MANILA, August 26
, 2004  (STAR) By Cynthia Evidente - Each weekday at 4 p.m., within the small confines of a modest multi-purpose hall in Barangay Calumpang in Molo, Iloilo City, community leaders and health workers unite in a common task: feeding the malnourished among the youngest of the village children.

At the makeshift day care center whose fixtures include a small wooden table and monobloc chairs, mothers and their toddlers barely six years old and younger partake of a measured serving of what, at first glance, appears to be regular ginataan or champurado.

Health officials tell a different story, however. Nutrimix, a special high-caloric, high-protein formulation consisting of ground rice, ground mongo, skimmed milk and sesame oil, has found its way into the recipe.

Such is designed to supplement the feeding of 32 children diagnosed as severely to moderately malnourished during the "Operation Timbang" conducted last March by the Iloilo City health officials.

Initiated last May, the minimum six-month feeding program for Calumpang dovetails the initial success achieved in nearby Barangay Benedicto in Jaro I where at least two third-degree malnourished children weighing less than 60 percent of their normal body weight showed improvements to second degree (or 61-75 percent of normal body weight).

This was achieved after daily center-based feeding since December 2003 by the barangay nutrition scholars and barangay health workers, using the Nutrimix formula processed by the city health office from the raw ingredients donated by Globe Telecom.

While the ideal scenario is total rehabilitation within six to 18 months depending on the gravity of the nutritional deprivation, it can only be achieved through consistent implementation of feeding programs supported by genuine assistance from the private sector, non-government organizations (NGOs) or foreign groups.

Indeed, in partnership with Globe Telecom, given its corporate desire to help alleviate the immediate health concern, local officials and health workers are keen on reducing, if not eliminating, the pattern of severe malnutrition, primarily Protein Energy Malnutrition (PEM), through their intervention program catering to the most vulnerable segment of the community.

In Search Of Solutions

The dilemma on how to approach the health concerns of Iloilo, particularly the proper nourishment of its young population, is a pressing concern today.

Dr. Urmanico Baronda, city health officer, states his case. Even as Iloilo City, with its 180 barangays, has always battled with the need to protect the welfare of its people, health issues remain low in the order of national priorities in favor of high-impact infrastructure projects. That is, health is not a concern after elections.

And yet the Philippines, just like other developing nations, is vulnerable to malnutrition, primarily PEM caused by insufficient dietary carbohydrates and protein, as well as micronutrient malnutrition or the lack of Vitamin A, iron and iodine.

This is brought about by poverty and the resulting lack of buying power for food, aggravated by the lack of nutritional awareness and attitudinal issues among parents, particularly in the rural populace.

Confronted with the reality of tight government resources, local efforts to involve foreign and local program sponsors have to date led to intermittent food development assistance packages with no lasting effects on the local beneficiaries.

"Feeding programs should be continuous. Di yung pababayaan mo yung second degree then at the end of the day yung second degree naging third degree, yung binigyan ng attention na third degree naging second degree. In totality, walang nangyari. We are looking for a long-term partner," Baronda says.

He adds that efforts to help alleviate malnutrition in the needy barangays of Iloilo City, if genuine, should be sustained using a program design (e.g. home- or center-based; milk or Nutrimix feeding, among others) that best fits the needs and wants of the intended beneficiaries.

Feeding programs are nothing new to the locality. Way back in the 1980s, Baronda says CARE (Cooperative for American Relief Everywhere) Phils. gave out burger wheat, green peas and corn soya milk for at least five years.

However, the successful implementation was only achieved via controlled center-based feeding with children reared to eat rice as a staple, directly monitored as they ate foodstuff foreign to their daily diet.

Since then, other feeding programs have been implemented with the hopes of finding relief for the need to nurture the health of the people. Through the years, however, what has emerged is a picture of sporadic moves that have yet to break the cycle of malnutrition.

Indeed, Iloilo officials are in search of a sustainable, effective and total program that directly benefits the malnourished children (and in some cases, parents as well), and addresses the deeper issue of parental skills and attitudes – perhaps via nutrition seminars and livelihood programs – in the fight for the healthy well-being of their people.

Globe-Iloilo Feeding Program Partnership

"When Globe Telecom approached us last November saying they wanted to help out in the community, we suggested that they help us in a manner that is tangible and cost-effective. Hindi yung bukas wala na," Baronda recalls.

From this stemmed Globe’s partnership in the Iloilo feeding program as part of the company’s corporate social responsibility initiatives. The objective: respond to an immediate community concern. In this case, fight malnutrition primarily among the pre-schoolers of Iloilo City.

The task on hand for Globe and city officials was to work together in the goal to eliminate, if not reduce, cases of third degree or severe malnutrition.

Thus, in December 2003, Globe Telecom, in consultation with the local health officials, lent a hand to the Iloilo feeding program with the provision of the raw materials that go into the Nutrimix formula: rice, skimmed milk, mongo and sesame seed oil.

Jean Garganera, nutrition-dietician 3 at the Iloilo City health office, explains that these raw materials are processed into Nutrimix – a high-caloric, high-protein mixture that can either be boiled and consumed as is – to meet the children’s dietary requirement for carbohydrates and protein. Nutrimix can also be added into everyday fare like ginataan, champurado, arroz caldo, pulvoron and maja blanca, as a dietary supplement.

"Since our malnutrition cases here are mostly PEM (lack of carbohydrates and protein), Nutrimix best combats this because it is high-caloric, high-protein. High-caloric because of the rice, high-protein because of the mongo. It is simple because the raw materials are indigenous," she says.

And to ensure stakeholdership across all levels, the raw materials donated by Globe were processed at the nutrition center of the city health office. In terms of actual implementation, parents were asked to bring their children at a designated time to the community feeding center.

First in the pipeline was the Globe-Iloilo feeding program in Barangay Benedicto in Jaro I whose success resulted in the lowest 0.2 percent prevalence rate of third degree malnutrition in the city.

Dr. Teresita Chiu, officer-in-charge of the Jaro district nutrition office, says that last December, Barangay Benedicto was allotted 1,557 packs of Nutrimix by the city health office for a center-based feeding program. At the time, the recently concluded Operation Timbang had identified 16 second and third degree malnourished children for treatment.

One of them was Margie Edenburgo who, at four years and 10 months, weighed a mere 10.7 kilograms versus the ideal 12.7 to 20.9 kgs. Severely malnourished, Margie is the eldest of three children of laborer Marvin Edenburgo, 34, and his wife, Virgie, 29, who are both mere high school graduates.

Also a third degree malnourished child, 14-month-old Mylene Demisana weighed a mere 5.5 kgs. versus the normal weight of nine to 13 kgs. She is the youngest of nine children of laborer Orlando Demisana, 41, an elementary graduate, and his wife, Myrna, 40, who only reached third year high school.

With consistent feeding and cooperation among the local workers and their mothers, both Margie and Mylene have been taken out of the list of severely malnourished kids and are counted as among the small, yet significant success stories of the program.

Currently ongoing is the feeding program in Barangay Calumpang which has 32 beneficiaries – 12 of them third degree and 20 second degree malnourished (based on the results of the Operation Timbang last March). Chiu notes that children in Calumpang, being a coastal village, is more prone to malnutrition.

Accordingly, using the Operation Timbang results, the health office is able to determine where and how much to give of the Nutrimix formula based on the distribution of second and third degree malnourished cases in the city, Garganera says.

"For Calumpang (with 32 beneficiaries), hindi lang feeding programs ang gagawin namin. We have to teach the mothers. We will have an organization that will conduct classes for the parents of the malnourished children," she adds.

This comprehensive thinking stems from their experience and observation through the years that parents, particularly mothers, play a critical role in their children’s nourishment.

While it is true that poverty may be an underlying key factor in the undernourishment and consequently, malnourishment of children, the indifference and lack of nutritional sense of mothers play an equally pivotal role in the health of their children.

"Kumakain sila but not the right food and the right quantity," says Baronda, citing cases of mothers who, out of negligence or lack of knowledge of nutrition, opt to feed their children street food or junk food instead of cooking highly nutritious fare using readily available food sources like mongo, squash or malunggay.

Ironically, parents themselves can prove to be the obstacles with their unwillingness to bring their children to the feeding center on scheduled days. Again, Baronda’s frustrated assessment: "Mahirap pilitin ang ayaw."

Yet going one step further, he says that in the concerted fight against malnutrition, it is not only the mothers who should be involved. Fathers have to share the burden, too. "If only mothers are involved, then you are only hitting one-half of the problem," he says.

Overall, however, they remain optimistic about the prospects of inculcating the right values for both parents to sensibly nourish their children given the resources on hand.

Working Through Linkages

Assessing the initial success profile of the Globe-Iloilo feeding program, Globe public relations head Jones Campos says, "The reception afforded to us by the community is inspiring. Our community relations projects are our way of getting closer to them. We hope to be able to sustain our programs so that in our own little way, we shall have made a difference in their lives. We will see to it that they are taken care of and our support is sustained."

This, as Globe seeks to reach out through linkages and partnerships with local community leaders, cause-oriented NGOs and other private entities who share a common vision to extend a hand to communities in need.

Reported by: Sol Jose Vanzi

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