Many people like me working in the field of public health nutrition in Nepal would have heard of Miriam Krantz. Somehow, I never had the chance to meet her personally or know in detail about her work. When the concept of Poshan Nanglo started to get attention, I heard that a similar approach was also employed in the past and Miriam’s name came up. I was intrigued to know more about the past experience from the lady herself and also about her. Hence, we connected. Ever since our first interaction, I have been captivated, inspired and thus prompted to share some of the significant contributions she has made towards nutrition in Nepal.
We recently enjoyed a beautiful nutritious meal together at her home. As the spring afternoon sun crept in through the windows and African violet blooms added cheer around us, we chatted about her life and nutrition.
Miriam was born into a farming household in Pennsylvania, USA. She was the youngest child, after four brothers and in her own words, ‘an exclamation point at the end of the family!’ She came to Nepal in 1963 as a 26-year-old nutritionist. She started work with United Mission to Nepal in 1964 as the manager of Dietary Department of Shanta Bhawan Hospital and moved to Community Health Programme (CHP) from 1972 onward.
During that time, she came to know from the CHP Nepali Medical Officer about rampant Vitamin B deficiency along the road to Chapagaon, a sub-urban outskirt near Patan. She visited the area and noted that electric rice mills were newly installed after the arrival of electricity. So, people had started eating polished white rice instead of the traditional dhikki le kuteko chamal (wholesome kind milled at homes.) Realising that the nutrient stripped rice was a key reason behind the sudden rise in Vitamin B deficiency, she did something simple yet smart. The discarded ‘dhutos’ (bran and germ) were collected from the mills and packed into two small packets and given as ‘medicine’ to people with the deficiencies visiting the local clinic. They were asked to mix and consume it with daily foods and come back after two weeks. Most patients recovered in 10-12 days and hence the importance of consuming whole grains!
“Development is a double-edged sword, if not handled properly!”
Miriam recognized the value and potential of Nepali foods from very early on. She traveled around many villages comprehending the array of cereals, legumes, dairy, fruits, vegetables and herbs that are available. She also tried to understand what goes on inside people’s homes with regards to nutrition, from the poorest to the richest – what were people eating, what utensils they were using, how is the food prepared, etc. Then she and her team introduced the concept of gathering and displaying those locally available nutritious foods on Nanglos, to convey and reinforce that people do not need to go very far for good nutrition. They are found and can be grown in people’s own homes and communities.
Miriam is an inherently creative person. Perhaps one of her greatest gifts to the children of Nepal is Sarbottam Pitho, an ingenious nutrition craft. It was around 1973 when she noted a lot of malnourished young children in local clinics. Their mothers were stressed and worn out. Those children needed food, not medicines. People seemed to have food at home and the parents were well nourished while the children were not. It occurred to Miriam that many mothers did not have the knowledge of how to get the appropriately prepared foods into the children. She discussed with her CHP team on what they could offer the mothers – something they can do themselves and that children could easily digest. After visiting the mothers in villages, the idea of roasted, powdered and mixed blend of whole grains and legumes to make porridge came up. The ingredients were nothing new to the mothers and they were already acquainted with the cooking techniques. All they needed to know was a way to make nutritious porridge for children and to understand how important it is for the children to get the nutrients.
She poured over her nutrition books and figured out a nutritionally sound combination (25% wheat, 25% maize and 50% soybean). After consulting English to Nepali dictionary, Miriam entered the name Sarbottam Pitho (excellent flour) in a naming contest organized by the Shanta Bhawan CHP. Contest entries were sent to the Women's Affairs Training Center, Local Development Ministry. The officials found the name acceptable from east to west and north to south in Nepal and selected it. Not surprisingly, those malnourished children recuperated well and Sarbottam Pitho gradually proliferated as a nourishing weaning food for children all over the country. I couldn’t help but fondly reminisce how my mother too had learned and used to make it, and decades later, I also nourished my children with Sarbottam Pitho!
“Often what mothers and families need is a catalyst to improve nutrition, the rest they can do themselves.”
Miriam has also co-authored a book titled ‘Child Nutrition and Health’ with Professor Ramesh Kant Adhikari, another eminent nutrition personality of Nepal. She later served as nutrition consultant or nutrition adviser with UNICEF ROSA, several NGOs, INGOs and hospitals. At 82 years of age, she is still active with advisory roles in nutrition.
Miriam’s multi-talents and quest for learning are extraordinary and inspirational. After retirement, she pursued two things that had long been on her to-do list: in her late sixties, she learned to play Sarangi (Nepali violin) and mastered the art of painting. She joined Kathmandu University School of Art and Design as a beginner level student and six years later, at the age of 75 and upon request of the school, she organised a solo art exhibition of 38 paintings!
Miriam's paintings reveal her love for her adopted home Nepal
Let us reflect with Miriam and soak up her wisdom and valuable experiences:
What potential do you see for nutrition in Nepal?
More people now have had the opportunity to get formal education. Relevant nutrition knowledge needs to be introduced at every level. Those in responsible positions should, by any and every means possible, stand up for the support and values of good nutrition– with integrity and enthusiasm. Service attitude.
Food producers are ready and willing to meet the supply of nutritious foods if they are encouraged and respected. Necessary resources are needed, those which safely enhance productivity and are profitable.
Education institutions could do more by introducing nutrition knowledge and concepts into actual subject materials, inviting related guest speakers and having only nutritious foods and/or by requesting parents to provide such.
Folks who are practicing good nutrition in their own lives and home situations need to take opportunities to share the benefits in interesting ways. As good role models.
“We need to appreciate farmers for their hard work that goes into producing food, so we can give full appreciation to the food we eat.”
What might be some of the challenges and how can they be overcome?
Farmers need more respect and recognition for their hard work and skills. Without them people could not live!
Children and teenagers are missing out on learning domestic skills within family – cooking, food preservation, gardening, farming principles, etc. Traditional foods are fast being forgotten. Parents need to encourage their children to learn those skills. Togetherness! This would generate respect and appreciation for others and build self-confidence for the future.
Mothers and mothers-in-law and other relatives need to be sensitively brought up to date on nutrition facts. The daughters and daughters-in-law are expected to follow their advice whether it is correct or not.
Attractive packaging of foods which are highly refined and/or have high sugar or salt content, are being bought even though the price is high. Advertising does not always reflect the actual value of the food. Food related enterprises can act responsibly and with integrity– by producing wholesome nutritious foods, not swayed by profit and uninformed popular demand.
Innovative ways are needed - demonstrations, poetry and songs on the values of local foods; case studies as a result of good nutrition; through visual means (photos and videos); venues/platforms for sharing available to all levels of society (information, insights and testimonies.)
“Children learn things doing together as family.”
What would you like to tell the younger generation of nutritionists?
They must truly know what their vision is, and then go forward with the respect for and knowledge of the best from the past traditions combined with the best from modern science in regard to foods and nutrition. They need to give time and thought to that – before becoming teachers, trainers, advisers, publishers or food and nutrition policy makers.
Communication needs to be open and inviting to further communication. This gives/makes room for personal initiative in many circumstances which can result in genuine, even remarkable change in attitude and practices. Respect.
There is great importance in learning the practice of keen observation and listening – it is through identifying the positives that individuals can solve their problems whether in regard to nutrition or other related or unrelated difficulties.