Author Archives: ci2113

Baseline: Day 2

Today we continued surveying villages in the Svay Antor district. Our enumerators acted like total pros, even though this was only their second day in the field.

I sat in on a 24 hour recall in the morning and a survey in the afternoon. The village where the recall took place was stunning. There was lush greenery everywhere, gorgeous views of rice fields, and a beautiful temple that we paused to admire.

Walking through a village in Svay Antor on our way to a 24 hour recall.

The path leading to a temple.

News of our arrival in the village spread quickly, and people kept coming into the house to look at us foreigners. We experienced a range of responses, from surprise, to fear (especially on behalf of the children who had probably never seen foreigners before), to warm smiles, to nosy grandmothers wanting to know if I was single or married!

This visit was the first time I stepped into a house, which was fascinating after only sitting under houses yesterday and in Kampong Chhnang. I finally saw what is under the roof of a typical (n=2) house: a big room with rolled up bamboo mats that are used as beds, and a TV. The TV surprised me given how few possessions people have, and how undeveloped the electrical infrastructure is in the region.

Being inside the house highlighted another way in which Cambodian culture differs from North American culture. In Cambodia, everyone sleeps together in the same room, which is also the living space during the day. This contrasts with the typical family dwelling in Vancouver (and probably most of the West) where almost everyone has their own bedroom, which is used mainly for sleeping.

We went to another village in the afternoon. I spent part of the time there sitting at the village chief’s house, which was the hub of a lot of action. Our anthropometry and hemoglobin analysis teams were set up at the chief’s house, so every mother and child that we surveyed came over. Today was the first day that I saw visible signs of malnutrition. The children we’ve seen in the past few days haven’t demonstrated any clinical symptoms of malnutrition. Today, however, we saw children with light, almost blond, hair. This is a sign that their diet is lacking in protein.

The supervisors also used the village chief’s house as a home base, so I observed them troubleshooting as problems arose (I will be writing a post about the types of problems we’ve encountered as baseline continues).

On top of all of that, a few people were bagging rice that had been harvested recently.

Bagging rice that is still in its husk.

But the kids were most excited about the arrival of the ice cream moto.

Trying to decide what to get from the ice cream moto!

Tomorrow we’ll be going to a health center to watch the first day of blood collection. This is a large, important (and expensive) undertaking, so hopefully it goes smoothly.

Baseline: Day 1

We left Phnom Penh early this morning and arrived in Prey Veng before lunch. Our task today was to interview women from a village in the district of Svay Antor. We stopped at the home of the village health volunteer to give the enumerators their list of houses to visit for the day, as well as directions.

Working with the village health volunteer to assign pre-selected houses to each enumerator.

The volunteer then took us into the village. where each enumerator managed to get one survey done before lunch, and one after. The goal is to for each enumerator to complete four surveys per day, which should be feasible since we won’t be traveling long distances every morning like we did today. Also, as baseline continues, the surveys will hopefully take less time to complete as the enumerators become more familiar with the questions and corresponding instructions.

Today was also the first time we tried our new and improved 24 hour recall. During the test survey, it was a series of questions incorporated into the survey. Today it was done as a separate event with a different team of enumerators. Bowls, spoons, and cups of varying sizes were purchased before our trip to help women measure their consumption. This turned out to be very helpful, as women could compare their own dishes with the sample ones to give us a better idea of how much they ate in the past 24 hours.

A woman compares her dishes to those provided by the enumerator during the 24 hour recall.

Though it is only 8:30 pm, it’s bedtime. The days are going to be long and hot, and with a 6:30 am departure time, I’m anticipating many early nights. I’ll leave you with the following picture:

A handful of the 20+ cattle that walked by the houses this afternoon.

Watching these cattle being herded down the village road definitely provided my first surreal “where am I?” moment. I’m sure there will be many more to follow.

An Afternoon at Central Market

Today I spent the afternoon on personal preparations for baseline, and I’m not talking about anything survey-related. I spent the afternoon purchasing non-perishable food to bring with me to Prey Veng.

Before I came to Cambodia, I never thought of myself as a picky eater. There are a few things I don’t like (to say I dislike ketchup is an understatement), but overall I can usually find something to eat. Growing up in Vancouver meant that I was exposed to multicultural cuisine from a young age. I love curry, dim sum, and sushi. My pre-travel research highlighted the prominence of fish, rice, soup, noodles and vegetables in the Cambodian diet. I love fish! I love rice! I thought I was set.

My first trip to Central Market in Phnom Penh was paradigm-shifting, to say the least. It could also be described as an olfactory assault. Before I even noticed what was for sale, I noticed how it smelled. There is an entirely unfamiliar, pungent odor that I now associate with Khmer food. Apparently I have an aversion to fish sauce, which is used in most dishes here as an easy way to enhance both the nutritional value and flavor (and odor) of food.

Outside of Psah Thmei, or Central Market

I forced myself to take in the scene at the market using my eyes rather than my nose. The offerings were more diverse than I expected. There were a lot of things I recognized, but even more that I didn’t. I had expected fish, but I hadn’t expected so many types of fish, prepared in so many different ways. Very few of the vegetables and fruits looked familiar. (I have since tried mangosteen and dragon fruit– yum!). Food that I thought I recognized turned out to be something different. Those hard-boiled eggs weren’t the hard-boiled eggs I’m used to – they were actually hard-boiled eggs with animal fetuses inside, for a little extra crunch. Things that I don’t even consider to be food were sold as food (see below).

Some of the offerings at Central Market

Left: Skewers of meat Middle: Boiling the skewers Right: Grilled Squid

Top left: Several types of fish available for lunch Bottom left: Roasted birds Right: fish and meat to purchase for home

I left the market with the few items I came for: some fruit and a tupperware container.

Left: fruit vendor Top right: dragon fruit Bottom right: mangosteen

Tomorrow I’ll stock up at Lucky Market, which sells Western food. On my shopping list: peanut butter, crackers, nuts, and dried fruit.

On my tuk tuk drive home from the market, I tried to process what I had seen and smelled. However, I ended up with more questions than answers. I wondered if a Cambodian person would have the same reaction to a Canadian market as I did to a Cambodian market. What foods at Granville Island would seem foreign or unappetizing to them?

I also wondered when the Western diet became so limited. In North America, it’s extremely rare to eat insects. It’s also unusual to eat all the parts of a fish (although I have seen this done – but usually when fish is on the menu, a boneless filet arrives at the table) or the organs of an animal (again, there are exceptions to this rule). When did we stop eating all the parts of an animal? Why did this happen? Is it because our society, as a whole, is affluent enough to be more selective?

Do Cambodians eat a greater variety of animals and animal parts for nutritional reasons, such as a lack of available Western sources of protein? Or do they eat these things because it’s what they’re raised to eat, so these foods are “normal” to them and are consumed without hesitation?

Protein-rich insects for sale

During my undergraduate studies at Barnard College, Columbia University, I took a course entitled “Edible Conflicts: The History of Food.” We discussed how food has shaped society from pre-historic times to the present. I’ve seen examples of this here in Cambodia, from the way people sit around a food stall at a market to enjoy their food and chat with the chef and other patrons (rather than going to a cluster of tables and chairs the way one might at a food court), to the way our survey defines members of a household as people who eat from the same pot in one house.

Eating lunch at the vendor's counter

But now I’m also trying to understand the Cambodian diet from a nutritionist’s perspective. After all, that’s what Fish on Farms is doing. We’re trying to take the Cambodian diet, which has developed along its trajectory due to historical and geographical conditions, and effect change in a culturally-acceptable manner to improve the lives of Cambodians. That’s why we picked aquaculture over chicken coops. Chicken and eggs don’t feature prominently in national diet, whereas fish is front and center.

I’m looking forward to observing several homes in Prey Veng during baseline to try to piece together my understanding of the Cambodian diet by integrating both a sociocultural and a nutrition perspective.

Countdown to baseline: 2 days!

Household Selection

While we were out in Kampong Chhnang on Friday, other important developments were underway for FoF: our household selection was completed. This means that we now have 900 households in Prey Veng who are committed to being part of FoF.

Certain criteria had to be met in order for households to participate:

  • The woman has to live at home year-round. Women who leave for part of the year to work in garment factories or rice fields will not show any changes in nutritional status, as they will not be home to benefit from our interventions.
  • The household has to have adequate land for planting fruit and vegetables (HFP group) or digging a pond (HFP + aquaculture group).
  • The women must have at least one child under the age of five.
  • The houses must have a similar socioeconomic status (SES). This is particularly important for our control, or comparison, group.

The countdown to baseline is on: 3 days!

Test Survey

Preparations are underway as the countdown to the baseline survey continues. Yesterday morning we checked off one of the most important “to-do”s on our pre-baseline checklist: the test survey. After a week of training, our enumerators had the opportunity to put their new skills to use. This also gave us a chance to work out any “bugs” in the survey.

The day began bright and early, as two vans carrying 20+ people departed from HKI’s office in Phnom Penh to head to the province of Kampong Chhnang. Although FoF is taking place in the province of Prey Veng, Kampong Chhnang is closer to Phnom Penh, and was thus better suited for a day trip.

Our first stop was at the Longvek Health Center, where we picked up iron and folic acid tablets to distribute to the households we were going to visit.

Outside the Longvek Health Center, our first stop in Kampong Chhnang.

Our next stop was at the home of the village chief. We informed him of our plans to meet with different households and ask them questions about nutrition and health. He directed us to the house of the village health volunteer, who would be able to assist us in identifying suitable households to visit.

The final stop for our van was at the house of the village health volunteer. The second van went to the next village to find more households to survey. Outside of the volunteer’s house, the enumerators set up stations to conduct anthropometric measurements and blood analyses. Then the volunteer took us to different houses to meet with women and their families. As an incentive, every woman who agreed to speak with us received a bag of detergent.

Bags of the detergent we distributed as an incentive to participate in the test survey.

The first house we visited was the home of a husband and wife whose three daughters were present. Two of the daughters lived in adjacent houses, while one still lived at home. We interviewed the two daughters who had young children.

The enumerator going through his list of questions with a mother and her child.

As the enumerator worked his way through the survey, I had time to observe the family’s home. Houses in Kampong Chhnang are very different from houses in Vancouver! The houses are all raised so that the “house” part is actually the second story. Underneath the house is the area where most family activity occurs. There are cots, tables, and chairs underneath, taking advantage of the shade the raised portion of the house provides. The cooking is done in a separate area nearby on the property. The kitchen I observed consisted of a cupboard and a heat source. Most families eat from the same pot. This particular family also raised chickens who roamed the yard freely.

The kitchen, separate from the rest of the house.

The kitchen at the daughter's house, which was behind the parents' house.

Chickens that the family raises on its property.

The question portion of the test survey went fairly smoothly. One of the challenges was that the infant wanted breast milk before his nap. However, women aren’t comfortable breastfeeding in front of strange men. Unfortunately, it was hard to find enough female enumerators who are able to leave their homes for the 2+ weeks of baseline, so the majority of our enumerators are men.

The final portion of the test survey involved bringing the women and their children to the village health volunteer’s house to get measurements and blood. First the women were weighed, their height was measured, and their mid-upper arm circumference (MUAC) was recorded.

Recording a mother's weight

...her height

...and her MUAC.

Then their children went through the same process. Most of the small children cried when they were placed on the length board! It must have looked like a scary contraption to them.

Recording a girl's weight

...her length (she was not happy)

...and her MUAC.

Finally, the women and children had their fingers pricked. A drop of blood was placed on a slide that was fed to a machine to analyze the hemoglobin content of the sample. Based on the results, many women were given iron and folic acid tablets.

Pricking the mother's finger to draw blood.

Analyzing the blood sample.

The day concluded back at the HKI office in Phnom Penh. Everyone gathered to discuss their experiences and raise any questions or concerns. A few questions were further clarified on the survey, but overall the results of the test survey were encouraging. Our enumerators are now confident and prepared to head to Prey Veng for baseline next Wednesday!

Introducing FoF!

FoF was formally announced in a press release by the International Development Research Centre (IRDC) on June 20, 2012. You can view the full text here:

www.idrc.ca/EN/Media/Pages/CIFSRF-june-release.aspx

We’re thrilled to be one of the 6 projects chosen this year to receive funding from the Canadian International Food Security Research Fund (CIFSRF), a $62 million fund established with the goal of improving food security in developing countries and providing research opportunities for Canadian scientists.

The Vancouver Sun gave an excellent overview of our project. Some of the key points include:

  • The magnitude of our project – it will cover 900 households randomly divided into three groups: a homestead food production (HFP) group that will grow nutritious fruits and vegetables, an aquaculture group that will raise fish to consume and sell (in addition to HFP), and a control group.
  • Our commitment to ending hidden hunger – nutrient deficiencies that aren’t obvious to the naked eye. In rural Cambodia, these nutrients are essential fatty acids, protein, Iron, Vitamin A, and Zinc. When these are lacking in sufficient quantities in the diet, pregnancy is risky to both the mother and the fetus, and children face several challenges as they grow.
  • The gender element – many of these households are run by women, and helping them grow diverse, nutrient-rich plants and animals should improve their health and economic situation, which will also benefit the entire household.
  • The biggest expense – transporting blood samples for analysis to see if our interventions have had an impact on the nutritional status of the households we are studying. Measuring changes in nutrient levels in the blood before and after the project will provide concrete evidence that our interventions are worth investing in for future development.

You can find the full article here:

www.vancouversun.com/health/researchers+tackle+hidden+hunger+rural+Cambodia/6838343/story.html

Getting Started

Welcome to the Fish on Farms blog! This blog will be chronicling the very exciting Fish on Farms (FoF) project, which is being jointly conducted by the University of British Columbia (UBC) and Helen Keller International (HKI) in the Prey Veng province of Cambodia.

First, a brief introduction to your blogger over the next few months. My name is Carly Isman, and I am a 4th year student in the Faculty of Land and Food Systems at UBC, studying  Food, Nutrition, and Health. I’m in Cambodia from June through August to cover everything FoF-related, from press coverage to our baseline survey, which is coming up very soon! For those of you with shorter attention spans, I will also be tweeting.

In the short week that I’ve been here, a lot has happened. Most importantly, I met Dr. Christopher Charles and Ms. Kyly Whitfield, two people from UBC who will be here in Cambodia to work on the project and who have already been hard at work to get FoF organized. I attended my first Nutrition Working Group meeting, where I got to hear about several projects relating to nutrition that are currently underway in the country. I’ve been to HKI’s offices twice to meet the people who are working on FoF and to hammer out the details for the baseline survey. On top of all of that, I’ve been exploring Phnom Penh and learning about the city’s charming idiosyncrasies.

FoF has been in the press twice in the past week, which we’re very excited about! The International Development Research Center announced our project in a press release, while The Vancouver Sun wrote an article about our project. I’ll be discussing these in more detail later, but right now it’s dinner time (both for me, and for the mosquitoes who will inevitably eat me while I’m eating).