When the Burmese government started intense persecution of the Muslim minority group, the Rohingya, in Myanmar, the Rohingya fled by the hundreds of thousands to neighboring Bangladesh, quickly establishing a refugee camp of nearly one million people in only a few short months.
Leslie was requested to help in clinics in the refugee camps to integrate nutrition into the clinical practice. One of her tasks was relatively easy: educate the clinic staff, including doctors and nurses, on identifying and treating malnutrition.
The other task was more complex: establishing a referral system for patients that came to the clinic and were diagnosed with moderate or severe malnutrition. In disaster response settings, many programs are established to address the most common needs in a population. Malnutrition is common in a disaster, and many organizations work to treat malnourished children through special feeding programs. But how do people get connected to these programs?
In the refugee camp in Bangladesh, different feeding programs had different catchment areas to avoid duplication of services. But these catchment areas weren’t very clear to families. If a parent was told that their child was malnourished and they needed to go to a feeding program, sometimes they would be referred to one that didn’t cover their area, or the family would approach one without knowing if they were part of that area. Some of these families were turned away from the centers and they didn’t understand why. Sometimes they thought maybe their child didn’t qualify. Many times they thought that the clinic staff was just trying to get rid of them and didn’t actually know how to help their child.
Leslie went to households that had a child diagnosed with moderate malnutrition to have a conversation with them about their reasons for not enrolling their children in these feeding programs. This is how she came to learn the barriers they faced, and what needed to change in the clinics’ referral systems. Thus, she learned the most common catchment areas so that families could be referred to the proper program, and also educated all the staff on talking points to families about the importance of enrolling their child in the program.
Finally, Leslie also trained community health workers (CHWs) on nutrition talking points and basic nutrition assessment and referrals. The CHWs were members of the Rohingya refugee camp who visited their neighbors on a rotation schedule, discussing various health topics. For nutrition, they talked about the importance of exclusive breastfeeding for children up to 6 months of age, and transitioning children to complementary foods up to two years of age. CHWs were trained on taking measurements of children and how to refer them to a feeding program if necessary.
Leslie also left the organization with some basic monitoring and evaluation (M&E) plans in order to see how the program was impacting people’s lives. Without measurements, it is difficult to determine what kind of effect a program has in a community, or where changes need to happen in programming. M&E helps ensure longevity of change in a community, and Leslie wanted to make sure the program continued to be successful well after she left.
Fulcrum Missions 