Towards Building A Vibrant and
Resilient Community Against Hunger And Malnutrition
Jan
Mitra Nyas, a non-profit organisation, with the support of Child Rights and You
(CRY), is working in Anei Musahar basti (Musahar slum) in Varanasi, Uttar
Pradesh, on the issue of child survival (maternal, neonatal health and
nourishment) for a healthy and happy childhood.
In October 2016, Jan Mitra Nyas,
a non-profit organisation, with the support of Child Rights and You (CRY),
adopted Anei Musahar basti (Musahar slum) in Varanasi, Uttar Pradesh, to work
on the issue of child survival (maternal, neonatal health and nourishment) for
a healthy and happy childhood.
In the base line survey (BLD) and focus
group discussion (FGD) we found that the community did not avail of government
facilities fully due to superstition and belief that they will get treatment
for all kinds of diseases from the ‘ojha’ (witch doctor). When a woman
gets pregnant, they bring her to the ojha to protect the mother and child from
evil and prevent stillbirth. Every month they have to pay Rs 200 to the ojha as
fee along with ‘daru’ (alcohol) and ‘murga’ (chicken) for protection.
After the delivery of the baby, the
ojha performs rituals known as ‘gadthant’ to prevent neonatal and maternal
death. The rituals are performed at midnight in any quadrilateral area, and the
fee the ‘ojha’ charges is between Rs 2,000-5,000.
With regard to the issue of
malnourishment, the community visits the ‘sokha’ for binding the bended limbs
of children stricken with rickets. The sokha uses chichidi leaves
(Amaranthaceae) as necklace for preventing malnourishment, and for this they
charge a small amount of Rs 10–20.
A sample survey was conducted in 20
villages of four blocks (Badagaon, Pindra, Harhua and Arajiline) of Varanasi
district, and it was found that due to ill treatment and negligence in
government hospitals 19 out of 20 families were in debt, ranging between
Rs1,000-Rs 1,75,000 for getting treatment in private hospital or by ojhas and
sokhas.
Stereotypical thinking, superstition,
and lack of trust in government-sponsored healthcare schemes and facilities are
the main hurdles in the realisation of health services for pregnant women and
their children, the study found. Thus, they resorted to the community
practice of home delivery for the pregnant women, and did not seek out
the posahar (nutritious food) distributed by the ICDS (Integrated Child
Development Services) worker. The ANM (Auxiliary Nurse Midwife) never
visits the ghetto of the marginalized communities for vaccination or
immunization of the child and pregnant mother. The ANMs sit in the localities
of the upper castes. When the Musahar community people go for availing these
facilities they have to pay money for getting the Jaccha–Baccha card (Child
growth card) and also face discrimination from the concerned stakeholders. .
The project by Jan Mitra Nyas, a public
charitable trust linked to the Peoples Vigilance Committee on Human Rights
(PVCHR), has a multi – layered and multi–dimensional approach to reduce Infant
Mortality Rate (IMR) and Maternal Mortality Rate (MMR) and focus on healthy and
happy childhood through changing their knowledge, attitude and practice by
breaking the culture of silence and creating resilience among the community
service providers.
Based on the knowledge, attitudes and
practices (KAP) mapping, we prepared our strategies in the context of mapping
stakeholders based on their interest and influence. Due to the existing
patriarchal system, the health and well-being of women is not taken very
seriously by the family. A woman taking care of her family and helping in work
is considered as healthy. Besides educating women and adolescent girls
and making them conscious about their own rights, the project also focused on
holding a dialogue and engagement with the pregnant women, their husbands and
in-laws.
Following are a few outcomes of the project:
* Of 23 pregnant
women, 18 went to the Primary Health Care centre, in Badagaon, for delivery,
utilising the facility of the ambulance service. Five pregnant women had
their delivery at home. The project staff assisted the Musahar community in
opening bank accounts to get the direct cash benefits of the Janani Suraksha
Yojana (safe motherhood) scheme as well as other government schemes. Aakash was
born in a Primary Health Centre, Badagaon, on 1st February, 2018. During
the delivery Aakash weighed only 1 kg and 500 gm and also did not cry.
The nurse provided kangaroo therapy (holding the baby that involves skin-to-skin
contact) to Aakash, and after half an hour he started to cry. At midnight
the hospital midwife was trying to convince Aakash’s grandmother to admit the
baby in a private hospital as he was underweight. But Aakash’s
grandmother did not listen to the midwife. Next day, the doctors discharged
both mother and child.
* Another finding is that
due to lack of knowledge, the mothers were giving water to their babies (0-6
months). During the advanced phase of pregnancy the project helped create
awareness and promote breast feeding and also demonstrated about proper care of
the child and food for children between 6 months to 5 years and also for the
pregnant mother. For example, Kajal (daughter of Reema and Lorik Vanwasi)
and Aakash (child of Sarita and Mahendra Vanwasi) were breast fed for six
months. Reema had the full support of her husband but her in-laws forced her to
work rather than take care of the child. Sarita got the full support of
her husband and in-laws. Aakash’s grandmother took care of him from time from
time.
* 15 of the new-borns drank
colostrum (the first form of milk produced by the mammary glands immediately
after delivery) after an hour of birth as their first immunization. The
remaining 8 babies did not get colostrum due to superstitious belief that a
child should be fed only 3 hours after delivery.
* Of the 18 adolescent girls in
the ghetto, 5 had a health test done in a camp organized by the ANM. In the
health camp one girl was diagnosed as anaemic and was referred to the public
health centre, Badagaon. There she got treatment by the female
doctors. Adolescent girls are using sanitary pads during menstruation,
and when they did not have money they were using clean cloths. The girls
participated in the Kishori Swasthya and Poshan Mela, (Adolescent Girls Health
and Nutrition Fair) organized in Pindra Block level. The mela had lots of
information on the various issues related to adolescence such as balanced
nutritious diet, taking care during menstruation, hand washing process etc. A
documentary “Menstopedia” was also screened and the girls were explained about
“good touch and bad touch” and a quiz contest was also organized. The girls who
gave right answers were awarded sanitary napkin packs.
* Now there is no Infant
Mortality Rate or Maternal Mortality reported in the village. During the
time the village was adopted 4 Infant Mortalities were reported.
* The severely acute
malnourished (SAM) rate reduce due to activization and availing facilities of
the ICDS centre.
* In 2018 with the
support of the New Zealand High Commission PVCHR initiated the kitchen
gardening. In this ghetto 50 families were initiated into kitchen
gardening.
Resilience of Service
Providers:
The Auxiliary Nurse Midwife (ANM) has
evolved a micro plan for immunization for the Anei Musahar basti since
2011. The ANM had the responsibility for immunization of the pregnant
mothers and children of both upper castes and also of the Anei Musahar ghetto.
However, the ANM would never visit the Musahar ghetto, but sit at a
roadside Hanuman mandir to vaccinate the mothers and children. She used to call
people from the Musahar ghetto at the same place for vaccination, but most of
the children and pregnant mothers got left out.
The project did advocacy with the
concerned authorities on the number of people getting left out of the
vaccination. Gradually the ANM started visiting the ghetto for the
immunization. From March 2018 the ANM began spending a whole day for
immunization in the Musahar ghetto.
ICDS centre
The mini ICDS starting in 2011-12
but it was not implemented at the grassroots level. After a few years it
started operating in the primary school Anei second development block. In the
school only one ICDS was operating with two ICDS workers. The Musahars would
not avail of any facilities from this centre. In October 2016 the
organization started the Bal Swasthya Poshan (Child Nutrition and Health) and
created knowledge and awareness on the services being provided. The staff
met with all the ICDS workers in Anei village to know about the ICDS worker in
Anei Musahar Basti. They were informed that the ICDS worker of the area was not
regularly sitting in the ICDS centre in the school. Neither were the Musahar
children going to the centre nor was the ICDS worker interested in operating
the centre in the ghetto. A complaint was filed with the regional Mukhya
Sevika (In charge) who in turn said the Musahars were responsible for not
availing the facilities. A complaint was filed at the Chief Minister’s portal
(online complaint), following which the ICDS centre started to operate in the
Musahar ghetto from November 2018.
(Shruti Nagvanshi is Managing Trustee,
People's Vigilance Committee on Human Rights (PVCHR), an initiative of Jan
Mitra Nyas)
Link of main article
https://www.outlookindia.com/website/story/towards-building-a-vibrant-and-resilient-community-against-hunger-and-malnutrition/332863
