Indonesia: A Holistic Approach
The causes of malnutrition and undernutrition are complex. While poverty does play a major role, it is not merely a lack of food that plagues these families.
Undernutrition occurs when not enough food is eaten and the child is repeatedly ill from infectious diseases with lowered resistance to infection and more likely to die from common childhood diseases such as diarrhoeal diseases and respiratory infections (UNICEF 2007). The ones who survive are likely to be caught up in a spiral of recurring sickness and slowed growth, often with irreversible damage to their mental and social development.
Well nourished women face fewer risks during pregnancy and childbirth and their children have a better start in life. Well nourished children perform better at school, grow into healthier adults and are able to give their own children a better start in life.
Children attending FMCH programmes in Jakarta are undernourished and come from impoverished families, living in basic conditions. Often their parents are unemployed or, if lucky enough to be employed, find work selling food on the streets of Jakarta or driving vans in their villages (kampungs). Families share washing and bathroom facilities with several other families in their village. Water is pumped by hand or winched up by bucket from wells in the ground: again several families sharing one pump. Water has to be boiled before being used for cooking or drinking. If the well water becomes contaminated through flooding, as happens frequently during the rainy season, families have to buy their water from local vendors. An additional expense for already stretched family resources.
Parents have often had limited education: many of them only having had schooling up to the ages of 12 years old. Recent statistics show that even though nearly 93% of children enrol in primary school education (7-12 yrs of age) only 82% of those who start in Grade 1 reach Grade 5 (Susenas 2003) and net enrolment ratio in junior high school (13-15 yrs of age) falls to just 58% (MoNE).
With these many problems facing families and their children, a multi faceted programme has been developed to try and alleviate the causes of undernutrition and poverty.
First, to address the most immediate nutritional needs, underweight children are given well-balanced meals three times each week. When severely undernourished children are brought to the Foundation an intensive daily feeding programme is set up to address their needs and occasionally hospitalization is immediately necessary.
But there are also longer-term efforts directed at eradicating the root causes of undernutrition/malnutrition.
Often mothers of underweight children simply do not know what to feed their children. Thus FMCH works with these mothers, teaching them about nutrition, hygiene and food preparation techniques.
The awareness of mothers is so important that FMCH has developed a comprehensive, self-sustaining programme to train health workers in the community at large. These key community resources will learn how to identify malnutrition in children that come to see them, and how to work effectively with mothers to combat it.
Illnesses, such as diarrhea and TB, can prevent perfectly nutritious diets from being of any benefit to a child. So doctors are available for consultation, free of charge, twice a week at FMCH premises. They also give the children monthly check-ups to monitor progress.
While poverty is not the only cause of malnutrition, it is a significant contributing factor. Thus FMCH runs skill-building activities for mothers that teach them income generating skills.
Finally, addressing their psychological and social development, children from poor families can also participate in an early childhood education programme that meets up to five times each week.
One morning a week, FMCH is open to English speaking mothers (Indonesian and expatriate) and their babies, who gather informally to talk to volunteer health professionals on topics such as breastfeeding, weaning and sleep problems New Mother Support Group.