Tuesday, June 28, 2011

Nutrition Training in Bushwere

A short course on nutrition had been piloted in a few communities near Mbarara. Numerous studies have been done which show malnutrition to be a major problem here with as many as 40% of children under five years being identified as malnourished. This is despite the fact or maybe because of the fact, that south western Uganda is the producer of matooke, a form of cooking banana, which is the main staple food for much of Uganda,.

Matooke has little nutritional value other than calories. Men ride and push bicycles loaded with as many as 6 huge bunches of matooke long distances to reach the main pickup points on the highway for trucks carting matooke to Kampala.

Matooke is much beloved by Ugandans, well southern Ugandans. If you have a dinner with corn, potatoes, salad, chicken, rice, fruit, cake, cassava, meat and ground nut sauce and you don’t have matooke, your Ugandan guests will inquire, “Where is the food?”

You think I am joking? Well think again.

The nutrition workshop involves one or two of the community volunteers from each parish cooking the noon meal together. They bring their own food and prepare the meal together one day in the traditional way.

The following day the trainers help them with the same food but make a number of changes. They mix various food together; leave the pumpkin seeds in to be steamed for added zinc and add more local greens. In the workshop they talk about the added nutrient value and food groups. But it is the delicious taste that convinces the volunteers. That and the fact that they have assisted in the preparation so are able to replicate it at home.

I have been asked to attend the training and give them feedback. I haven’t been actively involved in the training but some of the training exercises and pictures used in our child health manual have been incorporated.

Both the male and female trainers are doing an excellent job. While cooking largely falls to women at home, the male trainers are demonstrating some wonderful skills. Doudi peels a pineapple holding the green leaves with one hand and wielding a machete in the other, leaving a totally clean pineapple. Oscar shows how quick he is at peeling matooke, which unlike the yellow banana, had a hard, thick, sticky skin.

I watch a group of women make short work of cassava, which I have never before seen being peeled. They skilfully remove the thick skins and center piece, breaking it into smaller pieces sometimes with a knife and sometimes not. A huge pot is filled with matooke, then layers of other food placed on top and the whole thing covered with banana leaves so it can steam on an open fire. Because some people prefer roasted matooke, unpeeled matooke is also placed in the fire to roast.

I ask them, as they prepare the food, about the manual they are using. It is confusing and not much help, almost all the trainers tell me. Someone points out it is unclear and goes from one topic to another. The issues are mixed up says another trainer.

This surprises me, not for the usual reason, for I also have found the manual disorganized. What surprised me is that they are reading and relying on the manuals. Almost all trainers appear to pick up what they need to know about a topic and about how to facilitate it from watching other trainers. I have come to this conclusion by noticing that certain ways of facilitating sessions and certain messages that do not appear in the manual are being circulated whether they were right or wrong.

If trainers were referring to the manuals regularly, I thought, these deviations would be identified and corrected. But it seems I have been jumping to conclusions and some of the trainers are using the manuals and what is more are able to identify a well-written one from one that is not. Remembering that many of the trainers have just basic schooling, I wonder if what I am seeing is that they are getting more used to using manuals.

I praise the trainers for their facilitation, for how they incorporate the new cooking skills and techniques into the training and for using labelled rice bags representing the three food groups.

I suggest that the trainers identify a couple more interactive nutrition exercises for the classroom work, maybe some pictures of the appropriate size of staple food for different ages and collect more colour photos of food used in the area to add to their collection. They agree with me that they could cover the same material in two days rather than 3 or 4. I concur that the manual needs work but as they are doing a good job with the training at present, think it can be postponed for now.

Photos: rice bags used for identifying food group; laminated food photos; pumpkin put on top of matoke; more greens added; covering with banana leaves for steaming.



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