunteers in my ward and we desperately need primary health care. But VDC members ignore this issue. A sick person has to go to Kathmandu for treatment,î she says.

ìMy mother in law doesn't like me doing social work. Nevertheless, teachers teach us and we go to teach other people at other places. We get Rs 25 per day and we distribute pamphlets."

The program, initiated by the Ministry of Health, uses a campaign to provide high-dose supplements to children from 6 to 60 months twice yearly. The program is initiated in new districts each year. The program is scheduled to operate in Jajarkot, Salyan, Rukum, and Rolpa in the future, say experts at the organization.

Chinimaya Poudel, 48, from Ward No. 3 Tatopani, says: "I want the upcoming generation to benefit. I do this because I believe it's my dharma. People still believe in witches. People still marry young. We need to create awareness among the general public."

Speaking on February 7 to an audience comprising mostly of women, Yam Prasad Gautam uses various techniques to create awareness. He sings in a catchy tune, "Don't let a pregnant woman die, give her Vitamin A capsule in six weeks." And the audience hums along.

"Vitamin A is essential in rural areas because of inadequate amount of Vitamin A in the peopleís diet," says Gautam. Stressing that Vitamin A causes night-blindness, he breaks into another chant, "Don't survive only on rice and pulses (dal) because a child's life can be ruined by not eating fruits and vegetables." And the audience pledges to teach what they have learned during the three-day training program.

Gautam calls an elderly woman to explain to the audience what she's learnt. She can't read. Asked how she would preach the new message she said, "A pregnant woman needs Vitamin A because it affects the child in the womb. We need to plant vegetables and fruits in our backyards. Pumpkins, Karkalo, Sisnhu are a big source of Vitamin A. It effects all the village and it is up to all of us to strengthen this national program."

Among the major national programs of the Ministry of Health are distribution of polio drops and Vitamin A capsule throughout the country.

Gautam asks the audience to clap and dance and hums another tune, "Don't survive only on dal and bhat because your child will curse you for not feeding you with green vegetables and fruits."

Ram Kumar Shrestha, director of the National Vitamin A program, speaking to SPOTLIGHT on February 8, said, "Respect and social status, education and learning, leadership, social work, opportunity and achievement, trust, among others, are the elements which FCHVs use to motivate the people. If the community becomes responsible, the program can be successful."

The objectives of the program are to provide all children from 6 to 60 months high doses of Vitamin A twice a year. The program also treats Xerophthalmia, measles, prolonged diarrhea and severe malnutrition with Vitamin A capsules and supplement high dose of Vitamin A capsules to postpartum mother within six months of delivery and to improve food habits and to ensure that Vitamin A is consumed through foods that are rich in it.

MC Sorcar, the magician working for the program, was the sensation of the event. As his practiced fingers produced milk, eggs, vegetables that was definitely a new approach towards awareness. "We need to spread this message from Mechi to Mahakali," Sorkar says.

"We know everything, but if we see something that cannot be explained, it leaves an imprint on one's mind," Sorkar says.

"The economic conditions in rural areas are very poor. Supervision is not good enough. We need to boost the morale of the community. We have observed some positive aspects, though. We need a good support system. Why not give the female workers some facilities to encourage them in other works like this?" asks Shrestha.

By the end of October 2000 the program had covered 69 out of 75 districts in Nepal, according to figures provided by the program. And has managed to reach 89 percent of the population. Under the program, 62,202 multi-sectoral people and 38,801 FCHVs have been trained, over 2.90 million children have been provided with Vitamin A capsules. Over 25,000 child deaths have been averted each year, say experts.

"The program has placed FCHVs in contact with millions of mothers and their family members. This activity is oriented toward developing the skills of FCHVs to mobilize their community for health and nutrition facilities," says Shrestha.

By the end of 2002, the NVAP will implement programs in all the 75 districts of the country. The objective is to train 40,000 FCHVs and build a infrastructure and networking system.