In Emma's Shoes

CEBU, Philippines - As friends shrieked at dolphins flirting with onlookers from a boat cruising along Tañon Strait, Emma had to answer a mobile call from her barangay health worker in Cebu. Thanks to clear and efficient mobile signals in Bais City and right there in the middle of the sea where dolphins play with tourists, Emma had to troubleshoot a problem that her health worker had with Operation Timbang.

So what does it take to be in Emma's shoes? You would have to be in the truth-telling business, you would have to be in the life-saving business and you have to be willing to operate business in the spirit of compassion.

Tracking down malnourished children in Cebu City's population of 899,042 is something that requires performance much more than desired.

As nurse supervisor of the City's health department handling 32 barangays and Cebu City's nutrition coordinator handling five health areas, Emma Gaviola has to be patient with apathetic mothers, understanding with overburdened and underpaid health workers and creative to get the job done under stringent resources. What moves Emma is that she values the nutritional levels of Cebu City children. Her goal is to reduce malnutrition levels in Cebu City to one percent.

Since her stint as nutrition coordinator in 2010, there was a decrease of malnutrition prevalence among underweight and severely underweight children from ages 0 to 71 months from 4.3 percent in 2010 to 3.19 percent in 2011. Meaning from four malnourished for every 100 children in 2010, it went down to three malnourished for every 100 in 2011.

Reducing malnutrition prevalence to one percent takes a lot of truth-telling because there is no way that growth and nutrition levels can be faked or manipulated. Anthropometric or growth monitoring in the country are done with the National Nutrition Survey of the Department of Science and Technology, the health center or facility based growth monitoring and the Operation Timbang Plus that is done every quarter of the year. The annual mass weighing of all pre-schoolers 0 to 71 months (or five years and 11 months) old enables nutrition coordinators to identify and locate malnourished children because it measures weight for age, height for age and weight for height These now become the basis for nutrition planning at the local management level, basis for evaluation of local nutrition programs and basis for prioritization of assistance.

Weight of Compassion.

Apparently the Operation Timbang is not a simple weight issue. It takes the spirit of compassion to stay focused and take possession that reducing and eliminating malnutrition is a life-saving job. Parents need to know the nutritional levels of their children before anything dismal happens and if their children do get sick, checking on nutritional levels is the first line of defense.

Life saving comes with prevention, that is, raising consciousness and promoting awareness on breastfeeding even telling mothers the truth that no amount of milk formula promises to increase intelligence of children. Life-saving because just like lighthouses that spare ships from menacing structures and obstructions at sea, nutrition coordinators see it expedient to move mothers to have their children administered with Vitamin A supplementation and to cook nutrition-based menu in the home. The problem, Emma said, is that most mothers are apathetic. She finds it frustrating, that in mountain barangays in Cebu that are supposedly the vegetable baskets in the city, these have the most malnourished children. Mothers in the city are another thing, they cannot seem to keep their children away from fastfood and do more home cooking.

In steering parents and guardians to behavioral change, Emma launched creative ways for barangay health workers to hold the Pabasa Sa Nutrition, a group reading activity for mothers, The Pabasa is suppose to educate mothers on nutrition but most housewives and mothers would rather stay home instead of listening to the Pabasa lectures. Moms would rather buy a bucket of fried chicken instead of cooking vegetables or serving fruits for dinner. Wherever there is opportunity, Emma dispatches barangay health workers to day care centers where they can enjoin mothers to participate in the Pabasa while waiting for their children. Cebu City is a third-time awardee of the Pabasa Award.

The business of compassion is especially crucial when operating in stringent resources. The Operation Timbang Plus requires the use of standardized height boards. Barangay health centers are supposed to fabricate and reproduce height boards but budget limitations have made it difficult to faithfully comply with the height board requirement. So how do you measure height for age? Emma said barangay health workers use steel tapes to measure height. Besides, height boards are just too cumbersome, heavy and impractical to bring when trekking to mountain barangays. Fastidious about precision of measuring nutritional levels, Emma has been pushing her way arranging for audience in barangay council meetings if only to convince officials to allocate budgets for the fabrication of height boards for their health centers. Afterall, getting children in the city to be nutritionally nourished is a truth-telling and life-saving business. Sadly local executives are remotely aware that the purchase of height boards is a truth-telling and life-saving endeavour in improving the nutritional status of children and as basis for assistance prioritization.

In her barangay clearance, NBI clearance, GSIS cards and passports, Emma is Piladelfa Sanchez Gaviola. The simplicity bears the simplicity she gets things done. The Operation Timbang requires the filling up of several forms by way of standardizing measurements. While the forms are not always available, Emma visits or calls the National Nutrition Council office just to get forms and beat deadline -- what the weight of compassion is all about.

What Emma finds fulfilling about her job is that each day, a malnourished child is saved from having to eat the wrong food. That fulfilment is worth missing the fun of flirting and frolicking dolphins. Do you have what it takes to be in Emma's shoes?