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.
I’m often asked what keeps me going in the face of the hardships and emotionally taxing situations we face working on issues such as childhood malnutrition and HIV/AIDS day in and day out. My answer is simple: it’s all about finding inspiration in the most unexpected of places and circumstances.
Caitlin, and the mothers and children at the Malnutrition clinic
On Tuesday while out on a village visit we came across a little girl, Gila, who was extremely sick and dangerously malnourished. She and her family had just returned from a month long stay at a private hospital in Dahod, Gujarat where Gila was properly diagnosed with tubercular meningitis, but unfortunately was not given the proper treatment. Over the month she was there the family spent their entire savings and then some only to see Gila rapidly deteriorating. After a month when the family could no longer afford “treatment” they were sent home. This is when we found the family in the village, desperate for us to help in any way we could. As soon as I saw Gila I knew she needed expert medical care not available in the state of MP. We told the family that we would have to bring the little girl to the hospital immediately and they eagerly agreed without a second thought.
Introducing a new pilot initiative within RMF’s Eradicate Malnutrition Program: Strengthening Community Management of Childhood Malnutrition through community mobilization, and nutrition and health education of mothers and pregnant women in Barwani, Madhya Pradesh
Madhya Pradesh has the highest rate of childhood malnutrition in India, with upwards of 60% of all children under 5 years old underweight. In many tribal communities in the state, this rate may be even higher, with alarmingly high rates of severe and moderate acute malnutrition. These communities often have limited access to government resources meant to prevent and treat malnutrition and have low levels of awareness about proper young child care.
I finally arrived back to Jhabua after several planes, trains, automobiles, rickshaws, and countries. Go ahead and throw a bicycle in there for good measure. Unfortunately, I can’t say the same for skis, but it was definitely worth sacrificing the slopes for some family time. The United States showed me a wonderful Christmas and New Year, with as much family, friends, and food as I could cram in my short reprieve from India. And don’t forget the hot showers!
Every morning, when I wake up to the honking horns, howling dogs, and bustles of morning life I wonder how the day is going to be. As I lay out my yoga mat and dedicate my practice to what will be, I try to take a deep breath for all that I can not anticipate. See,life in the field is a constant state of uncertainty, a question of what will happen next, and a sequence of highs and lows, equilibrium a state I no longer know.
Over a year ago Ganesh Kamath was shocked to read about the staggering malnutrition rates in India. A native of Kerala who has lived in California for over 50 years, Ganesh knows India well, but was shocked to find out that almost half of all Indian children are malnourished. He started to research the problem some more and was moved by the grim tales of malnutrition coming out of the media in India. He and friends, who all felt that malnutrition should not exist in India, formed a group to look into this issue and explore ways in which they could do something. After a year of research and bouncing ideas back and forth Ganesh volunteered to go to India on behalf of the group to see firsthand what the problem was and what could be done. After contacting various NGOs working in India, they decided that Real Medicine Foundation was a good place to start and sent Ganesh out on a fact finding trip to see the reality on the ground.
Ganesh arrived in Jhabua after a grueling few days of travel but, notebook and camera in hand, was ready to start right away. Over the 5 days he was here Ganesh joined RMF India on our daily routine in the field, in the office handling 10 things at once, in the NRC, and at the Bhil Academy. Ganesh handled it all with enthusiasm, interest, and respect for the work going on. We spent three days out in the villages on spot checks to see our CNEs in the field and to check on NRC follow up cases. One day after over an hour in a jolting car ride we had to walk about 2 miles in the heat of the day to reach an anganwadi center buried in a remote village. This up and down hill walk through fields and across streams wore out me, and I’m a runner, but Ganesh was right there with us. He was able to see first -hand the scope of RMF’s work, the challenges we’re up against, and to meet the women who make this all happen. Now that’s due diligence!
Ganesh will now head back home and report to his group about what he’s seen here in India. He has many great ideas on how he can help out RMF and some of the individual children he met here. Ganesh plans on giving talks to local groups about the program and approaching his friends and neighbors about how they can contribute to ending malnutrition in India one child at a time.
Meet Sonu, a little boy who kept our whole RMF India team up worrying 2 weeks ago. He came into the NRC hardly conscious at hardly 5 kg and 2 years old. When we got his White Blood Cell count and it was over 40,000 they referred him to the District Hospital at 11pm so he could be seen by an better pediatrician. Dr. Fabian Toegel, RMF’ Team India’s Country Director, was at the hospital with Sonu until after midnight making sure that the doctor gave him proper treatment.
While got the right dose of anti-biotics and was seen by the right doctor, the conditions at the district hospital were horrible. With 3 patients per bed in the pediatric ward, Sonu’s family, from a rural village in Jhabua, were extremely uncomfortable. After a nurse at the district hospital yelled at the family for not taking care of their child, the family left the hospital. When we found out about this we sent out a car and our CNE Salma immediately to the village to get Sonu and his family and bring them back to our Jeevan Jyoti NRC treatment center.
We made sure the family was as comfortable as possible and brought the doctor from Jhabua to Meghnagar to look after Sonu and the other children at the NRC. Sonu’s mouth was covered in soars so bad it was painful for him to even drink milk. All members of the RMF team took turns sitting with Sonu and his mother and painstakingly used an eye-dropper to feed him F75.