From Invisible to Visible - Positive Deviance Initiative

Walking the corridors of the Clinic, we notice the original and collected works of art. Nancy Iversen,
our escort, points to a subtle, exquisite, monochromatic landscape titled “Winter Dusk and Big
Sky”—a rendering of the Big Sky Montana country. The painting is an original Russell Chatham, a
world-renowned Montana lithographer whose patrons include Hollywood legends Peter Fonda and
Jack Nicholson. Another painting is by Ben Steele, a former Billings Clinic patient and a famed
Montana artist, who survived the Bataan Death March in 1942 off the Bataan Peninsula, Philippines.
His sketches of the 60-mile long Bataan Death March and Japanese army atrocities, drawn from memory
after surviving the ordeal, are well-known internationally.
In the in-patient surgical unit sits a traffic light type contraption: A noise meter that turns red when
the decibels go up. Most of the hospital is designated as a noise-free zone. In a “healing” room, right
next to patients undergoing chemotherapy, we notice a stack of fragrant candles, incense sticks, and
an inviting massage chair. An RCA boom box sits on a table, playing a Tranquility Collection of forest
rain and wood-wind melodies.
Heal a person, no matter what the outcome, you win. Billings Clinic = Healing.
among commercial sex workers in Vietnam and
Myanmar.
families collected tiny shrimps
and crabs from paddy fields,
and added those with sweet
potato greens to their children’s
meals. xi Also, these PD mothers
were feeding their children
three to four times a day, rather
than the customary twice a day.
PD mothers were also more
likely to actively feed their children
by hand, in contrast to most mothers who
just placed the rice bowl in front of their children.
In 1991, as Director of Save the Children in
Vietnam, Mr. Sternin was asked by government
officials to create an effective, large-scale program
to combat child malnutrition, and to demonstrate
results within six months. More than 65 percent
of all children living in the Vietnamese villages
were malnourished at the time. The task seemed
impossible.
Building on Zeitlin’s ideas, the Sternins sought
poor families who had managed to avoid malnutrition
without access to any special resources.
They were the positive deviants (PDs). They
helped the communities to discover
that mothers in these
“We dance around
in a ring and
suppose, while
the secret sits in
the middle and
knows.”
The Sternins helped the community to design a
program whereby community members could
emulate the positive deviants. Mothers whose
children were malnourished were asked to forage
for shrimps, crabs, and sweet potato greens, and
in the company of other mothers, learned to cook
new recipes that their children ate right there.
Within weeks, mothers could see their children
becoming healthier.
After the pilot study, which lasted two years, malnutrition
had decreased by an amazing 85 percent
in the communities where PD was implemented.
Over the next several years, the
PD intervention became a
–Robert Frost
nationwide program in
Vietnam. The meme replicated
through families and villages,
helping over 2.2 million people,
including over 500,000 children,
improve their nutritional
status xii .
The PD approach emphasizes
hands-on learning and focuses
on actionable behaviors. xiii It
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