By Dr. Sherin Varkey
and Anupam Srivastava
Kanchanpur (Vaishali): As Kavita Kumari sits at the Anganwadi Centre familiarising children with numbers and alphabets, mothers and grandmothers keep pouring in. They come with children who have high fever, a bruise that is not getting healed, even more serious complaints such as the child getting breathless. As they come to her and narrate the problem, Kavita pulls out a handbook that gives her a corresponding procedure and treatment or advice for every symptom (she calls it her "most dependable aide”), she prescribes treatment and sends them back satisfied. “We are happy she can help,” says the mother of Shweta, a girl who walks in with the complaint that she gets out of breath easily.
Kavita, an anganwadi sevika at Kanchanpur village in Vaishali district, has been equipped to perform the task of a life-saver by the training she underwent a few months ago. Called the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) programme, it is aimed at preventing infant and child death. The training has made Kavita Kumari confident that she would be able to detect if the child is under distress and needs help in staying alive. In order to train Anganwadi workers and Auxiliary Nurse Midwives (ANMs) UNICEF is working with specialised agencies from the non-government sector and charitable institutions such as Kurji Holy Family Hospital and the Bihar Voluntary Health Association. In rural Bihar, qualified doctors are hard to find, and government health facilities are far from villages where children live. With about 2,600,000 children born every year in Bihar, about 158,000 children do not live to celebrate their first birthday. “We want to prevent these deaths, many of which happen as children do not get health care – even sound advice – when they need it most,” says Dr. Moses.This partnership has proven to be especially useful as these specialised agencies have the facilities to organise training as well as facilitate hospital and community visits so that the trainees can have a better grasp of the real-life situations.
The IMNCI training will help health professionals in identifying signs of distress among children and give them appropriate health treatment. To begin with, Anganwadi workers are being trained in Vaishali district. The next big task is training of 40,000 Ashas, who have already been appointed. Training them through these specialised institutions – something unique to Bihar – will ensure speediness as well as quality. "This is a wonderful opportunity for us to train health workers to prevent children's deaths. These health workers will be placed with communities, which means that a trained health professional will be available in virtually every village of Bihar to look after children," said Dr. Moses.
IMNCI training has already produced encouraging results. Kavita has prevented a few children's deaths or averted the possibility of simple illnesses getting complicated. At the anganwadi centre, she points out several children who have been helped. Divya, a three years old, had a liver ailment and was also anaemic. Her body was swollen, and she was in great pain. "I used my handbook to diagnose her case. I advised iron tablets, but asked the family to take her immediately to a doctor", she says. The girl is back, smiling. The pain has disappeared.
However, the case which was by far the most serious was Meera Devi's daughter, she says. Meera Devi had her second child even before the first one turned one year old. It was therefore no surprise that the child – a girl – was just one-and-a-half kilogram at birth (a healthy child should weigh two and a half kilograms at birth). Kavita called on the family within the first 24 hours of their arrival – a norm under the IMNCI training. The child, she found, was unable to suck milk from the mother’s breast – one of the worrying symptoms. Meera was trying to feed the child with milk, she expressed and fed her with a spoon, but the child would throw up. “It was a worrying situation”, recalls Kavita.
Kavita, however, was armed with her handbook, she counted the child’s breaths, examined if she had fever, and made her diagnosis. “The child was extremely weak. I told Meera to support the entire body of the child while feeding her; have her head turned towards her; hold her close to the body so that the child could feel close to the mother and feel the warmth of the body.” She also advised the family to take the child to do a doctor.
The child was not taken to the doctor, but two days later, she started feeding. “It worked. I know it works”, says Kavita, exuding confidence. The little girl, now one kilogram more than she was six weeks ago, has also been named Kavita by the family. She called on the family six times in four weeks, a norm for children needing extra care, and is still helping them look after the newborn.
Coupled with the IMNCI training are UNICEF’s efforts in setting up newborn care units in district hospitals which will provide much of what technology can do to save children’s lives. With all this in place in the near future, families can hope for a safer and healthier childhood for their children.