“Come along with me to a forgotten place; a tragical land of deep sorrow, of hungry orphans fighting rains and grueling heat, running from wars and stepping over dead bodies in the dense mountain jungles. With stomachs so big and eyes so heavy… they don’t even realize their little organs are malforming. They know nothing of stunting but what they do know is they don’t have shoes or clothes that fit and it really doesn’t matter because their hearts are torn as fathers fight mothers, many dying, leaving them to sleep on dirt staring up at the big bright moon above the mountains. Yet being so close to Mother Earth helped new ideas grow; ideas that changed everything. This is the story of how a new vision changed our place…”
This excerpt, from GlobalRise’s submission to Rockefeller Foundation’s 2050 Food Systems Vision Prize, captures the intensity of our journey from untested ideas to evidence-driven interventions using health information and technology to transform a region; the basis of this case study. Our effort is part of a workstream that is preparing viable food equity and nutrition innovations through the United Nations Food Systems Summit.
At the heart of our mission are children, including tens of thousands of precious babies who have extraordinarily difficult lives. Half of all children in Kasese District (pop: >700,000), located in the foothills of the Rwenzori Mountains in western Uganda, are stunted—short height for age and accompanied by other health issues. Their future, however, can be radically changed in the first 1,000 days of life with nutrition interventions. But this isn’t enough. Evidence reveals that sustainable change requires both sound nutrition and poverty reduction. Doing one without the other helps but does not position communities for sustainable change.
We believe that linking personal health records (PHRs) into a “food system of systems” approach can improve the lives of children, exposing areas of intense need for dietary and clinical interventions. The vast majority of families simply require maternal and child nutrition education—but how does one incorporate this into a sustainable regional program?
By overlaying everyday activities of village life with a technology super structure that expedites delivery of crops to market, we may have found a core change agent; specifically, by linking diet transformation to drone aviation. Our solution is broader, encompassing training in soil fertility, embedding gender equity and inclusiveness, saving indigenous culture and more, however, the transformative core unites two systems (one visionary) to advance health in the region.
It’s high time to bring high tech to the mountains. Fortunately, food scientists and others have affirmed our vision to radically transform the future of extremely poor mountainous families in Sub-Saharan Africa.
Stunting—A Human Quagmire of Epic Proportions
One of the women we spoke to during our field nutrition survey said “stunting doesn’t hurt.” Her observation underlies the deadly truth that stunting mostly remains untreated and hidden; yet, it is a pernicious killer. In the words of one NGO, it’s a “human affliction, and an abomination.” Some 144 million children are stunted today, with the worst or “red zones” located in Sub-Saharan Africa (where rates are increasing), India (decreasing in prevalence yet hosting the highest stunted population on the planet with 63-plus million stunted) and Guatemala’s West Highlands, where the Mayan community in particular exhibits an astonishing 70% stunting rate! According to USAID, chronic undernutrition “is attributed to high rates of poverty, food insecurity, inadequate hygienic environments, structural problems of inequality and exclusion, and also insufficient child stimulus and care.”
Cognitive capacity is also compromised by stunting. Education is stymied. Coupled with difficulty learning and a proclivity for infections that may shorten life span, this sad and intractable problem locks children, families and communities into extreme poverty from generation to generation.
In the “Mountains of the Moon,” as the glacially-capped Rwenzori Mountains are affectionately referred to, there is an estimated one million members of Bukonzo, the prevailing tribe. This majestic mountain range, a World Heritage site, straddles a boundary between western Uganda and the eastern Democratic Republic of Congo, where an additional 4 million Bukonzo live. For many reasons, this expands our potential scale of impact to over 5 million people, living in households with 4.9 members (our location-specific findings show six members) with an average age of just 15.8. In fact, Uganda has the second lowest median age on the planet – a veritable fountain of youth.
Applying innovation is necessary to leapfrog the conditions of high stunting communities living in the mountains. The financial divide among the extreme poor who live in the mountains (making far less than the World Bank standard of $1.90 per day) versus those in the safari tourism town of Kasese is remarkable. Those in town can access clinics, hospitals, proper nutrition, grocery stores, etc., that are mostly out of reach for mountain farmers. Farming on an average of 1.5 acres, most households are led by women who have zero hope.
The initial impetus behind the framework we used for thinking through this deep problem was in some ways arrived at by accident—a byproduct of laboriously climbing steep hills while implementing our household surveys. This influenced critical thinking around how to efficiently engage steep terrain. Guided by expertise at the Rockefeller Foundation in multi-thematic systems thinking, we added over three years of field experience to evolve a “system of systems” approach that we believe is capable of sustainably eliminating stunting, and other forms of malnutrition, in the community.
Development in the mountains has a unique set of challenges that are extremely difficult to address like poor access to roads, no electricity, excessive soil erosion and more. We knew that to implement change we needed good data and as our scan of the literature yielded little or old data, we had to start from scratch.
Using statistical methods, our team calculated a sample size appropriate for our target area. With the help of professors at the University of Costa Rica and two of our field partners—Biogardens and Rwenzori International University, we isolated a small village called Kirembe. The village is also home to Christalis Home, where our team implemented a nutrition system serving 42 orphans and helped with other types of assistance that the home provides to over 200 families in the community. As a key field partner, the home seriously leap-frogged our understanding of nutrition and health issues unique to the area.
With about 1,650 households, Kirembe presented the kind of sampling we needed to build broader hypotheses around key household characteristics—health status, livelihoods (mostly farming), finances, crops raised for home use versus to sell in the market, use of bank accounts, phones, how meals are prepared, food insecurity and much more. The data helped us to understand why kids are locked in a cycle of resilient stunting versus resilient health and wellbeing.
Traversing Kasese’s steep terrain in the Rwenzori foothills, our team geo-located 217 households with handheld GPS devices enabling us to easily revisit for follow-up. We trained two locals that spoke the native tongue to help us. The task was daunting. Until one walks the steep muddy paths it is impossible to appreciate the life of women who travel miles each day, baby on back, to sell produce in the market. The paths weave like spiderwebs; and this lead us (perhaps out of desperation but by accident) to our first innovation, Geospatial Nutrition Profiles (GNPs). GNPs are designed to predict community nutritional status without difficult and expensive surveys and may dramatically improve health campaigns.
After collecting and verifying our data we used IBM SSPS software to normalize and aggregate the data into usable formats with charts that described survey conclusions. Placed in front of two village groups arranged by Biogardens, one of our indigenous NGO partners, we received valuable community input. This was the beginning of our current process to build a sustainable community nutrition model, accepted by families in the area, that will be implemented in our Village Training Program.
With survey results in hand, the community nutrition program was developed by our nutritionist along with board member, Sylvia Klinger, DBA, MS, RD, CEO at Hispanic Food Communications, LLC, who brought in 16 graduate interns from the University of Illinois. A volunteer doctoral team from the University of Northern Florida’s Center for Nutrition and Food Security built our outcomes measurement methodology that is so important for grant funding from groups like USAID. Finally, our field partners in Kasese are helping to contextualize the program, making it culturally sensitive in ways that optimize impact using local food preparation styles, diet preferences and more.
Challenged by the food scientists at Rockefeller Foundation, GlobalRise co-created a regional plan with indigenous tribes deeply addressing six key themes—technology, culture, diets/nutrition, environment, policy and economics. Further refining our approach, we added a seventh theme—Human Rights in Food Systems; a strategic development priority of the Swiss Agency for Development and Cooperation (SDC) from 2017-2020.
Collecting data from internal and external research, multiple meetings with government and university officials and over 80 community leaders at the Kasese Better Living Center, a wonderful partner that offered to scale our program via 450 mountain churches, we engineered a “systems of systems” approach—an ICT/Drone-Enhanced Food System that efficiently bridges mountain farmers with formal markets to sell their crops—paid for and managed using mobile phones commonly used throughout the mountains (already used in a similar way for household electricity in Kasese).
This innovation addressed what the mayor of Kasese refers to as a deep issue—steep terrain. It was also affirmed by civic and university leadership, farmers, NGOs and others. We initially suggested using donkeys but the mayor said this was tried before and added, with some embarrassment, “They hunted them for food.” He shrugged it off and offered his opinion: “We have plenty of food, we just don’t know how to eat!” In many ways, we see this nutrition in the rich variety of foods typical in the mountains—cassava, beans, plantain, corn, huge jack fruits and more.
In a drone food system, positioned a pay-as-you-go community utility, users must first attend Village Training, visit med-kiosks and initiate digital PHRs for the family and bank accounts, access ready to use therapeutic foods (RUTFs) and more. Demand to onboard the platform is expected to be robust with villagers seeing neighbors efficiently selling crops. Drones will travel from the mountains to the farmer’s market below and make new markets in safari resorts, refugee camps (Uganda hosts the third largest refugee population in the world) and lakes. Funds will settle digitally with access via mobile phones.
As a reference model we drew upon the success of a California-based firm that delivers blood, vaccines and other medical supplies using drones in Rwanda, the country of 1,000 hills. At last count the firm is making 150 deliveries daily. Our program will use drones similarly for the purpose of improving community nutrition and incomes. Rather than drone warehouses that optimize speed like in Rwanda, we envision the use of “drone beehives,” that may optimize maintenance, ease of storage and handling and other operational needs around food.
Within five years, our road map calls for aiding government to implement a public private partnership that cedes control to local management. We will continue to provide advisory across several aspects—PHRs used in connection with mobile banking, 3D food printing lab, creation of a new index that addresses gender inclusiveness in policy formation and more. We envision an index potentially coupled with a new “FSFX” or food system financial exchange that helps government to finance drone food systems. The index will promote optimum use of technology, gender equity, climate factors, public health reporting, land rights governance, embed human rights to nutrition and other multi-thematic factors applied in our vision.
COVID-19 Pivot: Field Work and Finances
The COVID-19 pandemic lead to a strategic pivot away from working the field internally to greater co-development alongside field partners. This involves web-based training and re-prioritizing budgets accordingly. Interestingly, with greater reliance on field partners we have freed valuable time and costs that can be redeployed for scoping red stunting zones that may be ripe for drone food systems in India and Central America; advancing our mission globally.
As with any project, finances are critical. In addition to pivoting fieldwork during the pandemic, we also focused resources on building a monthly giving program, recently appearing on a TV network that caters to missional families. Twiga’s Crusade to Kick Stunting Out of Kasese, the name of our campaign, was prototyped at the University of Costa Rica as a student-led initiative. Buoyed by the passion of our Costa Rican co-founder and nutritionist, Karen Salazar, RD, the campaign sold over 700 animals.
Twiga means giraffe in Swahili. In the crusade, Twiga is joined by her friends: Tembo the elephant, Punda the zebra and Faru the rhino. Donors who give $25/month can bring Twiga home and as friends join, they progressively receive all of Twiga’s friends and other benefits. Each animal represents aspects of our Village Training Program that are collectively required to build “A World of Healthy Kids”—our guiding vision.
With pragmatic vision, we are building prototypes that offer first-hand views of how to bring critical transformational themes together in a system-of-systems approach; where technologies like health IT, drone aviation, food printing, GPS and more, can synergistically build health and nutrition equity for extremely poor children and families that the world has truly forgotten.
Making solid progress in three of the world’s worst stunting zones in Sub-Saharan Africa, India and Guatemala, GlobalRise is positioning for global impact by offering a demonstration platform that is truly needed by governments who struggle to help mountain communities—areas that match red stunting zones. UN’s Food and Agriculture Organization estimates that 15% of all humanity lives in the mountains with over one-third earning less than $1.25 per day.
In David Attenborough’s film calling for environmental change, drones are illustrated in the closing scenes picking up and transporting food from the mountains to a village below. It is just awesome how others are already thinking of how this kind of platform to provide proper nutrition can benefit humanity.
We believe integrating a drone aviation system with Village Training that promotes the use of health information and technology to spur positive behavior change can dramatically improve the plight of the poorest of the poor and raise generations of children to healthy and productive lives.
The views and opinions expressed in this content or by commenters are those of the author and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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