Tag Archives: empowerment

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

A Message for the Community

I was recently asked, “If the population Calcutta Kids serves were to remember only one of the messages you give, what would it be?” Without any hesitation, I replied with a wonderful message I had just learned: “A child gaining weight cannot be very sick. A child not gaining weight cannot be very well.”

This is a message that Charles Janeway, Professor of Pediatrics at Harvard Medical School told his students.

This simple, yet profound statement embodies the work of Calcutta Kids; it provides convincing verbal ammunition against many of the daily battles we fight against long-held superstitions, misinformation, and a general lack of understanding regarding the importance of good nutrition during the first 1000 days.

Explaining the science behind the cognitive and physical developments that occur in the first 1000 days of life depending on nutritional status is nearly impossible for an uneducated mother to understand. Counseling, behavioral change communication, growth monitoring and promotion, and access to healthcare — indeed everything we do at Calcutta Kids — does lead to reaching the objective of good nutrition within the window of opportunity. But the programs and the activities are not enough. In our efforts to get people to care about nutrition, I believe we are underutilizing our greatest resource — the women themselves with whom we work — the true movers and shakers. If these women truly grasp what we are trying to achieve for their children and why they will figure out ways to help others understand the problem; they will take the challenge personally and seriously; and they will ensure that they themselves are well looked-after during pregnancy and will ensure that their children get the nourishment they need at the right time.

There is simply no question that every mother wants what is best for her child. But in order to assure that she provides what is best to her children, she needs to understand and really believe that proper nutrition will make a difference.

We have translated Janeway’s message into Hindi and are promoting it as a sort of mantra for Calcutta Kids. Before long I hope that every pregnant woman and mother we work with will know the mantra — but more importantly will grasp its meaning.

Jab bache ka ho sahi vikas…

To hain ye sehat ka agaaz…

Jo bacha na ho mota Zindagi bhar hain woh rota…

(A child gaining weight cannot be very sick. A child not gaining weight cannot be very well.)

- Noah Levinson

Celebrating Women

Around the world, International Women’s Day is marked every year on March 8 to celebrate the participation, contribution, and achievements of women in society. In Fakir Bagan, women live day-to-day taking care of their children and husbands, and have little time to think about themselves. They live in a male dominated environment where alcohol abuse, verbal abuse, and domestic violence is considered a norm that they must accept. Women who earn an income to support the family not only face the same issues, but also face the problem of having their hard earned money taken away by their husbands to spend on alcohol or cigarettes. It is still a struggle for women in this community to make their own voices heard and to be aware of their rights and needs as women.

On the afternoon of March 7, Calcutta Kids held an early celebration of International Women’s Day in our Maa o Shishu Shiksha Kendra (Mother and Child Learning Center) in Fakir Bagan. Members of our women’s support group and their friends from the community joined in the celebration. We celebrated the immense strength women exhibit in their day to day lives throughout the year, recognizing the unlimited sacrifices made by women in this community.

During the event, our program coordinator Sumana helped the community reflect on the status of women in society, how to create awareness about women’s rights, and to think about approaches to empower women in Fakir Bagan. One beneficiary Hira Poddar, said, “These forums allow us the opportunity to get together and share our problems and gain strength from each other.” Another beneficiary, Mira Shaw, a single mother and sole income earner whose husband left her with two young children said, “I am very happy with my life because I can take responsibility for my own life and take good care of my children.”

After the staff members and women spoke, we stood in a circle and sang We Shall Overcome. The then danced to Bollywood music and played with Holi colors! It was a wonderful celebration and a reminder to all of us at Calcutta Kids to continue striving to create a space where women’s voices can be heard. –Danya Sarkar