Decolonizing medical treatment and nutrition rehabilitation process through narratives and storytelling
This paper aims to introduce storytelling and narrative therapy for facility-based management of severe acute malnutrition as a methodology to decolonize health and nutrition education dissemination. The participants were caregivers of malnourished children from birth till five years of age at Nutrition Rehabilitation Centre, Amjhuri Block Primary Health Centre, West Bengal. In countries with colonial past especially India to address systemic barriers involved with optimal feeding and nutrition, practitioners must acknowledge deeply rooted structures of casteism, gender inequality, domestic abuse, commercialization and non-familiarity of traditional foods, language, migration etc. The approach was to integrate these topics with nutrition counseling and help the caregivers to understand malnutrition, discuss and share their challenges for improved feeding and complete the required duration of treatment. The process included three steps; a) First, re-designing of children’s wards with nutrition messages in local languages to provide a learning environment. b) Second, a principle-based group narration of six stories to externalize the nutrition-associated health problem. Caregivers learned to construct their own narratives and deconstruct specific issues tied to the socio-behavioral causes of malnutrition. c) Third, one- on-one counseling with individuals and/or families. Results were recorded as observations from counseling and state-level monthly reports to assess the outcomes of care.
Keywords: Decolonization, severe acute malnutrition, nutrition counselling, narrative therapy
Sneha Rout is a public health nutritionist with research interests in prevention and treatment of severe acute malnutrition, maternal, perinatal and pediatric nutrition, food insecurity, community nutrition and education, implementation science, monitoring and evaluation of nutrition programs. She completed her Master of Public Health Nutrition from Tulane School of Public Health and Tropical Medicine. She did her Bachelor’s and Post Graduate Diploma in Dietetics and Applied Nutrition from Jadavpur University. Prior to New Orleans, she has worked in rural and urban settings for about seven years at several government and non-government organizations in India. She is a qualified trainer for her specializations in infant and young child feeding, facility-based management of malnutrition, social and behavioral change communication, and also holds certification in narrative therapy. Her ideas for social innovation and narrative nutrition therapy stemmed from her professional experiences while living in different states of Jharkhand, West Bengal, Maharashtra, Madhya Pradesh and Odisha in India. It was challenging to rehabilitate malnourished children not just in terms of making resources known and available but also account for languages, people’s perceptions and beliefs, religions, caste, healthcare practices, and livelihoods that intersected with medical and nutrition care. This motivated to reapproach her counselling techniques for complete medical recovery and sustain healthy feeding practices for children even after discharge.
Dr. Lesley Ann Noel is an Afro-Trinidadian design educator, based in New Orleans. In her work, she focuses on equity, social justice and the experiences of people who are often excluded from design research. Her doctoral research focused on emancipatory design thinking at a rural primary school in Trinidad and Tobago. She also attempts to promote a greater critical awareness among designers and design students. Deep empathy is a key theme in her classes, where students build relationships across difference before collaborating on design with community partners. Her research also highlights the work of designers outside of Europe and North America. Her identity is shaped by her ethnic background as an Afro-Trinidadian; experience as a daughter, sister and mother; and her lived experiences in Trinidad and Tobago, Brazil, Tanzania, Uganda and the USA. Her research interests included exploring design thinking curriculums applied at a young age if they could build better awareness of social problems among children or could create a sense of agency among them. Her study findings indicated that there are many ways to build empathy and critical thinking skills, as well as a sense of empowerment in children as they respond to design problems, even in a rural, low-resourced context. In future research, she plans to conduct longitudinal studies to track the impact of design education on the cognitive and social development of the participants.
Dr Subarna Goswami is a public health specialist with expertise in epidemiology. Born in a lower middle-class family at Santiniketan, Tagore’s land, grew up in a diverse cultural and rich academic milieu. A non-believer all through, he has an inborn curious mind and leadership quality. After passing out MBBS from R G Kar Medical College in Kolkata, he has completed both Diploma and Master’s in public health from the All India Institute of Hygiene & Public Health, Kolkata. He is serving the Government of West Bengal, India since last 17 years in different capacities. He has designed and successfully managed many public health intervention programmes including vector-borne disease control programmes, programmes for the prevention and control of non-communicable diseases and led a number of epidemic control programmes in many districts of West Bengal. Dr Goswami is one of the few experts in the State who are leading from the front in designing, planning and implementing effective COVID control programmes in difficult terrains of the State of West Bengal. Apart from being a popular columnist and public opinion influencer here, he is a fervent researcher with special interest in interventional and operational studies. Focusing on interventions like nutrition and widening immunization coverage, he aims to contribute in reducing both infant and child morbidity and mortality.