Pediatric Nutrition Review: the AFINS Research Project in Guangxi Province

September 12, 2012  •  Leave a Comment

On Wednesday September 5, 2012, Jenny Xu and Tracy Huang from Project HOPE China, Tanya Owens from Pfizer Global Health Fellow (GHF), and several health care professionals from Shanghai and Nanxishan embarked on a four day trip to Guangxi Province.  Guangxi Province is in southwestern part of China bordering Vietnam. The purpose of our trip was to follow up on the Abbot Fund Institute of Nutrition Science (AFINS) pediatric nutrition program at two rural, mountainous, primary boarding schools. The students who attend these schools are very poor; many, if not all are from the Zhuang ethnic minority group that is prominent there. I was informed by Lily Hsu, Program Director at Project HOPE China’s Shanghai office, that when the program was implemented the children ate at most two meals a day and the meals typically consisted of beans and rice. The children were undernourished, even mal-nourished and their growth was stunted.  To combat this, the Chinese government committed to elevating the nutritional status of the children and committed to 3 RMB per child, per meal.  The combined team of health care professionals visited the schools to follow up on the nutritional progress of the students and to conduct follow-up training. To learn more about the program and the baseline of the children, read the AFINS Nutrition Investigation in Rural China report on the Project HOPE China website.

 

Tracy Huang and I flew from Shanghai to Nanning南宁, the prefecture level city in Guangxi Province桂. After arriving in Nanning, we met up with Jenny Xu, who went down earlier to conduct nutritional training in Nanning. We joined up with the healthcare professionals from the Guangxi Zhuang Autonomous Region Nanxishan Hospital and drove three hours to Baise City百色 (longitude 104 ° 28'-107 ° 54 ', latitude 22 ° 51'-25 ° 07'). Baise City is historically known as the seat of an infamous communist uprising against the Ming Dynasty. Baise City has numerous construction projects going on with sky scrapers competing with the surrounding mountains.

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View of Baise City from the Baise Memorial Hall Museum 

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   Tanya Owens in front of the Museum

After touring the Baise Memorial Hall Museum  we drove five hours along the mountain roads to Leye County乐业县. Leye County is administered by Baise City; the area is northeast of Baise City. The route we drove is mountainous, fertile, rural, and has numerous terraced farms, valleys, streams, rivers, caves, villages, and small towns.

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Leye County city is in a valley that is 2km x 1km surrounded by steep mountains. We quickly checked into the hotel and attended dinner at the home of the lead volunteer Luo, whose three story home is towards the top of a steep road that was leading up towards one of the mountains. The town, albeit not too large, has numerous new concrete homes and quite a bit of new home and business construction projects. Once we arrived at Luo’s home we ate dinner out on the deck outside of the kitchen. We learned that the large pile of dried corn on the deck was for the pigs on the farm behind the home.

Pediatric Nutrition Review: the AFINS Research Project in Guangxi Province – Day Two
The second day of our trip, September 6, 2012, started out very misty with fog shrouding the mountains. We left the hotel in Leye County and traveled through Lousha Town, whose main road was under construction. Many people in the rural areas, small cities, and towns in Guangxi Province have never seen a foreigner, especially one with brown skin. I have seen many startled expressions as we traveled along the road.

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Once we turned off the main road, all of the roads going forward were dirt roads. We travelled along the primitive mountainous roads to Quanda Primary Boarding School. The ages of the children at the school are from pre-school to about 11 years old. The students live at the school during the week because it is too far to travel from their homes and villages each day.  The school was only 20 km from our hotel, however, due to the conditions of the roads it took us two hours to drive there.

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The school’s compound was not very large. Nestled almost at the top of the mountain, the compound consisted of three buildings: The main building was two stories and it contained the classrooms on one side and the dormitories on the other side; the kitchen with the staff quarters upstairs, and the bathroom, which had no running water.

 

We were able to observe the children having lunch. Good news, the children’s meals have improved. They were served rice, pork with vegetables, and vegetable soup all in one bowl.  Unfortunately, the children do not have a formal cafeteria and the kitchen facilities are primitive. The children had to line up outside in front of the kitchen with their metal bowels, where a makeshift serving station was set up. The children were served from the youngest to the oldest.

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Once their bowls were filled, they scrambled around the yard looking for a place to sit to eat their meal. The smallest of the children struggled with their hot bowls, but they did not complain, they happily enjoyed their meals. After lunch Project HOPE presented the children with school supplies. Forty of the top performers received backpacks with supplies in them, and the rest of the children received gift bags full of school supplies. We then presented the sports instructor with balls, rackets, and jump ropes. After photos the children rushed to their dorms and classrooms to open their gifts.

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After the brief speeches and gift presentation, Xie from the Guangxi Zhuang Autonomous Region Nanxishan Hospital conducted a 45 min training for the older children ages 10 - 13. He discussed proper nutrition and eating habits and encouraged the children to make healthy eating choices and to minimize junk food intake. During this time Jenny Xu and the other health care providers met with the school administration and teachers to discuss the program’s progress.

 

Once the presentation was over, we, along with the local volunteers, travelled a short way down the mountain to one of the local farmer’s homes. His home was in the traditional style with the pagoda style roof, free range chickens and roster, honey bin and walnut trees. This farmer sold walnuts. During our lunch at the school, we were able to enjoy fresh walnuts and honey, which came from this farmer’s farm.

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After a short visit we travelled the rest of the way down through the mountains where we had a farewell dinner for the local volunteers and the farmer at the only restaurant in Lousha Town, which was situated on the main road. The food was fresh and tasty; we were even presented with the local delicacy, fried grubs, which I refrained from trying.

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Unfortunately, my western tummy did not process the food from the school and Lousha town well. I spent a very fitful and sick evening at the hotel that evening.

 

Pediatric Nutrition Review: the AFINS Research Project in Guangxi Province – Day Three

The morning of day three, September 7, 2012, we said good-bye to Leye County city and traveled the short distance to the Huayan Primary Boarding School. Because I was ill the evening before I refrained from eating breakfast at a local restaurant in a neighboring town before we reached the school. I also refrained from eating lunch at the school and dinner in the village. The trek to the Huayan School was shorter and only took us an hour to travel over the mountainous dirt roads. The Huayan School is situated at the top of the mountain; however it was not as cool there as it was at the Quanda School.

 

The facilities at the Huayan School were more basic than the facilities at the Quanda School. The compound had three buildings: the main building, which housed the classrooms, a separate building that held the dorms and directly behind the dorms the kitchen. This school did not have a bathroom; everyone had to go into the woods behind the main school building to relieve themselves. As you can imagine with the number of students and staff at the school this leads to very unsanitary conditions. Thankfully, we observed two constructions projects at the school: the construction of a new building for the kitchen and directly behind the classrooms and adjacent to the dorms, a bathroom.

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Because it was Friday, it was a short day for the children and we did not observe them eating lunch. However, we did have the opportunity to observe a literature lesson. It was remarkable. The children scrambled to their classes and suddenly we heard this sing-song as the children were reading out loud from their literature books. It immediately reminded me of the style of reading I have observed from the Hebrew Cantors. The older children had a very definite rhythm, however when I went to the younger classes, the first grade class, they were not quite in sync. I asked Tracy Huang, what the children were saying and she initially said, the children were not reading in Mandarin. Upon closer examination they were reading in Mandarin, however, their southern accent made it difficult for the Shanghai team to understand them.

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I also had the pleasure of observing one of the teachers teaching the children. This is one of the times I wish I did not have limited language skills and was conversant in Mandarin. I had so many questions I wanted to ask about the teaching style they used and the success rate they had with it. After that morning’s lessons, the children all lined up out in the yard, which incidentally had places cordoned off with construction material, for the Project HOPE presentation.

 

As we did at the Quanda School the day before, we presented the top 40 performers at the Huayan School with backpacks equipped with school supplies and the remainder of the children received gift bags. After the speeches and presentations the older children sat for Xie’s lesson on proper nutrition. After the lesson, the children gathered their gifts and sauntered off the mountain to their respective homes. I was amazed watching the tiny preschoolers with their gift bags walking up the steep dirt road towards their homes.  I wondered how long it took them to get home and how safe was it for them to walk along the narrow dirt roads along the mountain, with very little clearance and steep drops.

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After lunch at the school our party drove down the mountain, off the dirt roads and onto paved roads going away from Leye County to Bama / Hechi County to the village of Bapan, which has one of China’s longevity villages. Actually Bama / Hechi County boast many longevity villages with numerous centenarians.  Along the way to Bapan, we enjoyed the beautiful natural scenery, the terraced rice paddies, banana farms, tea farms, and lots of vegetation. We even enjoyed the odd ox here and there, a few pigs and once in a while a wayward colt that refused to be tamed. Aside from a small bird here and there, I did not observe any wild life along the mountain roads. We stopped to observe the large sink hole in Tiankeng in Dashiwei, part of the karst mountain formations. And after seven hours journey we arrived at Bapan Village during the evening. After dinner was served by a local family, we resided in the village hotel, which was in the traditional Chinese style, located on the top two floors of the building, the second floor was a residence.

 

Pediatric Nutrition Review: the AFINS Research Project in Guangxi Province – Day Four

Day four, September 8, 2012, the last day of our journey, I awoke a bit sore from the very firm mattress and quite famished.

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However, due to our journey, which consisted of several hours of driving, I refrained from eating as I did not want to risk getting sick. Thus, I subsisted on crackers, cookies, water, and on day four a couple of bananas I purchased at a village, when everyone stopped for breakfast.

 

Before we ventured out to breakfast we stopped at the home of Huang Puxin, who is 113 years old. The secret to longevity the Bama centenarian’s state: “organic food, good air, and water;” “a peaceful heart;” and “do[ing] good deeds, help[ing] others, be[ing] kind, hav[ing] confidence, and never giv[ing] up.”

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We had the opportunity to read a bit about his life and engage Huang Puxin. I chuckled when he patted my back and leg several times and then said something about me being mocha (at least it sounded like mocha) and then asked in his native language where I was from. They told him that I am American, from the United States. Huang Puxin was surprised and remarked that he didn’t know that there were mocha people in the U.S. At least I hope he said mocha. When I asked Tracy to translate what he said, everyone chuckled, but she did not provide a word for word translation, other than that he was surprised to learn I was American and thought I was from a different country, I presume an African country.

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After visiting with Huang Puxin, we drove to a nearby village and had breakfast.  I refrained from eating but did purchase a few bananas from the outdoor market and a Coke.

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We then traveled to the Leye-Fengshan Geopark, where we saw the Ming River and a large Karst Cave with stalagmites and crystal formations. After this last bit of sightseeing, we stopped along the roadside and purchased mangoes and then after a few hours of driving we stopped for lunch at a city outside of Baise. I was surprised when I heard clucking outside the restaurant and saw two chickens running around without their heads. Yes, they killed, plucked, and cooked the chickens right by the street for the restaurant where our group was eating. I drank water and ate my banana.  After lunch we settled in for the three – four hour drive to Nanning and our 2.5 hour flight back to Shanghai.

 

Altogether, the trip was a success. The team of healthcare professionals and local politicians were pleased with the progress the children were making. There is greater awareness about nutrition and the facilities are being improved. There is still more to be done. Project HOPE is partnering with Kraft foods, Lily Hsu informed me. Kraft will be helping to build a more sustainable system by donating Kraft kitchens and helping to build small farms at the schools to help further improve the children’s nutritional welfare. As we drove through Leye and Bama / Heche Counties we could see abundant farms and vibrant food markets, so there is plenty of food in the valleys and mountains. The continued efforts to educate, promote healthy eating, and build better facilities and small farms at the schools will ensure the children who are attending these mountain boarding schools will be well prepared to go on to secondary school.

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Lousha Town Boarding School

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Huayan Primary Boarding School Children Reciting Literature and a Walkthrough of a Dorm

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