Purulia, West Bengal: Hemlata Mahato, in her distinctive purple saree of the Accredited Social Health activist (ASHA) worker, is a familiar figure in the far-flung villages of Jhalda II block, Purulia district in West Bengal. She walks more than 10 kms a day from one village to another, traversing roads that become a sea of mud during the monsoons, visiting pregnant and nursing mothers, examining under-5 children and implementing her newly-acquired skills in IMNCI (Integrated Management of Neonatal and Childhood Illnesses) in taking care especially of newborns. The IMNCI training equips community health workers not only with disease detection skills, but also to classify ailments, treat the minor ones and refer the serious cases to hospital.
While on her regular rounds she visited Basudebpur village where she knew 25-year-old Budhni was nearing her term. Hemlata found that Budhni had given birth to a boy the previous day at home, attended by the Dai (Traditional birth attendant). Budhni’s husband, Kingharu Mahato, a factory worker, was away and the hospital was too far for her to go on her own. Hemlata had carefully examined and weighed the baby. He was healthy, weighing 3kg, and was suckling well. Three days later, on her second visit, she found the baby had boils. She gave primary care, explaining to the mother in detail what to do. However, on her third visit three days later she found the boils had spread and were larger. She immediately referred the baby to Jhalda Rural Hospital where she was asked to get the baby admitted for treatment. Given the villagers’ deep-seated fear of hospitals, Budhni collected the medicine and returned home instead.
The child received the medication at home, the boils disappeared and he is well now. This would never have been possible without the IMNCI training that Hemlata has undergone. The IMNCI training equips community health workers not only with disease detection skills, but also to classify ailments, treat the minor ones and refer the serious cases to hospital.
Says Dr. Sardar, BMOH of Purulia, “The impact of the IMNCI is quite visible in my hospital. Earlier when babies were brought to us, they were often in serious or critical condition, suffering from severe dehydration or pneumonia. Now we see that because of early detection and an initial dose of medicine, the children do not come to us in that severe condition.” He adds “Earlier we had two major problems. Besides low birth weight it was the problem of weaning – what and how much will the child eat, who will do the feeding, how will the food be prepared. The IMNCI answers these questions before they are asked, reinforcing the steps to be taken through beautifully designed charts which the health workers carry with them on their visits to families. Even though it’s too early to observe the impact, the number of cases coming to us with acute respiratory infection (ARI) or boils have definitely gone down. But for the whole exercise to be really effective will take time.”
Hemlata is among the hundreds of young women being trained in the IMNCI under the UNICEF-initiated project in Purulia. These women, gradually becoming a familiar sight in the villages, are holding out a new hope for child survival in one of the backward districts of West Bengal, where infant deaths are higher than the state average.
In the Purulia hospital a fresh batch of community health workers have just completed their training and are eagerly looking forward to going back home to practice all that they have been taught. They feel one of the useful aspects of the training was the time they were able to spend together in the evenings. “We were able to discuss and share all that we learnt,” says one of them, “And we got to know the others from our block.” Some of them from the same area have already formed teams and divided the area among themselves so that they can be more effective in their work and create a synergy where there is neither duplication of any village nor is a village left uncovered.
“We have done a preliminary evaluation of the retention and practice among the trainees and found around 70 percent of the trainees doing well. Indicators for timely referral to hospitals and institutional deliveries are very encouraging” says Dr. Amabasu Das, CMOH, Purulia.
IMNCI is helping children survive where there was little hope and young mothers have a new friend to turn to, a friend who visits them at their doorstep - the ASHA.