Ana Maria Teles de Norões

Ana Teles is developing a new and more effective approach to the treatment and prevention of childhood malnutrition in the northeastern region of Brazil. In her approach, the locus of treatment is shifted from large public hospitals to clinics in local neighborhoods, and community-based strategies for rehabilitation and prevention are emphasized.

Ana Teles founded the Institute for the Prevention of Malnutrition and Disability in 1986 to revolutionize the way in which the medical community views and treats the problem of malnutrition and thus to improve the life prospects of the many children victimized by hunger arising from the systemic poverty in which they live. Ana Teles founded the Institute for the Prevention of Malnutrition and Disability in 1986 to revolutionize the way in which the medical community views and treats the problem of malnutrition and thus to improve the life prospects of the many children victimized by hunger arising from the systemic poverty in which they live. Before Ana began her project, most cases of severe malnutrition in the Brazilian state of Ceará were treated in large public hospitals, where the response was confined to emergency measures aimed at preventing imminent death. In marked contrast, her institute offers sustained and comprehensive care, including food, medication and training for family members to reduce the likelihood of relapse. Treatment is tailored to the needs of each child, ranging from emergency care for severely debilitated children to periodic outpatient programs for less severe cases. Since instances of malnutrition are rarely an isolated phenomenon, every positive diagnosis of severe childhood malnutrition is followed with examinations of all family members. In an effort to reduce the incidence of malnutrition over the longer term, Ana's community-based clinics and information centers provide training on prevention strategies for community leaders and promote related community projects. These include neighborhood vegetable gardens and "living pharmacies," in which medicinal plants and herbs are grown organically to provide supplemental nutrition.

In northeastern Brazil, where per capita income is extremely low, malnutrition reaches alarmingly high rates. According to the Pan-American Health Organization, more than 800,000 children suffer from serious malnutrition in the state of Ceará, and, for every 1,000 children born, approximately 120 die from dietary insufficiency. Large public hospitals are almost never able to provide the thorough treatment, information, family and community intervention and subsequent check-ups needed to address the problem of malnutrition in an effective fashion. In most cases, they simply weigh children, offer short-term treatment and observation and then send them back to the same conditions that brought on the malnutrition in the first place.

Ana's approach to the treatment and ultimate prevention of severe malnutrition is based on the twin premises that its cause is a complex web of physiological, economic and social phenomena and that its cure is a similarly diverse array of medical/nutritional, educational and resource-mobilizing measures. In the Institute's clinics, diagnosis and medical rehabilitation are carried out by nutritionists and doctors, who identify persistent symptoms and determine what specific elements are lacking from the child's diet. Problems often encountered include chronic chemical imbalances that interfere with neurological development and functioning or basic motor skills. Treatments include medication, high potency vitamin supplements, physical therapy and other interventions. The Institute also provides educational services and social assistance to families of malnourished children, and to the larger community when the incidence of severe malnutrition is high. Doctors and nurses teach families which specific nutrients are needed and show them methods for preparing food to retain and add these elements. They also arrange for donations of food, medication and transportation to help ensure that the patients continue to receive the care they need. Finally, with the aim of sustaining the varied efforts required to prevent malnutrition, the Institute helps local leaders design concrete working strategies intended to maintain community concentration on the issue over the long term. For example, many communities have established medicinal and vegetable gardens that provide supplemental nutrients while creating a visual focus and gathering point. The Institute is sustained by agreements with government and private institutions and by donations from the public. It currently has a total of 168 employees, including nutritionists, social assistants, occupational therapists, nurses, psychologists, pharmacists, a domestic economist, instructional specialist and coordinator. It now attends to more than 1,000 children each month, and its various programs reach more than 4,000 people, and those numbers will grow as Ana opens additional preventive centers in high-risk communities. The new centers are helping the Institute to build long-term relationships with a growing number of communities and adjust its various programs to their special needs. In one town, for example, an Institute clinic is providing specialized care for pregnant and breast-feeding mothers and distributing some 1,000 bowls of soup a day. Ana's long-term plans include the operation of a bakery and a nutritional milk-based supplement factory that can tailor its products to specific nutritional needs. The goods will be sold or donated to school lunch programs and nurseries. She is also working to build a network among all organizations and agencies in Brazil working in the field of malnutrition and to disseminate its approach through that network.

A university graduate in occupational therapy, Ana has worked in a number of large hospitals that care for patients from low-income communities. In one public institution where she worked for five years, she regularly encountered malnourished children with minimum chances of survival and witnessed the failure of traditional emergency treatment measures. A mounting conviction that a radically different approach was required to remedy the situation led her to decide to devote her full energies to that cause. Since founding the Institute in 1986, she has dedicated herself to the development and consolidation of that institution and to the elaboration and refinement of its strategies for the prevention of malnutrition. In addition to serving as the Institute's president, Ana is founder and current vice-president of the Philanthropic Organizations Association of Ceará.