When Jerry Sternin arrived in Vietnam, the welcome was rather chilly. The government had invited his employer, Save the Children, the international organization that helps kids in need, to open an office in the country in 1990 to fight malnutrition. But the foreign minister let Sternin know that not everyone in the government appreciated his presence. The minister told him, "You have six months to make a difference."When talking about making sabha sticky things can seem complicated. When we analyze a big, complicated problem -- like malnutrition in Vietnam or making a better sabha -- we seek a solution that befits the scale of the problem. If the problem is a round hole with a 24-inch diameter, our brains will go looking for a 24-inch peg to fill it. So, naturally, the experts on malnutrition in Vietnam wanted to talk about poverty and education and sanitation systems. Naturally when we think about sabha quality we start talking about getting better facilities, or better training of karyakars, or having more parent involvement so ideas are reinforced at home. Our focus automatically goes to the problem at hand. What's broken and how do we fix it? This troubleshooting mind-set serves us well -- most of the time. If your mandal is going to do the Hari Jayanti samaiyo and nobody shows up on the day of the samaiyo you should most certainly obsess about it and fix the problem. But in times of change especially when trying to make sabha stick, this mind-set will backfire. If we need to make major changes, then (by definition) we don't have a near-spotless report card. A lot of things are probably wrong. The "report card" for our sabha (and for that matter other things such as niyams, diet, or our marriage, or our business) is full of Cs and Ds and Fs. So if you ask yourself, What's broken and how do I fix it?, you'll simply spin your wheels. You'll spend a lot of time agonizing over issues that are TBU. When it's time to change, we must look for bright spots -- the first signs that things are working, the first precious As and Bs on our report card. We need to ask ourselves a question that sounds simple but is, in fact, deeply unnatural: What's working in our sabha and how can we do more of it?
Sternin had traveled to the country with his wife and 10-year-old son. None of them spoke the language. "We were like orphans at the airport when we arrived in Vietnam," he said. "We had no idea what we were going to do." Sternin had minimal staff and meager resources. The conventional wisdom was that malnutrition was the result of an intertwined set of problems: Sanitation was poor. Poverty was nearly universal. Clean water was not readily available. The rural people tended to be ignorant about nutrition. That analysis was, in Sternin's judgment, TBU -- true but useless. "Millions of kids can't wait for those issues to be addressed," he said. If addressing malnutrition required ending poverty and purifying water and building sanitation systems, then it would never happen. Especially in six months, with virtually no money to spend.
Ignoring the experts, Sternin traveled to a local village and called together all the village's mothers. He asked for their assistance in finding ways to nourish their kids better, and they agreed to help. As the first step, they went out in teams to weigh and measure every child in the village. Then, they pored over the results together with Sternin.
He asked them, "Did you find any very, very poor kids who are bigger and healthier than the typical child?"
The women, scanning the data, nodded and said, "Có, có, có." (Yes, yes, yes.)
He said, "You mean it's possible today in this village for a very poor family to have a well-nourished child?"
"Có, có, có."
"Then let's go see what they're doing."
Sternin's strategy was to search the community for bright spots. If some kids were healthy despite their disadvantages, then that meant something important: Malnourishment was not inevitable. The mere existence of healthy kids provided hope for a practical, short-term solution. Sternin knew he couldn't fix the thorny root causes. But if a handful of kids were staying healthy against the odds, why couldn't every kid be healthy?
To understand what the bright spots were doing differently, the mothers first had to understand the typical eating behaviors in the community. So they talked to dozens of people -- other mothers, fathers, older brothers and sisters, grandparents -- and discovered that the norms were pretty clear: Kids ate twice a day along with the rest of their families, and they ate food that was deemed appropriate for children -- soft, pure foods like the highest-quality rice.
Armed with that understanding, the mothers then observed the homes of the bright-spot kids, and, alert for any deviations, they noticed some unexpected habits. For one thing, bright-spot moms were feeding their kids four meals a day (using the same amount of food as other moms but spreading it across four servings rather than two). The larger twice-a-day meals eaten by most families turned out to be a mistake for children, because their malnourished stomachs couldn't process that much food at one time.
The style of eating was also different. Most parents believed that their kids understood their own needs and would feed themselves appropriately from a communal bowl. But the healthy kids were fed more actively -- by hand if necessary. The children were even encouraged to eat when they were sick, which was not the norm.
Perhaps most interesting, the healthy kids were eating different kinds of food. The bright-spot mothers were collecting tiny shrimp and crabs from the rice paddies and mixing them in with their kids' rice. (Shrimp and crabs were eaten by adults but they weren't considered appropriate food for kids.) The mothers also tossed in sweet-potato greens, which were considered a low-class food. These dietary improvisations, however strange or "low class," were doing something precious: adding sorely needed protein and vitamins to the children's diet.
As an outsider, Sternin never could have foreseen these insights. He knew nothing about sweet-potato greens. The solution was a native one, emerging from the real-world experience of the villagers, and for that reason, it was inherently realistic as well as sustainable. But knowing the solution wasn't enough. For anything to change, lots of mothers would need to adopt the new cooking habits.
Sternin refused to make a formal announcement. He knew that telling the mothers about nutrition wouldn't change their behavior. "Knowledge does not change behavior," he told us in the spring of 2008 (Sternin passed away in December of that year). "We have all encountered crazy shrinks and obese doctors and divorced marriage counselors." The mothers would have to practice it. They'd have to act differently until the different started to feel normal.
The community designed a program in which 50 malnourished families, in groups of 10, would meet at a hut each day and prepare food together. The families were required to bring shrimp, crabs, and sweet-potato greens. The mothers washed their hands with soap and cooked the meal together. Sternin said that the moms were "acting their way into a new way of thinking." Most important, it was their change, something that arose from the local wisdom of the village. Sternin's role was only to help them see that they could do it, that they could conquer malnutrition on their own.
Dozens of experts had analyzed the situation in Vietnam, agonizing over the problems -- the water supply, the sanitation, the poverty, the ignorance. They'd written position papers and research documents and development plans. But they hadn't changed a thing. Six months after Sternin's visit to the Vietnamese village, 65% of the kids were better nourished -- and they stayed that way. Later, when researchers from Emory University School Public Health came to Vietnam to gather independent data, they found that even children who hadn't been born when Sternin left the village were as healthy as the kids Sternin had reached directly. That provided proof that the changes had stuck. In tough times, we'll see problems everywhere, and "analysis paralysis" will often kick in. That's why, to make progress on a change, we need to provide crystal-clear direction -- show people where to go, how to act, what destination to pursue. And that's why bright spots are so essential: They provide the road map. Sternin's success began to spread. "We took the first 14 villages in different phases of the program and turned them into a social laboratory," he said. "People who wanted to replicate the nutrition model came from different parts of Vietnam. Every day, they would go to this living university, to these villages, touching, smelling, sniffing, watching, listening. They would 'graduate,' go to their villages, and implement the process until they got it right... . The program reached 2.2 million Vietnamese people in 265 villages. Our living university has become a national model for teaching villagers to reduce drastically malnutrition in Vietnam."