1. Rasumani Mahato and her one-year-old daughter Bhanumati Mahato, speaks to a clinic worker at a Nutrition Rehabilitaion Centre in the Purulia district of the eastern Indian state of West Bengal.
By Elliot Hannon
Purulia, India - When Rasumani Mahato’s one-year-old daughter, Bhanumati, was no longer strong enough to sit up on her own, Mahato knew something was wrong. She didn’t know what the problem was, but Bhanumati’s appetite vanished and she refused to eat even the biscuits that were part of her staple diet.
Mahato met the Anganwadi worker who referred her for a check-up at the Nutritional Rehabilitation Centre (NRC) in her village where she was told that her daughter was severely malnourished. “I thought she had some disease, but when I came here I realised it was food that was the treatment,” says Mahato.
Malnutrition, particularly during childhood, can have a lifelong impact on a child. Undernourishment makes common childhood diseases, like diarrhoea and pneumonia, potentially fatal and stunts the physical and cognitive development of a child.
In West Bengal, the problem is also acute, as 19 per cent of children under the age of five are undernourished. With UNICEF’s efforts and IKEA Foundation support, the Positive Deviance programme was extended to address the problem of severe malnutrition in the state.
In partnership with the Department of Health and Family Welfare and the district administration of Purulia, UNICEF established the first NRC at the Bengunkodor Primary Health Centre of Jhalda Block 2 to provide medical support, as well as nutritional care and lifestyle counselling for mothers with children suffering from severe acute malnutrition.
“We hope the Purulia model will be a role model for other districts,” says Purulia District Magistrate, Avanindra Singh, when talking of the 10-month old centre. “The target is to have 21 NRCs in the district so that the maximum number of such severe cases of malnourishment can be handled by professionals.”
The centre resembles the children’s ward of a hospital. Mothers sit on hospital-style beds nursing squirming children in each of the centre’s two dormitory-style rooms. Uniformed attendants shuffle around on squeaky clean floors. The hospital atmosphere underlines how serious the problem is for many of the children staying at the centre.
“All the children that come here are very thin, some can’t sit, some can’t play, some can’t walk and some are only skin and bones,” says Dr Bilweswar Chattaraj, the physician overseeing the NRC.
In the severest cases where there are medical complications, the child is admitted for between two and three weeks and receives 24-hour medical treatment and support.
Once admitted, every aspect of daily life of the mothers and their children is monitored. The mother receives hands-on training on child care practices, including feeding. Feeding and bathing times are scheduled, as is education and training on healthy cooking for the mothers.
“The mothers are learning how to feed, look after and cook for their children. Before they didn’t know about the food that is healthy for children and is cheap and locally available,” says Dr Chattaraj.
Sustaining a healthy family
Every bit helped for Bipula Kalindi, 20, who spent 21 days at the NRC. Before her stay at the centre, Kalindi fed her two-year-old son Bijoy mostly powdered milk because, she says, that’s what she thought was best for children.
During her stay she learned how to wash vegetables thoroughly before cutting them and was counselled on food hygiene and the importance of hand washing with soap at critical times. She was also taught how to properly bathe her son to keep him from getting sick again. “I now realise that I could have done the things I learned at the NRC at home,” says Bipula.
Fultusi Kalindi, 30, came to the NRC with her two-year-old son, Amit, after the community Anganwadi worker said he was dangerously thin. Amit’s doing much better, she says, but he’s not the only one. “They gave me nutritious food, so I’m feeling better as well,” says Fultusi.
To ease the financial burden for many of the women, who are sometimes surviving on less than 50 rupees (a little more than US$1) a day, the centre pays them 100 rupees (a little over US$2) as compensation for their daily wage so they will complete their stay here.
After checking out of the centre, each mother is visited by the Anganwadi Worker to check on the progress of their child. For Mahato, now that she’s learned how to keep her child healthy, she’s looking to the future for her daughter. “I have to make sure she gets a good education. I will have to buy books and stationery, but I will do whatever is required,” she says.
Many of the changes will be gradual, but some of the results are immediate, says Dr Chattaraj. “When they go home we see playful children. There’s a change in their faces, a change in their weight, some children who were about to die are now getting a better life because of this centre.”