Food for Thought

FOOD! I love food. Food probably occupies somewhere in the ballpark of 70-80% of my thoughts during a given day, and friends who know me well can testify to that fact. But now that my project with CORD is on Nutrition and Food Security (hardly a coincidence), the situation has exponentially worsened. Currently, the only situations in which I’m not thinking about food are (a) when I’m futilely attempting to use the internet, (b) to quote Olivia, “when I’m destroying half the local ecosystem using DEET” to kill the rampaging mosquitoes that are, somewhat successfully, trying to eat me, or (c) when Ravi is waking me up in the middle of the night with his incessant snoring, at which point nothing else is on my mind but getting him to stop; if it weren’t for me, he’d probably wake up half of Himachal Pradesh. Maybe it’s just revenge for locking him inside the room last week, who knows. But that just gives you a tiny glimpse of my group’s silly shenanigans. On the whole, we’re pretty dysfunctional, but in the best of ways, and I like to think that our escapades are unparalleled. I’ll post another time about some of our funny moments! Stay tuned for the adventures of Maniacal Michelle, Rambunctious Ravi, and Krazy Kurt!!

I love Indian food

I love Indian food

The Nutrition and Food Security project has been a delight so far, but also a challenge. It took much longer than I had anticipated to prepare for going into the field, for instance. I always like to have background context, however unnecessary, before embarking on some kind of project or study. So I spent some time reading up on literature about nutrition as it relates to maternal and child health in South Asia, jotting down notes in my journal that I keep with me everywhere I go. This alone took two or three days, after which I had become more aware about the major health concerns in rural India, such as the estimated 40-50% stunting prevalence in children under five in Himachal Pradesh, not to mention undernourishment.

To avoid going into lengthy detail about every aspect of my project preparation, I’ll summarize by saying that, after getting the “big picture” on nutrition in South Asia and India, I came to decide that my study sample would include two main groups of women: Women who are pregnant, and women with children age 0-2 years. This is because maternal diet prior to the onset of conception and in the first 1000 days of life has been shown to have a significant impact on nutritional status of children and influences outcomes of morbidity and mortality not only during childhood, but also impacts non-communicable diseases in adulthood. Furthermore, breastfeeding practices for mothers with children 0-24 months are very important for child growth and development.

I already had the opportunity to execute my interview plans on Thursday in the field, during which I spent time with five women farmers and asked them about their diet using the “24-hour dietary recall method,” where I basically ask what they ate the previous day; what the ingredients were, what quantities, and what time of day. The challenge lies in the fact that most people won’t remember exactly what they ate yesterday and how much of it, so facilitating their memory takes practice. And getting accurate measurements of height and weight, especially for infants who cannot yet stand, was a challenge in itself. But luckily, my translator, Neena, also happens to be a practicing nurse at a nearby health center. She has been extremely helpful and insightful. Day one in the field was a good start, but it wasn’t perfect. Currently I’m refining my interview questions and today I took the bus to Dharamshala to buy an infantometer, an instrument that more accurately measures the length of infants laying down on a flat surface. Alas, since my sense of direction is on par with that of a blind squirrel (just picture that), I got lost on the way back from Dharamshala. But definitely excited for Monday, my next day in the field!

This next part might seem tangential, but it’s actually related to my project and, in a more general sense, being a student at a research institution like Penn. My supervisor at CORD, Narender, has had extensive discussions with me about research versus action. At first, I thought he flat-out despised research, whenever he would voice his skepticism on gathering data for the sake of data. When I discussed my plans for collecting quantitative data on health measures in the farmers and young children, he would say “Ok, just don’t give me any sigma’s or pi’s or anything like that. This is about improving their lives, not about statistics.” He is clearly more concerned with action than with data. Coming from Penn, where so much value is placed in research, I probed further for his thoughts, and he expressed that research is more often than not “pure,” or done simply for the sake of generating knowledge itself. “What good is the data if it won’t be used for anything useful?” he’d argue. I would probe further, stating “Some people would argue that action can’t be taken unless the facts are straight,” and cited the example of my nutrition project, where, at least to me, it seems CORD can’t make an effective intervention unless accurate data is to be gathered on nutritional intake and health measures among farmers. Narender clarified, stating that research is indeed essential, but that there is often a disconnect between research and action.

This really has me thinking. I’ve read countless research articles that have demonstrated pretty convincing evidence on trends in maternal and child health in India, or the correlations between poverty and disease, but yet state in the conclusion: “Further research needs to be conducted.” So I’m really starting to see the wisdom in Narender’s reservations. How much more research does need to be done? Do we need more statistics to tell us that HIV/AIDS prevalence in sub-Saharan Africa is extremely high? Or that people living in poverty tend to be at a major health disadvantage compared to the rest of society? To an extent, one could indefinitely gather more and more data, and it could generate more and more knowledge. But at what point do we begin to intervene and bring change? Even in my own project, I’m so caught up in finding ways to get the most accurate length measures for children, and the best ways to facilitate 24-hour recall, that maybe I’m forgetting that the goal of my project is, eventually, to promote healthier eating practices in the community. At what point do I begin the transition from concerns about accuracy, to concerns about action?

Just some food for thought!

2015-05-31 18.53.39

In the field at dusk

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About Kurt Koehler

Class of 2016, Majoring in Health and Societies with a concentration in Public Health. Intern at CASI CORD, summer 2015.