Mobilizing help for malnourished children in Southern Laos
Attapeu province, Lao PDR - December 2010: Two-year-old Souk has no appetite. She can’t walk. Her parents say she cries relentlessly.
“She’s always sick,” says her father, Khian. “She’s just always like this.”
We ask her mother to hold Souk up for us to see. She lifts the child to her feet, but her emaciated legs can’t hold her weight. She whimpers and falls back to her mother’s lap.
We ask if they’ve ever taken Souk to the local health center.
The parents stare back blankly; the question appears completely foreign to them.
Tragedy and tradition
The family lives on the outskirts of Thalan village, an ethnic Cheng community, in Attapeu province, some 20 kilometers from the Lao-Cambodian border.
Souk was born just prior to a series of floods and storms that devastated the region’s subsistence crops. An assessment by UNICEF, following these disasters, confirmed that malnourishment was plaguing the region’s children. With nearly one-fifth of children under-five suffering from acute malnutrition’, the situation met the World Health Organization (WHO)’s definition of a crisis.
Khian and his wife know why their daughter is sick. They say the village health volunteer came to examine her and explained it was a problem of food.
I ask Souk’s mother, Vai, what she feeds her child.
“Rice,” she replies.
“Not really. Rice soup, sometimes.”
By now others from the village have gathered to observe us. There are at least three mothers with young children among them. All share the same gaunt faces and shrunken legs.
We ask these mothers the same question about what they feed their children.
We get the same reply from each: “Rice”. Clearly, in this part of Laos at least, such a diet is considered normal.
“It’s true, many people just don’t have much to eat, and natural disasters have made problems worse,” says Dr Bounthid Luangoudom, health director in the neighboring district. “But most parents also have very little understanding of feeding and nutrition.”
To further complicate matters, at least two-thirds of Attapeu’s population is comprised of ethnic minorities whose cultures and geographic isolation cut them off from health care and basic information. Many do not speak the national language.
“How do we convince people who believe in spirits to visit a health centre?” says Dr Bounthid. “When someone is sick they’ll sacrifice a chicken or a duck. If they’re really sick, maybe they’ll kill a buffalo.”
Seeking local solutions
To confront this challenge, Dr Bounthid is part of a campaign supported by UNICEF, WHO and Health Unlimited that is mobilizing teams of volunteers to screen local communities for malnourished children. Once identified, these children will be eligible for free specialized treatment, including food supplements and counseling, at health centres and hospitals.
Rice rations provided by the UN World Food Programme (WFP) will help families to take their children to the health facilities and remain with them while they complete their treatment. Malnourished children, pregnant and breast-feeding women receive specialized nutrition products at the health centers and enough rice to cover the staple food needs of their families. If the first efforts prove successful, the Government plans to expand the programme to reach 200,000 children across 13 southern districts.
“In the short term, we hope this will bring in more malnourished children for treatment,” Dr Bounthid says. “In the long term, we hope the improvements in children’s health will convince people of the value of seeking out healthcare.”
We ask Vai and Khian if they’ll go to a health center if the services are free and if someone gives them enough rice to last three months.
“Of course we’ll go. We need whatever we can get,” Vai says.
Her husband nods in agreement. “Yes, we’ll go.”
Remarks: Shane Powell & Judy Souvannavong are communication consultants with UNICEF working on nutrition issues in Lao PDR. UNICEF, WHO, WFP and Health Unlimited are working jointly to support the Lao Government in its efforts to combat acute malnutrition in Attapeu and other southern provinces.