Story of Change

KEEPING HOPE ALIVE – JEMTI FIGHTS FOR HER DAUGHTER’S HEALTH.

Radhika’s MUAC (Middle Upper Arm Circumference), used for tracking a child’s health, went from 105 mm in September 2018 to a dangerous low of 96 mm in December 2018. She was suffering from Sever Acute Malnutrition. Her family, neighbours, the village community and everyone thought Radhika won’t make it to the next year. Everyone except her mother, Jemti Singh.

A mother overburdened by responsibilities

Jemti lives in Dhar, a district in Madhya Pradesh known for its high prevalence of acute malnutrition in children. According to National Family Health Survey (NFHS-4), the prevalence of underweight, stunting and wasting in Dhar is 42.8%, 42% and 25.8% respectively in children under 5 years of age. Residing in the Gandhwani block of Dhar, Jemti’s immediate family includes 3 more children and her husband while the extended family has a total of 15 members. They own a little over 1 acre of farm land where they grow maize, soybean and wheat. In the dry summer months they migrate to the neighbouring state of Gujarat to work as manual labours.

With the farm, household chores, labour work and 2 more children to take care of, Jemti would find it difficult to devote enough time to Radhika. Even though she wanted to, she’d often be hard pressed between taking care of the family’s overall needs and looking after Radhika’s nutrition and hygiene. Radhika stared falling ill frequently leading to de-nutrition and weakness. She started losing weight and had become quite thin. Her mother recalls that Radhika would frequently have loose motions and diarrhoea. According to WHO, water borne diseases such as diarrhoea account for nearly 30% of the malnutrition cases globally.

Around this time, the family was on migration and her condition continued to deteriorate. Like most of the other families in Dhar, they too believed in superstition. Thinking of her condition as general weakness, they took her to various godmen in the hope they will be able to cure her. Unfortunately, nothing worked.

Breaking the resistance

During September 2018, Radhika was discovered to be suffering from Severe Acute Malnutrition during a routine screening in her village. Her MUAC was recorded at 105 mm. It was necessary to get her admitted to the nearest NRC (Nutrition Rehabilitation Centre) immediately. Jemti was at her wits end and was all for going to the NRC. But being pregnant with her 4th child, the family was not keen on her and Radhika being away from home. It took some time to convince that the treatment provided at the NRC was the best course of action available. After much convincing by everyone, including Jemti herself, the family relented and Radhika was taken to Dhar NRC with her MUAC now dangerously low at 96mm.

They stayed at the NRC for a total of 21 days. The situation was tricky since Jemti’s due date was nearing. Both Radhika and Jemti received the necessary treatment and care at the NRC. In January 2019 Radhika was back home much better than before. Jemti started participating in the community sessions on nutrition and hygiene conducted at the local Anganwadi Centre every week. She started implementing the sanitation practises recommended such as washing hands, safe disposal of baby excreta, filtering drinking water and safe storage etc. Seeing Radhika’s progress, her father too got closely involved and supported Jemti on adding a variety of nutritious food items to their diet. The family members now divided the household chores among themselves to leave time for Jemti to rest, and take care of Radhika and her new sibling.

Radhika is now 2 years old and healthy. Her MUAC now reads 139 mm and Jemti is glad she did not give up and continued fighting for her daughter. Whenever you ask her about the past, she feels proud that she always had the belief that there is a way!

Stories of determination and belief gradually overcoming seemingly difficult obstacles aren’t exactly scarce, and yet, everytime Jemti talks about her fight for raising Radhika to be healthy, you can’t help be feel the palpable joy!

A MOTHER’s FIGHT FOR HER CHILD’s FUTURE

For Neelam, a mother of 2, education ended abruptly when she was in class 12. She had to drop out of school, support her family’s sustenance through farming and was soon married off to a suitable groom. While Neelam does rue the missed opportunity of completing her education, probe her further and she excitedly says that she will make sure her daughter completes her education and grows up to be independent someday.

We came across Neelam during a house-to-house screening in Khaperkheda village of Dharni, Amravati. 19-month-old Dhristi, was found to be suffering from moderate acute malnutrition. Her Middle Upper Arm Circumference (MUAC) was 117. Action Against Hunger staff engaged with Neelam to better understand the cause of Dhristi’s condition and discuss with her the importance of nutrition. During her first counselling session, Neelam realised she needed to feed Dhristi at regular intervals and introduce her to various food preparations as a part of complimentary feeding. Without delay she began keeping a close watch on Dhristi’ s meals and fed her at regular intervals. Along with complementary food such as Daliyah (porridge), rice and simple preparations of pulses, she increased the frequency of breastfeeding. During our weekly home visits, the change in Dhristi was visible. From being quiet and expression less, she was now a curious child with a hint of smile forever on her face. Dhristi has not recovered completely, but she is slowly getting there.

Neelam says she plans to learn sewing and take it up as a profession to earn extra income. In the coming years, she believes she will be able to save enough money to make sure Dhristi keeps receiving good nutrition as she grow up, start schooling and hopefully grow to be financially independent and self-sufficient. Through determination, perseverance and patience, Neelam is slowing making sure that Dhristi becomes what she could not be.

A MOTHER DEFEATS MALNUTRITION THROUGH KNOWLEDGE

Khandela Kedi is a small village in Baran, Rajasthan where Madhu lives with her two children, her husband and mother in law. When Sandeep, her elder son was born, Madhu dedicated her entire time in caring for him. She made sure her was exclusively breastfed until 6 months of age and thereafter introduced to other simple foods. Sandeep was a chirpy, happy toddler. When Sandeep turned 18 months old, Madhu’s family fell on hard times. The family income was not sufficient to sustain them and to make matters worse; Madhu’s husband had become an alcohol addict.

To support her family, Madhu had to take up manual labour for an extra source of income. It often involved long, tiring days under the sun and returning home at dusk. Sandeep was left under the care of his grandmother. Madhu often missed her time with Sandeep but continued to toil for their sustenance. In some weeks, Madhu noticed that Sandeep was no longer the chirpy toddler he used to be, he had stopped playing and was getting weak and cranky.

One day when Madhu was out for work, a community mobilizer form Action Against Hunger measured Sandeep’s Middle Upper Arm Circumference during a screening drive. He was found to be severely malnourished. We advised his grandmother to take him to the nearest Malnutrition Treatment Centre (MTC) and begin treatment immediately. On discovering this, Madhu took him to the MTC the next day. At the centre, Sandeep was provided necessary medicines and fed nutritious food 5 to 6 times a day. Madhu received counselling on aiding Sandeep’s recovery though good nutrition and sanitation at home. His father too realized the toll his alcoholism was indirectly taking on Sandeep’s health and quit drinking. During her 15-day stay at the MTC, she learned taking the MUAC measurement on her own and was provided a MUAC tape by Action Against Hunger staff on discharge, to keep a track of Sandeep’s progress.

Sandeep’s MUAC reading had improved from 113 to 115 and he was gradually recovering. When Madhu heard of a fellow villager’s child getting weaker, she quickly put her MUAC tape to use and realized that the kid was in the yellow zone (moderately malnourished). She got in touch with Action Against Hunger and ensured the child’s mother received adequate support from the MTC.

Madhu is now a part of a 5 women group in her village who are well versed at MUAC measurement and regularly spread awareness on the importance of good nutrition and sanitation among other women in the village. She is slowing eradicating malnutrition from her village and empowering mothers like her.

BABY HASEENA

Shifa (name changed) lives in the sprawling Bainganwadi slums in northeastern Mumbai, and sits right behind the Deonar garbage dumping ground. Shifa is married to Zeeshan (name changed) Shah who works as a tailor for a small company earning approximately Rs. 7,000 per month.

Baby Haseena (name changed) is the youngest of Shifa’s 6 children (2 boys and 4 girls) and was referred to Action Against Hunger by an Anganwadi worker. Haseena was brought to the center on 11/12/2017 when she was 5 months old. Her height was 57.1 cm, weight was 3.4 kg and MUAC was 86 mm with no edema, she was suffering from Severe Acute Malnutrition (SAM) with SD < -3.

Haseena has been visiting the Outpatient Therapeutic center for 12 weeks now. Her general weight gain trend has been good, except for a couple of weeks when she suffered from diarrhea, high fever and pneumonia in her 2nd, 7th and 11th week of treatment respectively. All through those weeks, she was continuously monitored by our staff through home visits and assistance during hospitalization.

On her 12th visit, her health had improved considerably; height was 60 cm, weight 4.2 kg and MUAC 95 mm. Her mother was very happy with the improvement in Haseena’s health. Haseena is still under treatment in our program and is on her way to recovery.

SHILPA’S SLOW AND STEADY PROGRESS.

Baby Shilpa’s parents are landless farm labourers. Weighed down by their economic condition, her mother Sunita would often be on the field from dawn till dusk, leaving her alone at times at their small dimly lit home. During a door to door screening we discovered baby Shilpa was suffering from Severe Acute Malnutrition and convinced the parents to enrol her in the nearest Nutrition Rehabilitation Centre (NRC).

TOn her 4th day at the NRC, Shilpa’s father took them back home leaving her treatment midway. Every day that Sunita did not show up for field labour, they lost crucial and already meagre daily income and the stipend/ incentive provided at the NRC did not make their ends meet. It was a very difficult choice for them between Shilpa’s treatment and sustaining themselves as a family.

Understanding the predicament, we decided to double down on our efforts and improve Shilpa’s health through rigorous home based counselling. We timed our visits with Sunita’s presence at home and discussed Shilpa’s diet, sourcing easily available vegetables and grains from their farms, ensuring basic sanitation and care practices during common ailments such as flu and diarrhoea. In about 5 weeks the change was visible. Shilpa was more cheerful than before and was slowly gaining weight. Her parents encouraged by the change they could see, diligently took care of her needs and proactively engaged with us during home visits.

Although Shilpa hasn’t recovered completely, her MUAC has improved from 95mm in December 2017 to 115mm now. We are making sure we follow up on her every week and keep the progress going slow but steady.

SHRUTI’s MOTHER BRAVES CONFLICTS TO SAVE HER CHILD’S LIFE.

Action Against Hunger staff met baby Shruti during one of our routine screenings in Khodala in Palghar, Maharashtra. She was born pre mature, with a low birth weight of only 1.6kg and needed immediate medical attention.

Our community mobilizers immediately referred her to Khodala Primary Health Centre (PHC) and we enrolled her in our nutrition therapy program. Our team explained to Sheetal, her mother, the severity of Shruti’s condition and the measures to be taken to help her recover. During her first visit to our Out- Patient Therapeutic centre (OTC), Sheetal received an in-depth counselling on Infant and Young Child Feeding ( IYCF) practices. Techniques on how to hold the baby, what should be the baby’s position, number of times the child should receive breast milk and what should be the duration of feeding was explained thoroughly.

Sheetal, being an ASHA (Accredited Social Health Activist) Frontline worker herself, had sufficient knowledge on IYCF practices. Unfortunately, lack of support from her family in raising Shruti was one of the biggest barriers she faced. Our team began visiting her home every fifteen days to ensure Shruti was receiving proper nutrition. During these visits the team counselled the entire family on the importance and benefits of breastfeeding, on hygiene and sanitation practices and various causes and consequences of malnutrition which might be detrimental to her growth and survival.

As Shruti completed 6 months, the team started focusing on complementary feeding practices. Sheetal was encouraged to introduce simple food preparations such as rice puree and egg yolk to Shruti and it further aided Shruti’s progress. Shruti is on her way to recovery; we are closely following up on her and assisting Sheetal in her endeavour to raise her child to be healthy and strong.

SHYAM’S JOURNEY

In a remote village in Dhar, Madhya Pradesh lives 2 year old Shyam with his 4 siblings, parents and grandparents. It is quite a sight to see Shyam all happy and giggly, his chuckle grows on you. Unfortunately, his parents have never heard it, both of them being deaf.

With 5 children to take care of, coupled with the loss of hearing, Shyam’s mother, Rekha, has had a hard time taking care of him and his nutritional needs. He was suffering from Severe Acute Malnutrion (SAM) when our field staff discovered him during a door to door screening. Initially Shyam’s parents readily agreed to take him to the nearest Nutritional Rehabilitation Centre (NRC) after a discussion with our staff. His condition didn’t improve though. Rekha couldn’t completely understand the instructions on feeding practices and sanitation provided at the NRC due to her hearing disability. It took much convincing from our staff and to make them take Shyam to the NRC again and this time they were accompanied by his grandmother as well. Simultaneously, during a home visit, we decided to counsel his grandparents and elder siblings on Shyam’s dietary needs, feeding patterns and sanitation practices.

When Shyam returned from the NRC for the second time, his grandmother made sure to put into practise her learnings from the nurses. At the same time, his grandfather and his 7 year old elder sibling began to keep a track of his meals, made sure he was fed at regular intervals, his surroundings were kept clean and he was bathed every day. We requested his neighbours too to try and keep a check on Shyam’s health. The efforts taken by his family bore fruit and Shyam began to show signs of improvement in a couple of weeks. During his first screening, he was too feeble to stand on his own, Shyam now has gained enough strength to stand on his own and follow your voice if you call out his name. His current MUAC now reads 124mm and very soon he will completely recover from malnutrition.

TIMELY INTAKE OF THERAPEUTIC FOOD ENABLES FAHIM TO STAND ON HIS FEET

In one of the numerous pocket sized houses in Umarkhadi, Govandi, lives baby Fahim (name changed). When Fahim turned one, his mother Ruksana observed developmental delays in him. “He never used to play with anything and I could notice a difference that he could not crawl easily and his legs seemed too weak. Later when he was 15 months old, we tried to make him stand on his feet but he could not stand. His legs were different and they seemed bent or curved.” Fahim had a poor appetite and often wouldn’t breastfeed sufficiently. She even tried to feed him cow’s milk after he turned 6 months but to no avail.

Fahim was suffering from Severe Acute Malnutrition. At the time of admission in our Outpatient Therapeutic Center, Fahim’s weight was 7.7 kg, way below the standard weight for his height (less than -3 SD) while his MUAC reading was 123mm. Having almost given up on her son’s improvement, Ruksana was once again not optimistic about the Energy Dense Nutritional Supplement (EDNS) recommended by our staff but she agreed to try it in the hope that Fahim might recover.

“Initially there was lot of reluctance from my family members. I took my elder sister along with me and she also liked the way we were being treated at the center. Then we decided that we will continue the treatment despite reluctance from the family” says Ruksana. In a couple of weeks, signs of improvement were evident. He was gaining weight every week and gradually started standing on his feet. Ruksana was counselled on breastfeeding, sanitation, causes of malnutrition etc. Seeing the improvement, the attitude of his family members too started changing.

Fahim’s MUAC was 138mm at the end of eight weeks and his weight was 9.2 kg. Fahim fell sick twice during the treatment but retained his weight due to proper care and medical guidance. Fahim made full recovery.Ruksana is a happy mother and can’t get enough of running behind Fahim in her free time!

IYCF (INFANT AND YOUNG CHILD FEEDING) PRACTICE SAVES ROHIT’S LIFE.

On a hilly hamlet, situated on the difficult terrains of Washala village in Palghar, is where we found 2 months old Baby Rohit (name changed) during one of our routine screenings. He weighed only 1.5 kg at birth. His mother Rajashree was very worried at his failing health. Rohit was immediately enrolled in our programme in June 2017.

A discussion with her revealed that Baby Rohit was not receiving sufficient nutrition through breastfeeding. Due to her limited knowledge on ideal feeding techniques, Rohit was unable to suckle properly and often could not derive enough milk.

Rohit’s average weight gain was 14 grams per day in the first week and went up to 35 grams per day in week 4. “After I learned about the right way to feed the baby, Rohit started to gain weight and was more cheerful than before” – Rajashree, Rajashree was extremely happy to see such an improvement in her child. She is thankful to the Action Against Hunger team for teaching her about breastfeeding techniques. Our team is still keeping a close track of Rohit’s progress.

EDUCATION ON MATERNAL DIET PREPARES SAKINA TO HAVE A HEALTHY BABY

When Sakina was pregnant with baby Wasim (name changed) often she would be too occupied with her daily chores and sadly would land up skipping her meals. Sakina is a resident of Umarkhadi, an extension of the sprawling Bainganwadi slum in north-eastern Mumbai. Due to her nutritional deficiency, Baby Wasim was born premature in the 7th month of Sakina’s pregnancy and weighed only 2 kg. Wasim’s weight was low for a new born baby, and to make matters worse, within two months, Sakina suddenly stopped producing milk due to frequent bouts of illness and started bottle feeding him. In the coming weeks Wasim’s weight continued to drop below the normal standard weight for his age.

During a routine screening in Govandi, baby Wasim’s MUAC reading (Middle Upper Arm Circumference) indicated that he was severely malnourished and required immediate attention. Sakina enrolled him at our treatment center. Baby Wasim was provided essential medicines and introduced to a diet of energy dense nutrition supplement for gradual recovery. Nurses at the treatment center helped Sakina to start breastfeeding baby Wasim again. Through close monitoring and Sakina’s counselling on correct feeding practices, Wasim was showing signs of recovery.

His weight started to increase gradually. It wasn’t long before he was babbling and throwing his limbs around. Buoyed by the results, Sakina diligently attended the weekly counselling sessions and understood the importance of nutrition during pregnancy. Wasim recently turned one and has made complete recovery. His favourite toy is his red and yellow coloured ball and he will gladly throw it at you if you are game to throw it back! He will soon have a sibling to share his favourite toy with. Sakina is pregnant again. This time around though she is making sure she gets all the essential nutrients from her diet and never skips her meals. Sakina is determined to give her second baby the right start to grow up to be as healthy and strong as Wasim is now.

A MOTHER JOINS OUR EFFORT TO FIGHT MALNUTRITION!

It was a regular screening day at our Outpatient Therapeutic Center (OTP) in Baiganwadi , Govandi, and our nurse was examining baby Salma (name changed) as she was under treatment,. Our gaze fell upon her brother Shahid, who accompanied her, but was rather quiet for a toddler his age, staring with emptiness in his eyes. We immediately checked for signs of malnutrition and rightly so, our staff identified Shahid as suffering from Severe Acute Malnutrition.

During admission in the SAM program in November 2016, his weight was 8.5kg and height 82.3 cm.Shahid’s mother Zaiba, was very diligent to bring him to the OTP every week for follow up. She was delighted to observe the weight gain through Energy Dense Nutrition Supplement and close monitoring. The improvement in Shahid’s health encouraged Zaiba and her family members to continue with the treatment.

With every follow up Shahid’s mother was educated on various topics like complementary feeding and causes and consequences of malnutrition.
After attending all the counselling sessions, she was alert enough to identify the traits of malnutrition in other children in her neighborhood. She has already referred 4 children to the OTP and we are very thankful to her for that.
Zaiba is happy that Shahid made complete recovery.She is determined to give every child in her community an opportunity to grow up healthy and strong and often refers probable cases of acute malnutrition to our community mobilizers.