06 December 1998

Bonn, Germany: As a medical doctor and nutritionist in Mali, I am assigned to one of the poorest countries in the world. I work in a deprived rural community of 2,800 inhabitants in the Mopti region, some 800 km from the capital. We have no electricity, no phone. The people's diet is unbalanced and women and children often suffer from calorie or vitamin deficiency.

Like most rural African women, Dogon women are continually at work: they have to raise water from the 200 ft. deep wells, find fuelwood, do the cooking. To be sure that they attend when my assistant and I organise gatherings with them, we have to deal with issues that they see as their daily problems. We offer a flexible participatory approach. Each village has its opportunity to identify the obstacles and snags to its development as it sees them. The villagers analyse the constraints and the possible solutions, and plan action in the light of local characteristics and potentials.

Where concerns the women, the main difficulty faced is indeed the link between health and nutrition - simply because they are the ones who have to put food in front of the children. So the major topics we deal with include increasing and diversifying women's income (through revolving funds for buying wool-carders, say, cotton, sheep for rearing or handmills); access to basic health care; how to network information about food and nutrition through schools, video, street theatre and radio; and reducing workload so that they can spend more time with the children.

The aspect that I find most interesting is Information- Education- Communication (IEC), since lack of information is the key cause of malnutrition. Dogon tradition knew perfectly well how important it is to space pregnancies, but old family planning traditions are being ignored due to cultural changes over the last decade. Women return to their husbands after 40 days now, rather than spend the full weaning time with their mothers-in-law as in the past; the spread of Islam plays a part, as does anxiety about using "white medicine". The result is that children are weaned too early. IEC work is fascinating - educating the women, drawing in the health services, informing the men and encouraging dialogue between the sexes.

We have developed and tested several millet-, bean- and groundnut-based weaning recipes. But the mothers have to have the time to prepare such dishes - and have to resist the temptation to sell those crops for cash … The problems are complex, and so are the solutions.

Our project has inexorably evolved towards a broader, multi-disciplinary approach. Water-pumps can save time for the women, for example, and micro-credit has its place. This holistic strategy can bring about better integration of the women in the local economy. But it will be a long haul. It's about more than providing water taps - it's question of changing attitudes and customs.