Speech Cindy bij presentatie van de boekjes met voedingsrichtlijnen

Deze speech is gehouden tijdens een presentatie die ik samen met Naa Ashiley Van der Puye heb gegeven op 21 april 2005 in het gebouw van de UNDP in Accra.

De presentatie was gericht op het verschijnen van het educatie materiaal op het gebied van leefstijl en voeding die voor patiënten, familie en verzorgers en gezondheidsmedewerkers zijn ontwikkeld. Genodigden waren belangen organisaties voor mensen die leven met HIV/AIDS, gezondheidscentra en ziekenhuizen, lokale, nationale en internationale NGO's.

De locatie was beschikbaar gesteld door de UNDP omdat mijn deelname aan het Leadership for Development Programm van de UNDP heeft bijgedragen tot het realiseren van dit project.

Bekijk een aantal pagina´s van het ontwikkelde educatiemateriaal door de PDF bestanden te downloaden (klik op de plaatjes onderaan de speech of op de links in de kolom rechtsboven). Om de PDF's te bekijken, heb je Acrobat Reader nodig (zie link in de gele kolom).

De speech

Introduction my myself
First of all, I would like to introduce myself to the people who haven’t met me before. My name is Cindy Noordermeer, I am from the Netherlands and I am a dietician by profession. Almost two years ago, I came to Ghana to work as a volunteer with Naa Ashiley at the International Health Care Centre.
This was not the first time for me coming to Ghana. In 1999, I conducted my traineeship with the University of Development Studies in Tamale. And the decision to come back to Ghana was based on a wish to get more experience on living and working in an African country. And I really hope that this experience forms a fundament towards a professional future in the field of International Health.

Motivation for this project
Mister Kofi Nyarko and Yaw were the first patients I met in my life, who where living with AIDS at that time. And immediately I met them, I realized the importance of nutrition in the care and support system for people living with HIV/AIDS. Both patients faced all the food related problems you can imagine. Yaw was the most wasted person I had ever seen in my life and I was surprised that he was even still alive. He was running diarrhea day and night and his appetite was extremely low. His mouth was full of fungal infection and sores. He had no money to buy food.

Mister Kofi Nyarko was also very wasted. Lack of exercise made him fully constipated. He was a Fanti and continued eating white bread and tea, which did not really contribute to the solution of the problem. The constipation made him nauseous. The wife finished all the money on buying expensive foreign foods, what she thought was more healthy. The Gap
Within the care and support programs, there seems to be a gap where nutrition is concerned. is a gap (although more and more is done by for example OIC and CRS).

Fresh in Ghana, I tried to put all different kinds of structures in place in order to fill this gap. But realized that I will be in Ghana for a relative short time and will again leave a gap behind.
I went round from institution to institution, looking for practical information on nutrition and HIV/AIDS in Ghana to be used in the clinic. But at that time, I could not find where I was looking for.

How to fill the gap
Almost half a year later, the idea came up to develop something by ourselves. A practical guideline adjusted to the system and close to the understanding of the people. In order to reach the people from the rural area’s coming to the clinic, I wanted to gain experience about life in the rural areas. My interest in the rural areas made me meet somebody who became interested in my plan. I taught if I can develop something fitting in the rural area’s, it will also fit the urban areas. Linking his organization in the north with the clinic in the south and in this way reaching both area’s seemed a very good idea.
All nice ideas, but after a half year volunteering, my pockets became empty and I had to find a solution for getting means. Getting funding was also a whole story all together, I almost taught that my idea will only be an idea forever...but this is where the LDP came in.

Role of the LDP
Luckily for me, I was introduced at the UNDP and could take part in the Leadership Development Program in Elmina. A program existing of three trainings between November 2003 to April 2004. A training which inspired me a lot.
And the goal is to create new type of leadership and develop a breakthrough mentality that is needed to generate a necessary change in local leadership approach to combating the HIV/AIDS menace in the communities, institutions and workplace. The training is carried out in many African and Asian countries and has led to breakthrough initiatives in the fight against HIV/AIDS.
I am grateful that I could take part. I applied the skills on my own level and created opportunities for my own initiatives. A message I take along since then is that when you are inspired, you inspire others and when others are inspired what is impossible becomes possible. The inspiration I got from the UNDP and also from the work spirit and commitment of Naa Ashiley made me inspire others. I went to the Netherlands and organized a fundraising campaign for the realization of our idea. And although I faced many breakdowns as a manager of my own project, I was committed to accomplish my initiative. Thank you UNDP.

Constraints
Before I will tell you more about the breakthroughs and our result, I would like to share my constraints with you. What is always nice to do afterwards.
Focusing myself on my own project is something I find very difficult. The problems I saw around me, made me start all different kinds of side-line projects and activities. The number of people facing problems is enormous and I wanted to carry everybody's load. And in the end, there was only small time left to work on my main project.

In total I spent 7 months in the Upper West and I am very glad to have had this experience. But working over there was extremely difficult. Comparing the care and support system in Accra and Wa, the difference is enormous. Despite the effort of some organizations, the care and support is very very poor. Like in Accra, I was touched by the problems faced by people living with HIV/AIDS and tried to do all different kinds of things to help them. I cycled to layed-back villages where, due to marital tradition the virus spread within the family and sometimes more than 15 orphans are left behind. The high stigmatization, poverty and lack of medical care made me see many people dying of the disease. I really made a good start with the project. I mobilized PLWHA’s themselves to contribute towards the content. Because I wanted to develop a guideline together with the people who are going to patronize it.
But I involved myself too much in the personal problems faced by the members, that I tried to help them carry their load, and my own nutrition project lost its priority for a while.

Coming back to Accra, people asked me about my main project and I realized that when I want to achieve something, I have to focus me on it. I decided to come back to Accra, where there is more access to information and support.
I came back to the clinic where I integrated the knowledge from the north into the nutritional guideline. Accomplishing a material for people in the urban and rural area as well.

If I look back at the two years behind me, I have to laugh. I really taught, I knew a lot. But if I am honest, what does a young obruni in the complex world of HIV/AIDS in Ghana really know in the beginning. I made many mistakes, and I went through a process of trusting the wrong people, having high objectives and not knowing exactly how and where to pass. I realize that mistakes I made out of ignorance made me insecure about my project, my result.

I was surprised to receive all the positive reactions afterwards, what made me decide to print higher number and let more people benefit from it. If I had been so sure about myself and could have kept my focus during the whole project, I would have involved more institutions.

Results
A breakthrough is that we are standing here, with a finished a practical nutritional guideline based on the Ghanaian traditional foods and culture. We printed 3000 copies and created possibilities for reprinting. We also finished a second booklet about the aspects of Positive Living in general.
The first booklet is a guideline that could be used in health settings with or without professional nutritional staff. In the IHCC for example, we don’t have a permanent nutritionist yet who will be continuously available. But the counselors and/or ward assistant can implement nutritional support by using the guideline.

The content is based on already existing theory and research, I have translated this into practical materials for the field. The most important message is:

Eating well is important for everybody, but especially for people living with HIV/AIDS. Poor nutrition is very common in people with HIV/AIDS. Poor nutrition can be seen as a vicious cycle; with weight loss leading to decreased immune function, causing more infections, resulting in poor intake and digestions and more weight loss.

A good diet can help prevent the cycle of weight loss, help maintain and improve well-being, and contribute to the quality of life. Officially there is no special diet for people who are HIV positive, like there are diets for diseases like diabetes, kidney failure etc. Our goal is to teach people the importance and the basics about eating well and enjoying eating. Advices for maintaining weight and minimizing the common eating problems of people living with HIV/AIDS. Educating people how to eat well can help them feel more in control of their disease and their life.

More and more information is becoming available about the positive effect of certain food items and nutrients, that have positive effects on the immune system. A very interesting area, especially for areas where medication is not available. But going into this area is going on scientific ground, and is an area for future work.

The second booklet was very spontaneous. Due to the high illiteracy and stigma, I used metaphor to explain information in the Upper-West. The motorbike is common over there. I had a motorbike myself in the north and drove with my friend all the way from Wa to Accra. Sitting on the back of the motorbike I got the idea to develop this booklet on positive living, based on the way people can look down upon themselves. I wanted to draw them in a beautiful traditional way, to dispute this negative attitude.
I suggest to go together through the booklets together.....

Future the booklet
We advise to use the booklets as educational materials in health centers.
We printed 3000 copies of the nutritional guideline and 1000 copies of the one about positive living. And we would like to donate the in the following way:
Main treatment centers:

1000 copies to the Korle Bu Hospital...thanks to Arjan Hogewoning
500 copies to Gavernoty Hospital in Kumasi.
200 copies to Agomoya...thanks to doctor Richard Amenyah.
200 copies to Anastasia Navele... for the Upper West Region.
300 copies to the Ghana AIDS Commission, for all the interested organizations.
10 to every support association
5 copies to all the clinics and institutions working in the field of care and support

We stimulate dissemination of the guideline, and stimulate reprinting. The rest of the health centers can apply at the IHCC.
Although very knowledgeable people involved themselves in the project, we have already received advise for adjustments for reprinting. We would really like if everybody who came here will give their advises for adjustment for a possible second version. Please, leave your information behind, if you are working in care and support area. Probably, within one year, I will come back to Ghana and contact you for this information. In this way we can work together towards a maximum result.

Personally
Also personally, this project is just a beginning. By next month, I will go back to my country and start a two years master in International Public Health. I really hope you will hear from me in the future and wish everybody who is fighting the pandemic in their own way all the best. From the Netherlands, I will continue spreading the message.

Thanks to:
NACP/GAC - UNDP (Robert) - Yamens (Edmund Opari and Mister Lamptey) - IHCC (Naa Ashiley) - Anastasia Navele - Donors - Positive Living People - Apollo.

Het Nutrition booklet:

Het Positive living booklet: