Gisela Solymos is finding new solutions to resolve child malnutrition in Brazil by identifying and addressing the fundamental causes of the problem—the emotional and psychological challenges often rife among situations of poverty. Beyond treating the immediate physiological needs of malnourished children and promoting their recovery, Gisela’s unique methodology identifies specific weaknesses in the child’s family. These include the anguish of not being able to properly feed one’s own child and the insecurity and shame from not knowing how and where to get their next meal. In such fragile circumstances, a family often cannot prevent their child’s malnourishment. Unlike many other centers that simply medicate and hospitalize children with malnutrition, Gisela’s acts in a multidisciplinary way, creating an all-encompassing intervention that is highly focused on all of these factors. It seeks lasting solutions that will provide them with the dignity and the will to overcome their situation.
A nova ideia
Gisela launched the Center for Nutrition Recovery and Education (CREN) to address the deep psychological effects of malnutrition on Brazilian families. Beyond treating the immediate physiological needs of malnourished children and promoting their recovery, Gisela’s unique methodology identifies specific weaknesses in the child’s family. These include the anguish of not being able to properly feed one’s own child and the insecurity and shame from not knowing how and where to get their next meal. In such fragile circumstances, a family often cannot prevent their child’s malnourishment. Unlike many other centers that simply medicate and hospitalize children with malnutrition, Gisela’s acts in a multidisciplinary way, creating an all-encompassing intervention that is highly focused on all of these factors. It seeks lasting solutions that will provide them with the dignity and the will to overcome their situation.
The center is more than a nutritional rehabilitation center; it is a place that promotes recovery and human development. Gisela’s methodology starts from the basis of the environment in which the child lives, his/her desire to carry out a fruitful and successful life, and other resources that families already possess but do not value. It brings together community outreach to identify children suffering from or at-risk of malnutrition, outpatient care, and a semi-boarding day hospital providing more individualized treatment and education. During the child’s treatment, the center involves and gives active roles to the family by making home visits and offering training and psychological support when necessary. Such a comprehensive plan guarantees a real and lasting transformation in the life of the individual without forcing a separation of the child from the family.
The first venture in Brazil to fight child malnutrition through an interdisciplinary, family-oriented and psychological approach, the center is now developing new tactics to expand its impact beyond Sao Paulo. First, Gisela has created a new Overcoming Malnutrition online platform to spread the methodology. It is the only website in Portuguese, English, and Spanish dealing with the issue, and it is behind new associated strategies combating malnutrition around the region. Its work will complement the investigation and education arm that Gisela is now designing, which will position the center as the leading research institute on the subject. Given Gisela’s success so far in resolving this problem at its roots, addressing the many circumstantial factors that lead to child nutrition, she is ready to take her project to new levels.
In recent years Brazil has made incredible advances in income that have lifted a large portion of its population out of poverty, experiencing a drop from 25.6 percent of Brazilian’s living below the poverty line to some 4.8 percent. At this incredible rate, the country should eradicate extreme poverty by 2014, according to United Nations reports. A by-product of this increased income is a lower incidence of hunger: in fact, Brazil has already achieved the UN target for 2015 of reducing the proportion of the population starving by 50 percent.
Such advances in reducing hunger would suggest that the problem of malnutrition has been eliminated, but in fact it has only grown more complicated. The fact that a child is adequately fed does not necessarily mean that he/she is receiving the proper nutrients to grow and stay healthy. In addition to poverty, which the country only addressed at its most extreme level, human factors like parental unemployment or underemployment, the larger social network around the child and poor education, housing and living standards, healthcare access and eating habits all contribute to malnutrition. The roots of this complex issue, therefore, extend beyond actual hunger and a dearth of available nutrients to include macroeconomic, psychological, and emotional challenges that affect not only the child suffering from malnutrition but the entire family as well.
Because most efforts to solve child malnutrition focus on only boosting family incomes or supplying more nutrient-rich food, they fail to address these broader and more complex aspects that cause the situation. Simplistic explanations, including the myopic argument that a malnourished child possesses an unloving and negligent mother, belie the real problem at hand. In fact, as Gisela has observed in her extensive research, insofar as malnourished children are often closer with their mothers, as a result they become more absorbed in the larger issues facing their family. Sadly, many programs that follow such an inaccurate perspective will intern children in hospitals and clinics, separating them from their families and thereby causing even more psychological harm to the young patients.
Since founding the CREN, Gisela has realized that the solution to such an elaborate problem cannot be predicated solely on the increase of a family’s income or their access to food. Based on her practical experience as a psychologist and her studies of hundreds of families, she designed an integrated program of support and recovery for the child and the family that considers the suffering due to poverty as just one of its main elements. The center seeks a comprehensive solution that promotes a real and long-lasting solution in the life of each individual, while still upholding the bonds between children and their families.
The center maintains a tripartite approach consisting of community outreach, outpatient care and a semi-boarding day hospital. In partnership with professionals from the federal Family Health Program who are trained by the center, families are invited to attend meetings that the center organizes. There the specialists review the child’s vaccination records, measure vital statistics, and inquire about the family health history and the child’s nutritional status. If the child or adolescent—the center treats children from infancy to 19 years of age—exhibits malnutrition or obesity, her/she is referred to outpatient care. The center also offers training to professionals, community workers, and other people involved in the community and provide child care.
When children are referred to outpatient care, they receive individual clinical consultation and nutritional, psychological, and social assistance. They also participate in group activities and home care, with the presence of a physical education teacher. The center’s semi-boarding day hospital provides specialized care to malnourished children under five-years-old. Patients remain in the institution weekdays from 7:30 AM to 5:30 PM in groups classified by age. They receive five meals a day and medical, nutritional, and in certain cases psychological care. They can also participate in workshops designed with expertise in nutrition and pedagogy that enhance the children’s appreciation for better nourishment and increase their understanding about food and its preparation. Incorporating actual recipes picked for their nutritional value, their appeal to children and level of complexity, the workshops help children explore interdisciplinary topics that serve a larger educational function. These include oral and written communications, mathematics, and general cultural education. Children who take part in these workshops also learn how to transmit their knowledge to their parents, thus bringing the families into the picture.
In parallel, as part of the child’s treatment, the center’s psychological services include “listening spaces” for families and home visits. These are an important aspect to professionals and trainees who, by gaining closer contact with patients’ families, will engage in more sophisticated styles in their future therapy. The center also conducts various workshops that strengthen family bonds, like community cooking classes held by mothers themselves, in-home lessons around lunchtime, discussion groups of obese pregnant women, and other like activities.
Gisela has systematically measured the impact of the center since its founding. Indeed, its strong scientific background—the organization grew out of an academic project of the Federal University of Sao Paulo, which the center still maintains some ties but from which it remains independent—is reflected in its quantitative and qualitative methods of appraisal. Every week, evaluators review individual case studies. The overall results are tallied and analyzed annually in several meetings with the entire technical team. A technical committee meets monthly with representatives from each division and teachers from the Federal University to discuss the methodology and results they have achieved.
Gisela’s insight guiding her work is that no matter how poor a community might be, its members always are aspiring to reconstruct their reality to one of dignity. As such, the center’s core values are centered on people and their lives. Detailed assessment of the wishes, needs, and local circumstances always precedes any expansion of the center’s activities into new communities. To date, the center’s work has helped over 50,000 people, and this number is increasing rapidly. In 2011, its two units in Sao Paulo attended to 142 malnourished children in the semi-boarding day school and about 2,000 children and adolescents with malnutrition, overweight, and obesity in its outpatient clinic. UNICEF has also recognized the center as a center of excellence and national benchmark for malnutrition.
Gisela aspires to build on the incredible successes her center has had so far, developing plans for the near future as a way to further improve its methodology and impact. One means of replication of Gisela’s model in Brazil and around the world is through its Overcoming Malnutrition website, launched in 2002. It is the only site in Portuguese and English specialized in malnutrition in the country, and public health agencies and citizen organizations (COs) around the world, including in Latin America, Africa, and the United States, have consulted it. Its material has been printed several times and has been translated into Spanish and French for distribution in Peru and Haiti, respectively. The collection consists of seven books, seventeen folders and a video available for download on the website.
Moreover, Gisela hopes to create a Center for Information, Research and Development that collects, analyzes, and spreads information on monitoring and interventions in youth nutritional health. Most of the issues that her experts resolve in clinical situations—that is, through assistance to families and/or their children—could be addressed through education; therefore, she is designing other educational techniques to promote child wellness. The center will advise governments, schools, universities, the private sector, and social work programs. This objective responds to increasing demands Gisela is receiving to strengthen nascent or existing initiatives to combat malnutrition and promote good nutrition among children and adolescents. Gisela also plans to launch one or more sustainable businesses that will enable the center to diversify its funding sources. These numerous elements of her strategy will work in concert to distinguish the center as a leader in the field of nutrition.
The daughter of Hungarian father and Brazilian mother, Gisela says that she inherited his father’s desire for “achieving the infinite.” He served as a critical mentor and figure in her life; as a little girl Gisela delighted in watching him show her the constellations in the night sky, and she craved to learn more about the world around her, and, above all, about others. Gisela eventually grew into a deeply inquisitive and unsatisfied adolescent who was extremely sensitive to the needs of other people. As a teenager she joined a group of young people working in a favela. This experience gave birth to her commitment to do something to address the deplorable circumstances she saw.
Gisela turned to psychology and graduated in 1987 with her bachelor’s degree. Giving private lessons, she became fascinated by teaching children with learning disabilities, and she opened a private clinic to treat them. Sadly, the financial crisis forced her to close her office and seek other work. She then became a field researcher surveying the socioeconomic and nutritional conditions of residents of the Vila Mariana Favela. Almost by chance, Gisela and the rest of the research team developed a methodology for health intervention in this community. She went from house to house questioning families on some of their healthcare needs, ranging from emergency care to daily activities like breastfeeding or nutrition. This service in the community and the immense sensitivity to the issue of poverty that she perceived planted the seeds she later cultivated to launch CREN.
Although it was initially difficult to leave the direct service in the favelas and open a clinic, Gisela has maintained direct care with communities and an interdisciplinary treatment perspective as paramount. Her impressive work has made her and the center an international reference point on youth malnutrition and even garnered her recognition as a Schwab Foundation Social Entrepreneur (2011). To this day, Gisela remains restless and creative, seeing the center as always changing, growing, and improving its approach: to respond to the problem of malnutrition while engaging each child’s needs, desires, and challenges within a framework of extreme poverty.