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

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

Saving a Severely Malnourished Child

Ajay was born on August 20, 2011 in a village outside of Kolkata. Sadly, his mother died shortly after childbirth, and he was sent to be raised by an aunt, also in the village, who had two other children. Over time, Ajay grew malnourished and his aunt was unable to provide proper care for him. In late 2011, he was sent to live with another aunt named Pramila in Fakir Bagan, where we work. Pramila has been married for many years, but has never had any children of her own.

Ajay and Pramila in late January, 2012

Pramila learned about Calcutta Kids and on Friday, January 20, she brought Ajay in for his first immunizations at five months old. Our triage nurse was quickly alarmed; his distended stomach, loosely hanging skin, bulging eyes, skinny limbs, and lethargy made her nervous about the inoculation. Weighing in at 3.79kg (~8.4lbs), he had a weight-for-age Z-score (WAZ) of -5.392, which was off the growth charts in the severely malnourished category. Bringing him to the attention of our health workers and doctor, Ajay received a thorough examination and a counseling and nutrition plan began. Ajay’s dirty bottle and diluted cow’s milk were replaced with clean bottles and newborn formula. Thankfully, he was hungry and eager to recover.

Starting the following Monday, Pramila brought Ajay to the Swastha Kendra (health center) daily for supervised feeding of Ajay. CK mothers are always encouraged to exclusively breastfeed, but in this case, without a lactating mother and with the severity of Ajay’s malnutrition, formula became the only viable option. Thanks to generous donors, CK supplies Ajay with all of his formula, which is expensive but critical to his growth. Almost immediately, we also started complementing his formula feeding with kicheri (lentils, rice and vegetables), which he ate well. Our community health workers conducted regular home visits to make sure that feedings were successful in the home. By February 1, Ajay weighed 4.5kg (~9.9lbs), and had a WAZ of -4.49. Making great progress, he was looking healthier and had more energy.

Ajay in late February, 2012

Pramila was also taken in by our mother’s support group. They were eager to help her, and invited her to attend their meetings. At one meeting, they taught Pramila various ways to make household ingredients into baby food. As a first-time mother of a very fragile child, the women in the support group also took the initiative to visit her and make sure she had what she needed. On March 1 he weighed 5.7kg (~12.6lbs) and had a WAZ of -3.633. His cheeks and limbs were starting to fill out, he was able to roll over on his own, and his smile could light up a room.

Ajay and Pramila in late March, 2012

Ajay and Pramila have continued coming to Swastha Kendra 2-3 days per week for counseling and food. On March 20, two months after Ajay’s first visit to Calcutta Kids, he weighed 5.97kg (~13.2 lbs) with a WAZ of -2.95, and was officially out of the “severely malnourished” category. Throughout the whole process, Pramila has worked very hard, heeding the counsel of Calcutta Kids, and has expressed her gratitude for our programs.

Ajay and Pramila in late March, 2012

Sitting in Swastha Kendra, I am fortunate to be able to see Ajay and Pramila regularly, observing the feeding, assessing his progress, and enjoying their company. The transformation in this sweet child over these 2+ months has been remarkable to witness. Thanks to the great work of Calcutta Kids, he continues to grow well, and is reaching both physical and developmental milestones. – Margy Elliott, Fellow, American India Foundation

Staff Enriched Through Education Sessions

Breastfeeding Education Session Lecture

At Calcutta Kids we are currently revising our Child Health Initiative to strengthen and make improvements to our program activities. The revisions will be based on changes in international guidelines and lessons learned over the past six years. We recently carried out a similar process with the Maternal Health Initiative which included improved monitoring and evaluation, curriculum and protocol development, and in-depth trainings with our community health workers and other MYCHI (Maternal and Young Child Health Initiative) staff. Training and counseling will also be a major component of the child health redesign, particularly as we do not have a standardized training curriculum or comprehensive materials for child health counseling. Previous trainings have been informal and primarily verbal, using limited resources.

Case Study Group Work

At present we have two interns from George Washington University (Lisa and Lindsay) who are working on behavior change communication (BCC) at Calcutta Kids. Under the guidance of the MYCHI program coordinator and manager (Sumana and Danya), they are developing a curriculum for child health education sessions, and creating flipcharts with child health messages to be used by our community health workers and health clinic staff. The education sessions were launched this month comprising of all the relevant child health-related topics that we address at Calcutta Kids. So far we have held education sessions for our health workers and health center staff on Initiation of Breastfeeding, Postnatal Care, Care of a Low Birth Weight Baby, and Complimentary Feeding. Next month, we will be holding sessions on Immunizations, Care of a Sick Child, and Development Milestones.

Practicing Kangaroo Mother Care for Low Birth Weight Babies

Although most of these sessions are review for our old health workers, this serves as a comprehensive refresher training for them, and is crucial knowledge for new health workers and the health clinic staff. Our sessions have been both educational and fun for the staff, not only comprising of lectures, but also demonstration, case study competitions, and role play. The child health education sessions will ensure that all our staff have the same foundation of knowledge, which will enable them to give uniform information and messages to the community we serve. Following these sessions, our staff will be equipped with culturally appropriate flip charts to be used in home visits and community meetings. -Danya Sarkar

The Next Generation of Development Workers

While not a primary objective of Calcutta Kids, one of the roles we have found ourselves embracing is that of a mentoring organization for the next generation of western development workers. The organization is, in fact, flooded with applications from students seeking internships with Calcutta Kids (from which, unfortunately, we’re able to accept only a limited number.) Maybe this burst of interest is because Calcutta Kids was itself started by a young Westerner with whom young people can identify, perhaps it’s because Calcutta Kids embodies for some, what Nicholas Kristof refers to as the D.I.Y. (Do It Yourself) Foreign-Aid Revolution , or maybe it’s simply because of our clear objectives and proven track record. Whatever the reasons, we have, in taking on interns, been entrusted with an important responsibility, one we take very seriously.

Since Calcutta Kids Trust commenced its work in 2005, we have had the opportunity to work with over 20 undergraduate, graduate, and post graduate student interns from Europe and the United States, most of them having a public health interest or background. These interns usually spend between 2 and 10 months working on a specific project with clear objectives and an achievable if strict timeline. Projects range from illness-specific training and treatment protocol development to project evaluation to website development. The internships to date have been overwhelmingly positive for both the interns and for Calcutta Kids.

Apart from the value of their projects – which have invariably been valuable to our on-the-ground operations, these students have often opened their networks to Calcutta Kids for fundraising purposes, an unexpected but much appreciated by-product of the internship. When queried about it, they indicate that having seen the inner workings of the organization at close quarters – having participated in such a range of activities, been privy to managerial deliberations and financial records and having seen first hand the effects CK are having on these disadvantaged families, they believe sincerely that this is an organization they’d now like to support financially.

So along with providing an opportunity for this next generation of development workers to put into practice the theories and concepts they’ve learned in school, the Calcutta Kids’ internship program allows young persons to see and experience the workings of an organization guided both by values and by evidence. We hope that through our role in mentoring this next generation we can not only encourage replication of some of CK’s successful models, but, perhaps more importantly, inspire these young people to take the lessons and values gleaned from CK into their future work. – Noah Levinson

Swastha Kendra is Open and Fully Functional

The Swastha Kendra (Health Center) is now open to see patients five days a week. Over the last few months, we have been transitioning the space that was formerly the diarrhea treatment center into a health center that can treat all manner of minor illnesses. While before we had a ‘health camp’ once a week, we now have a fully staffed clinic in order to better serve the needs of Fakir Bagan. The patients are seen by a nurse for basic vitals, then see the female doctor for a full examination and finally receive any necessary medications along with counseling on proper administration and possible side effects of medications as well as beneficial behaviors in the home in relation to the specific illness or complaint.

This transition is an effort both to make the clinic space more cost-effective per patient treated, but is also an answer to the needs of the community. In the month of February, 226 clinical visits took place in comparison with an average of 126 visits from July to December. These 100 visits were made possible by the additional hours.

Transitioning to this health center approach has also allowed us to start implementing a clinical protocol based on the Integrated Management of Neonatal and Childhood Illness (IMNCI) guidelines. These guidelines are used worldwide for the simple diagnosis and treatment of childhood illnesses with minimal and inexpensive, but effective, medications. Having a full time doctor also allows us to treat more conditions than would be possible simply following IMNCI. It also helps to increase the level of confidence that the patients have in these relatively simple treatments.

The diarrhea treatment center is still fully functioning and will be an increasing part of clinical care as diarrhea season approaches. The only change is that diarrhea treatment is now a part of a larger clinic rather than sharing a space with the health camp once per week.

We have also incorporated a new nutrition corner where mothers can be counseled on a regular basis including observed breastfeeding and observed feeding of complementary foods. Look out for a post in the next few weeks about Ajay and Promila who have been taking advantage of this nutrition corner. – Dora Levinson

Note: We are looking for a sponsor to endow the Swastha Kendra and ensure that these services can continue. For more information about this endowment please write to Noah@calcuttakids.org.

Mothers Find Strength in Support Group

Mothers share best practices for preparing complementary foods

Although Calcutta Kids has a very close relationship with the women and children of Fakir Bagan, our efforts in community mobilization have been limited. Community meetings are held for pregnant women and mothers of young children, but these meetings are largely lecture style with information being given by our health workers. Our goal in organizing a women’s support group was to create a completely different type of forum, where women would come together as friends to support each other and discuss issues that are relevant to them in their daily lives. They would lead the direction of the group and decide what activities they would like to carry out for themselves and within the community. When we started our first women’s support group in mid-November, we had no idea what to expect as we sat on the mat and waited for the women to appear. One by one they came- Rekha, Santi, Sakuntala, Fulo, Rakhi, Priyanka, Sova, and Urmila, their young children in tow. As they sat on the mat, we offered tea and biscuits and asked mothers to introduce themselves to each other. Sumana, the program coordinator, explained about support groups and asked them to think about whether they were interested in forming such a group.

The women were hesitant at first, but with some encouragement from Sumana, they began chatting with each other about themselves and where they had come from. The discussion then turned to their opinions about Fakir Bagan. A few positives were mentioned: “We like being close to a school and close to shops.” One woman mentioned that she enjoyed celebrations like Durga Puja in Fakir Bagan. The majority of discussion centered on negative views: “We don’t like the water here. We don’t like the filth. Every time it rains it floods and water comes into our homes. It makes life very difficult. When this happens, the children get sick- diarrhea and vomiting. The toilets are disgusting and no one cleans after they use. It makes us feel sick to use the toilet.” Most of their concerns related to health, hygiene, and sanitation, but they all perceived a lack of community feeling in Fakir Bagan: “People only think about themselves. In our area people don’t help each other out.”

At the end of our meeting, the women told us that they enjoyed getting together and learning from each other, but most importantly they liked the idea of becoming a support group and becoming friends. Our senior health workers were very excited by this ‘different kind of meeting’, where women were able to speak and get to know each other instead of only sharing information with the health workers. As women were able to express their feelings, health workers were able to learn how they feel. At Calcutta Kids, these meetings are the first step in our community mobilization effort, and we hope that the group will encourage community-based initiatives that will help improve the quality of life in Fakir Bagan. – Danya Sarkar

Responsible Prescriptions

CK Medicine Cabinet

Over-prescription of medication is a challenge faced by any public health organization in India. In Fakir Bagan, mothers expect that they will receive at least three medicines including at least one antibiotic for most illnesses, no matter how mild the complaint may be. There is likely to be a relationship between the pharmaceutical company and the doctor, and therefore it is mutually beneficial to prescribe as many medications as possible. Because this system has been in place for many years, a mother is now unsatisfied if she visits a doctor and does not receive an antibiotic for her child’s runny nose. These are obviously generalizations, but the challenge of minimizing the role of unnecessary medicines looms large. We have been working with several doctors and public health professionals to narrow the list of CK’s regularly stocked medicines, and to make sure only necessary prescriptions are issued.

In the two weeks since we started significantly minimizing unnecessary medicines, there have been several unsatisfied beneficiaries. Our hope is that the majority of beneficiaries will realize that they have more time with our doctor and that she really is giving good quality medical advice, even if it does not include antibiotics. – Dora Levinson