Monthly Archives: May 2012

Programs to Address Malnutrition

Despite the progress that has been made on other fronts, including infant and child mortality, in India over the last decade, nutrition remains a major public health challenge and nutrition indicators for young children have barely changed. There are many factors that complicate ongoing efforts to implement successful community nutrition programs–including inadequate access to food, unhealthy environment and exposure to infectious diseases, and inappropriate care and feeding practices. Since its inception, MYCHI has targeted the nutritional status of young children in Fakir Bagan during the first 1,000 days of their lives, primarily through preventive care and counseling along with curative care as needed.

The earliest data on nutritional status of children based on weight for age was collected in October 2009. It showed that 33.3% of children 0-3 years old were normal weight, while 32.7% were mildly, 21.6% were moderately, and 12.3% were severely underweight. Two and a half years later, in May 2012, the percentage of severe underweight children has dropped by more than half—from 12.3% to 5.5%, a remarkable success. Data is currently being analyzed to explore the specific factors that have had contributed to the reduction of the severe underweight in our catchment area, but it is clear that the MYCHI approach to deliver key health interventions during pregnancy and young childhood coupled with close counseling, education, and preventive health have made a significant impact in our community.

Although we have made progress, there are still improvements to be made to our child health initiative in order to fully integrate nutrition and growth. This year, we began efforts to systematically address malnutrition and move away from short-term trials, which consumed disproportionate resources and time at the expense of our regular programs. We have made several recent changes to make it easier to monitor and track malnourished children, which we hope will help us reach every child at risk of improper nutrition and growth:

– Early this year, we began generating our lists for monthly home visits by health workers on the basis of the nutritional status of children. Children having a z-score of -3 and below in weight for age (severely underweight) are referred to Swastha Kendra for clinical examination. This also ensures that our health workers have nutrition and growth on their minds as they enter the home of each child and can provide appropriate and intensive counseling to the family.

– At Swastha Kendra the referred child is provided care to resolve any associated medical problems and given supplements for micronutrient deficiencies. Follow up homes visits are carried out by our health workers two days after the doctor’s visit to check up on the child.

– Last month, we designated a space in Swastha Kendra as a nutrition corner, where mothers can freely breastfeed younger children and feed older children when they come for a doctor’s visit. We offer a meal of kichuri and egg in this corner to malnourished children who have been referred by the health workers. The privacy of the corner also enables close counseling with the family.

– Child health community meetings have been re-started in our new community center for mothers of children 0-12 months with an increased focus on complimentary feeding, as we recognize that children begin growth faltering at the time of weaning and introduction of semi-solid foods.

We are optimistic that these changes will enhance MYCHI’s efforts to improve child nutrition in Fakir Bagan. – Danya Sarkar

Walking the Walk

As a fellow with the American India Foundation Clinton Fellowship For Service, I have spent the past nine months working with Calcutta Kids. It has been an incredible experience, and the things I have learned while working here will remain with me throughout my life and career.

One thing that has really impacted me is how this small, but mighty organization is not just one that “talks the talk”. Every day, every employee, every community member is provided with love, compassion, and a sense of humanity that so many organizations may lose as they get caught up in their day-to-day work. “Walking the walk” is what has made Calcutta Kids such a beloved organization in this community. I wish you could see them in action too. Here’s just a sample of the amazing things I’ve seen, which are just a part of Calcutta Kids’ daily work:

– I’ve seen the Community Health Workers in homes, teaching families intimate lessons that will improve their health; teaching mothers how to initiate breastfeeding; and being the first visitor a new mother receives after giving birth.

– I’ve seen technical staff carefully stop programs that turned out to be ineffective in our area.

– I’ve seen the staff embrace a child from the neighborhood, teaching him English, providing him food, and even brushing his teeth when his mother cannot.

– I’ve seen the work in the clinic, where the technical staff knows the names and faces of individual mothers and children.

– I’ve seen mothers come to receive diarrhea treatment, and stay for nap under a fan with her child without any disturbance by the staff.

– I’ve seen severely malnourished children literally being wrapped up in the arms and love of every staff member – from our cleaners to our doctor – as the mother comes daily to learn how to provide proper nutrition for her child.

– I’ve seen management put aside social norms to prove Calcutta Kids values girl children as much as boy children.

– I’ve celebrated with the staff when babies are born with a good birth weight, when our support group started coming to meetings without being called, and when 86 people came to the clinic the day a new immunization was offered (more than 50% increase from an average week of immunizations).

– I’ve joined in concern when unhealthy children come to the clinic, and have seen the staff go to great lengths, sometimes even on the weekends, to ensure the child’s health improves.

Calcutta Kids is not fancy, and we like it that way. Our interventions are simple and heartfelt. The staff prides itself on feeling like family, and the community members are treated like an extension of that family. The facilities are clean and the women are respected. I’m grateful I was able to spend my Fellowship with an organization as sincere and hard working as Calcutta Kids. – Margy Elliott

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

Witnessing the Growth of CK, Two Years Later

CK Staff at Opening of Community Center in January

As part of Calcutta Kids’ Richard Skolnik Internship Program, I spent the summer of 2010 creating a behavior change communication curriculum to combat diarrheal disease among children in Fakir Bagan. Almost two years later I have found myself back in the Calcutta Kids office once more, this time working to develop standardized training and counseling materials for our team of community health workers. Returning to Calcutta Kids has granted me the opportunity to witness first hand the incredible organizational growth that has taken place since my first internship. Here are some of the biggest changes I’ve observed:

– The Diarrhea Treatment Center has transitioned into an Integrated Management of Neonatal and Childhood Illness (IMNCI) Clinic: During the summer of 2010, the diarrhea treatment center was entering its first phase of construction. Two years later, construction has been completed and the DTC has now become Swastha Kendra (health center), with an expanded role as an IMNCI clinic in order to increase the range of services we can offer to our beneficiaries.

– The opening of the new community center: Calcutta Kids has opened a new community center, Maa O Shishu Siksha Kendra. Since its opening, Maa O Shishu Siksha Kendra has hosted community meetings, mother support groups and the monthly Growth Monitoring and Promotion program.

– A much larger staff: In order to support its organizational growth, a number of new staff have been welcomed into the Calcutta Kids family. Employee additions have occurred at all levels, from leadership, to community health and social health workers, to support staff. I have enjoyed working with a number of new faces, however, was very excited to return to a majority of the same colleagues I worked with during my first internship. High staff retention is indicative of the strong commitment Calcutta Kids employees have to the organization’s mission and its beneficiaries.

Although my second internship will shortly be coming to an end, I know it won’t be my last time working with Calcutta Kids. I eagerly await returning in the future to marvel once more about the organization’s impressive growth. – Lisa Hendrickson