Tackling Malnutrition Thru Primary School Peer Groups

John Briefs Kikunda PS Parents Meeting

John Ssenoga, the field coordinator of the Primary School Gardening Project, arranged to make his second visit to train Peer Group Educators (PGE) this week.  The project is funded through the American Academy of Pediatrics, I-Catch program for international community pediatrics. Officially the project is not with Harvest Plus, which is disseminating bio-fortified crops of high iron beans and orange sweet potato in Uganda, but because we would like OSP and high iron beans reach school age children, we are doing our bit to promote them in our school gardens. 

Parents Meeting Packed

However when John arrives at Kikuda PS, the Parents and Teachers are holding a last minute, urgent meeting.  They are very pleased to see John and ask him to tell them about the Gardening project. The parents are overwhelmingly in support  of the program.  In fact they want to be more involved!  They provide John with information about traditional farming practices, traditional weaning and pest control.  Parents living close by and the local Volunteer Health Worker (VHT), even offer to take care of the student's garden over the holiday. 

Parents Provide Farming Wisdom

“Wow”, says John when he tells me all this, “We should have involved them earlier.” 

The School teacher in charge of the Peer Group at Kikunda PS, has been very enthusiastic but  has had a number of problems with garden pests. He shows John around describing the problems in detail.  The local parents who are farmers say the problem is simple, the high iron beans and orange Sweet Potato vines provided were planted too late.  The Peer Group Trainer who has come with John, is Avictas, a 3^rd year Agriculture student at Bishop Stuart University nearby.  He concurs with the local farmers.  It seems project communications were not clear and the teacher thought he was supposed to wait for project staff to come before planting. 

The parents request that they be allowed to "take the project to their homes".  They want to grow high iron beans and orange sweet potatoes and start kitchen gardens. This is one of our hoped for outcomes.  They tell us they can help us to lobby the churches in the area for additional land for the school garden.  We have been very lucky at all the schools to have large areas set aside for the student gardens as well as generous offers of land from the nearby churches.

Peer Educators Use Puppets and Hats for HEd

At the beginning of the project, we had asked the designated teachers at each school to do things with us in a step-wise manner, but gardens of course have to be planted in season.   Another lesson for us non-farmers in the project, is that farmers till the land twice here.  Once, about a month prior to planting, land is tilled in order to turn under all the grass to let it decompose,  Then a second digging is done to turn the soil over at the time of planting.  Lots of things for us to learn in a gardening project!  
The aphids found on the beans are usually handled by sprinkling them with ash (kashenda) which causes them to die and fall off.

There isn’t time at Kikunda because of a lengthy Parent’s Meeting to teach the Peer Group Educators but John feels the contact and information has been invaluable for the project.  Planting was done on time at Bushwere PS and all their crops are doing well. 

Avitas Teaches Head & Fingers Hygiene Song

We have a huge flock of Peer Group Educators, 176 in the four primary schools.  All the schools have drawn their Peer Group Educators from the four classes from Primary 3-6 and their classes are very large.  One of the classes has 90 students.  As the schools and the project hopes to reach all the school children, the teachers have selected many PGEs.   In in the two schools in Mwizi area,  Kikunda PS has 65 PGE and Bushwere PS has 36.  
The other two primary schools are in Kibaare, quite a ways from the Mwizi Schools so are seen on another day later in the week..  At Kanyantura PS there are 40 with 36 at Kibaare PS.  It will be a real challenge to train all the PGE effectively, but the four Peer Group Trainers and our field coordinator are going to give it their best.

Snakes & Ladders on Rice Bag

Kanyantura PS had received an extra bag of OSP vines because it was thought that the vines were planted in small heaps and would not thrive.  However the 1^st crop looked surprisingly good even though the heaps were small.  The local VHT advises the teacher to have the children collect and add manure to the heaps as the potatoes continue to grow, so they are covered as they will begin to push upwards. The 2^nd crop of OSP vines have been planted on clay-like soil and were not doing so well, dry around the base with leeching .  Avitas suggests manure also be added to this soil as well and instructs the students set up composting bins nearby.  There is also time during the visits to Kibaare schools to train the PGE in Micronutrients such as is found in Vit A-enriched Orange Sweet Potato and High Iron Beans.  The sessions go well.    John, Avitas and the teacher demonstrate to the PGEs how to play Nutritional Snakes and Ladders.  The whole class gathers around on the large rice bag of the Snakes and Ladders game.  Two sets of die are given to each school but the teachers are happy we are also encouraging them to continue to use their traditional method of throwing 6 split seeds determine the count from the number in which the cotyledons land facing up.

Kids Collect Water After School

At Kibaare PS the children are doing tests so it is not possible to do a training session with them but John was able to tour the gardens and report that most are doing well.  One batch of OSP were planted in clay-like soil and are not doing well but both schools in Kibaare will have bumper crops of beans and be able to share with the parents. 

We are learning lessons as we go.  We need to meet with Parents Groups early and often and set up a Garden Advisory Committees with the teachers and parents. We need to schedule several non-training visits to each school . And we are going to have to be very creative to train so many Peer Group Educators effectively and well.  
Photos:  John Ssengo, Avitas

Harvest Plus Cooking Demonstration in Kibaare

Kibaare Balanced Meal 

Each VHT brought two community women and children to the Kibaare Cooking Demonstration.  The VHTs were all wearing their identifying T-Shirts.  They also brought along food from their own gardens.   As most mothers in this area know how to cook both beans and sweet potatoes, Angella and I used it as an opportunity for health education.  While we waited for people to arrive we had the VHTs colour in two small versions of the posters for use in one-on-one health education.

Deus with Food Wheel 

On our arrival wood for the fire was obtained.  While the community members peeled and chopped the vegetables, VHTs began colouring their health education material.  Angella made a presentation using the Harvest Plus poster.  VHTs were very reluctant to do presentations, suggesting that they have not been practicing how to do so in their training and/or do not have the confidence yet.  Finally two were coaxed to do a Health Talk, which was mostly talking and did not include questions until prompting.

VHTs Colour Food Wheels

Dovinia Colours Her Food Wheel

As we had brought with us vaccines from the Health Center III for Immunization Day a large number of mothers with young children were gathered on the Kibaare Health Center II porch, at one point numbering over 25.   VHTs were requested to go to the health center porch to do health education for the women waiting in line.  Keneth, the health worker, stepped in to assist them.

Angella Tells Stone Soup Story

Angella did a Flannel Board demonstration of Stone Soup which was watched avidly.  One of the VHTs started to do a return demonstration but when she lost her place in the story, a community member stepped in to assist. 

Community Member Does Stone Soup

For the large group of mothers with infants gathered on the porch of the Kibaare Health Center one of the male VHTs, Deus presented Stone Soup flannel board.  He is a great story-teller and did a wonderful job.

Deus Demonstrates on Clinic Porch

When the HEd pictures were coloured, they were mounted on the clinic wall with the best in each of the 5 different scenes given a small prize.   VHTs who finished two pictures put their names on them.  These will be laminated by Angella for them so they can be used in one-to-one health education.

A large amount of food was brought by the VHTs and cooked by them including many OSP which were steamed in their skins.  These were placed in an Ankole basket and distributed to some of the kids around.  There were 18 VHTs and approximately 25 mothers and children invited.

Beautifully Mended Sufuria

The bean harvest in this area appears to be bountiful.  One of the VHTs asked us what she could do with so many beans!  We suggested that if she was successful in telling her community members about the benefits of these beans, she would likely have more requests and customers for them than she could manage.  
During the day, I found myself mesmerized by the beautiful repair of the large cooking pot suitable for a community dinner. It had been mended in four distinct jobs, exquisitely, as you can see.

Cooking Demo in Nyarubungo

VHT uses Hand-Coloured Aid

Donated Food 

Angella and I arrive at Kinoni HC IV shortly after noon. The Nyarubungo Group asked for their cooking demo to start at 2 pm.  There are a couple of Volunteer Health Team members (VHTs) who begin to sort the dried high iron beans we have brought with us. The VHT coordinator arrives on his motorbike with a good variety of pumpkins, potatoes and tomatoes.  Other VHTs add to the enlarging pile.  Somehow the message that VHTs were to bring two community members was not understood so they have come alone.

 At the Orange Sweet Potato distribution a couple of weeks ago, when it appeared that seven of the VHTs from a distant village, had already supplied two community members each from their own fields, we had 7 “extra” bags of OSP vines to distribute.  Within an hour, the VHTs in the nearby parishes had brought in 14 new recipients.  
A tribute to the ubiquity of cell phones and the close connection of VHTs to their community, many of the last-minute recipients were poor, older, female farmers unable to write their names.  VHTs had been instructed to bring pregnant women and mothers with children under-five for the first distribution of OSP vines.  Most of the older female farmers of course would likely be supporting orphans and grandchildren, so we are pleased  with their choice of the VHTs.

HEd With Harvest+ Posters in Runyankole

The Nyarabungo group is eager to show their skills at group teaching using the Harvest Plus posters.  They demonstrate in pairs and play off each other, something I haven’t seen done before.  
Angella demonstrates the Stone Soup Flannel Board Story for them next.  One of the VHTs eagerly steps up to do a repeat demonstration and almost makes her presentation a dance.

Getting the Beans Started

Afterwards I say to Angella, “She made some changes to the story, didn’t she?”

Angella laughs, “She really liked the story!”

At the point in Stone Soup where greens are added to the soup by child saying his grandmother said they were ery nutritious, one of the VHTs go to the garden close to the cook shed and picks a big handful of pumpkin leaves to add to ourpile of ingredients. 

Pumpkin leaves, like all greens, although ubiquitous, are rarely included in meals here.  Like dodo and sumkumiwiki, other locally available greens, pumpkin leaves are regarded as poor people’s food.  I have heard people commenting in surprise, after trying the pumpkin leaves, how tasty they are.  One of our jobs in teaching good nutrition is to reinsert greens into the local diet. 

Flannel Board Stone Soup Captivates

The beans were started early as they will take a while to cook.  Angella is busy distributing and collecting the VHT forms for beneficiaries as we will be tracking who gets high iron beans and orange sweet potato vines after each harvest, hoping to saturate the parish within two years so that everyone has access to enough of both crops to keep their family healthy.

Hand-Coloured Aids Displayed

With the beans on the hearth, as we wait for the rest of the VHTs to arrive, we distribute nutrition pictures and coloured pencils.  A contest for the best colouring job done for each of the five posters is judged by the VHT trainer, Dennis, with pens for prizes.  We will take their coloured posters to be laminated back to back and returned to the VHTs for use in health education

Meal Preparation

I leave with Angella at 5:00 pm.  The beans are almost done but preparation of pumpkin, cassava, potatoes, sweet potatoes, OSP, tomatoes and pumpkin leaves is still underway.  Angella and I are glad we took lunch at one of the local Pork Joints in the area.  We return to Mbarara with the fridge donated to Kinoni HC for the MUST student placements more than 18 months ago.  The fridge according to the Health staff has never worked but unfortunately it was not fixed while it was still under warrant.  We plan to get it repaired at long last.  It feels rewarding  to be able to combine a number of activities on a single visit and we often can.