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A life with UNICEF 
Interview with Rolf Carriere
by Monte Leach

Bangladesh's UNICEF Director, Rolf Carriere, relates his team's experiences while working to better child health and development in Bangladesh.

Rolf Carriere has worked with UNICEF and other UN agencies since 1971. He has directed UNICEF’s nutrition programs in India and neighboring Bhutan, and has also worked in Indonesia, the Maldives, Sri Lanka, Nepal, Afghanistan, and Burma. He is currently director of UNICEF’s program in Bangladesh. Monte Leach interviewed him for Share International.

SI: Why did you decide to become involved with helping children?

RC: When I came to the US from the Netherlands as an exchange student with the American Field Service in 1961, one of the first places we visited was the United Nations. I was very impressed. I resolved then and there that I would work for the UN if I got a chance. At the end of that year, we met on the lawn of the White House with President Kennedy. He gave a brief but very upbeat speech about the Peace Corps, which was just beginning, and the idealism that went with it was very much in the air. I was there with some 2,000 students from all over the world. Internationalism, living in developing countries, working for the UN — that was almost a given for me.

I went back to the Netherlands and studied development economics and philosophy, and then applied for a job with the UN. The first organization I worked for was the Food and Agriculture Organization. I worked for two years with them, but decided that there was too much bureaucracy. I was then invited by a colleague to join UNICEF. “But I’m an economist,” I said. “I know about international monetary questions and economic growth models. What does that have to do with children?” And he said: “Well, you could, for example, estimate the economic contribution of breast-feeding,” which is something that I subsequently did.

I had never planned to work for an organization like UNICEF, or for children. But I must say it has been the most rewarding job that I could imagine. The UNICEF representative in a country has an enormous responsibility and authority delegated to him, and enormous flexibility to decide what to do and what not to do. There is very little bureaucracy and red tape. It is an opportunity to use your own creativity in finding non-conventional solutions to the pervasive, persistent problems of children.

SI: As head of UNICEF’s program in Bangladesh, what do you do?

RC: In Bangladesh, UNICEF has a $40-50 million per year program to provide a range of services to government and NGOs (nongovernmental organizations) in the areas of child survival, child protection, child development, health, nutrition, water sanitation, education, as well as problems of children in especially difficult circumstances — orphans, street children, homeless children, refugee children, children who are sexually abused, and trafficked children (children who are sold into prostitution). On top of that, we deal not only with supplying goods to help children’s programs, we also help in the conceptualization and design of the programs and their monitoring — the evaluation and documentation of successes and failures.

SI: What do you do on a day-to-day basis?

RC: I have a staff in Bangladesh of 270 colleagues. We have offices not only in Dhaka, the capital, but also in three other cities. We assist the Government as well as NGOs such as the Grameen Bank, the Rotary Club, religious groups, human rights groups. We work with the press. We have an extensive program to encourage journalists to do more investigative in-depth reporting on events. We work at the national as well as sub-national level with government colleagues. We deal with virtually all the ministries, trying to insert children’s concerns into what the ministries are already doing. For example, with the Ministry of Information and Broadcasting, we are working to help design programs for children. We have a three-minute spot on the radio and television in Bangladesh for children. We also work with artists, for example, and ask them to contribute their time to UNICEF in the production of radio or television spots, to be visible advocates for children’s issues and children’s rights. Help from religious leaders

SI: You mentioned that UNICEF works with all sectors of society on behalf of children. Could you talk about your experiences working with religious leaders?

RC: That started in 1976 or 1977 when I was working with UNICEF in Indonesia. We were up against a number of infant-formula manufacturers trying to peddle their wares, breast milk substitutes, in the Indonesian market. We saw that we had to mobilize Indonesia’s Ministry of Religion by stressing the fact that the Koran explicitly exhorts mothers to breast-feed for the full period of two years. Unless we had the support from the imams in the villages, we would not be able to protect Indonesia’s high prevalence of breast-feeding, which is extremely beneficial for child health as well as population growth and family size. The aggressive marketing techniques and advertising campaigns that these infant-formula manufacturers and importers were contemplating would certainly have led to a rapid erosion of the beneficial breast-feeding practices that were traditionally followed in Indonesia.

Subsequently, I lived in India, worked in Bhutan quite a bit, lived for a couple of years in Burma, and now live in Bangladesh. In each of these countries, I have had a chance to work with religious leaders. In Bhutan, we persuaded one of the “cardinals” of Mahayana Buddhism (he’s actually called a “pillar”) who deals with metaphysical affairs, to discuss and come to agreement on how religious leaders in Bhutan would be able to play an important role in child survival activities. For example, when a child has diarrhoea, which is the principal cause of death for children in that country, the mother takes the child to a “gup”, a local religious leader. There is usually a prayer and the performance of some religious ritual. But if that local religious leader can, at the same time, also hand a packet of oral rehydration salts to the mother and give her instructions on how to use it, that would be tremendously beneficial.

SI: Were the religious leaders cooperative?

RC: The religious leaders were very co-operative. It takes quite a while to explain the extent and severity of the problems that children or women face. We usually work with advertising agencies to put together a slide presentation, so that in about 20 or 30 minutes you can drive home the importance of a particular problem very vividly. We usually ask ourselves the question: What would we want to say to the King of Bhutan, for example, if we had a half hour of his time? Then we go to work for about half a year to create a slide presentation on child survival, immunization, nutrition, and so on.

We did one, for example, on iodine deficiency, and another on growth monitoring, that was seen by His Majesty, the King of Bhutan. With growth monitoring, you can make visible the growth pattern of young children. If you weigh a baby every month, and plot the weight changes on a card, you can actually make it clear to a parent what is happening to a child. You can then give tailor-made advice to that particular mother for that particular child. “In this month, mother, you should be doing this, or you should be doing that.”

Using growth monitoring, you can help initiate preventive action, rather than allowing a child to become malnourished. If the child is severely malnourished, it becomes very difficult to keep it alive or get it back into a normal growth path. But there is ample opportunity for progress early on if you identify and diagnose the specific reasons why a particular child in a particular family is not gaining adequate weight. The mother may not know how to manage the diarrhoea of the child, for example, and diarrhoea is perhaps the most prevalent malnourishing illness that we find in the Third World.

After viewing the presentation on growth monitoring, the King of Bhutan immediately said: “This needs to be seen by the National Assembly.” The National Assembly, when they saw this presentation in English, resolved that it should be translated into the four or five local languages of Bhutan, and should be seen by the local assemblies. In this case, if you want to convert the kingdom, you need first to convert the King.

SI: The King is a secular leader?

RC: Yes, but this presentation was also shown to religious leaders, and their blessing and support was requested. Without the help and blessing of religious and government leaders, there is often no sustainable change in a situation. You may have, for example, a short-term success in an oral rehydration or immunization program. But unless and until these programs are accompanied by a change in the ethic of the population, as it manifests, for example, in laws that the government passes, the sustainability of the programs may be dubious. Unless you embed a new ethic for children deep in the societal consciousness, as a moral issue, as an issue that requires our utmost and continued vigilance, you sometimes find that these programs are abandoned after a while, and the problems reappear.

Memorable experiences

SI: What is it like working with children who are malnourished and experiencing that level of suffering? Have you seen progress over the years?

RC: It has been an extremely rewarding experience. It is actually quite a privilege to be working on global issues of such great importance to so many people. In the years that I’ve been involved, I have seen tremendous progress in a number of countries, particularly with various types of malnutrition control — vitamin A deficiency control, iodine deficiency control, iron deficiency anemia, issues of breast-feeding, protein malnutrition.

We often mistakenly believe that malnutrition is the result of food shortages. But we find that in most households with malnourished children there is actually adequate food. But parents need to know how to prepare food better, and how to feed very young children to prevent malnourishment. There is often more ignorance-caused malnutrition, infection-caused malnutrition, than outright poverty-caused malnutrition. There is room for an immediate improvement of the malnutrition situation in all countries.

SI: Please talk about your most memorable experiences in India.

RC: That would be the work we did against all odds to bring immunization to children, to the level where now more than 80 per cent of children are being contacted by a well-functioning health system four or five times before their first birthday. There was a massive health infrastructure, but it wasn’t responsive to the priority needs of people. In a few years’ time, with a great deployment of UNICEF resources, and with considerable help from the Swedes, Norwegians, the US, and others, we have been able to create a functioning system that now allows many other services to be provided to that target priority group as well.

Public health history was made in India by literally hundreds of thousands of people who were mobilized to accomplish this. The number of lives that are being saved as a result of this program runs into millions every year. It will help India in its demographic transition to a more stable population because it will bring down the infant mortality rate dramatically. We had many false starts, many problems, but we worked together with creative people in ad agencies, artists, people in government, highly dedicated people who don’t make the headlines because they’re just doing their jobs at the national, sub-national, and district level. That was a very, very satisfying experience. On the other hand, if an effort fails and we did our best, we can learn from that failure. I am not attached to the fruits of the labor. Of course, one works as hard as one can, but I have learned living in Asia, and from Hinduism and Buddhism, that one should not work for the fruits of one’s labor. One should just work to get a job done as best as possible, and the results can be offered to the Divine, if I can put it that way.

SI: What is your sense of the future in terms of the world’s children?

RC: I am extremely hopeful. If we can continue and increase the activities that we are now doing, which are relatively simple health, nutrition, and educational approaches, we can make significant progress quite easily. But I am convinced that the sustainability of these activities can be achieved only if they are accompanied by a new ethic for children. The world’s religions, the media, and other sectors of society have a very important role to play in disseminating a new ethic for children. Only then will we be headed for sustainable success.

From the March 1995 issue of Share International

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First published April 1999, Last modified: 15-Oct-2005