Tag Archives: empowerment

Evidence-Based, Data-Driven

Calcutta Kids has always been focused on a data-driven approach to improve the status of maternal and child health and nutrition in Fakir Bagan. We have been collecting, monitoring and evaluating data from the field regularly to inform our programmatic interventions. We teamed up with a creative and passionate group of individuals from the Social Impact Program at ‘Thoughtworks’, a software company in the US with offices across India. They worked with us to enhance our old database, review the existing monitoring systems and helped create an updated and user-friendly tool.
The new ‘MYCHI database‘ is a tool to enhance the provision of health and other services to groups of pregnant women, mothers and children. The database collects and stores health and other information about women and children, displays the information on individual dashboards and uses visual representations of data and series of predefined reports to guide program management on the ground. The database is open source software, meaning its code is free and with the help of a developer, it can be tailored to the needs of a wide range of organizations.

The MYCHI database was developed around three overarching objectives

    1. To empower implementers with the tools to practice “developmental evaluation” and make evidence-based adaptations to a program, and maximize the impact on the beneficiaries.
    2. To monitor and guide day-to-day organizational operations and focus on beneficiaries in need of special attention.
    3. To identify beneficiaries who may fall through the cracks as they may not independently show up to receive the preventative care.

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MYCHI’s foundation is built around information most public health organizations collect about their beneficiaries such as: i. monthly weight and height of children and pregnant beneficiaries, ii. attendance at immunization sessions and iii. incidences of illness to name a few. Once uploaded, MYCHI displays this information on graphs and in reports and uses it to guide day-to-day program management.

Building on this foundation, MYCHI can be tailored to collect a vast amount of additional information about beneficiaries relevant to an organization’s focus and interests. Using beneficiary survey data collected in adaptable online forms, an organization can capture data points as varied as socioeconomic status, medical history and access to government services. This information can be analyzed to identify correlations between demographics and health indicators, red flags in beneficiary health and health seeking behavior, even the success or failure of a programmatic intervention.

Key Features

Dashboard

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A personalized dashboard is generated for every beneficiary immediately following his or her registration. The dashboard displays basic information, familial relations and links to any previously submitted forms. A child’s dashboard displays weight and height records from all GMP sessions on growth charts for growth tracking and captures a child’s personal immunization schedule in a color-coded table that indicates immunization status, (i.e. given, due, critical, overdue.)slide3

 

 

 

 

 

 

 

 

 

Growth Monitoring and Promotion (GMP) and Immunizations

MYCHI makes tracking and encouraging attendance for GMP and Immunization sessions easy using reports that display the names of all beneficiaries due for an upcoming session. Over the course of a three-day GMP session, a report is filled with the height and weight or absent reason of every beneficiary. An Immunization report will be similarly filled during an immunization session as beneficiaries receive their inoculations. When the reports are uploaded, GMP and Immunization data is stored, displayed on beneficiary dashboards and accessible for analysis.

Jasper Reports

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Data is pulled from the backend using reports written in SQL and generated in Jasper. These predefined reports fall into three broad categories, program management reports, status reports and reports for analysis. The first category includes reports that track our progress completing regular tasks like ANC visits for all pregnant women over the course of a month. An ANC status report will identify those beneficiaries who have not been visited so we can complete their visit in the time allotted. These reports help us stay accountable to our beneficiaries in providing the services integral to our program.

The second two categories, status reports and reports for analysis, display information pulled from forms and uploaded reports that a program manager can use to develop new programs and organize work flow.

The MYCHI Database has streamlined the work and improved the monitoring and evaluation systems at Calcutta Kids. As a result, our approach is more targeted and we are able to focus our attention to those who need it the most.

– Post by Lilian Olson

Rehydration Unit

In the video, the Haitian child was listless: his eyes were sunken and his shriveled body was limp. His mouth curled, turtle-like, to prepare to cry, but no tears came. A gloved hand, arm hairs poking out, reached for the skin around the child’s abdomen. The hand of the clinician pulled gathered skin to form a sinusoid mound. Then, instead of snapping into place as skin normally does, the mound slowly melted back like silly putty. The words “SKIN PINCH” scrolled across the bottom of the video.

The skin pinch is one of the main diagnostic criteria for testing severe dehydration. In those severe cases in which the body has lost more than 15% of essential fluids, the little fluid left in the body rushes to the skin to cause the counterintuitive effect of swelling. Taped during a cholera epidemic in Haiti, the CDC video was showing how to best manage dehydration. The child had become severely dehydrated from the watery diarrhea that is a common and deadly symptom of cholera infection. By the end of the video, thanks to provision of the best possible treatment, the child was healthy and alert.

This “best practice” is something we are replicating in the slums of Fakir Bagan at Calcutta Kids with the new Rehydration Unit. The Rehydration Unit will allow us to tackle the terrible effects of diarrhea on the children under the age of three in our area. I reviewed over this CDC video to train our community health workers to diagnose and deliver key messages in the Rehydration Unit. One of our four main objectives at Calcutta Kids is to ensure that children age 0-3 grow normally. Diarrhea, the cause of fatal dehydration, is one of the central culprits in preventing normal growth, since it’s been linked to stunting and slower brain growth (1). Over the past six months, Sriya Srikrishnan (the other AIF Clinton Fellow) and I have been working to develop training modules for the health workers, a treatment protocol, and new counseling materials for the Rehydration Unit.

There is no reason any child should ever grow less or die from diarrhea. Yet this preventable and easily treatable disease takes 1.3 million under-five lives a year, a large proportion of those in India (over 1,000 daily on the subcontinent) (2). With counseling on hygiene practices, we can prevent diarrhea by stopping the root cause of microbial transmission. Additionally, the best treatment for diarrhea is the simple and cheap solution of “oral rehydration solution” or O.R.S.

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The Rehydration Unit is built on lessons learned from previous experiences with fighting diarrheal prevalence in Fakir Bagan. Back in 2010, analysis of the monthly growth monitoring and promotion weights showed a strong correlation between low weights and having had diarrhea in the two weeks before weighing. This connection spurred a desire to focus in on diarrhea, as both a cause and effect of malnutrition. After studying the highly successful model of the International Centre for Diarrhoeal Disease Research (icddr,b) in Bangladesh, Calcutta Kids opened up the Diarrheal Treatment Center (DTC) in March 2011.

This first foray into treating diarrhea was highly successful, but in creating the Rehydration Unit, we sought to learn from the weaknesses of the DTC initiative. Funded by a grant the World Bank, Calcutta Kids had rented a separate space with a separate staff roster dedicated to the DTC. For the Rehydration Unit, we’ve gone in a different direction. While retaining the essence of the DTC (O.R.S., Zinc, counseling), we wanted the Rehydration Unit to be an integrated part of the central initiative of Calcutta Kids: the Maternal and Young Child Health Initiative (MYCHI) in terms of funding and staff. Health workers, with whom the mothers of the community are familiar and have a rapport with, deliver the innovative BCC materials (from games to demonstrations) and conduct the follow-up visits in the home. Funding is no longer dependent on external grant cycles.

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Each 90-minute treatment at the Rehydration Unit has been divided into prevention and treatment modules for counseling. Along with counseling, we have adapted practices from the W.H.O on how to best manage diarrhea with O.R.S. and Zinc while learning from our experience with the Diarrhea Treatment Center. This combination of counseling and the clinical treatment at the Unit (all administered by the community health worker) allows us to treat the short-term problem of diarrhea and dehydration in the most effective way possible while changing behaviors to prevent diarrhea from occurring in the future. The protocol and rehydration unit checklist has been designed to include all these facets and create a conducive environment for health worker-mother interaction.

We have deliberately called the new unit, attached to our daily health clinic, a “rehydration” unit rather than a “diarrheal treatment” unit. Calcutta Kids is seeking to change perspectives on what the ideal treatment should be for diarrhea. Rather than treating diarrhea with anti-diarrheals or anti-microbials (as is common in most of India), the treatment at the Rehydration Unit calls for replacing the lost fluids with O.R.S. to restore the body’s fluid balance. O.R.S. is nothing more than a carefully balanced salt, sugar, water solution that restores the natural transport systems of the intestines. Despite its simplicity, it remains the gold standard for treating diarrhea. It’s discovery, like many scientific advancements, was accidental but fortunate.

In the early 1970s with the Bangladesh War of Independence raging, refugee camps were overflowing and cholera was highly prevalent. The standard treatment was “intravenous fluids while starving the gut,” but the clinical staff ran out of IV therapy. In these desperate circumstances, one Calcutta doctor, Dilip Mahalanabis, decided to try an untested and new treatment: O.R.S. Miraculously, the mortality rates dropped to 3.6% instead of the normal 30% to 40% with IV fluids (3). Calcutta Kids has had the good fortunate to spend time with Dr. Mahalanabis on a number of occasions and he advised us with the DTC.

In India, only 31% of doctors prescribe O.R.S. for diarrhea (4), and often antibiotics are overprescribed. The first component of the behavior change communication modules aims to change these perceptions in the mothers of Fakir Bagan, and hopefully enable the mothers to use O.R.S. themselves at home in cases of diarrhea.

Additionally, the causes of diarrheal incidence stem from improper health and hygiene behaviors as well as from lackluster systemic factors (in water and sanitation). Changing simple behaviors, including hand washing, food handling, toilet usage and disposal of feces, and exposure to open sewers and animal feces, can reduce diarrheal incidence enormously. Hand washing alone can reduce diarrheal incidence by up to 53% (5).

The Rehydration Unit is an example of the innovative and deep thinking way in which Calcutta Kids functions. Calcutta Kids is bringing the most effective, scientifically verified solutions to a community that needs them. Efforts like this will make child morbidity and mortality from diarrhea a fact of the past.–Pranav Reddy

Persuasion Dissected

Persuasion Dissected

(1)Checkley W, Buckley G, Gilman RH, Assis AM, Guerrant RL, et al. (2008) Multi-country analysis of the effects of diarrhoea on childhood stunting. International journal of epidemiology 37: 816–830.

(2) Santosham M, Chandran A, Fitzwater S, Fischer-Walker C, Baqui AH, Black R (2010) Progress and barriers for the control of diarrhoeal disease. Lancet 376: 63–67.

(3) Ruxin, JN (1994). “Magic bullet: the history of oral rehydration therapy”. Medical History 38 (4): 363–97.

(4) Taneja DK, Lal P, Aggarwal CS, Bansal A, Gogia V. Diarrhea
management in some Jhuggi clusters of Delhi. Indian Pediatr 1996;
33: 117–19.

(5) Luby SP, Agboatwalla M, Feikin DR, Painter J, Billhimer W, Altaf A, Hoekstra RM. Effect of handwashing on child health: A randomised controlled trial. Lancet 2005;366(9481):225-33.

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.

PuppetShow

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.

NewspaperFasionShow

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.

GroupPresentation

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

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

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)

AIF Fellow impressions 2012-13 (1 of 2)

I am so impressed and inspired by the motivation you see at Calcutta Kids. Every health worker I have been able to spend time with during my first month here is doing a wholehearted job to be a good resource to the organization and more importantly to the community they are serving. Thanks to our mentor Danya Sarkar, who helped us feel settled down, Pranav and I have been able to explore the community and learn all the various functions of the organization. As we make our visits into the field with the health workers, the community has noticed and recognizes us as new members of Calcutta Kids. We realized this as we looked a little lost while trying to find our way to the community center and two women immediately gave us directions before we even asked them!

The mission of Calcutta Kids can be understood through the manner in which the health workers communicate with the women of the community. Every child is important and can be given adequate care by simply monitoring them. If a child’s weight has not increased during the monthly Growth, Monitoring and Promotion Program, the health worker visits the mother in the following week and counsels her. The health workers express how they are really sad when they see no positive growth in the child. They encourage each mother to take more care of the baby, give her simple tips on how to create a healthy diet and also praise her when she has done a good job. Thus, the health workers have built a great relationship with the mothers of the community. The mothers are always happy to see the didis and welcome them into their houses. They also offer tea or lunch and ask us to spend time with them. When the health worker completes filling up her form and questionnaire, the women thank her for coming and tell her that they felt happy they got to chat with them. The women also trust the health workers as much as they trust a doctor. Even when the health workers are merely on their walk from one house visit to another, many women stop them with their babies and talk about how their child still has a cold or might have developed a skin infection.

Meeting for pregnant women lead by Laxmi Gupta

Meeting for pregnant women led by Laxmi Gupta

The success stories from Calcutta Kids are commendable and its establishment in Fakir Bagan is very apparent in the number of people who visit the clinic everyday or the manner in which we are received in each house. However, there is still work to be done. Although the women recognize the messages delivered by the health workers, many women still do not seem to be adopting a change in their habits. They usually quote too much housework and stress in their lives as reasons for not being able to follow the health workers advice. Even when they come to the community meetings, they listen to the messages or watch the videos but whether they are following the key points is something yet to be assessed. This is a project I plan to work on during my time at Calcutta Kids. I will be working out behavior change communication strategies using different methods of delivering messages to the community. I will be working with the health workers and the beneficiaries to find out why they are not able to follow simple, yet key health practices. Through the health counseling sessions, community meetings and discussions groups I hope to understand the needs of the women, analyze existing techniques of delivering health messages and find ways to improve them. Eventually, I hope to create a sustainable structure to monitor and evaluate changes in health behavior as put forth by the health workers.- Sriya Srikrishnan (AIF William J. Clinton Fellow 2012-2013)

Immunizations – More Than Just a Shot

The immunization program has been a service of Calcutta Kids for many years, but during the last year, we have worked very hard to make it as effective and efficient as our GMP program. There are two primary ways that we have accomplished this; the first is a short multimedia education and counseling session and the second is a system in our database that tracks the immunizations for each child and correctly identifies those who are eligible for that week’s clinic.

Rather than simply telling mothers and caretakers that these immunizations are necessary, we are working to inform our beneficiaries about why these immunizations are important. The short education and counseling session is designed to convey information on both the disease (or diseases) that the immunization is preventing, and on possible side effects. We have already seen mothers taking a larger interest in the immunization program and asking the CHWs about the next session. And for those not taking the initiative, we have an accurate list of all children who should come to the clinic and take the time to remind each household on that list. Take a look at the immunization counseling materials here.

The immunization section of the database has been greatly improved in the past year, and now takes into account the immunizations that have been received and the dates of each immunization received. This is important because many children have missed doses and are therefore off the ideal schedule. For example, a child may have received the first dose of DPT, OPV and Hep-B, but then did not receive the second dose after four weeks, but instead returned after eight weeks. According to the age, the child should be receiving the third dose but in fact, he or she should be receiving the second dose. The system also makes sure that enough time has passed between doses. These two improvements are helping us toward our goal of full immunization for each child that participates in our program. -Dora Levinson