THE THESIS REPORT

In a thesis report, the writer establishes the report's structure and scope central statement that he supports throughout the document. This central statement is by definition arguable, neither an obvious matter of indisputable fact nor a mere opinion that cannot be successfully defended or verified. For instance, the statement, 'The process of refining crude oil into usable product is difficult, time consuming, and costly,' is a simple and undisputed matter fact; it might work for a long, simply factual school paper, but would be superfluous in the working world. Or the statement might serve as the thesis for a description of an oil refinery to a lay audience or novices. However, if audience wanting a description of an oil refinery were potential investors, thesis would not work because that audience implies a specific rhetorical purpose with many limitations and special demands. Similarly, using the description for public relations would imply a specialized document, not at all typical school report.

At the other extreme, a statement such as 'The oil industry does no about the consumer,' is an opinion impossible to prove. How can a prove caring or not caring? Such a statement is an emotional charge, supportable thesis.

The writer supports the thesis with a variety of evidence spread fairly evenly through the text. Such factual evidence as statistics, professional opinions, surveys, observations, experiments, and all sorts of test data can be used to support a thesis. In short, the author organizes the strongest possible evi-dence into the pattern most supportive of the thesis The author also blends her remarks smoothly into these docu-mented factual materials. The thesis report is a well-reasoned and supported argument. The facts supporting the thesis are based on carefully gathered and documented information. The thesis itself and the author's commentary running through the report are interpretations and conclusions drawn from the available facts.

The article 'Things Go Better with Coconuts' is an example of a thesis report. It appeared in a specialized journal dealing exclusively with nutrition. Many readers of this journal, administrators concerned with nutrition problems on a worldwide scale, face problems in their own parts of the world similar to those described in the article. Thus, the writer wants not only to describe her solution to her problem, but also to suggest that similar solutions might work on similar problems anywhere in the world.



Things Go Better with Coconuts-Program Strategies in Micronesia


Nancy Rody

Politics, economics and cultural traditions are considered factors in projects to increase consumption of indigenous foods.

Summary
A two-year nutrition education program was initiated in the U.S. Trust Territory of the Pacific Islands with the objective of promoting the increased utilization of indigenous foods and discouraging the use of expensive and nonessential imported foods. Program emphasis was placed on practical methods of changing nutrition practices and attitudes. Motivational techniques employed resulted in the reduction of soft drink importation and an increase in breastfeeding. Extent of behavioral change was measured directly by tax receipt data for soft drink consumption and through clinic observation for changes in infant feeding practices. By enlisting the active participation of honored persons and institutions and recognizing popular political views, support was achieved which enhanced efforts to modify food behavior through change in personal values.


PARADISE LOST

In the isles of Micronesia where island peoples once lived an idyllic existence reaping the fruits of the land and the sea, Micronesians now consume fish which is caught in waters off their shores, frozen, transhipped to the United States or Japan for can-ning, and sent back to the islands to be sold for very high prices (1).

Micronesia, with a population of approximately 120,000, is a U.S. Trust Territory comprised of 2,000 islands scattered across the Western Pacific. Twenty-five years ago most indigenous peoples lived primarily on a crop gathering and fishing subsistence level. The traditional diet appeared to have been quite adequate as evidenced by the reported general good health of the population at that time (2).

Interviews with district physicians indicate that nutrition problems are on the increase, particularly in those areas undergoing rapid urbanization. A 1975 nutrition study in the populous district of Ponape surveyed the problems in detail. The report indicated that although at birth and shortly after, most of the children are of average weight, by two years of age 50% of these children are below average weight for that age. Ponape children are infested with a great number of intestinal parasites which take a significant amount of whatever food the child consumes. In 1975 about one-third of all hospitalized children were infested with intestinal parasites; and just under one-half of all the children had a respiratory infection, quite often a common result of round-worm infestation. Additionally, these children are also subject to nonspecific dysenteries with resultant dehydration. In Ponape, one or two children die of kwashiorkor each year, and many more suffer from the effects of chronic undernutrition. Ponape children grow and develop slowly, are chronically ill, and have little resistance to infectious disease (3).

The World Health Organization has reported an increasing prevalence of diabetes mellitus around the world, particularly in areas where there has been economic development (4). Diabetes is the third leading medical cause of death in the Northern Marianas, the most 'modern' of the districts of Micronesia (5).

A health screening in 1977 of all children in Palau, the district largest in land mass, indicates greater occurrence of dental caries for young children as contrasted with their older siblings. Incidence of one or more caries was 12% for high school freshmen, 23% for children in grades one through eight, and 47% among preschoolers (6).
During the same year a similar study was conducted in the Northern Marianas, and the findings there were very much the same as those in Palau. Children six to seventeen years old averaged 1.4 teeth extracted for each filling placed (7).

The increase in nutrition-related health problems is thought to be the result of migration from outlying islands to heavily populated district centers where western commercial influence is dominant and wages are low in relation to imported food prices. Because of the high price of canned food and relatively low salaries, families are sometimes only able to buy rice, but no fish or meat (8). There is little concept of budgeting, and money is often wasted on low nutrient density foods such as sugar and soft drinks. The Director of Health Services for Micronesia has indicated that malnutrition may soon become the most extensive and seri-ous health problem affecting the preschool child in Micronesia (9).

Despite widespread concern about nutrition -related disease and malnutrition, little has been done throughout the area to put into effect any comprehensive plan to alleviate the problem other than some well-intentioned, stop-gap government group feeding programs that serve imported foods. These programs have real potential for abuse, and they tend to undermine traditional values of cultural integrity and self-reliance in Micronesia.


NUTRITION EDUCATION BEGUN

A nutrition education program was initiated through the Yap District Health Department with the objective of promoting the increased utilization of locally produced foods and discouraging the use of expensive and nonessential imported foods. Yap District is a group of 17 inhabited islands located in the Western Caroline Islands of Micronesia. The District consists of two distinct groups of islands: the four high volcanic. islands of Yap proper and the numer-ous low sandy coral atolls of Yap's outer islands. Each of these two areas has a distinct culture unique in language, dress, social structure, and problems. The district center, Colonia, is located in the central high island group and is the site of the island port, governmental offices, hospital, major stores, missions, and schools. Roads are limited, of poor quality, and may be impassable in the rainy season.
Many villages are not connected to the road and can only be reached by foot. One island is accessible by boat only, and another by a lengthy log foot-bridge from the main island. Life centers around the village, the extended family, and its lands. More than any other district of Micronesia, the approxi-mately 7,500 people of Yap depend on the land and sea for their food staples: fish, coconuts, taro and other tubers, various types of bananas and seasonal fruits. In recent years there has been a steady migration to the Yap district center, the focal point of the developing cash economy. Food imports were found to have increased 253% in Yap over the two-year period, 1974 to 1976 (10). However, the Yapese consider themselves the elite of Micronesia in that they still place high value on the preservation of their traditional culture, including long revered food cus-toms. They are a very conservative-people, inclined to look cautiously on outside influence.

The outer islands are largely coral and sand with limited agricultural possibilities. Staple foods are coconut and breadfruit. Since these islands are subject to periodic typhoons which heavily damage breadfruit and coconut trees, the sea has been the most reliable source of food until the advent of trading ships laden with rice. The closest outer island to Yap proper is 100 miles; the farthest is 500 miles. The district's erratic fieldtrip ship service is the only form of inter-island transportation. This government operated ship stops at the islands several times each year to transfer supplies and permit officials such as physicians to visit.

Mean annual income is less than $2,000 per household, averaging ten to thirteen members. The prices of most imported foods are prohibitively high. A 1976 survey indicated that imported food prices in Yap's district center average 74% above retail food prices in Guam, and that Guam's food costs, in turn, are higher than any of the 50 U.S. states (11). Prices in village stores are higher than in the district cen-ter due to additional transportation costs and because sales are usually made on credit. The most popular imported foods are polished rice, sugar, soft drinks, bread made from bleached flour, noodles, and canned fish. Because many of these foods are imported from Eastern countries, they are not enriched with vitamins and minerals lost in processing.

Costs of local agricultural and fisheries products are very low in relation to imported food prices, but these commodities have not been readily available. The Trust Territory Government is attempting to develop cash crops, such as copra and black pepper, for export, but no program has been initiated to reduce the importation of foods.

An average of 95% of the Trust Territory budget is derived from U.S. grants (12). This situa-tion is reflected in a serious imbalance of external trade. Exports, primarily copra, have not kept pace (1951-$2.2 million, 1976-$4.8 million) with the rapidly increasing rate of imports (1951-$8.9 mil-lion, 1976-$38.4 million) (13). Most of these imports consist of consumer goods, particularly foodstuffs, much of which could be produced locally. The United Nations Visiting Mission to the Trust Territory reported that 'such a trend in no way encour-ages the population to make maximum use of the Territory's own resources but leads it to rely increasingly on the purchase of foreign products, financed from the outside. Obviously, this situation has repercussions at the political level' (12).

The nutrition education program was implemented in Yap by a single nutritionist and has been in effect for two years. It has attempted to couple conventional educational techniques-instruction with posters, flannelgraphs, and flipcharts-with more unorthodox methods that together will achieve the desired change in food attitudes and practices.


THINGS GO BETTER WITH COCONUTS
A nutrition project with the objective to promote the popularity of coconut juice instead of soft drinks was developed in 1975. This objective was chosen due to the great concern of Yap District physicians and dentists over the high sugar intake which they observed throughout the local population. Individual diet histories accomplished by the nutritionist in Yap indicated that it was not at all unusual for an average Yapese adult to consume daily several soft drinks and as much as a half pound of sugar mixed with coffee, tea, milk, or plain water. The health staff felt that this intake was contributing to the increasing incidences of diabetes, obesity, and dental caries.

Project promotion materials included a locally produced comic book and bar graph charts illustrating the relative nutritive value of coconut juice and soft drinks. Attention was given in these materials to the fact that the sale of coconuts, a local product, is advantageous to the Yapese economy. This economic incentive to realize proportionately greater profits was discussed individually with storekeepers and potential coconut suppliers.

The largest grocery store in Colonia agreed to stock coconuts and to display posters that promoted drinking coconuts alongside advertisements for soft drinks in the store. Other stores soon followed suit and made their own signs. The island's only newspaper carried a photo of coconuts with a purloined caption indicating that they are 'real' while a well-known soft drink was captioned, 'It's the artificial thing!' Most young Yapese adults are literate, and the slogans soon became popular catch-phrases around the district.

A political cartoon feature, which was not originated by the nutrition program, appeared in the newspaper soon after the promotion campaign began. It depicted a canned soft drink as a character representing unpopular foreign political influence while a coconut character represented Yapese sentiments. This cartoon motif became a regular feature of the paper.

As a result of the campaign, most stores on the four main islands now keep cold drinking-coconuts in their refrigerators. Coconuts are sold for 20 or 25 cents, half the price of soft drinks. Several individ-ual stores report average sales of 1,000 coconuts weekly per store on the main island even though the total population is less than 4,000. Some store-keepers say they sell more coconuts than soft drinks. Coconuts are now served regularly in the most prominent local restaurant and as refreshments at the majority of official functions. They are also sold in the concession of the two local movie theaters. A problem was encountered by several storekeepers in obtaining sufficient coconuts to meet the demand of their customers. Coconuts are quite plentiful on Yap, but they were not usually marketed by farmers except as copra, the dried meat of the mature nut. Recognizing this, some secondary school employees organized groups of teenage boys to climb family owned trees and husk the available green nuts. The boys found this after-school enterprise very profitable to the extent that one energetic young man managed to save enough money for a vacation trip to Canada.

Based on district tax receipts, imports of soft drinks to Yap in 1974 totaled $450,216. In 1975, the total was $198,447. Complete figures on the import value of soft drinks in 1976 are not yet available, but through the third quarter the total was $88,478. Tax receipts do not show any significant increase in the importation of any other substitute beverage. These figures coupled with storekeepers' reported high volume sales of coconuts indicates that the decreased imports of soft drinks can be attributed at least in part to the sale of coconuts. The population of Yap has increased approximately 6% during the time importation of soft drinks has decreased, and the retail cost of soft drinks has increased by ten cents per can. These factors indicate an even greater per unit reduction in soft drink consumption than can be determined from import value alone.

Although economics undoubtedly accounted for much of the increasing popularity of coconuts, other factors also contributed to the success of the campaign. My observation is that change originat-ing from older values was accepted by the community and was not seen as something imposed from the outside. Attitudes were also probably influenced through political associations which were reinforced by events such as the appearance of the newspaper cartoon.


Another focus of the Yap nutrition program appealing to the 'old ways' and the 'virtues of tradition' has been to encourage breastfeeding and the use of inexpensive local foods for babies. A video tape was made with local people explaining the advantages of breastfeeding and the disadvantages of bottle feeding. It was narrated by highly respected local women in the three languages of the district. This video tape is shown in the hospital clinic waiting room at regular intervals. An illustrated booklet on breastfeeding is given to all prenatals seen at the clinic, and an illustrated baby feeding 'calendar' is given to all postpartums. These educational guides have been prepared in the vernaculars of the district. Almost all women in Yap come to the hospital for their birth deliveries.

Using a battery operated projector, a filmstrip featuring a well-known and widely respected Yapese woman breastfeeding her baby is shown at meetings with village mothers. A radio spot consisting of a dialogue between two fathers commenting on the money that can be saved by breastfeeding was aired regularly. Training in the advantages of breastfeed-ing has been provided to health department personnel, and they are encouraged to promote breastfeed-ing among their own families and in their home villages. Health curricula developed for secondary school classes encourages breastfeeding through activities such as calculating the cost of bottle feeding for one year and experiments with spoiled milk. The hospital clinic nutritionist provides individual counseling to mothers who have problems with breastfeeding.

A second video tape was made to demonstrate the preparation of homemade baby food from local foods. This tape featured a well-known, highly educated Yapese woman as the principal actor, narrator, and role model. It is also shown in the clinic. The baby feeding calendar given to postpartums at the hospital illustrates the use of local foods for infants. Training on baby food preparation was provided to health department personnel. Training was made available to the general public through a demonstration of how to make baby food from local food using a simple hand grinder. This demonstration was given inside the largest food store in the district center on government 'payday.' Samples of this food were given away after the demonstration. Illustrated handouts headlined 'Someone Is Paying $4.80 Per Pound For Bananas,' describing the relative merits of commercial baby food and home prepared baby food, were available at the demonstration. The content of the pamphlet was later published in the only local newspaper. Store management cooperation for the demonstration was facilitated through the use of a food grinder that is sold by the store.

Evaluation of the infant nutrition facet of the program has been confined to clinic observation. Two years ago more than 75% of the women seen in clinic were bottle feeding their infants and they were often actively encouraged to do so by health department personnel. Bottle feeding was considered a status symbol, the 11 modern' thing to do. Mothers were bottle feeding their infants mixtures of over-diluted milk, flour and water, or fruit-flavored soft drinks. Women who breastfed their infants were often ashamed to do so in public, not for reasons of modesty, as women traditionally go bare-breasted in Yap, but because they were considered old-fashioned. Now more than 50% of the mothers can be observed in the clinic waiting room breastfeeding, and those who have a bottle may try to conceal it. Documentation of the extent of use of local foods for infant feeding is difficult due to the lack of household surveys. However, clinical counseling nutrition records show that at least half of the mothers are utilizing indigenous foods for infant feeding.


IMPLICATIONS

The favorable response to the Yap nutrition education program appears to be based on the highly visible participation of respected local persons and institutions and the appeal to Yapese pride in traditional ways. The program reinforces nationalistic tendencies and certain valued cultural traditions. Realistic methods by which this developing area in Micronesia can meet its health needs, despite limited resources, are the major focus of all nutrition edu-cation activities. The sole budget item for the first year of this two-year program was the nutritionist's salary; the second-year budget Was increased by $1,200 for material and publication costs. Program strategy is based on practical methods of altering personal attitudes and practices for long-term benefit rather than on isolated remedial programs such as free food distribution. Behavior is based on learned values. Motivation to change behavior occurs only when opportunity is given to each individual to attain sufficient knowledge to make responsible value judgments. This premise has guided the development of Yapese nutrition programs.

The coconut juice vs. soft drink project is a case history which could have application in many parts of the tropical world. A value-based and emotionally appealing campaign could promote the popularity of coconut or other local juices in many areas where they are readily available as a tasty, money-saving substitute for high sugar drinks. Long-term evaluation is necessary to measure realistically the health, economic, and social impact of the program.

Family income is inadequate to purchase sufficient quantities of canned milk and processed infant foods in many developing areas. There is a great need for more aggressive advertising campaigns
utilizing persuasive, imaginative techniques to promote the use of breast milk and homemade infant food resources in these areas.


REFERENCES
1. McHenry, D. F., Micronesia: Trust betrayed, Carneg'e Endowment for International Peace, New York, 1975,
P. 8.
2. Murai, M., Nutrition Study in Micronesia, U.S. Na-tional Research Council, Pacific Science Board, Atoll Research Bulletin no. 27, 1954.
3. Demory, B. G. H., An Illusion of Surplus: The effect of status rivalry upon family food consumption, Ph.D, dissertation, University of California, Berkeley, 1976, pp. 53-54.4. Mitchel, H. S. et al., Nutrition in Health and Disease,
1. B. Lippincott Co., Philadelphia, 1976, p. 396.
5. U.S., Trust Territory of the Pacific Islands, Department of Health Services, Northern Mariana Islands Compre-hensive Five Year Health Plan 1977-1982, Saipan, 1977, unpublished.
6. U.S., Trust Territory of the Pacific Islands, Department of Health Services, Dental Study (TTPI): Paulau Dis-trict Department of Health Services, Saipan, 1977, un-published.
7. U.S., Trust Territory of the Pacific Islands, Department of Health Services, Dental Study (TTPI): Northern Marianas Department of Health Services, Saipan, 1977, unpublished.
8. Hezel, S. J., and C. B. Reafsnyder, Micronesia: A chang-ing society, Micronesian Social Studies Program, Trust Territory of the Pacific Islands Publications, Saipan, 1973, P. 33.
9. Kincaid, P. J., Trust Territory of the Pacific Islands Nutrition Survey, U.S., Trust Territory of the Pacific Islands, Health Council, Saipan, 1973, foreword. U.S., Trust Territory of the Pacific Islands, Office of Economic Development, Estimated Dollar Value of Non-Government Imports, Yap District, 1977, unpub-lished.
11. Rody, N., Yap's food prices 74% higher than Guam's, The Carolines Observer, 1 (No. 1):8,1976.12. Labby, D., The Demystification of Yap, University of Chicago Press, Chicago, 1976, P. 8.
13. Smith, U. N., Trust Territory: Foreign trade analysis, U.S., Trust Territory of the Pacific Islands, Department of Resources and Development, Economic Development Division, Saipan, June, 1977, unpublished.

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