Community-focused programs in Nepal

Enjoying the fresh air while attending a nutrition workshop in Balthali

Hello again, this is Ellina Wood. As the summer is quickly fading and my internship is coming to an end, I have been reflecting on my time spent in Nepal over the past three months. I have the great fortune to complete an incredibly fulfilling and rewarding dietetic internship with Helen Keller International (HKI) on Suaahara II: a project that has been implemented in Nepal since 2016 and partners with local stakeholders to address the health and nutritional status of women and children across 42 key districts.

Green leafy vegetables, pulses, and eggs to be shared at a swasthya aama samuha (health mothers’ group)

I agreed to the internship with the premise that I would engage in cooking demonstrations, analyze the nutrition content of existing recipes, make recipe recommendations to bolster the micronutrient profile, and write success stories to be shared in the annual report. Although some of my time has been spent on these objectives, a larger aspect of my internship has been spent on other tasks. While collaborating with a local dietitian and the Ministry of Health and Population (MoHP), I conducted literature reviews to develop a new national nutritional management protocol to aid in the recovery of moderate acute malnourished (MAM) children using nutrient-dense foods in place of imported formulated supplementary foods. Whilst there is currently no international guidance that endorses the use of local foods for the treatment of MAM, emerging evidence suggests that providing local foods may be comparable to formulated supplementary foods for recovery rate and weight gain so long as quality sources are used for the appropriate duration. In fact, the World Health Organization (WHO) is in the process of developing an international guideline, focusing on locally available food, for the prevention and treatment of moderate wasting in children presenting at health facilities with acute illness. It is the MoHP’s goal that any learning generated through monitoring and evaluation of the rollout of the new nutritional management protocol will be a valuable addition to the evidence base for the WHO guidelines.

Materials used during growth monitoring and promotion pilot testing

I also provided technical support to my team as they conducted pilot testing for an upcoming revision to Nepal’s Growth Monitoring and Promotion (GMP) guideline. The field-testing process meant that I had the opportunity to travel to different regions across Nepal to meet with the municipality-level governments and to support my team in training/ observing health care providers at Outpatient Therapeutic Centres (OTCs) and Non-Outpatient Therapeutic Centres (non-OTCs). Following each GMP pilot test, my team conducted exit interviews and focus groups with participating health care workers and mothers. Our observations and the following discussions ultimately guided our revisions for the GMP protocol and model recommendations for local and national government-decision making. Being able to travel to several districts not only gave me the chance to engage in monitoring and evaluation exercises with various government agencies and communities but it also allowed me to gain a deeper understanding of the region-specific customs and beliefs (trying new foods and getting glimpses of new, breathtaking views was a bonus!). I gained knowledge about the value of adaptability, how to effectively communicate in a culture that differs from my own, and how to be receptive when my worldview is challenged.

Although it is difficult to leave, I do so knowing that I am far better equipped to handle public health challenges. Overall, my internship has left me feeling inspired to continue working in the global health space.


From one of the world’s oldest mountain ranges to the world’s tallest

Ellina overlooking the Annapurna mountain range from the top of Poon Hill
Ellina overlooking the Annapurna mountain range from the top of Poon Hill

Happy summer! My name is Ellina, and I am in the MPH/RD program at Gillings (recent MPH grad!). For the Public Health Nutrition Management Field Experience and Advanced Nutrition Experience portions of my dietetic internship, I have the great privilege to work with Helen Keller International (HKI) on Suaahara II: a $63 million USAID-funded project in Nepal. HKI partners with the Government of Nepal, UN agencies, and six consortium organizations to implement a multi-pronged project that aims to improve the nutritional status of women and children who fall within the first 1,000 days.

Over the past few weeks, I have been working with a dietitian to write a protocol on how to incorporate affordable, locally available, and nutrient-dense foods for moderate acute malnourished children receiving treatment at Nutrition Rehabilitation Homes. Working on this national report has given me the opportunity to sit in a meeting with the Ministry of Health and Population of Nepal to observe and participate on national nutrition decision-making processes.

During my stay a political shift has occurred and, with the success of Suaahara II depending on the support of Nepal’s government, it means that HKI must build relationships with the new governmental parties. In the following weeks, I will support the nutrition team as we visit villages to discuss the importance of growth monitoring and promotion (GMP) guidelines at the municipality level. In the presence of the municipality’s health section chief and sub section chief, we plan to observe health care professionals while they assess childhood malnutrition and discuss the feasibility of following the newly proposed GMP guidelines. In addition to visiting the health facilities, I hope to make connections with the families that we hope to serve by actively engaging in cooking demonstrations and providing support to mothers during their children’s birth milestones.

I am fortunate to have the opportunity to visit villages before the monsoons prevent travel to areas outside of the Kathmandu Valley. Monsoon season means hot, humid days with lots and lots of rain that can cause landslides and road blockages, making it near impossible to travel. Luckily, I will get the chance to visit places outside of the Valley for work and HKI has been very gracious in allowing me to take a short recreational trek. I know that trekking during this time means blankets of clouds are likely to cover the mountains and other vantage points. While I am happy to see the greenery of the hillside, I am beyond ecstatic to see the clouds break away from the Annapurna mountain range to see a glimpse of my first proper mountain — in Nepal, a mountain isn’t considered a mountain unless it’s over 7,000m (22,965ft) and everything beneath that is a hill.

I’m not sure what all this summer will bring but I look forward to continuing her work with HKI, learning from the locals in the community, and eating as much dal bhat that my stomach can take.

If there’s no momo, then it’s a nono and we won’t gogo. Produce being dried in a village. Boudhanath Stupa under the night sky. Rice fields in Pokhara.
(L-R) (1) If there’s no momo, then it’s a nono and we won’t gogo, (2) Produce being dried in a village, (3) Boudhanath Stupa under the night sky, (4) Rice fields in Pokhara.