By McCall Mash
Despite staggering rates of malnutrition in Jumla, one of Nepal's poorest and most remote districts, international aid organizations are struggling to solve it. However, one Nepali NGO is committed to taking on the task
A child's first 1,000 days are their most important. It's when mothers have the opportunity to set them up for a long life, with a healthy brain and body, by feeding them nutritious food.
But in Nepal, children are facing an epidemic of acute malnutrition during their first five years — with around 50 percent of them severely malnourished, according to an assessment conducted by Chaudhary Foundation (CF).
“Malnutrition is a problem that is related to the future of children,” said Ratan Yogi, the Tila Rural Municipality chair in Jumla, Nepal. “When a child is suffering from malnutrition, [they] cannot be physically and mentally strong as other children and cannot contribute equally in the society.”
For most children born in Jumla — a remote, Himal district in the Karnali Province, one of the largest yet least populated provinces — this is their reality.
Jumla is one of the poorest and most inaccessible places in one of the poorest and most inaccessible countries. Despite having some of the highest rates of poverty and malnutrition, it's also one of the most neglected and underdeveloped districts in Nepal.
When Merina Ranjit, the deputy general manager of CF, first heard these stats, she said she knew the foundation needed to begin working in Jumla.
“Jumla is the gateway to some of the poorest regions in Nepal,” she said. “After hearing about its situation — Jumla has one of the lowest Human Development Index scores in Nepal, and poverty and malnutrition are rampant — I knew Chaudhary Foundation had to act.”
The foundation, CG Corp Global’s corporate social responsibility wing, first conducted an in-depth assessment of Jumla’s Kudari Village Development Committee (VDC) in 2014 and eventually set up a factory with fortified, ready-to-eat snacks that leveraged CG’s Fast-Moving Consumer Goods skills.
“Malnourishment is the biggest issue in Jumla,” said Birendra Upadhyaya, who oversees a village health post in Kudari, one of Jumla’s 30 VDCs. “Due to poverty [...] mothers cannot feed their children proper food.”
A silent ‘epidemic’
Jumla’s above average rates of malnutrition and undernourishment, where around half of Jumli children under five are underfed, are because they don’t have regular access to healthy and nutritious foods, according to the nutritional assessment of Kudari.
“The situation of child malnutrition in Nepal is very high due to the cultural, social, economical, educational and political structure of Nepal,” the assessment found.
The assessment noted that children in the Mid- and Far-Western hill and mountain regions, which is where Jumla is located, regularly experience physical and cognitive damage (stunting) and deadly low weight and height (wasting) because of malnutrition.
Malnutrition at “epidemic” proportions keeps Jumli children in the cycle of poverty, which affects their ability to lead healthy and productive lives in the future, noted Upadhyaya.
“We fear that this malnourishment [is an] epidemic,” Upadhyaya said. “If mothers are malnourished, then their children are malnourished as well. Later on, such child cannot develop both physically and mentally — it is a problem not just in Kudari but all of Jumla.”
It is “essential to eradicate malnourishment” in Jumla, Upadhyaya said — and it's possible by addressing some of the underlying causes.
At least eight factors play into Jumla’s above-average rates of poverty and, subsequently, malnutrition: the workload of mothers, food habits, lack of nutrition education, mother’s nutritional status during and after pregnancy, adolescent marriage and pregnancies, food taboos for pregnant women, unhygienic behaviors like not washing hands and the lack of male participation in housework and child rearing, CF determined following its assessment.
Most of the factors hinge on cultural taboos and the mother's health, especially her educational status.
In Jumla — where around 56 percent of women are illiterate, according to the 2011 census — both an uneducated mother and her children have an increased risk for malnutrition because she likely hasn’t had any basic health education, according to the assessment.
Women need comprehensive health education that includes what to eat before, during and after pregnancy to help themselves and the child stay healthy; hygienic practices, especially with food and water; and the risks of adolescent marriage and pregnancy.
However, many Jumli women do not receive an education because they are expected to participate in the family’s agriculture practices before leaving home at a young age to become a wife and, eventually, mother.
Yogi also noted that malnutrition starts before a child is born. That means solving malnutrition requires addressing the issues mothers in Jumla face.
“It is very important for mothers and especially pregnant women to be healthy and nutritious,” he said. “When babies are born [to malnourished mothers], they cannot perform properly in the society.”
An uphill battle
Jumla receives less aid than many of the other areas of Nepal, and what support it does receive is irregular, which makes implementing programs difficult, according to the foundation’s assessment.
However, Kudari does have a nutrition center and some educational programs that focus on healthy eating habits.
After reviewing its assessment and discovering the desperate need for aid, the foundation established Karnali Miteri Udhyog, a nutrient-enriched bakery and fortified “super flour” factory, in 2015 through its Nepal Social Business initiative.
The factory’s goal is to eradicate malnutrition by providing nutritious and tasty prepackaged foods to the region.
However, less than a month after production began, it stopped.
Gorakh Bahadur Sahi, one of the factory’s board members, pointed to two different elements that caused the factory’s failure: inadequate training on how to operate and fix machines and inter-village conflict that resulted in power cuts.
“The electricity is in the hands of somebody else; the machine repair is also in someone else’s hands — we don’t have any knowledge on machine repair,” he said. “We do not have any control over electricity supply, so we are having a problem in running the company.”
The machines began to break within the first week of production and were taken to the sub-metropolitan city of Nepalgunj, which is a 13-15 hour car ride because no one had the skills to fix it within the village.
“We haven’t received any training,” said Sahi, whose five grandchildren under the age of seven would benefit from eating what the factory produced. “We received training on the composition of cookie and lito pitho [fortified porridge usually made from rice flour]. We do not have any training on bakery or machine repair.”
Sahi said he requested training to repair the machines from the start of the project.
“My idea from the beginning was to send someone from the village for a month or so to receive training on the machines at the place where it was bought so that the person can come back and train others as well,” he said. “We will even bear the cost for it.”
At the same time as the machines began breaking, a neighboring village started to cut the factory's power supply because of inter-village conflict over one area receiving support for and not another.
“Maybe, due to lack of a conscious, we feel that people [in the neighboring village] do not [provide power] on purpose,” Sahi said. “When we have discussions, everything is fine. We have even signed an agreement paper regarding providing electricity. We have had several discussions at the powerhouse itself and even here as well, but even then they don’t provide electricity. They sometimes cut the wires — don’t send power at all.”
Though both problems would be temporarily solved, the situation was never permanently resolved — the factory has only worked sporadically since November 2016.
The foundation also noted that there are problems with managing the factory because the site coordinator struggled due to being perceived as an outsider.
“Kudari is one of the [most] rural parts of Jumla,” said Reshma Shrestha, the project coordinator. “It is harder for an outsider [there] because it is really difficult to convince the people of Kudari to trust me and there were language barriers.”
Shrestha noted that these issues, along with the lack of electricity and the project’s remoteness, led to its failure.
Despite Karnali Miteri Udhyog’s shortcomings, CF is committed to seeing the project succeed to help eradicate malnutrition in Jumla, and it has developed a three-step plan to secure the factory’s success:
First, members of the factory will be sent to learn how to repair broken machines, and the foundation also plans to have spare parts kept on hand.
Second, a major regional hydroplant is expected to come within the next 4–5 years. The foundation is searching for clean, renewable energy sources in the meantime and has targeted solar as one potential option.
It is also working to help rebuild relations between the two villages, which will hopefully prevent power cuts from the hydroplant to the factory.
Lastly, one of the most difficult challenges the factory faces is finding someone who can provide regular supervision within the village to ensure things run smoothly. It has placed advertisements for the position on multiple job boards but has yet to receive a suitable candidate.
If this project succeeds, Yogi said the government would guarantee the factory’s products would reach around 5,200 students at 27 schools within Jumla. It would also be replicable in other districts affected by malnutrition.
“To have a healthy society, it is important for the citizens to be healthy,” he said. “Only when a child is healthy can we expect the citizens are healthy enough. For example, when you are building a home, the base has to be really strong, so the house stands tall. It’s the same for the country — that the individuals have to be strong to have a stronger community. It is important that this process starts with children.”