Ensure Healthy Brain Development

The Problem: Lack of Iron Impairs Brain Development
Rates of iron deficiency can be as high as 50% in children in some rural Nicaraguan villages. This is mainly due to malnutrition in Nicaragua, the poorest country in Central America. Since iron is used by many reactions in the brain, the lack of iron hinders normal healthy brain development. Children with iron deficiency have lower cognitive, motor, social, and emotional development compared with their peers, placing them at a disadvantage for the rest of their lives. For example, these children may need to repeat grades in school or in some cases, permanent mental disability occurs. Comparatively, in the U.S. iron deficiency only occurs in 3% of children since malnutrition rates are much lower and many of our foods are fortified with additional iron.

There is a simple solution to iron deficiency in Nicaraguan children- giving liquid oral iron supplements can prevent and even reverse such adverse brain effects. Health clinics in rural Nicaragua give out free liquid iron supplements when they have a supply available. Still, many children do not regularly take liquid iron even when it's available. The reasons for this have not been identified. I am volunteering in Nicaragua for 5 months to find out why children do not regularly take iron supplements and to find ways to reduce iron deficiency. This commitment requires that I delay graduating from medical school for one year, but I'm willing to make this sacrifice in order to help these children have healthy brain development.

My Goal
The goal of my 5-month-long volunteer project is twofold:
(1) determine barriers to adequate iron supplementation for children of rural Nicaraguan families and
(2) reduce iron deficiency in these children.

The Community Effort
I will visit a different rural community each week, spending about five days in each community. During my time in each community, I will visit homes and talk with families about their children's diet, their knowledge of iron, and their use of liquid oral iron supplementation for their children. Through surveys and discussions about iron deficiency/supplementation, I will identify reasons that children do not regularly receive the liquid iron supplements. I will ask questions such as:
o Do parents have transportation to the local clinics where they can receive iron supplements for their children?
o Do parents understand the instructions for iron dosing for their children? If not, do literacy barriers exist that prevent understanding the instructions?
o Do parents trust that iron supplementation is beneficial for their children? If not, do the parents have fears of iron supplementation that have gone unnoticed or unaddressed?
o Is better communication regarding the dangers of iron deficiency and benefits of supplementation needed in order to improve adherence rates?
o Are taste and possible GI side effects of oral iron seen as reasons that children do not take liquid iron?
o Do unidentified cultural or religious barriers exist that prevent parents from giving their children liquid iron?
o What are the best sources of local food that have a large amount of iron, and how can we make sure that these food sources are available for families?

Sustainable Solutions
After investigating these questions and many more, I will use that knowledge and data to help the christian non-profit group AMOS Health and Hope train trusted local community health leaders. We plan to educate these local health leaders about practical ways for children to regularly take liquid oral iron and ways for children to eat more iron from local food sources. The local health leaders can then continue to educate families in their communities about iron deficiency prevention and therefore increase healthy brain development in these children. Using this community-based education approach, they can continue the effort to promote healthy brain development long after my volunteer work there.

Your Gift Would Provide
o Funding for 6 months for my food, shelter, and transportation so that I might provide my knowledge and work as a volunteer ($4400)
o The ability for AMOS Health and Hope to continue to address this and other medical/public health issues ($1000 and any funds raised in excess of my goal)

More Info
I will blog about my experiences in Nicaragua. I'll make the link available to my funders so that you can see your gift in action.

For more information on AMOS's iron deficiency anemia work, visit their website at http://www.amoshealth.org/programs/rural-community-health/

For more information on AMOS, click the video .

Video produced by AMOS volunteers Cassie and Jordan Timpy.

About Me
After three years of medical school at Wake Forest School of Medicine, I have decided to take my knowledge and skills to assist those less fortunate in Nicaragua, beginning this November. This decision arose from the interest that I discovered in pediatrics and hematology, as well as the desire to experience and alleviate the health care challenges faced in a developing Central American country that will influence the rest of my career as a physician. I've chosen to volunteer with AMOS Health and Hope because of their responsible mission. AMOS only serves communities that have invited them in to help. Additionally, AMOS focuses strongly on training local community members so that they can learn the lifelong tools that enable them to provide treatments and preventive care in their own community.
Thanks and God bless!
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Chris Stem 
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