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					                                       LIFE EXPECTANCY

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Case Study 1: A Village Nutrition Center, India

It is an overcast day, but a few streaks of sunshine slice through the dusty clouds. Abhirami
hurries past still-shuttered shops along the main street of the village. Already in the distance she
sees a large group of women waiting at the nutrition center. As the community nutrition worker,
Abhirami knows all of the women. A few mothers, curious about their neighbors' well being,
examine the signboard by the door which announces the birth weights of newborn babies, along
with information about immunizations and check-ups for pregnant mothers.

Inside Abhirami is happy to see Yogarani, a mother who often helps at the center. "Yogarani, I'm
so pleased to see you. We have two mothers coming today for the first time. You must meet with
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them to explain about the nutrients we add to the laddoos that we feed the children. And about
the importance of coming to the Center everyday. It was very difficult to convince them to come.
Now we have to gain their trust."

Yogarani smiles and nods. Both women are familiar with the challenges of their work. But they
also know that their willingness to actively seek out malnourished mothers and children helps to
make the Tamil Nadu Project the most successful nutrition program in all of India.

Abhirami opens the door and the line of women -- mothers, grandmothers, and even one great-
grandmother -- shuffle in with children, sometimes one in both arms, with others holding tightly to
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their saris . First, Abhirami registers and weighs the children and carefully records the
information. Then she distributes the laddoos. Three-year-old Balaji, squirming to avoid the
scales, however, is more interested in the laddoos. "Why do you like laddoos so much," Abhirami
asks. The question stops Balaji long enough for Abhirami to pick her up. The child thinks for a
moment.

"Laddoos are so sweet," she replies smiling.

"Well you shall have one in just a minute," Abhirami replies as she carries on with the weighing.

The next woman in line - a grandmother - would not be put off so easily. She always complained.
"I don't know why I have to bring my grandchildren here every day. My own children didn't have
laddoos."

Once again Abhirami must explain: "Laddoos are made from a special flour that has iron and
calcium added. They help children grow."

"Well, then, at least you could give us the flour, and we could make laddoos at home." It is an
argument that Abhirami hears often. She recognizes that it is difficult for the women to bring their
children to the Nutrition Center every morning. Yet Abhirami knew that if the laddoos were made
at home, the children would not always get them. For now at least, Abhirami believes, it is the
only way.

"You know," she said looking sternly at the grandmother and raising her voice so the others could
hear, "this place is not a feeding center; it is a village hospital where we help restore children to
health."
In the brightly painted pre-school room next door, Yogarani explains to the new mothers that they
must bring their children daily. "What we get here is not food for hunger, but medicine for a
disease, because malnutrition is a disease," she says forcefully.

She shows them the multi-colored weight charts by the door, and how their children are much
below weight for their age. She told them about her own child, Datshayini, now nine years old.
"She was my tenth child," Yogarani began, remembering those difficult days. "My husband died
soon after she was born, and there wasn't enough food in the house. Datshayini was sick and
cried all of the time. I would have been in great trouble if the workers from this center had not
visited me." Then looking the women, each in turn, directly in the eyes, she adds, "Just like we
came to visit you."

"I brought my daughter here for supplementary food, but in her case, she needed more. The
nurse here at the nutrition center sent Datshayini to the hospital in Walajah, because she had
become really sick." Yogarani paused, and poured more tea for the mothers. They listened to her
story intently. They had heard of the hospital, but they did not really believe that ordinary people
ever went there, especially babies - especially girl babies. Yogarani continued her story.
"Datshayini was sick with tuberculosis and was dangerously anemic. She couldn't eat much. They
gave her tablets, and soon she got well and began to eat and came back home to us."

"Now," Yogarani says proudly, "she is the best student in her class."

The hour passes quickly. The children eat their laddoos and their mothers hoist the youngest
ones to their arms and set off for their houses. The three- and four-year-olds, however, remain to
attend the pre-school.

Ahirami peeks in the schoolroom that the village men had painted with colorful pictures of fruits,
flowers, animals and vegetables. As usual there are several volunteers to assist. "This is a
mango, a guava, and a papaya," calls out four-year old Divya as she hops over colorful cards
lying on the floor.

Ahirami still has a lot to do. "I'm going to pay another visit that mother in the next village," she
tells Yogarani. "Do you remember her? She is too embarrassed to talk to anyone about her
pregnancy because she has a fourteen-year old daughter, and thinks she is too old to be
pregnant."

"What should I do here while you're gone?" Yogarani asked, always eager to help.

"We are receiving a new shipment of flour for the laddoos," Ahiramai said. "Be sure to count all
the packets, and make sure that none are broken open. And Govindaswamy will be stopping by
later to tell us the latest news."

Yogarani remembers Govindaswamy very well. As a washerman, he visits all the women in
several villages. He was trained by the nutrition center to advise mothers of the need for nutrition
and food supplements. He is always among the first to know if a woman is pregnant or if children
are sick.

"Oh, and if there's time," Ahirami says, already rushing out the door and seeing the children in the
garden, "You can also help the teacher with the garden," she shouted. Yogarani joins the children
in the garden in front of the center. The children are already at work weeding and gathering the
beans, guavas, coconuts, and papayas. Yogarani joins them and asks Jyapriya, a four-year-old,
"What are the papayas good for?" The boy looks up sharply appearing to be shocked that this
adult did not know such an essential fact.
"For the eyes," he replied authoritatively, but then more quietly, like it was a secret, he says, "but I
like the guavas best. And they're good for health too." The teacher often uses the fruits and
vegetables in the garden to teach and the children and their mothers about nutrition.

Later, as Yogarani and Ahirami prepare to close the center after their long day a familiar face
peers around the door. It is Paravai, their friend and village folksinger. "I have a new song, for the
festival next week. Will you listen?" As always Paravai bounces with enthusiasm that one would
not expect of this grandmother and farmer. She is very popular at the festivals, and sings many of
the old songs, which she adapts to carry messages about nutrition and health, such as this one
that the women know so well:

                                   On a greenish hill by the name
                                           Of Courtalam,
                                      There are five waterfalls.
                                    Likewise, for a mother-to-be,
                                 There are five things to remember.
                                  Early registration, tetanus shots,
                                   Regular feedings, iron tablets,
                                       And food and rest, too.

As Paravai continues with the familiar melody, both nutrition workers cannot help but think of all
the people who contribute to the center's work--and of all the children.




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Case Study 1 Exercises

1. Though the story is about a nutrition center, what other activities does the center sponsor or
promote?

2. At least three women in the story were reluctant to go to the Nutrition Center. Explain why.

3. Abhirami says, "We have to gain their trust." Why would people be suspicious about receiving
nutritious food for their children?

4. Why do you think the workers at the center weigh the children every day?

5. Why do you think that Abhirami believes that if the laddoos were prepared at home, "the
children would not always get them"?

6. Why do you think the two women in the story were surprised that ordinary people went to the
hospital?

7. Why might a woman be embarrassed about her pregnancy and not want to talk about it
because "she had a fourteen–year–old daughter"?

8. In how many different ways did the center educate children and adults about nutrition? Why
would the center choose to do all of these different time consuming activities instead of simply
feeding the children?
9. Find India on the Social Data Table. What is the 1998 Infant Mortality Rate? What is the 1998
average Life Expectancy at Birth? If India were to extend the Tamil Nadu nutrition project
throughout the entire country, what changes would you expect to see in these data over time?
Find your own country on the Social Data Table. How do the data for your country compare with
those of India? How would you explain these differences?

10. Do you think malnutrition is a problem for low– and middle-income countries only? Explain
your answer.

11. Is malnutrition a problem in your country? What programs do you know about that try to
change eating habits or provide more nutritious food for those who need it in your country?




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Case Study 1 Exercises with Answers

1. Though the story is about a nutrition center, what other activities does the center sponsor or
promote? [Immunizing children, conducting pre-school classes, giving check-ups for
pregnant mothers, referring sick children to hospitals, teaching about health, gardening,
and nutrition.]

2. At least three women in the story were reluctant to go to the Nutrition Center. Explain why. [It
was time-consuming to go to the center every day; some did not trust the center; one was
embarrassed about her pregnancy.]

3. Abhirami says, "We have to gain their trust." Why would people be suspicious about receiving
nutritious food for their children? [They may not understand about vitamins and other food
supplements. They have to leave their homes where they normally prepare food to receive
food from strangers. Laddoos are new. They did not exist when the mothers were young.]

4. Why do you think the workers at the center weigh the children every day? [The mothers can
see that the food supplements are working and that their children were growing normally.
It shows if a child is experiencing other problems that interfere with growth.]

5. Why do you think that Abhirami believes that if the laddoos were prepared at home, "the
children would not always get them"? [The family might decide to share the laddoos with all
the children in the family, even if they are not underweight. Or they might give them to
adults who are doing the heaviest work.]

6. Why do you think the two women in the story were surprised that ordinary people went to the
hospital? [Few people from poor villages go to hospitals due to the distance and the cost.]

7. Why might a woman be embarrassed about her pregnancy and not want to talk about it
because "she had a fourteen–year–old daughter"? [She may have considered herself too old
to have another child, especially since her daughter was now old enough to have a child
herself.]
8. In how many different ways did the center educate children and adults about nutrition? [Daily
weighing of children, explanations of the purpose of the laddoos, pre-school lessons
about food and gardening, using popular musicians to sing songs about nutrition and
health.] Why would the center choose to do all of these different time consuming activities
instead of simply feeding the children? [Answers will vary. By educating people instead of
just feeding them, there is a greater chance that people will change their behaviors and
learn to feed themselves in a healthy way. Using many different methods to teach mothers
and children helps to ensure that the lessons go beyond the nutrition center walls.]

9. Find India on the Social Data Table. What is the 1998 Infant Mortality Rate? [70 deaths per
1,000 live births.] What is the 1998 average Life Expectancy at Birth? [63 years.] If India were to
extend the Tamil Nadu nutrition project throughout the entire country, what changes would you
expect to see in these data over time? [The Infant Mortality Rate would probably decrease
and the Life Expectancy would probably increase.] Find your own country on the Social Data
Table. How do the data for your country compare with those of India? How would you explain
these differences? [Answers will vary.]

10. Do you think malnutrition is a problem for low– and middle-income countries only? Explain
your answer. [Answers will vary. Malnutrition may occur in any country–low, middle, or
high income—where segments of the population cannot afford enough nutritious food, but
it is more common in low– and middle-income countries. Even where there is sufficient
food people may be malnourished because they do not know how to eat a balanced diet or
understand the role that vitamins and minerals play in nutrition. Also, malnutrition may
occur as a result of unhealthy and extreme attempts to lose weight, a trend that appears to
be growing especially among adolescent girls in some high-income countries.]

11. Is malnutrition a problem in your country? What programs do you know about that try to
change eating habits or provide more nutritious food for those who need it in your country?
[Answers will vary.]

				
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