Practical solutions for child malnutrition
|
COMMENTS 
With half of India’s under-5 children malnourished, it isn’t enough to tell parents to feed their children a high-protein diet. At CINI’s Nutrition Rehabilitation Centres mothers learn which locally available foods are nutritious, how to cook them and how often to feed their children
Half of India's children under the age of five are malnourished. Being undernourished affects not only the physical but also the mental development of the child. Yet, in the form of the Integrated Child Development Services (ICDS), India has the largest nutrition programme in the world. Obviously, there is a great divide between the resources available and those actually acquired, between existing laws and their implementation, and between rights and the tangible services provided.
This is the great divide that CINI – Child In Need Institute, established by Dr Samir Chaudhuri -- is trying to bridge. CINI takes a sustainable approach to tackling child malnutrition: having realised that giving out free food and supplies creates dependency and does not tackle the root of the problem, CINI is now focusing on spreading awareness and constructive intervention.
Established 35 five years ago in Daulatpur, Kolkata, the small clinic started by an Indian paediatrician now works in five states and is collaborating with Unicef on making the Right to Food a realisable goal. It was the first clinic established for the sole purpose of treating malnourished children and here mothers were given guidance about what to feed their children.
Dr Chaudhuri also came up with Nutrimix, made of easily available, low- cost ingredients – wheat and pulses -- which can be made at home and is easily consumed by young children.
CINI soon opened a ward that accommodated six to eight mothers along with their children, who were moderately to severely malnourished. The ward now admits severely malnourished children. The mothers were shown how to provide proper nourishment for themselves and their children. With the problem of early marriage in India, a lot of these mothers are hardly more than children themselves, and are very malnourished.
The clinic was getting many cases of malnourishment with other complications such as infections, and hence an emergency ward was eventually opened to tackle them. What started with a weekly clinic every Thursday to coincide with the big market day at Pailan Hat is now a clinic that attracts close to 100 patients every weekday at the CINI centre at Daulatpur. Thursday is still a big day, with 300-400 people coming in to consult the doctors.
The first Nutrition Rehabilitation Centre (NRC) in India was also set up here. Nutrition encompasses as many, or even more, socio-economic factors than it does physical ones. It is not a disease like cholera or typhoid, and thus curing it is more about a lifestyle change. It can be dealt with in a cost-effective and easy manner and India really does have the resources to deal with it.
It is at this centre that mothers learn what locally available food they can prepare in order to ensure a high nutrition diet for the family. Apart from quality, quantity and frequency are also major considerations. Hence the mothers are taught how many times they need to feed their children and how much. As Dr Subhamay Paul, head of the Child Health Division at CINI, says, “Doctors usually prescribe a ‘high protein’ diet, which means nothing to a regular rural Indian parent. At the NRC, the caregivers are shown how to cook nutritious food so that when they go back home they know how to stay nourished.”
They are empowered to be independent and given the skills to be healthy and keep their families healthy. In the course of my visit to CINI, I overhear a conversation at the main clinic. Dr Debjanee Paul, who has been a medical officer at CINI for almost 10 years, is talking to a mother who wants to go back home with her baby.
“He cries,” she says, “and when he goes back home he will see everyone again and will be happy.”
Dr Debjanee is firm with her. “He will cry a lot more when he goes back home, if he is not healthy. You have to be strong. The baby is underweight, and until he is healthy you should not take him home.”
There is another couple with an 18-month-old baby. The anxious parents consult for a long time with Dr Debjanee if they should buy injections for the little one.
The clinic is overrun with mothers in colourful saris, clutching babies in their arms or little toddlers’ hands. I meet 19-year-old Rukhsana Bibi, mother of one-year-old Rohit, who was a premature baby, born in the seventh month of her pregnancy. Then there's Kulsum Khatun, whose baby has been howling because of an ear infection. The reason is investigated, and is soon revealed: she uses a rough cloth to clean out the baby's ears at home. At the NRC, Kulsum is given cotton earbuds and ear drops are prescribed.
At noon, all the mothers sit down for lunch with their children. The food is simple and delicious – rice, fish, dal. The mothers have been shown how it has been cooked. Two-year-old Rupsa, Bonosree Maity's daughter, has gained 400 grams in the four days that she has been at the NCR with her mother. Today she is surrounded by the other people at the NRC, all of them eating, but she does not touch her food. It is only when I pick up a little bit of rice and bring it near her that she opens her mouth and chews it slowly.
“Today she is moody. She is only eating when she is being fed,” her mother beams.
Probir Kumar Naskar, Project Associate of the Child Health Division, explains how the NRC works and about the social marketing of Nutrimix, a low cost eco-friendly source of nutrition which was launched on April 29, 2010. Rural women from self-help groups and other local groups will be involved in selling and encouraging the use of the product. He has been working with CINI for 30 years now, even more than Silpa Mandi and Saida Bibi, who have been taking care of the emergency ward for 26 years. All the health workers and administrators have a strong common vision that holds CINI together: that of a sustainable, rights-based and awareness-centred approach towards tackling child malnutrition at the core.
What CINI is advocating is a model called Child Woman Friendly Community, but, says Dr Subhamay Paul, clinics such as CINI are not the solution. The government already has medical workers and medicines and food enough for all of these people. The fact that a clinic such as CINI’s is badly needed, and on such a scale, is an indication that the system is not working. There is only a 6% recorded growth in the National Health Family Survey’s results from 2002 to 2005-06, which is not adequate at all.
CINI's radical approach is to act as a facilitator – between the community, the government and service providers. They have demonstrated in the work they have done just after the devastating Aila cyclone in the coastal areas of West Bengal, in areas such as Gosaba and Sandeshkhali, that this approach can work.
The approach is to coordinate with government officials such as those who work for the ICDS, and the local anganwadi and panchayat, as well as service providers such as hospitals, and direct the action in such a way that the resources available actually go to the people they are allotted for. The work in coastal West Bengal was in collaboration with Unicef, and many children who had no food and no home actually stayed at the NRC for some time before recovering and going back. It is this sustainable approach that many state governments are now learning from.
CINI is now working in five states – West Bengal, Chhattisgarh, Sikkim, Jharkhand and Orissa -- to tackle child malnutrition. This is apart from the work it is doing in seven districts in West Bengal, and other areas of focus such as CINI Asha, which is the urban unit that works with street children, CINI Yuva for young people, and CINI Bandhan for HIV/AIDS action. There is even a CINI International Unit in Golpark, Kolkata, which links with support groups of CINI outside India. It is small wonder, then, that this organisation has twice received the National Award for Child Welfare by the Indian government. They are living proof that a sustainable and successful approach to deal with malnutrition is within the capacity of India.
(Shreya Sanghani is an independent writer and social worker in Kolkata, India, interested in development issues, anthropology, and the empowerment of marginalised communities)
Infochange News & Features, July 2010