Isabel De Almeida is the leading nutritionist in Guinea-Bissau. Her goal is to establish a nutrition "museum" to address malnutrition and related health problems, matters of widespread concern in her country. Isabel's ambition is to develop a creative space to research food and nutrition issues, to develop imaginative ways of informing and educating the Bissau-Guinean people on the essential elements of nutrition and healthful eating habits.
The New Idea
Isabel's work as a nutritionist has shown her first-hand that malnutrition and undernourishment have strongly negative repercussions on national economic and social development. Drawing on her important experience as a nutritionist and as an active member of her community, Isabel is convinced that providing access to basic but crucial information about nutritional health and food resources is fundamental to helping ordinary people understand the importance of a nutritionally balanced diet.Her work over the last decade has shown her that information and counseling are key. Working mainly with women and children in recent years, she observes that, "In my experience, more than 50% of malnutrition cases are surmounted by the mother through counseling."
While her medium-term objective is to provide food and nutrition related education to fellow Bissau-Guineans, Isabel's larger vision is one of a more healthy, informed citizenry, better able to engage actively in community and national development, as well as to participate fully in decision-making at all levels. Thoughts on these issues have been preoccupying Isabel for many years, sometimes even pushing her to rise in the middle of the night to write down her ideas. Now a number of these ideas have been gathered together in an imaginative plan of action to be implemented at her "Nutrition Museum".
At the heart of this innovative idea is the development of a popular, museum-like center for study and education about food and nutrition. This museum would be a new type of research center, through which information on a variety of food-related issues, from the history and anthropology of nutrition to food groups and nutrients readily available in Guinea-Bissau, could be widely and attractively disseminated. The center would also undertake basic analysis of national food policy and agrarian issues, principal factors in the country's socio-economic development. This nutrition center is to be named "Bemba", a local word meaning granary or place where one stores good things.
Determined that the idea be different from other more formal research centers, Isabel is concerned that the "museum" contain "user-friendly" exhibitions and permanent displays, and that it be accessible to passers-by, the general public, and specifically targeted social groups in urban and rural areas of the country. An adjacent horticultural space will be planted with fruit trees and other flora, and developed for experimental and teaching purposes. To further complement the activities, Isabel hopes to use this space to set up a specialized library on food and nutrition matters. This library would also eventually cover broader areas related to sustainable, locally-based projects.
One of the poorest countries in the world, Guinea-Bissau became independent in 1974 after an anti-colonial armed struggle that endured for 11 years. The war of national liberation gutted the country, destroying most of the infrastructure and food production capacity. With roughly a million inhabitants now, around 43% of the population is under 15 years of age.Although statistical evidence is hard to come by, the gravity of the nutritional situation prevailing in Guinea-Bissau is indirectly revealed by social indicators such as that the most vulnerable social groups are infants, young children, and pregnant women. Mortality rates show that before reaching age five, 25 children out of every 100,000 die. Of these, 15 die before reaching the age of 12 months.
Weight-for-height studies from the 1970's showed that 22-23% of 5 year olds were suffering from moderate or serious malnutrition. Overall, it is believed that infant malnutrition is widespread today, with ratios rising to as much as 40% in some regions of Guinea-Bissau. Other evidence, and the government's own data, shows that this situation could indeed be worsening, as would indicate the disturbing increases in cases of serious malnutrition, marasmus or emaciation and kwashiorkor.
Furthermore, it has been estimated that 60% of the causes of death are connected to malnutrition and related illnesses such as diarrhea, malaria and respiratory diseases. Other signs of nutritional deficiency are seen in the fact that as many as 74 out of every 100 women in Guinea-Bissau are suffering from anemia caused by parasites and by the enormous amount of energy expended by women, particularly in the rural regions. A high incidence of goiters has also been found in the north and east of the country.
General vitamin deficiency from poorly balanced diets is also attributed to the low consumption of protein-rich foods such as red meat. Traditional food taboos often compound the problem for more vulnerable groups such as pregnant women and infants. Per capita consumption of fish and meat in Guinea-Bissau is thought to be the lowest in the sub-region, especially as the consumption of red meat is traditionally reserved for ceremonial celebrations. With very little purchasing power, most families give priority to the purchase of rice over other nutritional foodstuffs.
An estimated 90% of the population either practice subsistence cereal farming or cultivate food for consumption at home, or barter. Agrarian policies need to be rationalized to ensure and encourage self-sufficiency in national food production.
Isabel's strategy is well developed and multi-faceted. Her immediate priority is to establish a structure to house the library and exhibition space. The site she has chosen is in a rural location of 20 hectares of land, a few kilometers from Bissau. The setting is also key to attracting travelers, as it is situated on a busy crossroads linking the capital to major arteries which lead to the North, East, and South of the country.Having worked in many parts of Guinea-Bissau, Isabel strongly believes that the demands of the fast-encroaching modern world require creative and appropriate communication strategies for the sensitization and education work to be undertaken. She considers that social marketing schemes can be effectively used to attract the attention of people, particularly the young, and to provoke desired changes in their behavior.
Isabel plans to use a variety of social marketing tools to push through her ideas and information. She has observed that people in Guinea-Bissau love "modern" things, an even if the majority are resource poor, rural inhabitants are greatly influenced by, and have a tendency to imitate, the urban world. "If urban citizens begin to develop correct attitudes and behavior", she says, "then this will have a positive influence on rural people." Through her community-based experience with public education and "consciousness-raising" programs, Isabel has noticed that interesting new ideas can be popularized fairly quickly if presented in a compelling and participatory manner.
The core elements of her program, the specialized library and museum exhibition space, will be developed as part of the initial information and educational component of her strategy. The museum will present imaginative and dynamic exhibitions and permanent displays that will include the use of simple audio-visual presentation techniques to stimulate the curiosity of visitors. The displays will cover such aspects as the history and importance of nutrition, the availability and value of local food resources, the transformation of primary foodstuffs, engaging presentations of food preparation, and ways to determine energy and nutrition needs.
The emphasis will, however, be on ensuring that these exhibits and displays are accessible and comprehensible for different levels of understanding in a country where the vast majority of the population is illiterate.
The specialized library on food, nutrition and related issues will facilitate research on such subjects as locally available food resources, conservation and transformation of artisanal and semi-artisanal produce, and preparation of these local nutritional food sources. The on-going research and experimentation undertaken on-site will facilitate training and sensitization efforts aimed at the community at-large. Educational excursions for children and young people will be organized, and more formal training sessions for government cadres and development workers will be initiated as well.
While her target training groups will reflect society in general, special animation and organizational efforts will be focused on rural communities and per-urban populations, particularly children, youth, and women. Decision-makers also make up a special target group to be brought in as allies in the dissemination of important messages and in the facilitation of the center's work.
Isabel is especially keen to focus on the urban as well as the rural milieu, "so that villagers don't think we are targeting them only because they are poor and ignorant." Working in collaboration with NGOs and their grassroots partners, Isabel will ensure the participation of rural people by organizing NGO-sponsored visits and training workshops to the museum. She also plans to touch rural areas by circulating informational materials and by organizing mobile exhibitions which will stimulate discussion around key nutritional issues, particularly those of special value to the health of women and children.
An essential element of Isabel's strategy is to dynamise the normally static approach to learning practiced by more conventional museums. Part of her aim is to create local employment and to make the site more productive through horticulture and animal-raising schemes. In the long-term, Isabel hopes to add other attractions to her center, including a hostel which will provide lodging for workshop participants, and refreshment stands to attract visitors and passers-by. The overall intent is to contribute to a healthy, restful and attractive environment conducive to learning and reflection, and in doing so to help overcome the health and nutrition problems of her society.
One of five children, Isabel and her siblings were brought up under the influence of her grandmother, a strong woman from a family whose women have always had strong characters. Indeed, Isabel's own mother had a secondary school education - a vary rare achievement even for men under colonial rule. As a serious and serene child, Isabel was already teaching the household employees to read by the time she was 8 years old. Brought up in a strict household, however, Isabel's only escape as a child was through church-related projects, which she claims initiated her early into the planning and organizing of activities.On finishing secondary school, and swept up by the post-Independence euphoria, Isabel decided to move out from her "controlled" home environment, and work to build her country. She thus found herself head of the department of national education at the young age of 17, in charge of teacher training. Later, after starting to study medicine at Dakar University, Isabel changed her vocation from medicine to nutrition and was subsequently awarded a scholarship to study in Brazil.
Her experience in Brazil, Isabel says, had a very important influence on her. The warmth of the Brazilian people helped draw her out from her shell while she studied with a politically aware, idealistic group of mostly women. In addition, this new and exciting course allowed her to undertake training in social nutrition in a "favela" called Péle Porco in Salvador, reputed to be the most dangerous at that time in Brazil.
Participating in the student movements, Isabel became interested in agrarian and land reform movements, and was invited by an elected member of the general assembly to take part in a debate in Brasilia on agrarian reform and the problem of nutrition in Brazil. These student activities thus strengthened her resolve to work for the improvement of social conditions among her people at home.
Returning to Bissau in 1986 as the country's first nutrition specialist, Isabel worked within a government department that was unreceptive to her new dynamic nutritionist's approach to public health matters. With credit to her motivation and perseverance, Isabel was able to persuade the Minister in charge to create a Nutrition Unit in 1990, of which she was named the head.
Since then, Isabel has strived to build up the Unit with very limited resources, using a different approach which stressed training and sensitization work. Her efforts later had a major influence on the development of an Integrated National Plan on Nutrition.
In 1991, Isabel was one of six founding members of the Association for Research and Alternatives (Alternag), one of the first legally registered non-governmental organizations in the country. Alternag's objectives are to help develop, through participatory research techniques, alternative solutions to social and economic problems facing the country, and to help bring about an informed citizenry capable of participating in the great decisions now facing the country.
During a trip to Switzerland a few years ago, Isabel was greatly stimulated by a visit she made to the Nestlé Food museum, which provides public relations and educational displays along with Nestlé food products. Seeing in this museum the kernel of an idea worth building on, Isabel has imagined how effectively similar techniques to those she observed in Switzerland could be improved and adapted to fit the context and needs of her own country.
Favoring a more dynamic approach to her work than that of the more clinical methods practiced by her Ministry colleagues, Isabel is now ready and committed to putting her more imaginative ideas into action.