I figure as much as quasi-experimental designs and the nerd level discussions on the amazing profession of public health appeal to a small population, more writing on the country itself and my adventures in it would appeal to that wider range (you know, that 95% of you). So for every work-ish or nerdy post I write about peanut butter I will do my best to write one about Haiti itself. Although I have only been here a week I have gotten to explore and have a few adventures already and gotten right into the groove that is working in Haiti.
Language: Haiti has two official languages; French and Creole. While French is mostly spoken in Port-au-Prince (or so I’ve been told) I have been able to speak it to most anyone here which has helped me in work as much as getting moutard from the boutique. Haitian Creole does use a number of French words, and while they may not be spelled the same (for example, every letter you write in Creole you say which makes complete sense) the pronunciation is so similar. For example; l’ecole (school in French) becomes lekol in Creole. I have been able to understand a bit of Creole and I actually think my “dirty” French helps me because I don’t always use correct grammar and can pick up on Creole words easy. Anyways, the language is really interesting and I’m excited to be learning it.
Apartment: I have a place to live! And it is not full of termites or scorpions or toads or has a mamba that hangs out back! And a working toilet…indoors! Seriously, I knew that I would have an apartment when I got here and that it was considered “really nice” but Haitian standards. However, I was not expecting how truly nice it is and it feels like a little oasis. It’s breezy and cool; I have a little kitchen area complete with fridge, oven and sink and a balcony that has quickly become my favorite spot.
Market: I was expecting something similar to our lumo days up north or the market I frequented in NDioum where everyone is calling out to you and it is crowed and overwhelming. However, the small market that is nearest my apartment is quite lovely. Yes, it can be crowded at times, but I haven’t felt rushed or overwhelmed yet. Although I have yet to figure out the real prices for things.
Driving: The roads here are currently getting a huge makeover because Carnival will be in Cap this year instead of Port au Prince. This means that there are construction crews out constantly paving, rolling, hammering away and usually during the rush hour traffic. Though it isn’t anything I’m not used to (reminds me a lot of the Ponty in Dakar) there are always surprises. Like the recent installment of four traffic lights throughout the city, one on a street with no intersections. Traffic is more polite here though and I’m not in constant fear that we will either hit a goat, a cow, a child, another car, or the person sitting next to me in the back.
Beach: The beach, the beach, the glorious beach. Just a short drive away from the city is literally paradise. Just drive up a mountain and down the other side and bam- right there is a long beach with clear blue water, a waiter that serves you the beach rum drink you will ever have and a lounge chair that you won’t want to get up from. I never knew this about Haiti- it has great beaches and some beautiful landscapes and I can’t wait to find more!
Wednesday, January 30, 2013
Tuesday, January 29, 2013
What's in a study?
Arrived in Cap-Haitien late Sunday afternoon and despite the seven hour delay I couldn't believe how incredibly beautiful my first glimpses of the country were. We flew in a small prop plane and so we were not as high up as we would have been had we been in a jet. Haiti is extremely mountainous but I was not expecting the mountains to greet me as we descended. The literally rose right out of the water and into the clouds and as we landed in Cap, flew between them. Of all my descents and flights, this is definitely in the top three for its sheer beauty.
Come Monday morning, I got right into the swing of things and visited the schools we are partnering with. These schools (six total) are throughout Cap and cover students from first grade through sixth, although a few schools also have the equivalent of kindergarten as well. Like Senegal, these schools operate with very little resources and I am always amazed at the teachers who are dedicated to work within these obstacles - many of whom have not been paid for several years. But the children love school and they love learning - it is so easy to see that on their faces and the pride they take in wearing their uniforms and caring for their textbooks. Each of the schools are very different, for many reasons; some are in the city center and are smack in the urban chaos while others are more on the outside of the city, able to enclose a larger area for the kids to play. Some have electricity (though very limited), some have separate rooms for classes while in others classes are all taught in one large space. Nonetheless, every school has been more than gracious and cooperative in letting us constantly disrupt classes in order to conduct this study.
The government of Haiti (Ministries of Health and Education), as part of their child nutrition initiative is looking to add a school snack component to schools. As several of the kids I've met do not get to eat breakfast and are maybe given enough money to buy a bonbon at school (think processed, sugar and no nutritional value) it is important that the school snack be up the upmost nutritional value while being low cost to produce and distribute. There are three groups for the study, two schools in each group. As the study is quasi-experimental, it is important that the schools get matched and paired as equally as possible so that any noticeable difference between the groups can be identified and should the study be effective, reduce bias and strengthen validity. One group is our control group where they carry on business as usual with no specific snack or snack time. Although this group is not getting one of the two snacks we are studying, I feel that these groups are the most important in getting a picture of the school lifestyle that these kids encounter as well as getting an accurate measure of the nutritional status of these kids. The second group is testing a granola bar made from peanuts, oats, sesame and honey. While it isn't fortified with any micronutrients, it does have a decent amount of nutritional value for the kids. It is currently being made in Haiti and is very affordable. The third group in the study is receiving Mamba, a fortified peanut butter and soy bean blend. It is jam-packed with micronutrients and while slightly more expensive to make, would cover a child's nutritional needs for the day. So that’s a basic overview of setting up the study and the different between the three groups.
So the study is currently in it's implementation phase. This means that all of the children have gone through baseline measurements; their height, weight and hemoglobin have been recorded before the start of the study. This gives us a base from which to compare our mid-line (to be conducted in March) and end-line (to be conducted in June) data with, highlighting any changes in growth and iron content. While we are taking anthropometry measurements (height and weight), changes to these are harder to contribute to our study as kids naturally grow over time and it is affected by lots of outside forces (ie, genetics). However, where we hope to make the biggest impact and record the biggest change is in iron content in the body. Iron is just one of several micronutrients that significantly impacts anemia rates. Improving micronutrient status like iron is important for fighting infections, addressing diarrhea and improving cognitive development. Should the Mamba product we are studying be significant in improving rates of anemia, there is potential further impact child nutrition throughout a child’s life. During implementation, the children in the granola bar and mamba groups receive their snack everyday during the school week that they are present. So if there are present everyday, they receive the snack five times a week. The control group does not receive any snack but as I said before, it is common that the children are given a little money (usually about one Haitian dollar) to buy something.
What I'm doing now is visiting the various schools during snack time and in the morning to help with and observe snack distributions. Are the kids eating the snack? Do they like it? Do they eat something afterwards? How do the teachers think the snack impacts the children? Do the teachers like the snack? These are all qualitative questions that I ask that will give me a deeper understanding of the snacks' impacts beyond just what the data says. I’m also assisting in getting all of the baseline data entered and organized so that we can conduct a descriptive report of the kids as a preview of things to come.
It has been a busy first week in Haiti, but a great one. The schools have been so much fun to visit and learn about and I have gained a wealth of insight from the teachers, our enumerators (who distribute the snacks) and the kids themselves and look forward to work every day as I know it brings something new for me to learn and experience. Stay tuned for more!
Peace,
Jaime
Also- if you are more interested in learning about fortified peanut butter projects in Haiti, check out a few old stories on NPR
Come Monday morning, I got right into the swing of things and visited the schools we are partnering with. These schools (six total) are throughout Cap and cover students from first grade through sixth, although a few schools also have the equivalent of kindergarten as well. Like Senegal, these schools operate with very little resources and I am always amazed at the teachers who are dedicated to work within these obstacles - many of whom have not been paid for several years. But the children love school and they love learning - it is so easy to see that on their faces and the pride they take in wearing their uniforms and caring for their textbooks. Each of the schools are very different, for many reasons; some are in the city center and are smack in the urban chaos while others are more on the outside of the city, able to enclose a larger area for the kids to play. Some have electricity (though very limited), some have separate rooms for classes while in others classes are all taught in one large space. Nonetheless, every school has been more than gracious and cooperative in letting us constantly disrupt classes in order to conduct this study.
The government of Haiti (Ministries of Health and Education), as part of their child nutrition initiative is looking to add a school snack component to schools. As several of the kids I've met do not get to eat breakfast and are maybe given enough money to buy a bonbon at school (think processed, sugar and no nutritional value) it is important that the school snack be up the upmost nutritional value while being low cost to produce and distribute. There are three groups for the study, two schools in each group. As the study is quasi-experimental, it is important that the schools get matched and paired as equally as possible so that any noticeable difference between the groups can be identified and should the study be effective, reduce bias and strengthen validity. One group is our control group where they carry on business as usual with no specific snack or snack time. Although this group is not getting one of the two snacks we are studying, I feel that these groups are the most important in getting a picture of the school lifestyle that these kids encounter as well as getting an accurate measure of the nutritional status of these kids. The second group is testing a granola bar made from peanuts, oats, sesame and honey. While it isn't fortified with any micronutrients, it does have a decent amount of nutritional value for the kids. It is currently being made in Haiti and is very affordable. The third group in the study is receiving Mamba, a fortified peanut butter and soy bean blend. It is jam-packed with micronutrients and while slightly more expensive to make, would cover a child's nutritional needs for the day. So that’s a basic overview of setting up the study and the different between the three groups.
So the study is currently in it's implementation phase. This means that all of the children have gone through baseline measurements; their height, weight and hemoglobin have been recorded before the start of the study. This gives us a base from which to compare our mid-line (to be conducted in March) and end-line (to be conducted in June) data with, highlighting any changes in growth and iron content. While we are taking anthropometry measurements (height and weight), changes to these are harder to contribute to our study as kids naturally grow over time and it is affected by lots of outside forces (ie, genetics). However, where we hope to make the biggest impact and record the biggest change is in iron content in the body. Iron is just one of several micronutrients that significantly impacts anemia rates. Improving micronutrient status like iron is important for fighting infections, addressing diarrhea and improving cognitive development. Should the Mamba product we are studying be significant in improving rates of anemia, there is potential further impact child nutrition throughout a child’s life. During implementation, the children in the granola bar and mamba groups receive their snack everyday during the school week that they are present. So if there are present everyday, they receive the snack five times a week. The control group does not receive any snack but as I said before, it is common that the children are given a little money (usually about one Haitian dollar) to buy something.
What I'm doing now is visiting the various schools during snack time and in the morning to help with and observe snack distributions. Are the kids eating the snack? Do they like it? Do they eat something afterwards? How do the teachers think the snack impacts the children? Do the teachers like the snack? These are all qualitative questions that I ask that will give me a deeper understanding of the snacks' impacts beyond just what the data says. I’m also assisting in getting all of the baseline data entered and organized so that we can conduct a descriptive report of the kids as a preview of things to come.
It has been a busy first week in Haiti, but a great one. The schools have been so much fun to visit and learn about and I have gained a wealth of insight from the teachers, our enumerators (who distribute the snacks) and the kids themselves and look forward to work every day as I know it brings something new for me to learn and experience. Stay tuned for more!
Peace,
Jaime
Also- if you are more interested in learning about fortified peanut butter projects in Haiti, check out a few old stories on NPR
Sunday, January 20, 2013
Peanut Butter Haiti Time!
The blog is back! Although, no longer a Peace Corps blog, I figured I would keep up to date on the latest gypsy adventure, Haiti. With any luck, this will be updated much more regularly and contain progress and highlights of my work and not the ramblings of a country girl suffering from constant heat rash and heat happies. With any luck, but no guarantees.
First off, I should explain what I am doing in Haiti. One of my dear professors at Wash U is a leading expert in undernutrition and has done work in Haiti and Kenya for several years. She’s currently heading several research projects in Haiti around fortified peanut butter (Nutributter, PlumpyNut are some of the more recognized names of this type of food). This pb has been shown to be effective in combating child malnutrition among young children under 24 months. The project that I will be working on is an expansion of sorts to school age children to see if similar fortified pb can impact growth and diet diversity (aka improve nutritional status).
So I am part of the Wash U branch of this project (research, data collection, analysis) which is just one branch of the project tree. Meds and Foods for Kids, a ngo based in St. Louis, acts as the organizers of the project (coordinating with other partners, managing project staff, distributes the pb). This is who I will mostly be working with, though I’ll also be working with the other partners from time to time. Edesia is a company that developed and designed the package design of the pb (aka branding the pb). The National Soybean Research Lab was responsible for early acceptability of the project. The Ministry of Education in implementing the school feeding programs which feeds into the the Ministry of Health’s role in implementing national scale nutrition initiatives. So, needless to say, there are a lot of players involved.
Like I said before, my roles is primarily research and working in the implementation of the program (assisting in trainings, data collection, analysis and reporting). We are working with six different schools across Cap-Haitien…
…allow me to take a slight tangent…
I won’t be living or working in Port-au-Prince, the capital of Haiti but a slightly smaller city in the north called Cap-Haitien. It’s located right on the coast and I’m told has lovely beaches for what it’s worth. Google earth actually has a number of great photos of the city should you be of the satellite stalking kind.
…back on track. So we are working with six different elementary schools, three of which will act as the control group (not get the pb) and three will be the experimental (get the pb). Not all kids at the schools are enrolled in the program but we hope to maintain our 1200 participants (aka kids). Kids getting pb will get it every day for several months. Each kid is measured three times (before the project, midway and at the end).
So that’s the project and the reason I’m in Haiti in a nutshell- more to come as I get in country and started with my work!
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