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Angel of Life
" The hamlet of Karra, girdled by the rocky Kultulu range, wears a festive look. It is celebration time in this tiny tribal village in the Khunti district of Jharkhand. "

Mother with her son with village sevika Grace Hereng. Grace Hereng the bright-eyed village sevika is regarded as an angel by the young mothers across the village.

Sugata Roy

JHARKHAND, India, 14 November 2009 ¬ The hamlet of Karra, girdled by the rocky Kultulu range, wears a festive look. It is celebration time in this tiny tribal village in the Khunti district of Jharkhand.

The festival of Karma is just round the corner and the people are all set to offer their adoration to nature. In this festival, trees are worshipped and the surrounding lush greenery around seems to bear testimony to the perfect harmony that exists between nature and man.

However, the jubilation is not just in anticipation of the festival. For the first time in ages, a whole year has gone by without any single death in the village.

All thanks to the Integrated Management of Neonatal & Childhood Illness or IMNCI, a pioneering strategy for improving child health.
In 1990, WHO and UNICEF started developing a strategy for reducing the mortality and morbidity associated with the major causes of childhood illness. In 1996, a set of generic guidelines for management of childhood illnesses was completed. This was the IMCI (integrated management of childhood illnesses).

Neonatal mortality is a major contributor to infant mortality in India. Low birth weight and  poor feeding are the major reasons for malnutrition in infants and children. Proper care practices of babies in the first seven days of life is also central to educe the infant mortality. The neonatal component was added to IMCI to make it IMNCI (Integrated Management of Neonatal & Childhood Illnesses).

IMNCI – A philosophy, a concept, a strategy

IMNCI is a philosophy, a concept, a strategy – an approach that can strengthen any health programme. Its importance has been proved many a times over in Khunti, where UNICEF is collaborating with the Government of Jharkhand to implement the IMNCI programme.

Tribals – Oraons and Mundas – make up 75 per cent of the population of Khunti. Karra, an idyllic village in the district has a population of just 646 and 10 healthy infants in the 0-1 age-group. “Our sevika (helper) and her sahiya (assistant) see to it that the babies are in fine health,” says Nane Horo, the village pradhan (head).

Indeed, Grace Hereng, the sturdy, bright-eyed village sevika with a determined chin, is regarded as something of an angel by the young mothers across the village. When she completed her graduation in 1998, she was the only literate woman in the whole village.

Three years later, she began working as a sevika and in 2007 received the IMNCI training. As she does her rounds of the homes that have children, with her sahiya, Bishwasi Horo in tow, young mothers pour out their woes to her.

Hereng neatly examines the babies, advises the mothers on child care and breastfeeding, and now and then stops to administer medicine to an ailing child.

She goes by the book. The IMNCI training has furnished her with a booklet in which three primary colours, red, yellow and green, help to classify the illness. For instance, symptoms related to improper breastfeeding are marked in green.

Hereng checks the infant for any symptoms and advises the mother accordingly. If the baby shows any of the symptoms marked in yellow, Hereng administers the appropriate medicine and waits for a couple of days to see if the child shows any improvement.

If there is no improvement, she refers the case to the hospital. For symptoms marked in red, she immediately refers the child to the hospital. Thus the IMNCI booklet helps Hereng to make a decision based on the severity of the illness.

Two-year-old Ashu Bhengra is seen frolicking in the courtyard outside their house. When he was a month old, he weighed less than 2.5 kg – a fragile, sickly baby wasting away for no apparent reason.

Hereng’s trained eye immediately detected the problem: the baby needed to be breastfed and get skin to skin warmth. Thus, she had advised the child’s mother, Jolen Bhengra, to keep the baby’s head covered with a cap, feet cased in socks, and the posture that will ensure the baby to get warmth from his mother’s skin.

Hereng showed Jolen, on how to keep her baby on her chest in the ‘kangaroo posture’ for an hour or two to three times a day. It was also convenient to breastfeed Ashu in this positon.  Ashu’s health improved rapidly, and months later, he is a chubby and energetic kid.

“There are 15 different breastfeeding postures illustrated in the IMNCI booklet,” informs Hereng. “So it is quite simple for me to advise mothers on the correct posture.” Thus, by improving the case management skills of health workers, the IMNCI intervention has sought to improve family and community practices, particularly health-seeking behaviour.

“There must be no more infant deaths in our village,” Hereng says firmly, “not if I can help it.” Matlu Oraon, an influential village elder, is confident that Hereng, armed with her IMNCI training, can indeed help ensure that healthy babies grow up to be healthy adults.


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