malnutrition in india

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Voices from the field: An angel, from Justdail.com

February 15, 2011 in Caitlin McQuilling, General, Helping Children, India, Providing Medical Support, Voices from the Field by Jonathan White | Comments closed

An angel, from JustDial.com by Caitlin Mcquilling

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.

Along with Gila’s father, Suroj, we consulted a doctor in Jhabua to get his opinion on whether or not the girl could travel.  With the doctor’s immediate advice to go straight to Ahmedabad Civil Hospital and BJ Medical College,  I set out along with Sumitra, our CNE who first met the family, our wonderful and uncomplaining driver Mesul, and the little girl’s father and cousin on the 8 hour car ride.

As soon as we reached BJ Medical College, one of the best government health facilities in the country, we were rushed straight to the pediatric ICU.  The wonderful team of doctors there immediately put the little girl on oxygen and started treatment immediately.  They told us that the little girl’s condition was extremely serious and her chances of survival weren’t good, but promised to do everything they could to save her.  I spent the day in the hospital with the family on Wednesday, understanding the next steps with the doctors, getting all the lab tests they needed expedited, and making sure that they were comfortable.   We set the family up with a network of kind local volunteers who promised to look after the family on a daily basis since RMF couldn’t station one of our team members at the hospital for the 3-4 weeks the family would need to be there.

At 5am on Thursday while I was rushing to get my things together for the airport, I got a phone call from Suroj.  Between sobs, Gila’s father told me that she had passed away a half hour before and he didn’t know what to do.  He wanted to go home as soon as possible to cremate Gila, but didn’t know how he would get her body the 10 hours home.  He begged me to help the family find a way home as soon as possible.  When I got into the taxi a few minutes later I knew my options were severely limited.  I had to be on a flight in an hour to go to an important meeting in Bhopal, but I also couldn’t leave this family stranded.  I’m not very familiar with Ahmedabad, especially to find an emergency hearse at 5am capable of making an 8 hour trip across state boundaries.  But as I greeted the taxi driver, that my friend found from JustDial.com, I immediately had a good feeling about him.  I had 20 minutes to convince Nitin, the driver, to drive 10 hours with a sobbing father and a dead body.

I laid it on thick.  In my remedial Hindi I told him about the work RMF does in Jhabua, about the malnourished kids, about this caring family who tried to do everything for their daughter but who were failed by the medical system.  I wasn’t ashamed to beg this man to do us this favor.  By the end of the taxi ride this driver had no choice but to agree to my outrageous request to go directly from the airport to the district hospital to find a family who didn’t speak his language (Bhili v. Gujarati) and to take them and child’s body 8 hours to a tribal area which many individuals in Ahmedabad have prejudice about.   The driver was hesitant to take on this responsibility but conceded to take the family as far as Jhabua (not their village) as long as there was a death certificate.  While the taxi driver seemed honest, I could only wish for the best as I handed him money and ran into the airport to catch my flight.

While going through airport security I arrange an expedited death certificate from the hospital and connected Nitin with Suroj and Suminta.  As I boarded the flight Nitin was lost on the hospital campus.  On my layover in Indore I confirmed that Nitin had in fact picked up the family and that they were safely on the way to Jhabua.  Phew.  Job done.  I could now concentrate on PowerPoints and process indicators.

Thursday evening I got a call from Sumitra, our CNE who met the family in Jhabua when they arrived.  After she filled me in on how the family was doing, how the cremation went, and so on, she also had a message for me.

Not only had Nitin driven the family the 10 hours to Jhabua as agreed, he also insisted on driving them all the way to their remote village himself.  Not only did he go out of his way to drive them to the village, he attended Gila’s cremation as a member of the family.  The next morning he called Sumitra, not to complain, as many people would, but to thank her.  He told Sumitra that he was grateful that RMF asked him to do this.  He said it made him feel so good that he was able to be there for this wonderful family during their time of need and was just happy to be part of all of this.

Thank you Nitin.  Its individuals like you who keep us going and remind us that even in the most terrible of circumstances, humanity can be found from the most unexpected places.

For more information about RMF’s Malnutrition Eradication Program in India, click here and for more on our HIV/AIDS click here.

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org.

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India: Barwani Pilot Program for our Eradicating Malnutrition Initiative

January 24, 2011 in Asia, Caitlin McQuilling, General, Helping Children, India, Providing Medical Support, Rebuilding Communities by Jonathan White | Comments closed

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.

To respond to these alarming levels of malnutrition in Madhya Pradesh, the Real Medicine Foundation (RMF) launched a childhood malnutrition program across 5 of the worst hit districts in Southwest Madhya Pradesh – Jhabua, Alirajpur, Khandwa, Khargone, and Barwani – employing 55 local women to act as Community Nutrition Educators to help empower communities to combat malnutrition and to identify children with severe acute malnutrition.  Given the success of these women in addressing malnutrition at the community level over the last year, RMF is teaming up with the Department of Women and Child Development and the Madhya Pradesh Technical Assistance Support Team MPTAST) to roll out a pilot program in Barwani district to address childhood malnutrition through community mobilization.  This program is supported with financial help from DFID and from technical assistance from Action Against Hunger.

Our staff attending training session

Project Objective

To build the capacity of anganwadi workers and supervisors to drive community mobilization and provide high quality health and nutrition education services in order to develop community capacity to recognize malnutrition, respond to malnutrition using local resources and make referrals when necessary, and to prevent malnutrition in the long-run.

Target Area

This pilot program will provide full coverage to two blocks in Barwani District – Pati and Barwani blocks –with a total of 204 villages and 370 anganwadi centers.  The target population will be children under 5 years old and pregnant and lactating mothers.

Barwani is a remote and rocky district at the southern most corner of Madhya Pradesh, boarding Maharashtra and Gujarat, with a population of 10,81,039 (2001 census).  It is the second most tribal district in Madhya Pradesh, with 67% ST population.  The size of each village varies from roughly 800 and 3000 people, with larger towns scattered throughout the blocks.  Barwani is considered one of the most remote districts of India.  Many of its villages are located in hilly regions, cut off from roads and access to markets.

Staff in the field

Social Mobilization Approach

The project’s social mobilization approach is founded on strengthening the capacity of the government’s ICDS programme to mobilize communities for child nutrition by delivering quality nutrition and health education classes to mothers.  This will lead to increased community understanding of child nutrition issues, more women and families adopting better nutrition practices, and increased demand for government services that people are entitled to.

The project will achieve this by capacitating Anganwadi Workers, Supervisors and CDPOs to hold regular monthly community sensitization meetings to generate interest in and sustain momentum for community action.  The sensitization meetings will increase awareness of malnutrition, its signs and the care that malnourished children need. Tools are being developed to help raise awareness of the scale of malnutrition in the village, how it can be identified, the location of pockets of malnutrition in the village, and stimulate debate on what individual families and the community can do to address this problem.

Through awareness raising events, influential persons and opinion leaders will provide support to the sensitization program through the Village Health, Sanitation, and Nutrition Committee which will serve as the local nutrition monitoring group. These newly formed Village Health, Sanitation, and Nutrition Committees will monitor the regularity, reach and quality of services provided at the Anganwadi Centre.  They will provide feedback and suggestions to key members of the local community and will report any gaps in services to the panchayats for community action. Community leaders and influential persons and the local monitoring group will meet regularly to share monitoring information, help resolve local problems and enable the smooth functioning of Anganwadi Centres. Additionally, by focusing on strengthening anganwadi supervisors’ capacity for supportive supervision, the project will not only institute a system of stronger monitoring and evaluation into the program, but will begin a process of on-going trainings.

Output

As a result of the on-going capacity building and trainings, this project will capacitate Anganwadi Workers to hold regular, participatory and practical health and nutrition education sessions for the mothers of malnourished and underweight children.  It will also strengthen their interpersonal communication skills which will benefit other elements of their duties.

Anganwadi Workers with support from Supervisors and CNEs will hold nutrition and health education classes twice a month.  CNEs will also assist supervisors and anganwadi workers on active case finding in children from hamlets and areas within villages who are not currently accessing anganwadi resources and will help connect these families with the system.  Referrals for complicated cases of SAM and MAM will be made to the Barwani NRC.

Progress thus far

RMF began the groundwork for this project in November 2010 and officially started working on the project at the project’s approval in December 2010.  The first step was to introduce the program to local leadership, and then work to recruit new positions for the program, begin developing manuals and IEC/BCC tools, hold the training for new CNEsm and to make the plan for the project moving forwards.

Follow us on Twitter, Facebook or become a fundraiser for us at Causes.com

For more information about RMF’s Malnutrition Eradication Program in India, click here.

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org.

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Voices from the field: Goals for the New Year in India

January 19, 2011 in Helping Children, India, Jaimie Shaff, Providing Medical Support, Rebuilding Communities, Voices from the Field, Whole Health by Jonathan White | 1 comment

by Jamie Shaff

Pankaj walking

Happy New Year!

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!

As I sit on my porch and watch the sunset across the valley, I find it hard to believe that just a few days ago I was sliding around in the snow. Globalization is truly remarkable.

My time in India began with an all-to-typical “doh!” moment as I heard my glasses tumble down the squat toilet on the train from Delhi. I write “heard” as I am quite literally blind, with vision of -7. I thank the Lord and every deity for the gift of contact lenses, for saving me from being absolutely handicapped, but life without glasses is not one I wish to live much longer! I do hope that some poor blind person finds the specs and is given the gift of sight. Note to self: from now on, I will only get large dark frames so that, if such an event is to ever reoccur, I will have a greater ability to see where they landed and stop them before they end up on the tracks!  However, my friends, glasses are not what I want to discuss.

My first days back in Jhabua left me with enough smiles and cheer to cover the glasses and more. Some of my absolute favorite patients came back for follow up with nothing but good news!

Twins

*Pankaj (4) has finally started walking, running, and saying, “Hello!” He enjoys playing with the toys at the NRC, and his 9-year-old aunt, Maria, is still taking excellent care of him. He eats with fervor, and has turned lethargy into attitude. We are still hoping to find a school for the two of them, but for now we are happy with his health and steady development.

Naiara and Pankaj

*My goal for the New Year was to make Basanti (3) smile (a girl who presented with full body edema November 2010, requiring an intraosseous blood transfusion-sans anesthesia- and NG tube). Not only did she smile (with teeth!) but she is also trying to walk and talk! Basanti needs an operation for her cleft foot, so my new goal for the year is to fix Basanti’s foot. It shall be done!

Basanti

*Our serious measles cases-Sangeeta (3), Pannu (1), Jaimuna (2), Gunga (2), and Mahima (2)-all came for follow up happy and healthy. They had plump little cheeks, were smiling and playing, and are altogether doing wonderfully! As we jump into our new year, we have some serious follow up to do post-measles outbreak, but I’m ecstatic to start off the year with some success cases.

Sangeeta and Pannu

Altogether, a India’s welcome has been filled with miracles. As we begin to get new programs started, old programs revamped, and future programs conceptualized, these miracle cases give us hope and inspiration. I guess we did something right in 2010—here’s to 2011!

Follow us on Twitter, Facebook or become a fundraiser for us at Causes.com

For more information about RMF’s Malnutrition Eradication Program in India, click here.

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org.

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Malnourished Miracles: Vishal’s story

December 3, 2010 in Asia, General, India, Jaimie Shaff, Voices from the Field by Jonathan White | Comments closed

Continuing with our Malnutrition Eradication Program series and fundraiser another great blog from from Jaimie Shaff in the field in India…

by Jaimie Shaff

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.

But it all somehow balances out.

Vishal on his first visit to NRC

Today I arrived to the NRC to the smiling face of Vishal. Vishal arrived at the NRC two months ago presenting with severe acute malnutrition, apparent moderate mental disability, vomiting, and diarrhea, and was not taking food. He had a very severe infection that was treated, but he continued to refuse to eat. His mother was pregnant, and had stopped breastfeeding him 5 months previously—Vishal had never had complementary feeding, and was not responsive to attempts to give him F75, even through the breastfeeding assist.

Vishal continuously reached for the breast of his mother and grandmother, particularly when food was offered to him. However, it appeared that when Vishal’s grandmother was with him, he was more cooperative to feeding. His mother did not come to the NRC for several days, and Vishal began to take the F75. When his mother returned, Vishal stopped eating again. After a week we referred them to seek treatment at another hospital to seek further treatment, but they told us that they had been there before and would not go back. We continued to tell the grandmother and mother how important it was to get him better treatment/nourishment. The grandmother made every effort to get Vishal to eat, but the mother seemed apathetic.

Vishal was my first seriously complicated case in which I had no idea what to do next. At one point, I was up in the middle of the night blending peanuts to make RUTF! When we weren’t watching, his mother and grandmother would try to sneak him biscuits and chips (definitely not in the protocol!), which he would nibble on occasionally, but eventually throw in a fit of anger. In some last ditch efforts, we tried to put RUTF on the biscuits to see if he’d take that, but he wouldn’t. After a week we had asked the family to go to Jhabua District Hospital, but they refused and asked to stay at Jeevan Jyoti.

Vishal after 2 months of treatment

After two weeks, the family wanted to go home for a few days and come back. A wave of kids had just arrived and we knew that another child would fill the bed—we had no choice but to, once again, refer. They told us that they wouldn’t go and asked us to try more, promising to come back in a couple of days. We couldn’t guarantee an empty bed, and when they left the hospital, we could only hope they sought treatment elsewhere.

Every follow up day I’ve looked for Vishal. We’ve sent Community Nutrition Educator’s to his village, but he was never home and no one knew where he was or if he was migrating. I knew when we referred him to a higher center that his condition was critical, and didn’t want to think of the worst-case scenario.

And then today I see his smiling face. He’s up running and laughing and sharing toys with other kids in the NRC. I was absolutely overwhelmed with happiness. His cheeks were plump, he had a sparkle in his eye, and he was smiling. Far from the listless, angry, stubborn child from 2 months ago, Vishal was on the mend.

It turned out that our counseling had actually worked. The grandmother took Vishal to Dahod for treatment and he was put on anti-Tuberculosis medicines. They used our feeding techniques to get him to eat nutritious food, and they have also been engaging him psychosocially, stimulating his mental development and helping him achieve the catch-up that he needs. His mother gave birth to her second son 15 days ago.  Now is the true test to the efficacy of our counseling efforts and emotional support: will the family take back the knowledge given to them at the NRC to raise a happy and healthy child? We hope so. Based on Vishal’s incredible improvement, I think things will work out.

Follow us on Twitter, Facebook or become a fundraiser for us at Causes.com

For more information about RMF’s Malnutrition Eradication Program in India, click here.

We can use any financial help you are able to provide on this project to continue our Education, Treatment and Outreach and help towards our goal of Malnutrition Eradication in this region of India.

To contribute to this initiative, please click Donate button or visit our website at realmedicinefoundation.org.

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Volunteer’s story-Ganesh visits our India Malnutrition Initiative

October 29, 2010 in Caitlin McQuilling, India, Voices from the Field by Jonathan White | Comments closed

By Caitlin McQuilling

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.

RMF thanks Ganesh for coming halfway across the world to see malnutrition in India and what RMF is doing to stop for himself.  It was a pleasure to host such a compassionate and caring individual for the past five days.  We look forward to working with you and your friends to eradicate childhood malnutrition in India.

For more information about RMF’s Malnutrition Eradication Program in India, click here.

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To contribute to this initiatives, please click Donate button or visit our

website at realmedicinefoundation.org.

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Meet Sonu-Nutrition Rehabilitation Center patient of the month

October 20, 2010 in India by Jonathan White | 2 comments

by Caitlin McQuilling

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.

Now, 2 weeks later look at him! (See photo at bottom)  Sonu has gained 2 kg, is smiling, giving attitude, and eating everything he can get his hands on.  He’s been switched over to F100 and his on a solid, local foods diet as well.  The other day Jaimie and I were sitting by the canteen and saw Sonu and his father come over and buy a piece of candy.  Sonu saw us staring at him as he dove into the candy and then held out his hand and offered his candy to us.  Jaimie and I both had tears in our eyes.

Sonu still has a long way to go to make a full recovery.  He’ll probably be with us for another 2 weeks or so and we’ll have to keep a constant eye on him to make sure he doesn’t get sick again or loose this momentum in weight gain.  But we’re optimistic!

We have a lot of very serious cases in the NRC right now who we’re worrying about, but its success stories like this that keep us going.

For more information about RMF’s Malnutrition Eradication Program in India, click here.

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To contribute to this initiatives, please click Donate button or visit our website at realmedicinefoundation.org.


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How hunger has changed across the developing world (Economist.com)

October 19, 2010 in India by Jonathan White | Comments closed

Interesting chart and short article from The Economist about the current scoring on the Global Hunger Index for developing countries around the world.

http://www.economist.com/node/17244014

India is among the countries with “Alarming levels of hunger”

Our Malnutrition Eradication Initiative in Madhya Pradesh, India is on the front lines educating and treating for this issue.

For more information about RMF’s Malnutrition Eradication Program in India, click here.

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To contribute to this or any of our other initiatives, please click the Donate button below or through our website at realmedicinefoundation.org.


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“Be the change you wish to see in the world”

October 5, 2010 in Helping Children, India, Rebuilding Communities, Whole Health by Jonathan White | Comments closed

By Caitlin McQuilling

On Saturday October 2 India celebrated the 141st birthday of Mahatma Gandhi.  This day is a public holiday in India, but as usual, the RMF India team didn’t take the day off.  We are always inspired by Gandhi’s famed quotation “Be the change you wish to see in the world,” and decided to honor this inspiring leader’s birthday not with talk or taking a holiday, but with action.

At RMF’s behest, the Jhabua District Collector (in-charge of the district) called Jhabua’s first ever Nutrition Rehabilitation Center Review Meeting on October 2nd.  The Collector called together all the NRCs in Jhabua district to discuss challenges, lessons learned, and best practices across the 4 NRCs in the district, including Real Medicine Foundation’s NRC at Jeevan Jyoti Hospital.

For a year before starting our NRC, RMF staff had been visiting NRCs across India and researched their functioning globally.  We had a pretty good idea of how an NRC should be run, how one shouldn’t be run, and had lots of suggestions for improvements.  We realized though that to really create lasting change and workable reforms in NRCs we had to become part of the system and create change by setting an example.  We knew that the most valuable lessons are learned by doing and that by running our own NRC and documenting our processes well we would be more able to contribute to developing best practices in NRCs.  We started our NRC not only to serve the needs of the children in Meghnagar block where we are based, but also to be able to bring up the other 254 NRCs in the state by example.

We’ve already made some big progress in this arena.  We’re helping the state government to procure better nutritional products for the states’ NRCs and have given numerous policy recommendations, backed with evidence from our NRC, which have already been applied across the state.

This meeting was another step to “be the change.”  Our immediate goal is to not only make our NRC a model center, but also to bring up all the NRCs in our district so that Jhabua District can become a model district for the rest of the state.  We led the meeting by sharing our challenges and questions with the group and, in a system which encourages inflating numbers, honestly shared our data.  We learned from the experiences of other NRCs and had a lively debate about interpretation of policies and protocols with the doctors and NRC in-charges from across the district.

The meeting ended with a series of directives from the Collector on the individual improvements centers should make and how we would all work together with the Department of Women and Child Development on following up with cases to prevent relapses.  We’re developing a list of critiques and clarifications to submit to the central government together as a district so that it’s not just RMF’s voice, but a unified voice of practioners on the ground who are calling for change.

For more information about RMF’s Malnutrition Eradication Program in India, click here.

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To contribute to this or any of our other initiatives, please click the Donate button below or through our website at realmedicinefoundation.org.


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India: The Importance of a Whole Health Approach

September 1, 2010 in Helping Children, India, Jaimie Shaff, Voices from the Field, Whole Health by Jonathan White | Comments closed

Maria and Pankaj

The Importance of a Whole Health Approach: malnutrition and psychosocial neglect

By Jaimie Shaff

With malaria season at its peak and migrant families returning home, complicated cases of severe acute malnutrition (SAM) are presenting themselves at the NRC daily. In my short time here, I have seen a steady caseload of children presenting signs of tuberculosis, worms, malaria, diarrhea, and vomiting. For every child that comes into our NRC, we attempt to provide the best possible treatment, addressing underlying health conditions and symptomatic responses. Most complicated cases will flourish with antibiotics, de-worming tablets, and nutritional support while more serious cases might require a blood transfusion and vigilant monitoring.  Fortunately, medication and care is enough for most children.  Their ailments will be properly treated, their bodies will receive much needed nutritional support, and their caretakers will leave with new knowledge for malnutrition prevention.

However, there is another side to malnutrition in Madhya Pradesh that can’t be treated with pills or an IV—psychosocial neglect. In MP, there are many factors that lead to a decline in focus on the emotional development of children, such as parental employment, migration, and death. While the resiliency of children is naturally high, the ability to cope largely depends on temperament of the child and dynamics of the neglect.

Last week, a seven-year old girl, Maria, came to the NRC with a 3-year-old boy, Pankaj. Pankaj was found to be suffering from SAM complicated with a respiratory infection. Once he was admitted, it was noticed that he wasn’t interested in eating, was unresponsive to sensory stimulation, and appeared listless and sad. After some discussions with Maria and some other caretakers at the NRC, we figured out that Pankaj’s mother had passed away and his father migrated for work. Maria was Pankaj’s aunt and caretaker. Imagine being seven years old and handed a very sick three-year-old boy to care for.  Despite her age, Maria looked after Pankaj to the best of her ability, taking her motherly role in earnest.

Every time I went to the NRC, I worried about Pankaj. I had never seen a child in such a depressed state. Even Urmila, our 9-month-old suffering from malaria-induced anemia, was responsive to stimulation.  Pankaj would not play, walk, talk, or crawl. He ate with a cloak of reluctance and, when left alone, would suddenly start screaming until Maria returned. When I caught the rare glance from Pankaj, I found myself overwhelmed with sadness. His eyes told the story his voice could not.

One day, Pankaj was sitting on the floor by himself with a pile of rocks, barely moving.  I had noticed that Pankaj had a slightly enlarged head and appeared to only use one side of his body in his rare attempts to scoot across the floor. I sat down to play with him, and felt incredibly accomplished when I finally got a smile and a laugh. I watched as he demonstrated equal muscular strength, reflexes, and spatial understanding. He even surprised me with his ability to process thought when it came to counting, adding, and removing objects from his visual field. For all intensive purposes, Pankaj was significantly less developmentally challenged than we had thought. Maria returned and tried to get him to walk again. Typically, Pankaj would scream and go limp in his legs. This time he walked!

The next day I walked into the NRC and Pankaj smiled with recognition. He then grabbed my hand and began to walk. You cannot imagine the emotions that flooded into my being as I saw the effect a small amount of inter-personal play can have. With just a half-hour of attention the previous day, Pankaj began to smile, interact, and react with myself and others. Pankaj was not just starved for nutrients—he was starved for attention.

When Fabian, our Country Director came down to check on patients, he noticed Pankaj’s stature—the enlarged head, downward glance, etc. The initial diagnosis is that Pankaj suffers from hydrocephalus, a disorder that causes cerebrospinal fluid to build up in the brain. This ailment typically requires a shunt to be placed to drain the fluid from the brain. Unfortunately, these procedures are rare in the developing world as they are costly and riddled with complications. Children who receive the procedure require rigorous monitoring, as the shunt can shift, become infected, or be rejected by the body.  For a child of 3-years old whose caretaker is a 7-year old girl, the operation is not an easy option.

Emotional support is essential to the betterment of a human life. Treating the medical issues without addressing the whole-developmental being is not enough. I am proud that RMF works to empower its staff to address the social and emotional needs of its patients.  With this step, we are working to improve every aspect of a person’s health to provide the best possible course of treatment. We may not be able to fix his hydrocephalus, but we can take a step to improve his quality of life right now, medically and mentally.

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Voices from the Field: Jaimie Shaff in Madhya Pradesh, India

August 12, 2010 in India, Jaimie Shaff, Voices from the Field by Jonathan White | Comments closed

By Jaimie Shaff

Program Manager: Health and Nutrition

This past Tuesday marked my 14th day in India, aka my deadline for registration with the government of India. Since landing in this beautiful country, I have hit the ground running. The programs developed and implemented by RMF-India are absolutely incredible. Despite the fact that I was here evaluating the malnutrition program in January, I was certainly unprepared for how much the programs have expanded. The community has become more familiar with the faces of Caitlin, Michael, Fabian, and the rest of the field-staff, and the programs are developing with a strong focus on community.

With some slight confusion, train travel, and broken Hindi, I finally registered with the government powers that be this morning. My handwritten FRO note is in my passport, and I’m about 60% sure that I’ll be able to leave the country in December without any major hurdles.

In my short time here, I have met with many of the major organizations contributing towards humanitarian and developmental efforts in under-nutrition and HIV/AIDS in India.  RMF is well received and respected by large organizations, as the only International NGO working directly with the Bhil tribal population in MP. I look forward to becoming more familiar with our programs, working to increase our efficacy and community-based sustainability, and creating technical/operating partnerships with other actors in this field.

For now, I am quickly adjusting to the fast life of Jhabua, squat toilets, regulated electricity, and all. Our landlady downstairs is attempting to teach me Hindi (difficult!), and I’m managing to keep up with my early morning yoga practice (while slowly converting the rest of the team into Ashtanga yogis!). It is exciting work this organization is doing in the world, and I’m very happy to be a part of the efforts.

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