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.
“Giving to the less fortunate and to worthy causes is a task learned early on in life” says Sara Citak-Demir. “My husband and I want to make sure our daughter Anjelina grows up with good ethics, values and the heart of a ‘benefactor’.”
RMF Benefactor, 7-months old Anjelina "Pegruhi" Demir
While here in Armenia, I have been visiting and spending lots of time with RMF’s project beneficiaries and the communities at large in the villages we work in. A few weeks ago as I was visiting the village of “Medzen Ayrum” in the Alaverdi region of Armenia, I met with the family who takes care of the chapel built in my late cousin, Hovig Saghdejian’s memory. Continue reading →
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.
Virgil wrote that fortune favors the bold, but I’m pretty sure this isn’t what he had in mind.
I’ve been in India for a grand total of 36 hours, most of it in transit, and it’s this last leg that is the most terrifying. Flashes of colour and sound as we hurdle down a road with what might generously be called lane markers, drivers in opposite directions flashing their headlights and honking frantically. There are seat belts in the car, but somewhat incongruously, the ones that actually have clips don’t seem to have anything in to which they buckle. Our driver (who, appropriately enough, has been dubbed ‘Michael Schumakr’ by the local staff) seems to revel in swerving away from oncoming trucks at the last possible second, dancing to and fro between lanes like a hippopotamus on roller skates, its sheer bulk and momentum defying the manoevres it seems to barely pull off.
My companion turns to face me, and grins. “Welcome to India.”
I heard about the Real Medicine Foundation and that they would be needing help in Ahmedabad, Gujarat through a friend of a friend. Always looking for any unique volunteer opportunity, I jumped to the occasion. They needed me to assist patients and their families that came to the Civil Hospital, a local government hospital, for advanced medical care. Even though I had vast experience at hospitals in the United States, I had never before been to a hospital at India. I was only vaguely familiar with how healthcare worked in India. But, nonetheless, when I got a call saying they have a patient admitted and would I go to help out, I was elated at the prospect of being able to help.
It was not until I got to the hospital and realized how monstrous it was that I felt totally apprehensive and overwhelmed about the situation. But I carried on and went inside to find the first patient, Rahul. As soon as I saw the look of relief on Rahul’s parent’s faces when I introduced myself, all of my fears vanished. I visited the hospital daily during Rahul’s admission. I learned to communicate with the doctors and translate the information they told me (or that I got out of them) in my broken Hindi. I quickly realized that the parents were simply scared and overwhelmed. They just needed someone at their side to advocate for their child and help them navigate. My regular connection with them kept them rooted at the hospital and prevented them from eloping. Knowing that my connection with them kept his parents in the hospital and allowed Rahul to get the treatment he needed made my time and efforts worthwhile.
This past weekend, Real Medicine Foundation & the Florence Western Medical Center hosted their first “Back to School” Event, providing more than 60 children and families with brand new backpacks filled with school supplies.
Recognizing the needs of this community has not been the challenge; the challenge has been how to encourage the community to show up for the services available to them. Free health and fitness programs for adults and children are offered at the center by Real Medicine, yet often we find a low attendance due to lack of access to information, transportation and health issues. While we have worked diligently to encourage the patients with incentives to attend these programs, at times it can be frustrating. Many charities in Los Angeles share this dilemma.
So the question becomes how can we bring about awareness of our programming in an area where the digital age has fallen behind? Phone numbers on sign-up sheets are often disconnected the following month. Most patients do not have home computers, making emails a futile effort. How can we meet the needs of the community and bring forth something that they will show up for, while giving them access to information about the center’s services and our programming?
In March 2010, Caitlin and I were driving around Khandwa district on a motorcycle desperately searching for staff to begin operations of our ambitious “Eradicate Malnutrition” program. In our heads, we had a checklist of criteria for potential new staff, mostly focusing on education levels and any experience in the health, nutrition, or NGO sector. As we drove from hamlet to hamlet, over dried streambeds and through fallow, dusty farmland, the checklist was whittled down to one item: literate.
In July of 2011, 5 of our amazing CNEs from Khandwa are now on the cutting edge of technology, helping Microsoft design their Digital Slate technology for data collection in the field. At the same time, the rest of our Khandwa team is collecting information with an application on their phones specifically designed from RMF called Commcare. After a 3 month study, Microsoft Research will publish a paper based on the inputs of our team comparing these solutions to data collection problems. It seems that my initial pessimism, as it so often is, may have been a bit misguided.
Monitoring and evaluation is often the most difficult part of any development program. It’s often an afterthought for implementers, too busy worrying about rolling out the immediate and the tangible to worry about how they’ll evaluate their work at some later stage.
It’s important that data is not something that’s just written down in a grid each month and never seen again. The strongest programs are the ones in which ground level staff find their reporting useful in their daily work. By making data helpful to ground level staff it makes their reporting in turn more accurate.
Even though RMF put a focus on our M&E from the beginning of our program, it has continued to be one of the biggest struggles in implementing our program on the ground. As our program grows we are not only constantly assessing, analyzing and evaluating our data but also try to give the same level of analysis to the processes by which we collect data.
In this age where there seems to be a tech solution for everything, many development programs make the mistake of thinking that technology will be a “silver bullet” which will fix all of their challenges in the field. The best advice we received from one of the technology experts we were consulting with when deciding which direction we should take our program was “don’t automate a broken system,” meaning that before introducing any new technology, an organization should make sure their fundamentals are solid. As we moved forward with the planning of two innovative technology pilot programs for data collection integrating technology such as mobile phones or digital slates, we also needed to ensure that the fundamentals of our program are strong and that we understand and were honest about our strengths and weaknesses in data collection.