Dr. Vellani is a distinguished Professor at the Aga Khan University (AKU), Karachi and the Planning Coordinator of Aga Khan University’s Human Development Programme, (AKU-HDP). His research interests range from health services for economically under-privileged communities, cardiology and Early Child Development.

AKU-HDP is dedicated to enhancing human development through enhanced Early Childhood Development (ECD) which it seeks to achieve through integrated community-based ECD programme, multidisciplinary research, capacity building and advocacy.

Youshey Zakiuddin of the Sindh Education Foundation interviews Dr. Vellani on the importance of the early years in a child’s overall development and the challenges of child development in Pakistan.

Why are the early years so important for learning? What are the limitations on a child who is deprived of learning opportunities during these early years?

That’s a critical question. There isn’t a simple straightforward answer because there really isn’t sufficient understanding of this critical period of development that occurs well before the child ever gets to school, and what is most remarkable of all is that it is in this period when sensory inputs actually result in structural changes of the brain. Sensory inputs are means of learning and they also determine how the brain is connected.

The other remarkable thing is the part of the brain, the cortex. The earliest development takes place in the sensory path of that cortex. The brain understands its environment through perception of sensory inputs. These perceptions influence learning ability and this is not simply learning which someone has directed you to learn, it is learning from experience, perception, observation and social interaction.

The ability to learn is a continuous process. Someone whose learning ability is impaired can be exhibited by physical stunting; i.e. the individual may be short throughout life and yet continues his life normally. But you can’t expect this person to be a basketball player. Hence there is a limit to what an individual can learn.

So those people who have been deprived of these learning opportunities during their early years how would they cope up later in life? Also, apart from learning how else are children affected if they are not fully developed?

There are some people who grow up in the most dreadful circumstances and they do well. You are looking at a phenomenon of resilience and that leads you to the domain of gene expression. Under certain conditions susceptible genes will not be expressed and the necessary development will not take place. On the other hand if one is equipped with genes that are capable of full expression then those individuals are resilient, they manage to survive despite the environment. There is no way of knowing whether a child is equipped with a full or partial genetic force that is susceptible to environmental conditions.

The other element apart from learning ability that is also affected by conditions in the early stages of life is behavior. Social environment influences behavior, for e.g. violent behavior at the age of 2 associated with violent behavior at the age of 14 and later on in life; and many other antisocial traits that you find in youth have their origins at home. The pattern of behavior is set within the child during his/her childhood which affects his behavior later on in life.

The third element that is affected very early in life is health. This also includes the mental health of a person; the ability to cope with ones circumstances and with stress. There is a limit to handling stress after which an individual becomes ineffective in doing so. The effect of care during the early years is extremely beneficial for a child’s mental health later on in life as well.

What needs to be emphasized is that during the early years brain development takes place which lays the foundations of an individual’s development. This foundation is formed as a result of stimulation. The lack of stimulation can cause the foundation not to be formed properly. From then on the next stages can’t materialize. That stage setting takes place very early in life.

In reference to nutrition there is this term referred to as RDA. Can you briefly explain for our readers what it means? Does RDA have a lot of relevance to children’s diet?

The RDA is the ‘Recommended Dietary Allowance set by the Food and Nutrition Board of the National Research Council of the National Academy of Science. It sets the recommended (not ‘required’) nutritional intake for healthy human beings. The main RDAs include recommendations for energy (calories), proteins and many other vitamins and minerals. The RDA for a nutrient is based on the amount needed to prevent a deficiency.

It does have a lot of relevance for children, especially the mother’s diet during pregnancy. The fact of the matter is that there is no single nutrient that provides everything with the exception of breast milk especially during the first 6 months of life. So one needs a variety of nutrients and those nutrients are present in a variety of foodstuffs. There is a lot of information on the nutritional values of various foods. The biggest challenge is to convert that knowledge into something practical so that individuals can understand which foodstuffs are available in their environment that they should take to constitute a balanced diet.

In some communities of Hala, Sindh we found something extremely astonishing. The children as well as the adults ate just chapatis (whole meal bread) and red chilies. That’s a very narrow range of nutrients! So that’s the challenge. That’s also one of the things that we are working on. To convey messages about a variety of foods that contains a range of nutrients required.

When you talk of access of nutritious foods the usual response is well you know these people are too poor to afford a good diet. No doubt there is a problem but it’s those same people that can afford cigarettes, paan, tobacco, supari and so forth. So the issue is where you assign the resources that you have. What factors do you take into consideration when allocating those resources? This is the question that households need to be cognizant about. But there is no doubt there is a need also for economic growth of such households.

What do you suppose is the best way to inform parents about the need for good nutrition habits?

What we’re trying is a home-based approach. There is a direct contact, between the early child development worker and the mother, i.e. the women folk in the house, who really control the food; and the idea is to get these nutrition based messages permeated through the household. This process can only be meaningful if there is also an understanding of what’s available in the bazaar so that the household can have access easily to nutritious foods.

There is also the realization that people don’t change their practices readily. They know what is necessary but they still don’t change at times. Perhaps the most useful lever of change is the ability to exchange ideas with others. Among those who can exchange ideas, the most effective are the ones who have already benefited from those certain ideas. The fact that someone has tried something different is a stimulus for more change, for other people to try. So we try and create forums where individuals who have adopted proper nutrition habits share their experiences with other community members.

What should parents and schools be teaching children to ensure they know the importance of having a wholesome and healthy life?

Well, at a very early stage of course children don’t have much control, i.e. they take what they are given and often don’t know any different. Also later on in life say during the early schooling years there is not enough information available to inform children broadly about nutrition. One should be aware about human biology. Nutrition is just one aspect; the others include lifestyle, exercise, adequate rest and a host of other factors including exposure to cigarettes.

In the event that a mother was unable to have a healthy diet during pregnancy, what chances does a child have of overcoming the consequent ill-effects on his own development as a result of that pre-birth malnourishment?

The first twelve weeks of the child’s life are crucial since all organic structures are being formed. Some of the effects are never overcome, for e.g. if the mother is deficient in folic acid. Well one of the structures that isn’t formed properly (owing to a lack of folic acid) is called the neural tube and the neural tube then closes. If it doesn’t close it causes a condition called the spina-bifida where the lower part of the spine is open. Such people are paralyzed in the lower half of the body, and they may have a whole set of other neurological problems as well. It’s an absolute disaster. There is nothing you can do. The incidence of that kind of problem has gone down since the regular introduction of folic acid in a mother’s diet, during antenatal care.

At times parents, possibly owing to a lack of knowledge, only stress on the physical health and development of their children, ignoring aspects such as the mental health and emotional wellbeing. What balance would you suggest is most helpful for the child to grow into an adult that does not only have a strong immune system but also an emotional foundation?

It is a matter of attitude I think. There is a tendency to look upon a child as a mini adult. A child is an organism of a particular kind at a particular stage in life. You cannot treat him/her like an adult so early in life. Children need a lot of support, affection and security. They need nutrition; they need freedom to explore and to express. It’s the exploration that leads to sampling, discovery and an understanding of the world around them. If you don’t allow it to happen they won’t know about the world and if they cant express themselves or are not allowed to because there is not any adequate social interaction, you have individuals who become miserable, frustrated, angry and violent. They will get bashed by society and that abuse is an unpleasant stimulus which then influences the way the brain is connected and makes that individual susceptible to impulsive behaviors, violence and anxiety.

How would you suggest that parent’s measure or assess the emotional wellbeing of their children?

It’s not easy. Of the basic observable properties of the brain, memory is certainly one of them. But the one that we tend to overlook is curiosity. The child is normally naturally curious and curiosity is the drive for exploration. By exploration I mean a child can’t move and can’t crawl but reaches out for whatever is within reach, his/her hands, feet, rattles and toys. At a later stage they crawl. Everywhere they walk they explore. The thing that drives this exploration is curiosity. So if you see a child who isn’t curious there’s something wrong. The fundamental property is missing. You see a child is apathetic if s/he do not take heed of his/her environment whereas if you look at a child at a very young age, who sees you and reacts by sensing, recognizing gazing at you then he/she has a sense of curiosity. Mostly children who have been brought up in orphanages as infants are apathetic as they are allowed to just sit and lie in their cots to stare at the ceiling. They are at a great disadvantage as they do not exhibit a high level of curiosity and thus the development of their brain suffers.

Creativity and confidence is a by product of ECE or ECD. How do you define creativity?

One of the reasons one does not necessarily recognize creativity is because it gets bashed out of the system which lays a heavy emphasis on that which must be learnt. The education system evaluates and if a child is evaluated well s/he gets a carrot and if not then s/he expects the stick. So where is the room or incentive to be able to do anything other than that which is dictated by the stereotype? But go back to the child and talk to a child who is 2 years old and you will find that that child lives in an imaginary world and imagination is all about creativity. It’s actually an inborn phenomenon. Just like curiosity is. But I think both curiosity and creativity are being bashed out by the system.

What thoughts do you have about the attitude of the masses towards paying attention to their children’s and their own health needs? Is it something that needs to be improved?

Yes, of course health attitudes do need to be improved upon. In Pakistan, there is a certain level of awareness amongst families pertaining to what major health services are available to them, the most prominent being the immunization service being promoted by the government. But there are certain health services that are not being offered to families, especially in the rural areas, by both the public and the private sector. Hence, no matter how much the family knows about the importance of health care there isn’t really much access to health facilities. So part and parcel of the process of supporting children and family health care includes providing the needed health facilities and forming connections between the families and the health services.

What have been the biggest achievements, in terms of providing health services for children during their early years that the AKU-HDP has accomplished so far?

The most useful thing we’ve done is to link pregnant mothers with the local service. Local service where there is antenatal care, maternal care and backup service of referring mothers to a station where more complex care can be provided such as the Liaquat Medical University in Hyderabad or the Bolan Medical College in Quetta. That is the beginning. We have also identified children with disability in need of help and there we’ve contacted the government and certain civil society organizations. Mostly civil society organizations have provided guidance and care to individuals with disabilities but these organizations are few and offer scanty services. The best thing you can do with a disability is to prevent it. Hence our focus is to work with families to ensure that a child grows up healthy and reaches his full potential.