Being a fly on the wall

Throughout my early childhood development project this year, and, in fact, in all my projects, I´ve faced a puzzle. How do you actually measure a behavior, like handwashing, protein consumption or time spent playing with a baby. Self-reporting has been proved biased and squidgy by countless studies, especially in the imprecise area of diet. In all my projects, I´ve looked for the magic question, some way to approximate what I really want to know.  For example, to measure hand-washing, I asked about the important times to wash hands, for the person to demonstrate hand-washing, and then check if there is a towel and soap next to their sink. While it´s far from perfect, it gives me a decent idea of whether the household is likely to wash their hands. Then there is the product indicator: does anyone have diarrhea in their house at the moment? The later measures almost too much, of course.

With nutrition and early childhood stimulation, I´ve fumbled for an adequate measure and still, after over a year of work, am not satisfied. For nutrition, I try to plan house visits for a time when the mother will be cooking to at least see that the beans or salad or meat exists. Even so, I have no way of knowing how frequent this happens (once a week, once a month, daily?), the typical portion size for the child, or how many times a day the child actually eats. Frequent visits give me a sense of these questions, true, but they are difficult to nail down. For early stimulation, I ask where and with what the child plays (the answers to these questions are comedic and often bizarre. To “what does your child usually play with?” “Chickens” is a common answer. “The dog” and “with whatever he can find” being close seconds). It´s not good enough, by far, and I´ve considered far more complex surveys, but discarded them in favor of simpler questions that can be replicated by my health promoters.

After all this pondering, I stumbled upon the answer this week. For background, I´m in the midst of a final phase of my Early Stimulation project, which entails creating Play Corners in all the homes with the mothers. For the past 5 months, I´ve held weekly or bi-weekly meetings with mothers to make toys, and now, in each home, we are paint murals as a final stimulant for the children. Originally, my plan was to use stencils and have the mothers paint on their own. However, I love drawing and painting, and the number of moms is less than I´d planned for, so I decided to draw and paint with the families. It means spending hours in someone´s home, while daily life hums along around you. Thus, it is a far better observation and investigation than any short survey could hope for. Instead of asking how often a child eats, I see how often they eat over the course of a day. Instead of asking where a child spends most of his time, I see that he is usually sitting on the floor, laying on the bed, or running around in the road like a crazy man (the last subject, a wayward 2 year-old, is no surprise. His mother can often be found dragging him out of neighbor´s houses, the corner store, or the health post, where he wanders alone).

The problem is, though my curiousity is satisfied, I´m not sure how to use this information in any evaluation of my project. Since I didn´t do a baseline study in the same way, I have no comparison. Still, I wouldn´t give up the opportunity, and what better way to spend my last months than painting, surrounding by the moms and children that I love?