Amid the rolling hills and green fields of Nias Island, North Sumatra, lies a silent crisis that slowly erodes the future of children. Small bodies that are shorter than they should be for their age, dull eyes even though the day has just begun, and poor school performance—these are just the surface of one word: stunting. For some communities in Nias, short stature in children is believed to be hereditary, not a health emergency requiring immediate attention.

 

But that perception is beginning to shift—not because of sophisticated tools from big cities, but thanks to something simple: an illustrated module in the Nias language. This is not an ordinary book. It is a bridge between medical knowledge and everyday rural life. It was born from sharp observation, heartfelt conversations with village mothers, and a strong desire to reach those who have long been overlooked.

 

Cashtri Meher and Fotarisman Zaluchu, in their article titled “Methods for Stunting Education in Impoverished Rural Areas Using Illustrated Modules in Local Languages”, share the story behind this research, now published in MethodsX. “We can’t come with formal language and expect everyone to understand. Here, education must begin at the most basic level: the mother tongue, visuals, and empathy,” said Cashtri Meher.

 

Their first step was not to write theory, but to listen. Through six Focus Group Discussions (FGDs) across three regions—North Nias, South Nias, and Gunungsitoli—the team listened to stories, myths, and confusion among mothers about stunting. Many believed it was genetic, with no relation to diet or sanitation. “It’s not their fault,” said Fotarisman Zaluchu, the second author and an anthropologist. “The information that reached them never used their language, nor their way of understanding the world.”

 

From FGDs and in-depth interviews with community leaders and healthcare workers, one urgent need emerged: educational materials rooted in the local context. This led to the idea of creating a bilingual illustrated module, with narratives in Indonesian carefully translated into Nias, and images reflecting local life—mothers pounding rice, fathers working the fields, toddlers carried in traditional slings.

 

The translation was not merely linguistic—it was cultural. Each sentence was meticulously reviewed with translators and local residents to ensure messages about nutrition, clean water, and parenting were not only familiar but emotionally resonant. The illustrator was also instructed to depict traditional clothing, Nias-style homes, and warm, communicative facial expressions.

 

“We wanted mothers to look at the pictures and say, ‘This looks like me,’” said Cashtri, showing pages of the brightly colored module.

 

The module consists of 29 narrative pages covering the definition of stunting, signs such as delayed speech or lethargy, long-term consequences like chronic illness or dropping out of school, and practical guidance on the importance of exclusive breastfeeding, nutritious food, fathers’ involvement in caregiving, and treating boys and girls equally.

 

What’s most touching is how these stories do more than inform—they invite dialogue. One page, for instance, shows a father helping his wife cook, with a caption reading: “A husband who helps with housework keeps his wife healthier during pregnancy.” Another page shows children weighing in at a Posyandu (village health post), highlighting the importance of growth monitoring.

 

Before the module was printed and distributed at community gatherings and churches, the team conducted a pilot test with 30 mothers across three target locations. The mothers were asked to evaluate the module through eight questions, such as whether the language was easy to understand, the pictures appealing, and whether they would follow the recommendations. The results were outstanding: the average score was 9.06 out of 10. The highest marks were for “usefulness of the module” and “important for others to read.” Participants didn’t just read—they discussed, asked questions, and even started reminding each other about nutritious food and prenatal checkups.

 

“What surprised us most was how this small module sparked conversations in communities that were previously silent about stunting. Their language, their stories, images that mirrored their lives—all of it made the module come alive,” Cashtri explained.

 

This success didn’t come without challenges. The module was designed specifically for Nias-speaking communities, and implementation would be difficult without local teams fluent in the culture and language. This is both its strength and its limitation. Yet the research team sees this as a prototype—a model that can be adapted for other regions using similar principles: cultural grounding, visual storytelling, and community participation.

 

“We want modules like this to become the mainstream in public health education. Not just about content, but how it's delivered. People deserve information that respects their identity,” said Cashtri Meher.

 

In a world where education is often reduced to lectures and formal posters, this module teaches something deeper: that knowledge must be wrapped in empathy, delivered in the mother tongue, and presented through images that make people smile—and then think. In the heart of Nias, a small booklet has shown that change doesn't have to start with a PowerPoint slide or a politician’s speech, but with the quiet act of a mother reading to her child.