Monday, January 15, 2018

Skilled health workers helping mothers to tackle undernutrition in Timor-Leste

Joaquima Felisberta (30) is the Nutrition Coordinator at the Maliana Community Health Centre
is checking health of  Francisca’s baby.
She estimates of the 300 patients her team sees every week,
approximately 10 will present with malnutrition.  @UNICEF Timor-Leste/2017/bsoares
The baby cradled in Francisca Isabel Revio’s lap shifts and whimpers, waking from a nap in the sticky afternoon heat as her mother sits in the Maliana Community Health Center waiting room. Anticipating the baby’s cry moments before it happens, Francisca (41) calmly pulls up the hem of her shirt and begins to breastfeed the child without pausing her sentence.

“I don’t know why it’s this one that has the problem,” she’s saying, gesturing to the 13-month-old now suckling quietly. “None of the others ever got it.”

Francisca’s baby daughter is her youngest child and the first in her family who gets often sick and low weight. She is surprised, and she’s come to the health facility to seek treatment for the girl.

Mothers leading the way, considering every cause

“We wash our hands before we cook, we drink water only from the gallon, the baby drinks breastmilk,” Francisca continues, confidently reciting several factors may reasons that her child may get sick. “The other children eat rice, yam, cassava, corn, papaya leaves, other vegetable leaves … we’re farmers, so whatever we can grow.”

Like most of the population in Timor-Leste, Francisca and her husband are subsistence farmers, who eat whatever they can grow on their land, and live on a wage of around USD 1 per day. At 41, she’s strong and active, and despite the difficulty of growing food in drought-stricken Maliana, Francisca makes sure her family eats at least twice a day.

If you didn’t know, you’d assume Francisca to be the nurse, not the worried mother of a malnourished child. A subsistence farmer, pregnant at 20, she’s not the first person you’d guess to be examining paperwork, explaining nutrient profiles, questioning sanitation practises and conducting diagnoses.

But, of course, as a mother, she’s the best person for the job – and the resources, information and trustworthy consultancy provided by the Health Worker ensure she’s equipped with what she needs to do it well.

The baby’s diet is unlikely to be the problem, and Francisca knows it. Feeding practises, sanitation and diarrhoea and illness can all contribute to poor nutrition in children. While around a third of children in Timor-Leste are underweight, a lack of food isn’t necessarily the problem: according to the country’s 20013 National Nutrition Survey, it’s because nearly three-quarters of children aren’t getting an adequate diet, which comprises both the frequency of meals and the diversity of a child’s diet.



Eating habit and contaminated water make it difficult

The baby in Francisca’s arms is the youngest of her eight children. While Francisca’s older children eat just twice a day, the green leaves and orange-yellow yams on their plates are usual.  Sometimes, families in Timor-Leste just eat plain white rice or bread without any meat, dairy or vegetables, and may drink contaminated water from local canals instead of paying for gallon jugs of clean water, like Francisca does.

“We used to drink from the canal,” Francisca says. “But we learned about water contamination, so now I only buy gallon water.” A 20-litre refill bottle costs nearly USD 1, but when the wet season rain comes, the canals flood every afternoon with putrid waste and murky water from nearby houses,
leaving families with few options.
Delfina Florentina is on her way to check her baby’s health.
@UNICEF Timor-Leste/2017/bsoares
“Some women feel embarrassed,” says Joaquina Felisberta, the Nutrition Coordinator for the Community Health Centre in the rural town of Maliana Administrative Post, who assess and treats Francisca’s baby. “They know malnutrition complicates other health problems but they don’t know how to fix it. We use the posters to explain the importance of handwashing and link to nutrition to them.”

Joaquina says the Community Health Centre also provides maternal health services for mothers like Francisca, including offering antenatal and post-natal care, distributing iron folic acid supplements, and providing nutritional advice to pregnant and breastfeeding mothers.

“We ask them if they understand, and then they say yes they do and they ask us questions,” says Joaquina of the mothers she receives.

With support from the European Union and UNICEF, Timor-Leste’s Ministry of Health is conducting training and providing standardised national guidelines and knowledge-dense resources for health staff in rural areas like Maliana, to ensure parents are equipped with the knowledge required to nourish their children, and to help fight one of the tiny island nation’s most serious public health problems.

Health Post reaching out with service

Francisca’s baby eats solid foods, too. When we ask Francisca when she started feeding the baby solid foods, she pulls an A5-sized coloured log book out from beneath the child on her lap.  “July,” she replies confidently, scanning hand-written notes.

She pauses, thinking about the baby, then concludes it’s likely that with seven children and a newborn, she can’t monitor the whole family’s hand-washing, which is probably how the child got sick. “All the older children know how to cook, they help me in cooking; but I can’t control them all, all the time,” she says, breaking into a rueful grin

She props the baby up to sit and rearranges her top – pale pink with floaty chiffon sleeves, matched with bright floral-printed pants – and gathers her documents together. It’s time for the baby’s check-up.
Francisca Revio (41) nurses her 13-month-old daughter at the Maliana Community Health Centre.
Despite eating a healthy diet, Francisca's daughter is malnourished,
like more than a third of children in Timor-Leste. 
@UNICEF Timor-Leste/2017/sraynor
“I love coming here,” Francisca says of the Maliana Community Health Centre whose nurses provide free nutrition, sanitation and illness management advice to mothers like Francisca. “I can use my knowledge to help my children.”

With that, she gathers her daughter in her arms, drops a final goodbye grin, and marches back out to the Community Health Center with her back straight and head held high; pink sleeves floating in the muggy afternoon’s first breath of a breeze.

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By UNICEF Timor-Leste

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