The Nutrition Rehabilitation Unit at the hospital has the most severely malnourished children in the region; most of them have been sent to the hospital from the mountain dispensaries in Tienne and Bastien. The surveys by HAS of households of risk factors for malnutrition indicated that the area served by the Tienne dispensary included the highest proportion of high-risk households. This was corroborated by the most recent monthly weigh-ins which showed an inordinately high rate of Low and Very Low Weight for age children.
In order to better understand the actual conditions of households in this region, a team of four members of the SCI team went to Tienne and accompanied animatrices in home visits to selected houses. In many of these houses, we found children who had been admitted to the hospital’s Nutrition Rehabilitation Unit, which validated the survey findings. However, in the locality where my son Edward and I were visiting, we also encountered a number of homes which had high risk factor ratings, but the children’s weight charts showed normal growth. This raises the question as to why households with extremely limited resources do not have malnourished children. Part of the answer to this question lies in the concept of Positive Deviance, in which the expected negative conditions are not found. An understanding of the strategies which are deployed to avoid the hazards and health consequences of poverty can help to shape an effective intervention strategy, to help other families to discover approaches to preventing malnutrition and illness.
Our discussions with the mothers of PD children brought out some of the steps taken by mothers to ensure that their children were well provided for. When we complimented one mother on her child’s obvious good health, and noted that surely life was difficult in the mountains, she explained “nou pa chita”; we don’t sit down. Very animatedly, she told how during that week, she had bought limes from neighbors, loaded them in straw bags on her donkey, and took them down to the Verettes market to sell. She took the money which she earned from the limes, and bought toothpaste and imported foods from the Dominican Republic (which are not available in the mountains) and sold them to her neighbors. With her small profits, she bought rice, which only grows in the irrigated lowlands, for several nutritious meals for her family.
Her energy and creativity, as well as her concern for her family, combine in the design of her work week to add income to the household and to protect her children. The strategic plan for HAS’ nutrition services include the establishment of nutrition rehabilitation services at the two mountain dispensaries, which will reduce the need for the children and mothers to spend several weeks far from home, and will provide a base for community-based education in nutrition. One of the key resources for this effort will be the mothers who have developed strategies to protect their children. These shining examples of Positive Deviance will be folded into the educational programs as local experts, to share their success stories with their neighbors.