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What if doctors could prescribe seeds?

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Guest blog post by: Julie Carney and Jessie Cronan of Gardens for Health International

When a worried mother in Rwanda brings in her severely malnourished child to a health clinic for care, she is provided with emergency food aid--a sticky peanut butter and milk powder paste - and sent home. She might come back to the clinic for more when it runs out, and, if she's lucky, a nurse might tell her to "feed her child better," but that's it. She is dependent on the system and disempowered both as a patient and as a caregiver. But what if that mother could get another prescription, one that would also give her the resources to feed her child better over the long-term, one that would give her information and education, as well?

Malnutrition is limiting the potential, and often cutting short the lives, of 165 million children worldwide. It has wide-reaching and devastating effects on health, economic growth, and human capacity, and is among the most pressing and pervasive public health challenges facing the global community today. And we are learning, often the hard and costly way, that food aid alone can't solve the problem. That is why an increasing number of clinics and hospitals are including agriculture extension programs as part of their approach to treating malnutrition.

Including agriculture in the clinical treatment of malnutrition makes a lot of sense. Seventy percent of malnourished people in the world are engaged in agriculture; if we want to dramatically reduce rates of malnutrition, there is widespread consensus that agriculture has to be a part of the solution. USAID estimates that a $1 investment in agriculture today saves $10 in food aid down the road - a figure that doesn't even factor in the cost savings to the health care system that occur when we are able to prevent malnourished children from returning to clinics, time and time again, with increasingly serious, and expensive, illnesses.

It is not enough, however, to simply apply traditional agricultural outreach methods and inputs, which tend to be oriented toward income generation, as a component of rural healthcare - instead we need to start thinking about the seeds and support we provide through the lens of improving long-term health and nutrition.

Too often "kitchen garden" initiatives are given short shrift when it comes to program design, and even shorter shrift when budgeting decisions are made. Instead of thinking of agriculture outreach as an "add-on" to clinical care, we need to bring together farmers, agronomists, nutritionists and community health workers to come up with creative and culturally appropriate ways to help every family make the most of the land and resources available to them.

That is what we do at Gardens for Health International: we partner with health centers in Rwanda to bring sustainable agricultural solutions to families in need at the point of care. Nurses at our partner health centers don't literally hand out chickens and kale seeds, but they do give patients who are diagnosed with malnutrition, and their families, a prescription for our program, in addition to the medical intervention they receive.

We work with families at their homes, designing a home garden that takes the best of sustainable agriculture and applies it to the real world conditions in which they live. We provide things like fertilizer trees - to enrich the soil and improve yields over time - and promote indigenous vegetables that are rich in nutrients and grow well in local soil. Because we recognize that seeds alone won't solve malnutrition, our field staff educates families on issues like family planning, gender-based violence, HIV/AIDS, and maternal depression - all of which can make it harder for mothers and families to feed their children.

By broadening the definition of healthcare beyond immediate medical interventions and by pushing those interventions beyond the clinic walls and into kitchen gardens and backyards, we believe that it is possible to dramatically reduce malnutrition among vulnerable farm families. We are seeing results to back up our approach: one year after enrolling in our program, 71% of infants and children we worked with are at a healthy weight. While many of the effects of malnutrition can be irreversible, these children are on track to stay in school longer and perform better than their stunted peers, they are likely to earn more and to live longer lives, and when they have families of their own, those families are less likely to be trapped in the cycle of malnutrition.

Not only are children gaining weight, the consumption patterns of entire families are changing. 88% of families we worked with report that, one year later, they are eating at least 4 different types of food each day - food they grew in their own backyards.

Liberatha, a recent graduate of our program, credits her garden - where she has started growing amaranth, ground-nuts, green peppers and orange flesh sweet potatoes - with changes she is seeing in her family. Her four-year-old daughter, Denise, has gained nearly 8 pounds since she enrolled in our program in January 2013, and no longer exhibits the telltale signs of malnutrition. Liberatha reports that now, not only does she know what to feed her family, she is surrounded by the food she needs to create a balanced meal.

When we start to imagine seeds as a form of preventative medicine, it doesn't just change the way we think about healthcare. It also changes the way we think about smallholder agriculture. We can begin to view farming not as a backward economy for those unfortunate enough to be born in the tropics, but rather as a tool of empowering families to grow better health. By pushing the boundaries of both, we can start to solve the problem of malnutrition for millions of farm families around the world.

-- Julie Carney and Jessie Cronan

Gardens for Health International is a Segal Family Foundation health network partner and works to provide lasting agricultural solutions to chronic childhood malnutrition.