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Life Expectancy
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Case Study 1: A Village Nutrition Center, India

It is an overcast day, but a few streaks of sunshine slice through the dusty clouds. Abhirami hurries past still-shuttered shops along the main street of the village. Already in the distance she sees a large group of women waiting at the nutrition center. As the community nutrition worker, Abhirami knows all of the women. A few mothers, curious about their neighbors' well being, examine the signboard by the door which announces the birth weights of newborn babies, along with information about immunizations and check-ups for pregnant mothers.

Inside Abhirami is happy to see Yogarani, a mother who often helps at the center. "Yogarani, I'm so pleased to see you. We have two mothers coming today for the first time. You must meet with them to explain about the nutrients we add to the laddoos1 that we feed the children. And about the importance of coming to the Center everyday. It was very difficult to convince them to come. Now we have to gain their trust."

Yogarani smiles and nods. Both women are familiar with the challenges of their work. But they also know that their willingness to actively seek out malnourished mothers and children helps to make the Tamil Nadu Project the most successful nutrition program in all of India.

Abhirami opens the door and the line of women -- mothers, grandmothers, and even one great-grandmother -- shuffle in with children, sometimes one in both arms, with others holding tightly to their saris 2. First, Abhirami registers and weighs the children and carefully records the information. Then she distributes the laddoos. Three-year-old Balaji, squirming to avoid the scales, however, is more interested in the laddoos. "Why do you like laddoos so much," Abhirami asks. The question stops Balaji long enough for Abhirami to pick her up. The child thinks for a moment.

"Laddoos are so sweet," she replies smiling.

"Well you shall have one in just a minute," Abhirami replies as she carries on with the weighing.

The next woman in line - a grandmother - would not be put off so easily. She always complained. "I don't know why I have to bring my grandchildren here every day. My own children didn't have laddoos."

Once again Abhirami must explain: "Laddoos are made from a special flour that has iron and calcium added. They help children grow."

"Well, then, at least you could give us the flour, and we could make laddoos at home." It is an argument that Abhirami hears often. She recognizes that it is difficult for the women to bring their children to the Nutrition Center every morning. Yet Abhirami knew that if the laddoos were made at home, the children would not always get them. For now at least, Abhirami believes, it is the only way.

"You know," she said looking sternly at the grandmother and raising her voice so the others could hear, "this place is not a feeding center; it is a village hospital where we help restore children to health."

In the brightly painted pre-school room next door, Yogarani explains to the new mothers that they must bring their children daily. "What we get here is not food for hunger, but medicine for a disease, because malnutrition is a disease," she says forcefully.

She shows them the multi-colored weight charts by the door, and how their children are much below weight for their age. She told them about her own child, Datshayini, now nine years old. "She was my tenth child," Yogarani began, remembering those difficult days. "My husband died soon after she was born, and there wasn't enough food in the house. Datshayini was sick and cried all of the time. I would have been in great trouble if the workers from this center had not visited me." Then looking the women, each in turn, directly in the eyes, she adds, "Just like we came to visit you."

"I brought my daughter here for supplementary food, but in her case, she needed more. The nurse here at the nutrition center sent Datshayini to the hospital in Walajah, because she had become really sick." Yogarani paused, and poured more tea for the mothers. They listened to her story intently. They had heard of the hospital, but they did not really believe that ordinary people ever went there, especially babies - especially girl babies. Yogarani continued her story. "Datshayini was sick with tuberculosis and was dangerously anemic. She couldn't eat much. They gave her tablets, and soon she got well and began to eat and came back home to us."

"Now," Yogarani says proudly, "she is the best student in her class."

The hour passes quickly. The children eat their laddoos and their mothers hoist the youngest ones to their arms and set off for their houses. The three- and four-year-olds, however, remain to attend the pre-school.

Ahirami peeks in the schoolroom that the village men had painted with colorful pictures of fruits, flowers, animals and vegetables. As usual there are several volunteers to assist. "This is a mango, a guava, and a papaya," calls out four-year old Divya as she hops over colorful cards lying on the floor.

Ahirami still has a lot to do. "I'm going to pay another visit that mother in the next village," she tells Yogarani. "Do you remember her? She is too embarrassed to talk to anyone about her pregnancy because she has a fourteen-year old daughter, and thinks she is too old to be pregnant."

"What should I do here while you're gone?" Yogarani asked, always eager to help.

"We are receiving a new shipment of flour for the laddoos," Ahiramai said. "Be sure to count all the packets, and make sure that none are broken open. And Govindaswamy will be stopping by later to tell us the latest news."

Yogarani remembers Govindaswamy very well. As a washerman, he visits all the women in several villages. He was trained by the nutrition center to advise mothers of the need for nutrition and food supplements. He is always among the first to know if a woman is pregnant or if children are sick.

"Oh, and if there's time," Ahirami says, already rushing out the door and seeing the children in the garden, "You can also help the teacher with the garden," she shouted. Yogarani joins the children in the garden in front of the center. The children are already at work weeding and gathering the beans, guavas, coconuts, and papayas. Yogarani joins them and asks Jyapriya, a four-year-old, "What are the papayas good for?" The boy looks up sharply appearing to be shocked that this adult did not know such an essential fact.

"For the eyes," he replied authoritatively, but then more quietly, like it was a secret, he says, "but I like the guavas best. And they're good for health too." The teacher often uses the fruits and vegetables in the garden to teach and the children and their mothers about nutrition.

Later, as Yogarani and Ahirami prepare to close the center after their long day a familiar face peers around the door. It is Paravai, their friend and village folksinger. "I have a new song, for the festival next week. Will you listen?" As always Paravai bounces with enthusiasm that one would not expect of this grandmother and farmer. She is very popular at the festivals, and sings many of the old songs, which she adapts to carry messages about nutrition and health, such as this one that the women know so well:

On a greenish hill by the name
Of Courtalam,
There are five waterfalls.
Likewise, for a mother-to-be,
There are five things to remember.
Early registration, tetanus shots,
Regular feedings, iron tablets,
And food and rest, too.

As Paravai continues with the familiar melody, both nutrition workers cannot help but think of all the people who contribute to the center's work--and of all the children.

1 Laddoos are made from a flour mixture of roasted wheat, chickpeas, and powered soy. A vitamin mix with iron and calcium is added. The result is high in protein and calories.

2 A sari is a garment worn by women in India consisting of light material that is draped around the body.

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