Category Archives: Calcutta Kids Blog

CK’s Child Development Corner

The child development corner project, which was initiated last year, is almost complete. The corner is now a bright spot in our community center, Ma o Shishu Shiksha Kendra, with yellow colored walls, shelves filled with toys and books, and comfortable foam mats for the children to explore and play. Display boards have been put up to exhibit children’s artwork and important child development messages. Once the curriculum has been finalized for child development sessions—due to be completed this month—child development sessions within the child health community meetings will be initiated. In the meantime, during community meetings (which take place almost every afternoon) the space is being used for play by children whose mothers are attending the meetings.

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In February, Calcutta Kids organized a training workshop on child development to achieve the following goals:

1.) To provide a foundation on child development for Calcutta Kids’ health workers who will be working with mothers and children during the child development sessions. The health workers will use the lessons to teach mothers how to stimulate their children through play.

2.) To solidify curriculum development for the child development sessions to be started in April. This will ensure that the messages and counseling given to Calcutta Kids’ beneficiaries are standardized and evidence-based.

Jane Thompson, a child development and education specialist, and Director of Next Step Early Intervention, conducted the two-day training, “Helping Children Grow” for our health workers. The training started with an overview of ‘secure and nurturing attachment’, and the importance of the emotional bond between the child and the mother (or primary caregiver) which is critical for a child’s growth and development. She also spoke about ‘active learning’, a process by which children develop and learn through interaction with their environment. She emphasized that the most optimum form of multi-sensory learning is achieved through play, which is the major goal of the Calcutta Kids’ child development corner project.

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The rest of the training workshop was divided into age groups: 0-3 months, 3-6 months, 6-9 months, 9-12 months, 12-18 months, 18-24 months, 24-30 months, and 30-36 months. For each age range, Jane discussed key milestones in different areas of development including: cognitive, communicative, social/emotional, adaptive, and physical. She demonstrated activities that could be done during each age range, using materials that she had brought, along with materials that we had procured for the child development corner. A summary of the training and key topics can be viewed on the workshop presentation here.

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We are very appreciative of Jane, for conducting such an informative workshop on child development. The lessons learned will be applied when we hold child development sessions with the beneficiaries (mothers and children) and when we use the space to entertain children while mothers are attending community meetings. —Danya Sarkar

Child Health Counseling Training February

Since the last Calcutta Kids off-site training in May 2011, our staff members have frequently asked, when will we go away again for training? For our staff, training is more than just an opportunity to learn new skills, it is also a special and exciting opportunity to leave the office and their homes to spend a few days away– a much needed break from the daily grind. We held a long awaited training on protocols and child health counseling last week at Monobitan, a training center south of Kolkata in Pailan run by our friends at CINI. The training was a welcome opportunity to take a step back from our day-to-day work and enjoy some fun learning activities.

The first day of training was held on-site in our new community center in Fakir Bagan—Ma o Shishu Shiksha Kendra (MoSSK). The first task was to come up with an entertaining nickname name for each staff member, using an adjective starting with the same letter as their name. The name would be used throughout the training, and it proved to be a great source of amusement. The names ranged from simple— ‘Sincere Sima’ and’ Jumping Jayanta’—to more complex –‘Na sunne ka pasand nahi Nasreen’ (Doesn’t like to hear no Nasreen) and ‘Shundor moner odhikari Sumana’ (Soul with a good heart Sumana).

The goal of the first day’s training was to clarify protocols for program activities held in MoSSK. The day was spent learning about new protocols for Growth Monitoring and Promotion (GMP), our MYCHI Clinic, Immunizations, Nutrition Corner, Community Meetings, and Child Development Corner, all which are now carried out in MoSSK. The team members role-played each of the activities to internalize the protocol and enjoyed playing different parts such as patient, doctor, mother, and counselor.

The next morning the CK team piled into several Tata Sumo trucks and sped through the streets of Kolkata, heading south to our training site in Pailan. After a quick breakfast, we dove into the training sessions on child health. We focused on two new child health topics: Family Planning and Hygiene & Sanitation. They were not unfamiliar topics to our health workers, but they were new in the sense that we were introducing standardized education and training materials for them. Each topic session consisted of a lecture, videos, and the introduction of an innovative counseling technique. After the Family Planning session, Sriya, our AIF Fellow, who has been working on behavior change communication (BCC) for maternal and child health, introduced a technique called Forum Theater  an interactive form of theater that is used to demonstrate problem situations and involves the audience as part of the activity and resolution to the problem.

Chandan and Susmita participating in Forum Theater

Chandan, Malti and Susmita participating in Forum Theater

After the Hygiene & Sanitation lecture, our program coordinator Sumana, who has taken a formal training course on puppetry for community health and awareness, organized a puppet show on the topic performed by the AICs and CHWs in order to demonstrate another creative technique that can be used for counseling and BCC.

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It was incredible to see how quickly our staff members and, in particular, our health workers, adopted the new techniques. Performing both forum theatre and puppet theatre for the very first time, they successfully incorporated essential messages and both identified and found resolution to key problems using these two creative and interactive mediums.

As the day came to an end, the staff took time to enjoy the last bit of sunlight to walk around the gardens and playgrounds of Monobitan, pushing each other on the swings and merry-go-round. In the evening, we did a ‘guess the baby’ game which included showing baby photos of staff members and having to guess who they were. The highlight activity was the eco-friendly newspaper fashion show, where we split into groups by topic—popular female leader, favorite political leader, famous TV advertisement, movie, book, or cartoon character, and Bollywood actor or actress. Each group dressed up one or more models using newspapers and then walked up the runway as a group, using song or dance. It was truly a hysterical experience and brought out the creative side of our team members. Arpita dressed up as the Chief Minister and sang Ekla Chole Re along with her group. Kalyan posed as Rahul Gandhi, and Chandan danced around as the Joker from Mera Nam Joker—much needed laughter therapy for all of us.

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The next day, the entire day of training was group work, focused on new strategies for BCC including the forum theatre and puppet theatre techniques from the previous day, along with counseling cards, interactive games, poster making, role-play, discussion groups, visual media, and demonstrations. Participants were divided into five groups and given child health topics–PNC and Care of Newborn, Immunizations, Care of Sick Child, Feeding Practices, and Child Growth and Development. All of these topics are familiar to the staff and our health workers already counsel beneficiaries on these topics. However the novel task was to identify key messages, challenges in changing those behaviors, and present solutions in a new counseling medium. Each group presented their topic and form of counseling technique to the rest of the participants, followed by discussion and feedback. All the techniques mentioned were effectively utilized—and at the end of the session, the whole team felt that they had really learned new skills in the BCC arena, and accomplished something very important. We will take this confidence building to our work in Fakir Bagan community, imparting essential health messages through effective delivery tools. The health workers commented how each of them had started at Calcutta Kids with virtually no knowledge of maternal and child health, and now they not only have internalized the information and the messages, but are able to teach the women they work with in new and exciting ways that will truly change the face of counseling and behavior change at Calcutta Kids.

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As we left Monobitan that evening, I think that each of us felt a sense of triumph, that the training was a success and we came away from it with so much knowledge. We also felt a sense of peace, and sense of togetherness, as I think the training solidified relationships within the organization and really made us feel that we are working towards a common goal. Our Director Noah commented that the training was ‘a memorable few days which not only strengthened our team as a whole but also strengthened each individual working at CKT.’                          —Sumana Ghosh and Danya Sarkar

 

New BCC Techniques Introduced

At Calcutta Kids, community meetings are held to divulge health messages through meetings focused on various health topics. The community meetings also serve to promote interaction among the mothers of the community. Through the monthly meetings, Calcutta Kids promotes positive health-seeking behavior through the method of Behavior Change Communication (BCC). Women from the community have expressed the need for such a platform where they can share ideas, discuss challenges they face or simply sit along with other women from their community as they drink chai and listen to the health workers about life-saving practices they may adopt.

The health workers do a great job of getting the health messages across to the mothers, usually through an interactive lecture. They encourage mothers to ask questions, share personal experiences and initiate discussions. However, there seems to be a gap between the information that is conveyed during these meetings and the change in practices of the women. After a meeting, the women are able to repeat verbatim, some of the messages of “You must wash your hands before cooking” or “You must eat 6 times a day when pregnant.” Are they really adopting these practices in their homes though? In some of my visits to the community I found that this is not the case in all households.

For example, during my community visit with a health worker on the day of a religious festival, I observed 6 pregnant women who were fasting all day for the good health of their husbands in the future. In some of these cases pregnant women were fasting despite discouragement to do so from their husbands and mothers-in-law (both powerful family members who influence the actions of the mothers). These were mothers who had been to the community meetings and knew well the information about the importance of good nutrition for themselves and their children but continued this detrimental practice. Cultural and religious factors, domestic burden of having to work at home all day, and the simplicity of not having to take that extra step to eat one more meal or wash your hands one extra time often becomes the cause of poor health.

In order to initiate transformative change in the mothers of the community, it is necessary to create reflective processes in a safe space for women to explore their feelings. Providing them with health messages is necessary to build awareness, but in addition to this the health workers need to use approaches that encourage women to think about their behaviors. “Experts who study behavior change agree that long-lasting change is most likely when it is self-motivated and rooted in positive thinking.”(1) Additionally, the setting of a community meeting helps to “recognize the social nature, because it is the co-presence of others thinking alongside us that matters as much as the thinking itself, helping us change our attitudes and reflect on our values, while also acting as commitment devices.”(2)

In order to address this challenge and use different strategies to inculcate positive health behaviors, we are having an offsite training this week where we will introduce various counseling techniques to the health workers. A review of Child Health topics such as “Care of a Sick Child”, “Care of a Low birth Weight Baby, Child Growth and Development”, “Post natal care and Breastfeeding”, and “Feeding practices and Immunizations” will be carried out through the use of various activities to communicate the health messages. Two new topics will also be introduced 1) Family Planning and 2) Hygiene and Sanitation. These health topics will be reviewed using puppet shows, discussion groups, role-play, interactive games and ‘Forum Theater  to demonstrate the use of multiple techniques that can aid in communicating behavior change.

Forum theater  created by the Brazilian director Augusto Boal, serves as an interactive form of theater where dramatic sketches are created through discussion to show scenes where we see a problem that needs to be changed. When the play is acted out, members of the audience are allowed to step in and portray their solution in the given situation thus evolving from mere spectators into “spect-actors”. “The aim is not to find the best solution but to produce a variety of options that could be used in this type of situation.”(3) Forum theater functions by allowing the audience as well as the actors to experience real-life situations in a stage setting with the opportunity to offer multiple solutions to a problem they face. We aspire to introduce the concept of Forum theater to the staff of Calcutta Kids to build community and dialogue on the various problem situations that create obstacles for behavior change in the community. Through this training we hope to ignite the creative minds, especially our community health workers who can use such activities at the community meetings to aid in their counseling techniques.

The training begins at our MoSSK on Thursday 7th February and will continue at an outside training center where we will spend the weekend together.  There will be briefing about the various protocols, lecture sessions, leadership training activities and group work. Word on the street is that there is also an eco-friendly newspaper fashion show to encourage staff bonding and a little bit of fun! -Sriya Srikrishnan

References:

(1) Harvard Women’s Health Watch January 2007 issue

http://www.health.harvard.edu/newsweek/Why-its-hard-to-change-unhealthy-behavior.htm

(2) John, Peter and Smith, Graham and Stoker, Gerry (2009) Nudge nudge, think think: two strategies for changing civic behaviour. Political Quarterly, 80 (3). pp. 361-370. ISSN 0032-3179

(3) Séguin, Angèle Rancourt, Clémence The Theatre: An Effective Tool for Health Promotion http://whqlibdoc.who.int/whf/1996/vol17-no1/WHF_1996_17(1)_p64-74.pdf

The Art and Science of Diagnosis

A professor from Ohio State e-mailed me the article with the deceivingly understated subject line of all-lower case “fyi.” The Hindu write-up’s headline, though, didn’t mask the shocking contents: “Appalling condition of primary healthcare services” it read. (1) Short and potent, it described the lurid details of a study carried out across the health sector in India, rural and urban, private and public. The details showed a fundamental lack of ability by medical professionals to diagnose even the most common conditions (asthma and dysentery, for example) or ask the most basic questions (whether there was “pain radiation” for an unstable angina). The result was a low rate of diagnosis, whether it was in rural Madhya Pradesh or Delhi.

Overall, healthcare providers provided the correct treatment only 30.4% of the time. (2) Even worse, 41.7% of the time the clinics provided unnecessary or even harmful treatments for “patients” that the research study trained (“from the local community”, the article notes). Many providers, even in public clinics, were unqualified. Medical guidelines and treatment protocols were followed at low rates; providers only asked 33.7% of the recommendations. In Madhya Pradesh, doctors spent 3.6 minutes with patients, while Delhi medical professionals spent a marginally better but still terrible 5.4 minutes. For reference, the Medical Council of India recommends doctors spend at least 10 minutes with each patient. (3)

The article highlighted tough facts that Calcutta Kids has been tackling for years. Through our experiences with the health clinic, we’ve worked to combat the norm of primary health in India: brief, non-comprehensive visits and a disregard for protocols and checklists. We’ve uploaded to the resources section of our website our child health World Health Organization’s IMCI and IMPAC-based Child Health and Pregnancy and Maternal Health protocols and checklists which our doctors are trained and demanded to use. Our two health clinic physicians, Drs. Pal and Sen, work with our management staff to ensure that the protocols we have provided them matches their process for diagnosing patients. See the above-mentioned resources below:

Child Health Protocol (0-2 months)
Child Health Checklist (0-2 months)
Child Health Protocol (2 months to 5 years)
Child Health Checklist (2 months to 5 years)

Pregnancy and Maternal Health Checklist and Protocol

It’s an important process that Calcutta Kids has to do to ensure our beneficiaries get not just quantity but truly quality care. It hasn’t been an easy process to bring in this cultural change into our clinic over the years, but it’s a necessary one. In addition, the creation of standardized protocols ensures a consistent level of care that our beneficiaries can expect, regardless of personnel changes. As Atul Gawande noted in his Harvard Medical School commencement, it’ll require an understanding of a team of healthcare providers- a “pit crew” that includes our health workers- not just the lone cowboy physician:

“The work is rooted in different values than the ones we’ve had. They include humility, an understanding that no matter who you are, how experienced or smart, you will fail. They include discipline, the belief that standardization, doing certain things the same way every time, can reduce your failures. And they include teamwork, the recognition that others can save you from failure, no matter who they are in the hierarchy.” (4)

Many rightly criticize the low rates of spending on health per GDP in India, ranking 171st out of 175 countries according to a WHO study. (5) But the situation is even grimmer: it is not enough to just increase spending, build more primary health centers or even to write diagnostic protocols at a national level. The groundwork of implementation at a doctor to patient level must be accomplished. At our health clinic, we work on this ground level to make sure that provision of the highest level of primary healthcare is a reality for the mothers and children of Fakir Bagan.–Pranav Reddy

Citations:

  1. Appalling condition of primary healthcare services. The Hindu. R Prasad. December 6, 2012. Retrieved from http://www.thehindu.com/health/medicine-and-research/appalling-condition-of-primary-healthcare-services/article4167677.ece on Jan 1, 2013.
  2. In urban and rural India, a standardized patient study showed low levels of provider training and huge quality gaps. J Das, A Holla, V Das, M Mohanan, D Tabak, B Chan. Health Affairs. December 2012. 31(12):2774-84
  3. MCI wants docs to spend at least 10 mins with each patient. The Times of India. K Sinha. September 1, 2011. Retrieved from http://articles.timesofindia.indiatimes.com/2011-09-01/india/29953546_1_opd-patients-doctors on Jan 1, 2013.
  4. Cowboys and Pit Crews. The New Yorker. Atul Gawande. May 26, 2011. Retrieved from http://www.newyorker.com/online/blogs/newsdesk/2011/05/atul-gawande-harvard-medical-school-commencement-address.html#ixzz2H02jhJMO on Jan 1, 2013.
  5. World Health Statistics 2011 Report. World Health Organization (WHO). 2011; 127-139. Retrieved from http://www.who.int/whosis/whostat/2011/en/index.html on Jan 1 2013.

Illuminate India Brightens Calcutta Kids

On December 5th, Calcutta Kids received a very special visitor, Brie Mahar, who shared her inspiring story with our beneficiaries and employees. Brie was born in Kolkata and was adopted and brought to the US when she was 2 months old. She realized her dream of returning to the country of her birth when she came to Kolkata in 2011 to adopt her second daughter. During this trip she witnessed the poverty first-hand and saw the tangible ways she could help meet the needs of orphaned children in India. She was inspired to develop an NGO to advocate for and help impoverished children in India. In 2011, she co-founded an organization called Illuminate India, along with Kristi Werre who has 3 adopted children from Kolkata. Illuminate India currently partners with two organizations in Kolkata: ISRC (Indian Society for Rehabilitation of Children) and Angel House, providing basic necessities, therapeutic and supportive resources for orphans, vulnerable children, and children with special needs.

Brie, Kristi and another colleague Nicole were in Kolkata in December to visit their projects at ISRC and Angel House, and during this time also wanted to meet with other NGOs working with children. Brie contacted Calcutta Kids and we organized for her to visit our programs and meet with two groups—beneficiary women and their children, and Calcutta Kids’ staff. Given Brie’s remarkable story, we specifically invited women in Fakir Bagan who had struggled with issues of having girl children and the negative response from their families and society. In this community, as all over India, issues such as sex selective abortion, female infanticide, and gender discrimination are very much prevalent and greatly affect the lives of mothers and female children.

Brie Mahar Illuminate India Dec 2012

Brie shared with us her story of how she was relinquished at birth by her mother and taken to an orphanage. Back then, Brie was called Metali—she was a small baby, malnourished, and suffering from scabies and giardia when she was flown across the world to the US to unite with her adoptive family. She grew up in a loving family and in a typical American lifestyle,but she always wanted to know more about her country and culture of birth. She always wanted to return to India and adopt a girl child from the same place where she was adopted. After she married, she and her husband had a (biological) daughter whom they called Metali, and then adopted Tanaya in Kolkata four years later.

Despite her precarious start to life, Brie told our women that it was her mother’s love, guidance, and support that shaped her into the woman she is today. She said, a mother’s love is the most important part of a child’s life- without that love and support, a child will not thrive and reach their full potential. Our CK mothers told Brie that though they have affection for their girl children, it is difficult to raise them when their own families do not support them unless they have a boy child. Brie urged the mothers, despite these obstacles, to love and support their girl children just as much as their boy children–a girl child is just as valuable as a boy child and can have the same bright futures if their mothers believe in them. They do not need to go to America for better opportunities, but they can witness the change in their own country, in their own communities, if they understand that they have the strength within themselves to be that change. She said it was her mother’s love that now allows her to raise her own two beautiful daughters.

Our beneficiaries were deeply moved by Brie’s account, of where she had come from and where she is now- a wife, a mother, a nurse, and founder of her own NGO, helping vulnerable children. Our beneficiaries identified with Brie easily because of her background and the passion that she emanated. One mother said, “I can see that Brie is who she is because she had a mother who loved her so much, and she truly believes what a child learns from her mother will be passed on to the next generation. I feel motivated to pass these lessons of love on to my own children.”

Calcutta Kids’ health workers who also face many of the same issues were also encouraged by Brie’s story. They all agreed that what Brie has done in coming back to India, adopting a second girl child, and working with orphans is extraordinary. One of our health workers, Laxmi, who is from a very traditional Bihari family was especially inspired by Brie. She said, “I really liked to hear that even though you have a biological daughter that you also adopted a girl child and are giving her the same love and care. In our society it is seen as a huge burden to raise a daughter, let alone take a second one, but after hearing your story I realize how proud I am to have a daughter, and proud of myself for fighting to keep her in school all these years.” Brie and Nicole, thank you for visit and for inspiring the Calcutta Kids team.–Danya Sarkar

Welcome To Our New Trustees

On the top of the agenda for Calcutta Kids during the year 2013 is sustainability. Too often in development the word sustainability is meant only to refer to financial sustainability.  But one of the major challenges development workers face in the field is organizational sustainability—how will the organization manage times of uncertainty and change; how will the vision and passion of the founder remain present in the team in such a profound way as to drive them without the physical presence of the founder? Since its inception Calcutta Kids has been focused on ensuring successful implementation of its programs in order to achieve its objectives. As significant changes in health indicators are now visible and attributable to our interventions, the obvious next step is to focus on the sustainability of the organizational systems and then scale up.

In the summer of 2012 following the unexpected death of our co-founding trustee in India, Mrs. Shwasti Chaudhuri, we inducted two dynamic new trustees to help guide the organization. I’m pleased to introduce Mr. Sudipta Sinha Roy and Mr. John Ambat. In the past several months, both of these trustees have spent a considerable amount of time at Calcutta Kids getting to know the staff and observing and participating in our activities. Aware of the organization’s desire to scale up, both John and Sudipta are carefully analyzing the existing systems and policies with regard to accounts, investments and human resources to ensure that we are ready.

Both Sudipta and John run their own companies and are able to provide 360 degree visions of how to run an organization in India. Given their rich professional experiences and backgrounds, they are able to guide Calcutta Kids to improve organizational sustainability.

A major challenge faced by organizations in the non-profit-sector in India is that of striking the right balance between policies guided by standards versus emotions. Individuals who choose to work in the non-profit-sector usually do so because of an emotional desire to serve the poor. A common purpose among a group of devoted employees often creates a feeling of family which certainly improves service delivery. But it also makes it difficult to standardize systems and ensure smooth functioning of the organization. In order to ensure healthy sustainability and growth, it is crucial for us to create an environment with a balance—one where we maintain an environment in which the staff feel like family, and is also able to function in a manner in which standardized policies and guidelines are followed. As we prepare to grow and move forward, we are confident in the guidance and support of the newest additions to our Board.

John and Sudipta have already proven to be wise additions to the governing body of Calcutta Kids. As do all of our trustees, they believe deeply in the work of Calcutta Kids and are committed to the organization’s sustainability and growth.–Noah Levinson and Evangeline Ambat

US Consul General visits Calcutta Kids

On Wednesday 28th November, the United States Consul General Dean Thompson and his wife Jane paid a call on Calcutta Kids. They arrived at our office in full pomp and circumstance with an escort of 3 police jeeps. The Thompsons have been stationed in Kolkata since August 2011; have heard about the Calcutta Kids and its US connection; and have been anxious to see our growth monitoring and promotion (GMP) program in action. The visit was a great success and a major coup for Calcutta Kids.

Chandan leads the US Consul General, Dean Thompson to Ma O Shishu Shiksha Kendra

We began the visit by having tea around our lunch table while the senior management and CK Trustee, John Ambat, spoke with the Thompsons about the history; the objectives; the successes; and challenges of the organization. The Thompsons asked good questions and made several suggestions of potential collaborations we might pursue especially surrounding alternative mediums for behavioral change communication which they have seen work in various places, i.e. puppet shows and theater.

Gopal, welcomes Dean Thompson to Fakir Bagan

The next stop was Ma O Shishu Shiksha Kendra—our community center in the heart of Fakir Bagan. Wednesday was the second day of GMP—indeed the busiest of the three day program which takes place each month in which more than 550 children are weighed and measured. When the Thompsons entered the 1200 square foot center there were no less than 90 mothers and children. Mr. and Mrs. Thompson observed the weighing of the children and spent time with families waiting in line.

Danya and Sumana explain to the Thompsons about how data is collected at GMP

The Thompsons meet with beneficiaries waiting to be weighed and measured

We then organized a series of conversations so that our guests could interact personally with two of our health workers, Munni and Sima, and a few mother/child pairs. It was during these conversations that the Thompsons were really able to understand the power of the work Calcutta Kids does from the people who do it and from the people who benefit from it. After this series of conversations, Dean spoke to our health workers, about the importance of their work–that it is one thing to gain the knowledge, but the most impressive and most important thing is the transferring of that knowledge to lift up the other women in this community. Jane then mentioned that it was very evident from the way Munni and Sima spoke, how passionate and committed they were to their job—that it was good to see such empowered women in the community.

Some of the staff posing for a photo with the Thompsons in front of our office before they wrap up their visit

We are most grateful to Dean and Jane Thompson for their visit and we hope to welcome them back to Calcutta Kids again sometime soon. We are also most grateful to Danya Sarkar who encouraged and organized the visit. –Noah Levinson

SWOT Weakness–>Monthly Meetings

In the spring of 2012, our 2011-2012 AIF Fellow Margy Elliott conducted a SWOT (Strengths, Weaknesses, Opportunities, and Threats) analysis for Calcutta Kids. Margy carried out long interviews with representatives of all of our stakeholders including all of the staff; beneficiaries; donors; former interns; current interns and volunteers. The management team along with the board of trustees has carefully gone over this detailed document and is implementing changes so as to promote and further reinforce our strengths, fix the weaknesses, take advantage of the opportunities, and close the holes on the potential threats. Over the coming months, we will share ways in which we have used the SWOT analysis to strengthen and protect Calcutta Kids.

One of the discovered internal weaknesses was a lack of communication between the field staff and management. Many staff members commented on the need for regular communication and regular staff meetings. So we started such monthly meetings in July and we’ve been having such fun with them.

October 2012 Monthly Meeting. Staff sitting in front of “jack-o-lanterns” they made.

We follow a simple agenda for these meetings:

  1. Ice-Breaker
    1. At the end of the previous meeting, a staff member is nominated to prepare and conduct the ice-breaking session at the beginning of the next meeting.
  2. Introduction
    1. We start off each meeting with a case study from the field—usually in the form of a PowerPoint presentation with photographs and associated text. The case is often meant to inspire the staff; share a lesson learned; or show how a particular counseling technique worked or didn’t work. As our work is divided into three geographical areas, each area has a chance to present once every three months.
  3. Updates/Announcements
    1. Job openings
    2. Program changes
    3. Data Feedback–we discuss the quantitative accomplishments of the past month
    4. Welcoming of new staff members; bidding farewell to departing staff
    5. Status updates on ongoing projects
    6. General explanation of accomplishments over the last month
    7. General plan for the coming month(s)
  4. Questions & Answers
    1. This is an opportunity for anyone in the organization to ask questions and raise concerns which need to be dealt with as an organization.
  5. Birthday Celebration & Welcomes and Goodbyes
    1. At these meetings we celebrate all the employees who have birthdays that month.
    2. While eating snacks and cake, we toast our departing staff members and welcome our newcomers.
The meetings are events which both management and field-level staff look forward to. They are a time for recommitting to our cause and to celebrate the community that is Calcutta Kids.

Ice-breaking activity

At the October monthly meeting, Noah and Evangeline were in charge of the ice-breaker. The day before the meeting, we told every member of the team to come in to work the following day with a cooking knife (they dubiously obliged) and Halloween and pumpkin carving was introduced. The staff broke up into groups of 2 and made beautiful ‘jack-o-lanterns’. The following day, Area-In-Charge, Barnali took all the pumpkins and cooked them into a delicious pumpkin stew and the whole staff ate it for lunch along with home-made luchis. –Noah Levinson

Chandan and his carved pumpkin

Sumana and her carved pumpkin

Gov’t-assisted immunization training

In September, Calcutta Kids organized an immunization training program, which served as a refresher training for some of our team and a new experience for others.  The training was carried out by a colleague in the government sector, Dr. Swagata Mukherjee, the Assistant Medical Officer for the Howrah Municipal Corporation (HMC).  Despite his busy schedule, he volunteered his services to Calcutta Kids during his personal time.  During the training, participants learned about vaccine-preventable diseases and related vaccines, the proper vaccination schedule, and how to technically administer each type of vaccine.  The training comprised of two days of observation at the Municipal Health Center during immunization camps, and three days of theory, observation, and practice in the Calcutta Kids clinic.

Training with Dr. Swagata Mukherjee

The training is one of many steps in the process towards implementing a community-based health care model at Calcutta Kids.  Until recently, our curative health, nutrition care, and immunization components have been held in our health center, Swastha Kendra, situated outside of Fakir Bagan.  During immunizations, vaccines were primarily administered by our nurse under the supervision of our doctor.  But this month we are merging the health center into our community center Ma o Shishu Shiksha Kendra, so immunizations are also transitioning to the new space in the heart of Fakir Bagan.  This is part of our effort to bring cost-effective healthcare solutions closer to the community.

The immunization camp will now be carried out in the community by the area in charges (senior community health workers) and the health assistant-counselors who are now qualified in immunizations as a result of the excellent training they received in September.  Where we once relied on one person to conduct immunizations every week (with the doctor as a back-up), we now have four trained staff members who are proficient in administering immunizations.  This will help ensure that immunizations are even more accessible for the families in Fakir Bagan, and provides Calcutta Kids the capacity to extend our immunization program to neighboring areas, thereby targeting more children in need of immunization.

Laxmi administering vaccinations after the training

Around the world, routine immunizations have reduced and even eliminated many childhood illnesses that once killed and debilitated many children.  Although many vaccine preventable diseases (VPDs) have been controlled, children are still dying from diseases that could be prevented by providing the critical vaccinations during the first few years of life.  The World Health Organization estimated that, every year, 1.5 million children die from diseases that could have been prevented by routine vaccination.  That staggering total represents almost one-fifth of all the children who died worldwide before reaching their fifth birthday. (1)

The Indian National Immunization Schedule includes the following six VPDs: Tuberculosis, Diphtheria, Pertussis, Tetanus, Measles, and Polio. For a child to be considered fully immunized, he or she must have received one dose each of BCG and Measles and three doses of DPT and Polio in the first year of life. There is still much more work to be done in terms of immunization coverage in India: Nationally, less than half (43.5%) of children 12-23 months are fully immunized. West Bengal is faring better than the national average, with 64.3% of children 12-23 months fully immunized. (2)

Waiting for immunizations at the Calcutta Kids clinic. Photography by Brett Cole, November 2012

Immunization in India must be sustained, not only to prevent VPDs, but also to reduce the incidence of measles and tetanus, and eradicate poliomyelitis. India, known as one of the greatest challenges for the global polio eradication campaign, has now been polio free for 18 months. (3) The last reported polio case was in Shahapur village in Howrah district, the same district where Calcutta Kids operates. Sustained immunization and coverage will ensure that polio does not make a comeback to this country.

Calcutta Kids is committed to help sustain immunization coverage in Fakir Bagan by ensuring that every young child in Fakir Bagan is fully immunized and therefore protected against vaccine-preventable childhood illnesses.–Danya Sarkar

1.http://www.who.int/immunization_monitoring/diseases/en/
2.NFHS-3, India and West Bengal Factsheets
3.http://www.un.org/millenniumgoals/pdf/UNGA%20Polio%20Event_Press%20Release%20and%20Quote%20Sheet_Final.pdf

AIF Fellow impressions 2012-13 (2 of 2)

On our first day working as fellows at Calcutta Kids, about a month back now, Sriya and I found ourselves rolling our pant-legs up and wading into dark, murky water. We were walking door-to-door with the community health workers in Fakir Bagan. The health workers, who form the foundation of CK’s mission, cajoled and persuaded, informed and explained, about the basic behaviors that were essential for their health and the health of the child in their womb. I realized then, as the gentle fans in the homes of the expecting mothers did a valiant effort to dry our monsoon rain-soaked clothes, that public health didn’t get more grassroots than this. Calcutta Kids worked, rain or shine, at the deepest and most essential roots of maternal and child health, in areas that are black holes in the larger Indian public health system.

Cleaning the drains in Fakir Bagan

Compared to the U.S., Calcutta is, of course, a risky place. One thing that I heard many times from family and friends was to take care of my health. But the truth is no matter how much riskier my life has gotten since I came to Calcutta from Ohio, daily life for an inhabitant of Fakir Bagan is laden with an immensely greater amount of risk. We can look to life expectancy (an admittedly crude indicator). Life expectancy at birth in the U.S. is 78.5 years, and in India it’s 67.1 years (CIA World Factbook 2012). These are averages though; estimates of life expectancy in slums across the globe, ones similar to Fakir Bagan have ranged from seven to fifteen years lower than non-slum urban areas. The risks begin at the very beginning of life and continue throughout, and are not far from what the average American would have faced a century ago.

A healthy CK child

In my view, all health providers at their core attempt to mitigate and prevent risk for their beneficiaries. At the most essential and highest impact stages of life, Calcutta Kids tackles this vast disparity for risk of death and illness. I’ve seen this done through a myriad of MCH programs, including nutrition for malnourished children, regular immunization, check-ups with an on-staff physician, and regular meetings with our health workers.

Immunizations about to be given

Over the next year, Calcutta Kids’s capacity to be involved and engaged within the community will increase, including the behavior change communication programs and community health meetings Sriya will be aiding with as well as the new child development corner. Additionally, Calcutta Kids will be transitioning the health clinic into the Ma o Shishu Shiksha Kendra community center, right in the thick of Fakir Bagan, and initiating a potential geographical expansion within the Howrah slums. I look forward to helping with these goals throughout the year and many more rain soaked home visits.–Pranav Reddy (AIF William J. Clinton Fellow 2012-2013)