Scaling Up Nutrition (SUN) in the first 1000 days: Window of opportunity for mothers and babies­!

By Brenda de Kok, EBPP Public Health Nutritionist Volunteer

The past three months I have learned a lot about the lives and the needs of the people in East Bali. Much more than if I would only stop by as a traveler, a thing that I had been doing over the last months. I quit my job in the Netherlands as a Nutrition Researcher and started travelling the world. It has been a thrilling experience, exploring new cultures, meeting inspiring people and discovering amazing landscapes. But there is more to it. You see the inequalities in the world with your own eyes: families in poor housing, transport via broken roads,and men and women dealing with harsh working conditions, to name only a few.

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This made me want to do something in return for the people that are so generous and welcoming to a stranger in their country. Not only by buying some food from a street vendor or a bracelet from a little girl, but in a more sustainable way. My idea fitted perfectly with the philosophy of East Bali Poverty Project: “Helping the people to help themselves” and that is how I ended up sending my application for three months volunteering as a Public Health Nutritionist.

After arranging my visa, I settled down in Sanur – close to the Annika Linden Centre where EBPP has set up their Health and Nutrition Centre. In this office, the expertise of the organisation is extended to other communities who need special support.Here, I supported Putri Krismayanthi (a highly-motivated Public Health graduate and member of EBPP Health Team since December 2014) with providing nutrition counselling to children with cerebral palsy (a developmental disability that affects movement, posture and coordination). Many of these children are malnourished and by providing tailored advice to the parents we aim to improve their nutritional status and ability to benefit from the therapy they receive from YPK, a Balinese NGO dedicated to support people with physical disabilities. It was lovely to see the parents caring so much for their son or daughter, being interested to try different food textures and new recipes to stimulate the children’s appetite and increase meal variety. In the last month, we had seen some positive influence on children’s growth -the result you are hoping for. Though, not all parents were easy to reach to book successes. Therefore, I am proud that EBPP has the ambition to develop new resources for counselling and reach out to more families in 2017.

In addition to the activities at the Annika Linden Centre, I was introduced to EBPP’s health and nutrition outreach programs in Desa Ban in my first week. I visited several Posyandu (local health posts) where Cadres (volunteer community health workers, recruited and trained by EBPP in 2003-4) measure the weight and height of children aged 0-5 years. According to their data registrations and additional research of EBPP, there are still many undernourished infants in the 19 sub-villages.

Hence, there was a need to gain more understanding of the root causes of malnutrition to be able to tackle the problem: the starting point of my assignment. Actually, as time had passed there were only ten weeks left to develop, perform and evaluate the research! A challenge that I was happy to take up together with Amy Cardamone (EBPP Health Program Advisor) and Karina Suryawinata, who also joined EBPP as a qualified and experienced volunteer Public Health Nutritionist this September.

copy-of-4Our aim was to learn from parents, Cadres and midwives using focus group discussions. While working on the assignment, I realized the cultural and religious influences are really strong here in Bali. Not only it had an impact on planning our focus group schedules but it also appeared in the answers that the participants gave. In four weeks’ time, we managed to speak to 38 parents, 14 Cadres and 6 midwives that serve the area during eight focus group discussions. All staff members of the Health Team contributed to accomplish this, a great team effort that I found so amazing. Our results show that there are many opportunities to improve the nutritional status of the children in Desa Ban – especially in the first 1000 days between a woman’s pregnancy and her child’s 2nd birthday. It is the window of opportunity and can break the cycle of poor nutrition for a healthier and more prosperous future. We heard many stories that struck me deeply; families that have no water in the dry season, no money to buy meat, no transportation to go the health clinic, no soap to wash hands, no proper feeding practices for babies and so on. But I keep hope as the results are the foundation for EBPP’s 2017 outreach programs to encourage behavior change and raise awareness about the possibilities to make a change in the first 1000 days.

The organisation is blessed with passionate employees who made my time a lot of fun as well. Terima Kasih! Thank you guys for the great time with East Bali Poverty Project.Again, I learned a lot about the lives and needs of the people in East Bali – and putting things into perspective regarding my own life. I am glad I could contribute in this way and I am grateful for this valuable experience.

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