In August 2012, RMF CNE Santosh Pall found Pooja, a 9 month old girl, in Devigarh village, with a MUAC of 7.9. Picture the circumference of your thumb: that was the size of her upper arm.
Pooja was immediately rushed to the closest Nutritional Rehabilitation Centre (NRC) in the Thandla Hospital. There, she received the care that was required, and slowly began gaining weight. After 16 days in the NRC, she was released for home feeding.
Over the course of the past three years, RMF’s Community Nutrition Educators (CNEs) have helped thousands of children recover from malnutrition. Some times these cases are easy to handle: the CNE diagnoses a child, refers them to treatment, and the family agrees to do everything they can to help their child. Often, however, there are too many challenges for these families to overcome to give their child the treatment they require.
Right now in Madhya Pradesh, the only treatment option for children suffering from Severe Acute Malnutrition (SAM) is a 14 to 21 day stay in a Nutrition Rehabilitation Centre (NRC), located at central facilities outside of villages. In addition to the child, a primary caretaker, such as the mother, has to also stay with the child for the duration of their treatment. With responsibilities at home, work required in the fields for agricultural livelihoods, the care of other children, and a high level of migration for work during the dry season, it is extremely difficult to convince parents to take their children to the NRCs for this care.
My father is from a small, no-name town in desperately underdeveloped central India. Though my father emigrated to the United States over 40 years ago, we still manage to go back to India each year and visit his brothers on their estate in our no-name town. The town has historically only been recognized as the birth place of cinema genius Kishore Kumar or for the massive train junction that is its raison d’etre. More recently, the town and greater district of Khandwa have become infamous for having some of the highest child undernutrition rates in the country at nearly 60% of children under five. I came back to Khandwa as a graduate student seeking answers to such unacceptable malnutrition rates and ended up unpacking the relationship between food security and nutrition outcomes among the tribal population in the district.
Amelia training RMF CNE's in Khandwa
As a Dimagi field manager, I was pleased to learn that we partner with an NGO working in Khandwa on just these sorts of issues. I had the opportunity to visit five districts in the so-called “tribal belt” of south western Madhya Pradesh – from Jhabua to Khandwa – with our partner agency the Real Medicine Foundation (RMF). For the last several years now, RMF has been working to eradicate child undernutrition in the area by employing and training local women from various communities as Community Nutrition Educators (CNE’s).
RMF’s Childhood Malnutrition Eradication Initiative has the largest field presence of any NGO working in malnutrition in the region, a result of strong partnerships with government, NGOs, businesses, and most importantly, local communities. Our team of 60 Community Nutrition Educators (CNEs) and 6 District Coordinators is covering enormous ground every week across 5 districts and 600 villages in Madhya Pradesh. Madhya Pradesh carries India’s highest malnutrition burden, with 60% of its children under 5 malnourished – approximately 6 million children whose futures are at risk.
Amita, one of the many malnourished children reached by RMF's Malnutrition Initiative
Our strategy continues to be closing the gap between the resources available and the families who need them by focusing on the basics of malnutrition awareness, identification, treatment, and prevention and inserting simple, but innovative technologies and practices.
By: Pratik Phadkule, Program Manager Health and Nutrition
Talking about periods of the human life span, what period do you think is the most difficult? Childhood? ‘Old Age’? Every period of human development comes with its own unique set of challenges and it is very difficult to classify which is the most challenging, but for our work in India, in the last month we decided to focus on adolescence, particularly in girls from our communities, because of the relationship between the challenges faced early in life compounding those faced later.
RMF India Program Manager – Health and Nutrition Pratik Phadkule writes about his experience with CommCare and the challenges of treating Malnutrition in Madhya Pradesh.
Living in an age of extreme technological advancement certainly is a boon for mankind. This technological advancement has helped us in all the fields – communication, space travel, medicine, and engineering. Most importantly, with the help of this, our lives have become so much easier. I think, on this point, no one would disagree.
Two and a half years ago, I realized I had a large challenge in front of me. In order to complete the first step of our program, a baseline survey in 500 villages to determine the exact malnutrition situation we were dealing with, I was going to have to get creative. Sitting in front of me at the New Delhi train station, in heat of well over 100 degrees, were 500 survey books, over 1 ton of paper. I had a train ticket, 50 new workers at a training over 600 miles from where I stood, and 12 hours to get there.
Two of our Community Nutrition Educators learning to use the Commcare mobile phone survey tool