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A Developing Ideas series.

FOCUS ON VIETNAM: Poverty in the midst of run-away growth

At Last, an American Success Story in Vietnam. Part 1 of 4

By Shirley Brady

THANH HOA, Vietnam - Long before President Clinton normalized his country's relations with Vietnam this summer, another American had been quietly working behind the scenes to thaw the deep freeze between the US and Vietnam following the Communists' victory in 1975.

Jerry Sternin has changed more than just his fashion sense since his idealistic days as an international development worker in the Peace Corps. Garbed in the style of striped shirt favoured by executives, Sternin dismisses the "warm, fuzzy goals that may have been acceptable in the 60s." His "more CEO than NGO" approach led the Vietnamese government to extend an unprecedented invitation in 1990 to Save the Children-US to help avert starvation in the countryside as the nation struggled to transform its economy into 'market socialism'.

One of the most densely populated countries in the world, Vietnam's 73 million inhabitants have since 1986 been vying to capitalize on the economic reforms of doi moi - the switch to a market economy. This has created a widening gap between the motorcycling go-getters of Ho Chi Minh City and Hanoi and the 70% of the population still struggling in rural communes.

Despite being widely touted as Asia's next 'economic tiger', Vietnam is still among the poorest nations in the world. A World Bank report on poverty, released this spring, pegs the average annual income at less than US$240 per person, and a government report released in May estimates that 22% of households are poor and hungry. As the world's third largest exporter of rice, Vietnam calculates 'poor' as families unable to purchase 13 kg of rice per person each month, and 'hungry' as less than 8 kg.

The health care system deteriorated rapidly after doi moi was introduced. Government cutbacks led to layoffs in commune clinics. Poverty and malnutrition increased, despite national gains in agricultural output. Sternin and his team found that two-thirds of children under three were grossly malnourished, more than half of them severely so. "The health centres were virtually non-functioning and basic health care was non-existent," Sternin recalls.

Vietnam has long attracted the attentions of international lenders and non-profit organizations seeking to lift the country onto the global platform, where it so eagerly wishes to be. Since the war ended two decades ago, the country has been the site of many relief and aid efforts aimed at providing food, reforesting the environmentally devastated areas and giving (sometimes false) hope to those Vietnamese who didn't abandon their country for economic or political reasons.

In developing a model for their program, the director of Save the Children sought to not only wipe out starvation but to foster self-sufficiency - "to give a hand up, not a hand out", as Sternin puts it. Working with local leaders, in 1990 he launched a pilot project among 20,000 of "the poorest of the poor" living in Thanh Hoa province south of Hanoi.

Women's Union volunteers weighed all children under three in the commune and recorded their levels of malnourishment. The most seriously at-risk infants were enrolled, along with their mothers, in a Nutrition Education/Rehabilitation Programme run by the health volunteers. Together, they investigated how the families of better-nourished children were able to beat malnutrition, often on as meager, if not poorer, resources.

The solution often turned out to be as simple as adding small shrimps and crabs - found in rice paddies - to their children's meals. Mothers were then asked to create "coloured bowls" of rice with the tiny crustaceans as their daily admission price into the two-week program. The women (and occasionally fathers or grandparents) took turns cooking, then fed their children and learned nutritional lessons. Some myths had to be put to rest: green vegetables don't cause diarrhea, and shrimp and crabs don't create skin problems. In place of greens and protein, MSG had once commonly been added to enhance the taste of children's meals.

Children too underweight to 'graduate' after two weeks could re-enrol in another session. Mothers of children who remained malnourished after three sessions were given a loan in the name of their child to purchase a chicken, with an egg a day to be added to the child's diet and the other eggs to be sold to help the family improve its income.

At the end of the pilot project, severe malnutrition dropped by a staggering 85%, and more than 90% of the malnourished children whose families received loans recovered. The government declared the programme the national model for community development, and it has now spread to sixteen villages and 100,000 beneficiaries.

Communes in Thanh Hoa province proudly display the project results in the formerly empty health clinics. The mothers speak about how involved and useful they now feel in their communities. Health volunteers also advise pregnant women on pre-natal and infant nutritional needs. The district's doctor credits their initiative with the reduction in premature births and increase in birth weights they've seen since the program started.

Towards the final phase of each project, the commune makes a wish list for its long-term economic growth. Villagers identify an income-generating scheme for the entire community, such as cargo boats or a milling machine, which they can purchase with a loan from Save the Children. Families can also take out loans for fertilizer, poultry or mat-making schemes. To aid in the endeavour, an educational project called the 'Living University' was introduced, where communes, NGOs and government agencies learn first-hand how to identify and maximize their resources to better address their needs. These initiatives allow villagers to escape the cycle of poverty once hunger has been tackled.

Most tellingly, the project is still running five years later in the pilot communes, now administered by them alone. People express confidence about the future of their health and community development programme, long after their American friends have left. As one Thanh Hoa villager asserts, "We will miss them, but we will continue it ourselves."

Sternin keeps a quote from the Taoist philosopher Lao Tzu pinned to his office bulletin board, a saying on how to work with people: "Learn from them, plan with them, begin with what they have, build on what they know," so when the goal is met they can say, "We have done it ourselves."

"We didn't arrive on a white horse, waving our banner," says Sternin. "We didn't promise all sorts of 'white man's magic' -- instead, we're finding the solutions together." This approach is in striking contrast to the style of American involvement during the war, and could well point the way for the new era of Vietnam-US cooperation which has just begun.