A Nourishing Start

After a successful pilot project, Holt and SPOON Foundation secure a four-year grant to implement a nutrition and feeding program for orphaned and abandoned children in five more countries — starting this year in China and Vietnam.

It’s lunchtime at an orphanage in southern Vietnam. Children eat their meals in separate rooms— grouped together by age and degree of special need — and caregivers help feed the youngest and most disabled children. In one room, a caregiver is feeding a boy on a stretcher. He is about 8 years old and has severe spastic cerebral palsy. Many of the other children in this room have cognitive or behavioral delays, and you can hear them screaming or clapping in the background. Some are waiting their turn to be fed. One sits on the floor, feeding herself.

The caregiver is a young woman who wears her hair in a neat bun and little pearls in her ears. She smiles as she spoons congee into the mouth of the boy with CP, who is laying flat on his back with a towel spread across his chest and his arms up around his head. Congee is a watery rice soup common in Vietnam and other parts of East and SE Asia, but it’s especially difficult for a child with CP to swallow. The boy keeps shaking and coughing — sometimes gagging — after each spoonful. Unsure what to do, the caregiver continues feeding him — rubbing his chest as he coughs. Thinking he might have an easier time if flatter on his back, she lowers the stretcher. This only makes it harder for him to swallow, and he shakes as he tries not to choke on his food.

Two years ago, Holt teamed up with SPOON Foundation, a Portland, Oregon nonprofit and truly the first organization worldwide to take a special focus on improving nutrition and feeding for orphaned, fostered and adopted children. After identifying two pilot sites among Holt’s partner organizations overseas, SPOON implemented a 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, SPOON also suggested small changes that could dramatically reduce malnutrition and improve the overall health and wellbeing of the children.

After implementing the nutrition program in India, anemia prevalence dropped dramatically among children in care.

In India, these changes included introducing cow milk to infants at 6 months instead of 3-4 months; delaying the introduction of cereal to infants to when they are 4-6 months instead of 2-3 months; providing iron supplements with Vitamin C to increase absorption and adjusting the dosage depending on whether the child is anemic; and giving iron at mealtimes but not with milk, which lowers absorption. Although some nutritional measurements such as stunting and head size will take longer to show impact, one outcome was immediate. Just six months after SPOON implemented these changes, anemia prevalence among the children dropped from 45 percent… to nine. At one site, anemia was completely eliminated.

“Anemia is the big issue children face in orphanage care,” says Dan Lauer, Holt’s VP of Africa programs. Dan helped forge Holt’s partnership with SPOON. “If 75 percent of children are anemic, we have a real issue.”

Most commonly caused by a deficiency of iron, anemia can have very severe consequences for a growing child. As Zeina Makhoul, SPOON’s nutrition scientist, explains, “Iron is a very important mineral for brain development. For a child between 0 and 5-years-old — especially between 0 and 2 — this is when their brain is developing at an accelerated rate.  So having a deficiency in iron at that time is really going to impact their brain development.” Long-term studies of anemic children have shown that they have lower IQs and perform more poorly in school. Iron is also very important in disease prevention and immunity. As Zeina explains, “Those who are iron-deficient tend to get sick more easily and for longer periods of time and then those who are sick have poor appetite, and poor appetite means not enough nutrients. Not enough nutrients mean iron- and other deficiencies. It’s an ongoing cycle.” Continue reading “A Nourishing Start”

Food for Thought

Nutrition scientist for SPOON Foundation, Zeina Makhoul, spent a week training staff in Haiti’s Fontana Village to recognize and treat causes of malnutrition, which is often a deeper and more complicated problem than just making sure a child has enough to eat.

by Billie Loewen, Staff Writer

Nutrition scientist for SPOON Foundation, Zeina Makhoul, trained nurses and staff at Holt’s Fontana Village to recognize and treat issues related to malnutrition in children.

Late June was a time of celebration at the Holt Fontana Village childcare center in Haiti. Everywhere, children prepared for the festivities of kindergarten graduation — which they traditionally celebrate in a big way —  and the International Day of the Child. Boys and girls practiced dances and presentations, dressed in white and tan linen suits and skirts. Some children received haircuts, and many greeted the few American visitors with hugs and games. One of those visitors, Zeina Makhoul, is well known by the children at the village, since she had visited less than a year before.

Children after receiving their kindergarten graduation certificates.

Zeina is the nutrition scientist for SPOON Foundation, a Portland, Ore., based nonprofit that began in 2007 and now works internationally and domestically to improve the way orphaned, fostered and adopted children are nourished. As a partner of Holt, SPOON works to design and implement a wide range of sustainable and affordable nutrition programs to optimize the health and well-being of children in care overseas.

Continue reading “Food for Thought”

One Child at a Time; Holt and SPOON Partner to Improve Nutrition

Jennifer Goette, Holt’s director of strategic initiatives, is currently visiting Holt’s partner programs in India with Zeina Makhoul of the SPOON Foundation. Here, Zeina and Jennifer are working to develop a pilot nutrition screening program for orphaned and vulnerable children. Once complete, the nutrition screening will be implemented throughout Holt’s country programs — ensuring all children in care receive the vital nutrition they need to grow and thrive!

by Jennifer Goette, Holt Director of Strategic Initiatives

Jennifer with children in the kitchen at VCT.

There is a story of an elderly man and a little boy who discover a beach littered with thousands of starfish.  The starfish go on and on as far as the eye can see.  Knowing that these little creatures will surely die in the hot sun while the tide is going out, the little boy picks up one of the starfish and throws it into the sea.  He does this a few times before the old man says, “Son, you will not be able to save them all!  Why are you wasting your time?” As he tosses another starfish into the sea, the boy replies, “But father, it made a difference to that one!” He picks up another.  “And that one!”  And he reaches for another.  “Also that one!”  As the boy continues to throw starfish into the sea, the old man understands.  Soon he joins in and one by one, they both throw starfish into the sea.

This story comes to mind when looking at the complex issue of malnutrition in India.  In a country where a staggering 47% of children in the general population are malnourished, it is horrifying to think about the number of orphaned and abandoned children who are failing to receive the nutrients they need for healthy development.  But much like the story, while the numbers are overwhelming, our actions do matter to the children we are able to reach.  We are able to make a difference for those children who come, one by one, into our care.

At Vathsalya Charitable Trust (VCT) in Bangalore, one of Holt’s long-time partners in India, the staff estimates that 85 to 90 percent of children entering their care show signs of malnutrition.  To help address this issue, Holt recently began partnering with the SPOON Foundation, a Portland, Oregon-based non-profit agency that strives to improve nutrition for orphaned, fostered and adopted children. With training and technical support from SPOON, Holt and our staff and partners around the world are hoping to change the picture for children who get off to a difficult start in life. Holt and SPOON have designed a bold new initiative to identify malnutrition in children and create positive changes in our pediatric nutrition and feeding practices. Three of Holt’s partner organizations will take part in the first phase of the project, including two in India and one in Haiti.

Zeina Makhoul, SPOON’s nutrition assessment specialist, and I are here in India this week to visit and learn from the two local organizations participating in this pilot nutrition screening program. Zeina and I have spent the last few days with the staff at VCT to learn more about their current nutrition and feeding practices, as well as clinical support for children in their care. Expert in child care and child welfare programming, VCT’s staff already possesses a strong understanding of the critical role nutrition and feeding play in the lives of the children in their care. With insight and training from Zeina, our goal is to give the staff an even wider range of resources and empower them to identify and treat different forms of malnutrition, including vitamin and mineral deficiencies. Continue reading “One Child at a Time; Holt and SPOON Partner to Improve Nutrition”

SPOON Foundation Visits Holt Partners and Children in India

Zeina with a 3-month-old girl in care.

For growing children, we all know that good nutrition is vital. But nutritional deficiencies aren’t always readily apparent. Last year, Holt began partnering with the SPOON Foundation to develop a nutrition screening system that will ensure children in our programs are receiving the nutrients they need for healthy development. Holt and SPOON chose two pilot sites — the Holt Fontana Village in Haiti, and Holt’s partner organizations in India.

In September 2012, SPOON’s nutrition assessment specialist, Zeina Makhoul, visited the Village in Haiti to learn about their nutrition and feeding practices. She now joins Jennifer Goette, Holt’s director of strategic initiatives, on a trip to India. Holt’s collaboration with SPOON is part of our effort to increase technical support and services to our partners around the world.

Click here to read Zeina’s blog from India!

Zeina also kept a blog during her time in Haiti. Click here to read it.

To learn more about Holt’s work in India, click here.

Two Exciting Weeks for Holt in Haiti!

Sarah Halfman, Holt’s director of programs for Africa and Haiti, is currently in Haiti leading the first group of Vision Trip participants. But before meeting up with the group, Sarah spent a week at the Holt Fontana Village with Zeina Makhoul of the SPOON Foundation. Here at the Village, the care center Holt supports in Haiti, Zeina and Sarah completed the first assessment for a pilot nutrition screening program. Once complete, the nutrition screening will be implemented throughout our country programs — ensuring all children in Holt’s care receive the nutrition they need to grow and thrive!

by Sarah Halfman, Holt Director of Programs for Africa and Haiti

Sarah with children at the Holt Fontana Village, photo credit Zeina Makhoul.
Sept.8, 2012 — It’s an exciting two weeks here in Haiti!

Last week, Holt and the SPOON Foundation completed our first assessment together at the Holt Fontana Village! We have teamed up with the SPOON Foundation to pilot a nutrition screening and training program for orphaned, abandoned and vulnerable children in our care. This program aims to deepen our knowledge in pediatric nutrition and feeding – SPOON’s specialties!! – and enhance our capacity to develop our very own experts in growth tracking, nutrition screening, feeding practices and training for staff. Together, we are working to ensure that the children in our care receive the best nutrition possible to allow them to grow and thrive!

At the beginning of last week, SPOON’s nutrition assessment specialist, Zeina Makhoul, joined me at the Holt Fontana Village to conduct the first of three assessments for this new initiative. She learned about Holt’s program in Haiti and more specifically about our nutrition and feeding practices at the Village.

I won’t lie, I felt like I was showing off a bit! Our staff at Holt Fontana run a very atypical care center by international standards. Started by Peter and Shay Fontana, founders of the Hope for Haiti Foundation, the Holt Fontana Village was designed to mimic family-like care. All of the children live in little cottages with no more than eight children per house.  Siblings live together and children in the cottages eat together family style.  There is no large dining hall for the children.  On average, each cottage has two housemothers to care for the children, and they stay with them all hours of the day. They wash their dishes, clean their clothes, put them down for naps, play with them and most of all provide a loving atmosphere.  It never ceases to amaze me! These children all know that they are loved… unconditionally.

Overall, I think that Zeina was impressed. Throughout the course of the week, she was able to interview our childcare and administrative staff as well as our clinical team, and she got to spend a day with the Village’s resident cooks. She even learned how to prepare a typical Haitian meal in the kitchen! I don’t know how she withstood the heat in there, but I’m glad she did because lunch was DELICIOUS!

Continue reading “Two Exciting Weeks for Holt in Haiti!”