Orphan Nutrition Update

Holt’s Child Nutrition Program team travels to India, where the program’s impact on the health and wellbeing of children — as well as the reach and ripple effects of the trainings — continue to grow.

BSSK NutritionChahel* would not have survived. Born premature with a serious heart condition, he came into care shortly after birth at a rural branch site of our legacy partner, Bharatiya Samaj Seva Kendra (BSSK), outside the central India city of Pune. Transferred to Pune for better care, Chahel needed constant hemoglobin testing and regular blood transfusions. Fortunately, Holt had recently equipped the staff at BSSK with a Hemocue machine and training to measure hemoglobin for iron-deficiency anemia. Chahel received the medical interventions he needed and today, he is able to stand with support and recently took his first few steps. BSSK is now seeking a loving family for him.

Sabal* and Ibha* were frail and seriously underweight when they came into care. At 15 months, Sabal weighed just 18 pounds, while Ibha at nearly 2 months weighed under 5 pounds. This brother and sister were always tired and struggled to adjust to life in care at BSSK. Well fed at BSSK and fully treated for their health conditions — Ibha was living with HIV, and Sabal wore an eye patch over his infected left eye — their continued failure to thrive puzzled the caregivers and staff. When staff from Holt and our partner SPOON Foundation visited BSSK in February 2015, they helped to correct nutritional deficiencies in Ibha and Sabal. With adjustments to their diet, today they are full of joy and life and the staff feel confident they can find a loving adoptive family for them.

Sabal, Ibha and Chahel are just a few of the children who are benefiting from Holt’s child nutrition initiative since we began implementing it in partnership with SPOON Foundation a little over two years ago. In this short time, the  child nutrition program** has had a tremendous impact on the health and lives of hundreds of children at pilot program sites in India, China and Vietnam. With plans to expand to more countries in the coming years, the child nutrition program will ultimately impact thousands — thousands of children whose low energy and poor health were previously a mystery to their caregivers. Children whose nutritional deficiencies undermined their ability to reach developmental markers, to grow and learn with the same vigor as other children, to thrive in care and one day, a family.

“We have seen a growth spurt not expected,” says Vineetha Austin, a long-time administrator at another of Holt’s legacy partners in India — Vathsalya Charitable Trust (VCT). “The children with anemia have really improved.”

In 2013, Holt chose VCT and BSSK as the two partner pilot sites in India for the child nutrition program. Together with nutrition experts from SPOON Foundation, Holt has since fully implemented a comprehensive nutrition screening system and trained caregivers and staff to properly track the growth and nutrition of children in care. Looking at the diet and feeding practices at each care center, small changes were suggested that could help dramatically reduce malnutrition and improve the overall health and wellbeing of the children.

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The staff at BSSK train the branch staff in Sangli in how to take measurements as part of the child nutrition program curriculum.

Already, our partners have noticed significant physical changes in the children — and measurements for key nutrition indicators reinforce what the staff can plainly see.

When the first measurements for the child nutrition program initiative were taken, 77 percent of the children at BSSK were below normal height for their age; this is known as stunting and indicates chronic malnutrition. Eighteen months later, that number has dropped to 45 percent. During initial assessments, it was found that 77 percent of the children were also underweight. Eighteen months later, the figure is at 18 percent. And perhaps most dramatically, the prevalence of iron-deficiency anemia among the children has over the past year dropped from 40 percent… to zero.

While the child nutrition program provided the training, the dedication of BSSK staff to implement suggested dietary and feeding changes was the key to success, says Holt’s child nutrition program program manager, Rose McBride.

“By embracing key learnings on nutrition screening and growth monitoring, as well as incorporating SPOON’s suggested modifications for feeding children with special needs, BSSK has helped us achieve the results we hoped for,” Rose explains. “BSSK has always provided excellent and loving care for every child, and Holt’s orphan nutrition program supports them in their day-to-day efforts.”

BSSK Training
Lead BSSK trainer prepares for her first training with branch staff.

Three months ago, Rose traveled to India with child nutrition program project coordinator Aloura DiGiallanardo as well as SPOON’s nutrition scientist and occupational therapist.

In Pune, Rose and Aloura immersed themselves in the SPOON-facilitated trainings alongside BSSK social workers and nurses. They observed as BSSK’s nutritionist, nurses and social workers evaluated children in care — taking weights and measurements and updating growth charts. They also observed as BSSK staff conducted their first training session at a rural branch site in Sangli — sharing the knowledge they attained from previous child nutrition program trainings, and scaling up the program to reach even more children. BSSK trainers will scale the child nutrition program out to three branch sites by end of summer.

“Seeing our partners embrace child nutrition program concepts and fully utilize all they learned during trainings in their daily care of the children is gratifying,” says Rose. “It also confirms a result we hoped for from the beginning.”

Beyond Orphans

Seeing the extraordinary impact of Holt’s child nutrition program on children in their care centers, both VCT and BSSK have felt inspired to adapt the program concepts to help children living within fragile family situations in their communities. Especially at VCT, where recent changes in adoption laws have compelled the staff to adjust their primary focus away from direct care and adoption to providing highly needed services for children and families in the community.

Just last year, VCT identified a particular need among children of migrant families who have moved to Bangalore seeking construction work. As most of the families live directly on construction sites, children are often left alone — out of school and in dangerous conditions — while their parents work all day. VCT saw a need for a day care program to give the children a safe place to go during the day.

VCT Daycare
Children in the migrant daycare at VCT have shown an unexpected growth spurt since the implementation of the child nutrition program.

At VCT, between 60 and 70 children are now receiving nourishing meals and two healthy snacks each day. School-age children are being brought up to speed through regular mentoring in grade-appropriate subjects. Although the school is informal, it is sometimes the first education children have received. For other children, the daycare staff are diligently working to bring them up at their grade level so they can enter a formal school. They are also learning basic self-care skills. “We teach them hygiene, give them baths and cut their nails, if needed,” says Vineetha.

Once a month, VCT staff also provide special training sessions for the children’s parents — many of whom are illiterate or have minimal education. Here, they have an opportunity to directly speak to parents on the importance of education and equip them with positive parenting skills. Reinforcing the importance of good nutrition is key to these sessions — and the nutrition curriculum essential to their understanding of nutrition.

Schoolgirls VCT India
Girls sit outside at Colonel Hill High School, where sponsors support the education of 150 girls and VCT recently provided nutrition training for their parents.

“The staff at VCT were eager to show us how they are using child nutrition program concepts to screen and monitor the health of children in daycare and to show the true living situations of the children at the construction sites,” says Rose. “Since they’ve changed their services, they’ve spent significant time thinking about how to utilize the child nutrition program curriculum to its maximum to help children in the community.”

The children in daycare are among those who have experienced unexpected growth spurts and, in some cases, overcome serious malnutrition and anemia.

Going beyond the migrant daycare, VCT is also adapting the child nutrition program curriculum concepts for other families they serve in and around Bangalore. During the child nutrition program team trip, VCT invited their Holt and SPOON guests to attend a training on anemia, food allergies and intolerances at a local high school. The training is part of an ongoing series of trainings for primarily Muslim families whose daughters are attending the high school under education sponsorship. Holt sponsors support 150 girls attending this particular high school.

CH School Training
Anitha, a teacher in the daycare program at VCT, provides nutrition training for the parents at Colonel High School.

On another day, Holt and SPOON staff observed as VCT trainers lead a lively lecture and discussion on anemia, growth, diarrhea and fever to a room packed full with mothers and their older children in a rural village just outside of Bangalore. “There’s a lot of malnutrition in the villages — both from lack of food and the wrong foods,” explains Joyce Ranjan, VCT’s educational coordinator. “The have the same dishes every day. It’s not balanced, and many of the children are anemic.” Once a month, VCT staff visit the community health center, which serves as the hub for 21 villages of roughly 25,000 people. Here, they train local doctors and government “asha” workers in everything from parenting skills to child protection to nutrition. The asha workers then work directly with families in the community. Asha, aptly, means hope.

“You could tell they were absorbing and appreciating the information they received,” Aloura says. After both the village and school trainings, many of the parents approached the VCT trainers with specific questions about everything from anemia to breast-feeding.

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Parents in a rural village outside Bangalore listen to a presentation on anemia, growth and other nutrition-related topics.

“This is really interesting because it’s outside the scope of the child nutrition program, which is designed for orphans and other children in institutional care,” Aloura says. “We’re trying to figure out how to support these initiatives because it’s so needed. It really shows the potential reach and ripple effects that the child nutrition program could have.”

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Girls at a local village school outside Bangalore, where VCT held a training on nutrition.

At BSSK in Pune, lack of proper and adequate nutrition is also a major concern among the children BSSK serves in the community as well. “Nutrition is still one of the biggest problems in the city because there’s not enough awareness among families,” explains Smita Mande, BSSK’s resident clinical psychologist. “Families will still give tea or coffee to children instead of milk.” In the slum communities where BSSK works to strengthen and educate families and children, they too have independently adapted the child nutrition program curriculum and begun tracking the growth of the children who receive their services — another ripple effect of the child nutrition program, and an opportunity to scale up the program to reach as many children as possible.

“Already, this program has rippled out far more than anticipated,” says Aloura, who is traveling to China next month to assist with follow-up evaluations of nutrition and growth screenings implemented last November at two orphanage partner sites. “It’s a robust amount of information and tools that empowers care workers and parents and even children themselves if they’re old enough. It’s exciting to watch.” During the China trip, SPOON’s feeding specialist will also provide a week of training centered on feeding support for children with special needs at each location.

Holt’s plan is to fully implement the child nutrition program in China and Vietnam by Spring 2016 and to scale up the child nutrition program to other areas in India in 2016. We are also working to identify where next to take the child nutrition program among the countries where Holt works.

 Robin Munro | Managing Editor

* names changed

** Created by SPOON Foundation for Holt International.

 To read more about Holt International’s Child Nutrition Program, click here.

 If you are interested in supporting the child nutrition program, contact Rose McBride at rosem@holtinternational.org or give a nutrition item from Holt’s Gifts of Hope catalog!

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