“Sternin, you have six months to show results.”
The man saying it was a senior official in Vietnam’s Ministry of Foreign Affairs. Jerry Sternin had arrived in Hanoi in December 1990 with his wife, Monique, and their ten-year-old son, to open an office for Save the Children. His job was to fight child malnutrition in a country where, by the account he later helped write, two-thirds of children under five were malnourished. The official spelled out the stakes: show impact in six months, or he could not extend Sternin’s visa.
The government had already learned that handing out extra food didn’t last. When the feeding programs ended, the gains tapered off. The Sternins had little money and no time to wait for the country to get richer.
They went to Quang Xuong district in Thanh Hóa province, a four-hour drive south of Hanoi. In four villages, health volunteers with six scales and bicycles weighed about 2,000 children under three in three and a half days. Some 64 percent were malnourished.
Then the Sternins asked a different question. Were there any well-nourished children from very, very poor families?
Yes, the volunteers said. There were some.
Villagers visited six of the poorest families with well-fed children in each village and watched. These parents added the greens of sweet potato plants to their children’s meals. They collected tiny shrimps and crabs from the rice paddies. They fed their children three or four times a day instead of the customary two, fed them actively so nothing went to waste, and washed the children’s hands before and after eating. The shrimps, crabs and greens were there for anyone to gather. Most families believed they were wrong for small children.
The Sternins didn’t print posters. A village elder told them a thousand hearings isn’t worth one seeing, and a thousand seeings isn’t worth one doing. So mothers of malnourished children waded into the paddies with small nets, cooked the new recipes together for two weeks, and weighed their children as they went.
Six months after the Sternins arrived, the same official handed them a renewed visa. They stayed six years. By the Sternins’ account, malnutrition fell 85 percent in the pilot communities over two years, and the approach became a national program that reached more than 2.2 million people.
The Sternins and their colleagues were more careful in the BMJ in 2004. Early-1990s evaluations showed a 74 percent reduction in severe malnutrition among participating children under three, but the study designs were too weak to prove the program caused it. So Save the Children ran a randomized trial in 12 communes in northern Vietnam. The children in the program communes grew better.