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A Fistful of Rice
Nine out of every 10 children in Nepal suffer some form of malnutrition. Paradoxically, it's because malnutrition is so widespread that it's also invisible, unnoticed. This is particularly true of Protein Energy Malnutrition, or PEM as it's known - a condition officially defined as being short and underweight for age, but which, in reality, is a devastating intergenerational cycle of lost potential, both physical and mental.
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Development in Nepal has been slow and the distribution of services to the rural areas even slower. As a result migration to the city has made Kathmandu one of the fastest expanding metropolises in Asia over the past 25 years, bringing with it problems of poor planning, pollution, water shortage and overcrowding. For the 300,000 migrants in the city, life without community support or extended family means adapting quickly to a new environment, an environment where everything, including food, has to be paid for with hard earned cash. Out of the one and a half million inhabitants of Kathmandu, recent arrivals are the most vulnerable to PEM.
Dev Kumari is one of many migrant women who has learnt to live with disappointment. Seven years ago she left her village and came west to Kathmandu in search of a better life. But life in the city has proved harsh. Living from hand to mouth means a daily struggle; selling enough roasted corn to pay the rent and feed her family. With her eldest daughter, Sarita, she spends over 12 hours every day on the busy streets of the city - but that's only one part of her reality: her children and grandchildren are locked into an invisible cycle that is crippling Nepal's development. After 50 years of foreign aid and nearly three billion dollars of development money, PEM still accounts for over half of Nepal's children being stunted; an irreversible condition after the age of two. It's also implicated in nearly 70% of children's deaths in Nepal through related illnesses, and has strong links with poor mental development
"My parents were well off but what would my parents do for a daughter?" says Dev. "Nothing! And in my husband's house there was always suffering, very little land and not enough food. I thought: if we leave things would be better."
Her daughter Kopila's baby is 45 days old, but has been sick since she was born. Kopila takes her to Patan Hospital. Dr Neelam Adhikari, Chief Paediatrician at the Hospital, tells Kopila she was too young to have a baby. "If you have a baby before you are 20 years of age the baby can be small - till then you are still a child and your body's not ready for the baby - understand? It is like children having children. So do not have another baby until you complete 20 years of age."
Because of teenage pregnancy and lack of care during maternity, 25-30% of infants in Nepal are born with low birth weight. These children are prone to PEM and are more susceptible to disease and infection. Kopila's baby has severe malnutrition and has caught pneumonia.
Stewart McNab of Unicef Nepal explains that malnutrition begins in the womb, and a low birth-weight baby is born. He explains the vicious cycle: "If that child is a girl child she may not receive enough food... Then if she is lucky enough to go to school, she also has to work hard in the household, in the farm, collecting firewood; water. Her growth is stunted and this in itself then leads to a problem when she becomes a young bride - maybe getting married by the age of 15, 16. But invariably that's what happens and that child will also fall into the cycle of malnutrition. So the cycle goes round and round and it's essential that we break this in early childhood."
And this isn't just a problem affecting migrants to Kathmandu. Gayatri is a community mobilizer in Jalpadevi, a small village in Achham, a remote rural region in western Nepal. For just over a year Jalpadevi's village development committee has been working with UNICEF to try and make the problem of PEM more visible to the women: through a simple system of monthly weighing sessions and discussions, the children's weights are plotted on a chart. Since all the children in the village are small for their age, plotting their weights against an international standard helps the women to recognise the problem.
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Just 20 years old now, Gayatri was married at the age of 16 and is eight months pregnant with her second child. Her job is to help other mothers to identify children who are not developing properly, to analyse the reasons why, and work on solutions together. She talks as she weighs the children. "This one is not healthy either - he too is malnourished. If he moves from here to here, he would be well nourished. He is better than last time." As for herself and her baby, she says: "Since I already have a daughter, I would like a son. I cannot decide on whether or not to have more kids without consulting my husband. If it were up to me I would stop after this one. I suffered because of early marriage - I did not get to study."
For Dr Roger Shrimpton, Senior Nutritionist, Helen Keller International, the solution is women's empowerment: "Wherever women are in control of resources at family level, in general there is far less malnutrition. Wherever women are oppressed, wherever women are not treated as equals, then you tend to get more malnutrition. So the solutions lie in that direction - in the long run. Perhaps the most important for achieving that is ensuring that all women are properly educated."
Two-year-old Laxmi is malnourished. Her mother was married at 17 to 58-year-old Bir Bahadur, who wanted a son. He explains: "Once daughters blossom we don't know where they go, they do not take care of us. That's why you have to marry again." In some districts like Achham, sons are the only ones who are considered as children. The birth of a daughter is a curse and she gets condemned along with the mother.
Gayatri says that unless men are educated, they are useless. "Here, they drink and scold their daughters and wives." And it's women like Gayatri who provide hope that a way can be found out of the cycle of PEM and poverty. Because, although she never finished her education, she has a vision for the future: "In five years from today I wish that no parents make their children suffer from malnutrition; everyone pays attention to cleanliness, and that everyone has a toilet in their house. When there is a meeting and when the children are weighed that both the father and the mother bring the child. This is what I wish for. I hope the children get to study on time and get to eat and for them to stay far from malnutrition. I wish for both sons and daughters to get love and affection in equal amounts and for them to go to school."
TRANSCRIPT
Read the full transcript of A Fistful of Rice
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