The Hindu Business Line, January 2015
Jack Sim, sanitation champion and founder of the World...
Twenty-five year old Durga has travelled 15 km from her village to get to Darbhanga (Bihar), the district headquarters, following the advice of the local auxiliary nurse and midwife (ANM). Her daughter Puja, who is 10 months old and severely malnourished, lies listless on her lap. At the Nutrition Rehabilitation Centre (NRC), Puja is at the right place, where hopefully she will be brought back from an extremely critical situation. For Durga, being at the NRC is also an opportunity to learn how to look after this child. Sadly, she lost her first born two years ago.
Conceived and operationalized by UNICEF in 2010 and now run by the Government of Bihar in collaboration with a non-governmental organization Nidan, the Darbhanga NRC has become the model for the State. Officials of the in Darbhanga NRC, say that the center’s maintenance, cleanliness, quality of food provided to the mother and child; brightly painted walls that have pictorial messages for the mother; and basic television entertainment are among the reasons why this center has been successful. To date 1,116 children, who were on the verge of wasting away, have been to the center from not only from the immediate area of Darbhanga but from even further away.
Dr. Mahadev Chaudhary, District Immunization Officer in Darbhanga and medical officer in charge when the 20-bed NRC was set up, says “In the 20 days that the mother and child are at the NRC, we keep track of their diet. The mothers are provided health education – how to stay clean, how to keep the children clean, how to keep their environment clean. They are also encouraged to adopt better behavioral practices such as hand washing.”
A link worker, working closely with Accredited Social Health Activist (ASHA) and ANM look for malnourished babies in the villages adjoining Darbhanga district and they are brought to the NRC by the ASHA. Apart from the incentive to improve the health of the child, the mother is given Rs 100 ($2) a day for the 20 days she is at NRC with the child. The ASHA too gets an incentive of Rs 100 for each malnourished child she identifies and brings to the center.
Often times, when the infants are brought to the center, like Puja, they are debilitated, listless, and have a foul odor. Both mother and child are bathed, cleaned, and weighed on arrival. Each child is administered nutrition according to their weight. For the first seven days, children are put on a diet of milk, water, puffed rice powder, oil, and sugar. In the next seven days mashed potatoes are added to the diet. The targeted weight gain is 8 to 10 grams per kg of body weight per day. This weight gain target is achieved in 75 per cent of the cases. With this care, there is a dramatic improvement in the physical appearance within a few days of admission to the center. The aim is to try to help the child gain 1.5 to 2 kilograms by the time s/he leaves.
To monitor the progress, mother and child are expected to return after 15 days for the first check up, followed at 15-day intervals for two months. The majority of the malnourished children are from the poorest of the poor in Bihar.
Says Nidan’s counselor, Richa Kumar, “We try our best to help mothers be able to take better care of their children even when they go back home. During the period that they are here we try to cover important topics – cleanliness, nutrition.” She adds that most of the women who have come to the center have had up to five children and are often from the most socioeconomically deprived communities of the State. Unfortunately, ten percent of the cases relapse into malnutrition, due to the absence of functioning Integrated Child Development Services (ICDS) facilities or parents’ inability to access care in their villages.
Extremely acute cases of malnutrition are referred to the Malnutrition Intensive Care Unit (MICU) in the Darbhanga Hospital, which has 30 beds and the medical equipment to deal with very sick children. This unit has recently been set up by Medicine Sans Frontier (MSF). Each batch of the 20 children admitted at the NRC has three to four children who are very sick and sent to the MICU.
UNICEF social mobilization coordinator Chandra Bhushan Kumar recalls a child, like Puja, that he still keeps track of, who was brought to the NRC in a critical situation a few years ago. Today Kumar says, not only is the child alive and healthy, but the mother keeps the child clean and works to provide basic nutrition from the resources available to her despite the challenge of poverty. That is why Puja is at the right place at the right time.Read more
Why is it that many children in the developed world don’t get sick from drinking water? Is there something in the water? Or is it actually what’s not in the water?
In the poorest regions of the world, children don’t have access to safe drinking water. Instead, they are forced to drink contaminated, dirty water that is often miles away from their homes. These children also become extremely sick because many of them don’t have even the most basic toilets and sanitation infrastructure in the communities where they live.
The result? Millions of people are left with no choice but to go to the bathroom outdoors where they can. Open defecation contaminates living areas and water sources with human waste and other harmful bacteria. As a result, children are highly susceptible to potentially life-threatening illnesses like diarrhea and intestinal worms. In fact, the World Health Organization found that over 1,400 children die every day from diarrhea linked to dirty drinking water and poor sanitation and hygiene practices. Think about it: more kids die every single day than the entire student population of most city high schools.
748 million people still do not have access to safe water, and 2.5 billion people do not have proper sanitation – that is over one third of the world’s population! To safeguard public health, communities must have access to what we like to call “WASH”: safe and clean water, basic toilets, sanitation infrastructure, and hygiene education programs.
Water for the World Act of 2013: Everyone, Everywhere Deserves Drinking Water and a Toilet
Less than one percent of the funds for international assistance is used for water and sanitation (in turn, the total international affairs budget is less than 1% of the entire Federal Budget!). Allow me to repeat that: less than one percent of the all the money the United States provides to developing countries goes toward water and toilets.
The US taxpayer dollars that are used for international development are already very limited—only $50 billion, which pales in comparison to the $496 billion for the Department of Defense! That’s why we need to make sure that the money is efficiently allocated to the right places in order to help the people most in need. The Senator Paul Simon Water for the World Act of 2013 (H.R. 2901)introduced by Representatives Ted Poe (R-TX-02) and Earl Blumenauer (D-OR-03) will do just that.
The Water for the World Act of 2013 will ensure that WASH projects are sustainable and long lasting. It will also make sure that they are put into action in the poorest regions of the world. And it will increase federal agency transparency, and monitoring and evaluation so as to improve the way projects are developed and implemented. Water for the World takes existing taxpayer dollars and makes sure that the money going to water and sanitation projects abroad is used ever-more responsibly and efficiently. We don’t need to spend more money to have more impact for the world’s poorest people.
NOW is the time to have your voice heard. This session of Congress has a couple of months left to pass legislation, so time is of the essence. Protect children’s health, ensure your tax dollars are well spent, and stand up for people in need: for those in the developing world who do not have safe drinking water and toilets like we do. Contact your member of Congress TODAY and tell him/her to SUPPORT Water for the World!
-- Robyn Fischer is Policy & Advocacy Officer for WaterAid AmericaRead more
Two years after we first met ColaLife in Lusaka, Zambia, we welcomed them to Seattle. The city didn’t disappoint: ColaLife founder Simon Berry lamented a forgotten raincoat upon his introduction to typical Northwest weather; and he even garnered his own stern warning from a local police officer after jaywalking. (We do not jaywalk in Seattle.)
Simon and DefeatDD chatted over coffee, Seattle's own beverage of choice, catching up on ColaLife’s accolades and lessons of the past two years.
ColaLife has grown quite beyond its original concept of transporting anti-diarrhea kits in the empty space of Coca-Cola crates, hasn’t it?
Yes, through our trial, we learned that the most important thing is not the space in the crates, it’s the space in the market. But the original concept has a lovely logic: Coca-Cola gets everywhere, medicines don’t; put the medicine in the crate, and it gets there too. But when we really drilled into it, we learned that actually it’s incredibly naive. The ratio of demand for bottles of Coca-Cola would never match the ratio of the kits filling up all that space. That would be 10 kits for every 24 bottles of cola!
It was quite difficult to walk away from that original idea, but we had to. Because that concept, the crate-centered design, really captured people’s imaginations. The awards we’ve won based on that are incredible, and they’re even beyond the health sector – product design of the year, packaging design of the year. But the trial is actually telling us that fitting in the crates is not what’s most important, in terms of getting the kits in people’s homes.
However, the doors might not have opened without that original concept, so it was ultimately important. And we learned so much about distribution and working with shop owners. And in some certain circumstances, in the future, the crate design might work. Imagine a humanitarian crisis: a cholera outbreak isn’t going to stop Coca-Cola trucks. Just for a month you could put the kits in the crates, flood the market. So it could have a role, but it’s not the sustainable approach.
In addition to a change in the kit’s design, what would you say are the one or two key lessons you’ve drawn from the trial?
When we initially engaged partners, we focused on public/private partnerships at the global level. But as we’ve implemented the distribution and sales, we found that grassroots public/private partnerships were most important: the partnership between the retailers in the community and the government-run health centers. We couldn’t do this without the Ministry of Health at our side.
On our latest trip, we went to a district I’d never been to before. There were 150 meters between the health center and the shop. Underneath the tree, outside the shop was a woman with a very sick child. She had two ORS sachets from the clinic and 4 tablets in a clear plastic bag. And in her other hand, she had a Kit Yamoyo. The clinic had said, “Here is the medicine, but also go and get a Kit Yamoyo from the shop.” That was a public/private partnership at work.
Another lesson is about respecting local systems. If you are going to intervene, do it in a way that strengthens local systems rather than undermines them. Don’t make yourself indispensable. As a foreign body, quite literally, we should be a transient presence. It’s no good if the whole thing depends on ColaLife because when ColaLife leaves, the whole thing is going to collapse. But because we’re not part of the local system, we can leave. The product is in the market, it’s being produced locally. Any wholesaler or distributor can ring up our local manufacturer and order the kits.
What have been the biggest highlights in being involved with this project and seeing it grow?
Every week, something amazing happens. Little kids drinking ORS or wanting to drink ORS from our kit – that is the highlight. Mothers love it. We inquired deeply into what they thought of the kit, whether they would buy another one, etc. And we didn’t get a single negative response. From mid-line (6 months into the trial) to end-line, we asked people if they thought the kit was affordable. At mid-line, it was a respectable amount; by end-line, that had doubled. People would buy it again and they thought it was valuable.
In October, we’d just started the trial and went out to one of the districts. We spoke to a woman whose child had diarrhea, since April, she said. The clinic had given her ORS each visit, and she gave it to the child, but the child never fully got better. And then she had gotten the kit, with zinc. And there the child was—running around, being naughty, doing everything a small child should do.Read more
In two short weeks, my daughter will turn one year old. Looking back at her newborn photos, I wonder how this year went by so quickly. How could that wrinkly creature who could scarcely open her eyes or control her little limbs now be this squawking, nearly walking toddler? A solid and healthy tyke today, she seemed so delicate and breakable back then. It’s no wonder my anxiety ran amok! What if her swaddling covered her mouth while she slept? How could we tell if her skin tinged the slightest bit, threatening jaundice? And how could I politely convince neighbors and friends to slather themselves in antibacterial gel?
I had an online community of mothers and easy access to pediatricians to help me keep my girl safe and healthy. In places where new parenthood is fraught with far greater threats, the recent Every Newborn Action Plan aims to bring the same security. Issued by a partnership that includes UNICEF and the World Health Organization, and boosted by supportive evidence published in The Lancet, the action plan calls for a renewed commitment to dramatically improve the health and survival of newborn babies and their mothers. Coupled with the global commitment to safeguard the fragile health of all children under five years old through the 2012 Promise Renewed pledge, this new plan completes a circle of protection for the most vulnerable among us.
While plans like these center on inspiring action among policymakers and donors, they are supplemented by tools that communities and families can implement today to increase children’s chances at a healthy start. Chief among these early interventions is breastfeeding, which gets to work straightaway to help develop infants’ immune systems, improving responses to vaccines and preventing infections including pneumonia and diarrhea.
Another powerful tool at a mother’s disposal is her voice. One of the most striking statements in The Lancet’s summary of its Every Newborn article series notes that the most affected communities can often be “the most vocal agents for change.” Not all mothers have a platform like this very blog to share news, encourage healthy behaviors, and call for national commitments to their families’ health. But a key component of the Every Newborn plan aims to empower and engage parents. I am proud to lend my voice to raise awareness about the urgent needs for health equity and the opportunity for all mothers and fathers to rely on a safe start for their children. And I hope to raise a daughter who one day adds her voice to this global community as well.Read more
Heather Ignatius, Senior Policy and Advocacy Officer for PATH, is the proud mom of 3 year old Cleo and 7 month old Lily.
Every night when I put my three-year-old daughter to sleep I ask her, “what are you thankful for?” I’m trying to teach her the concept of gratitude and it’s nice to have the last thoughts before going to bed each evening be about the people, privileges or experiences that we are grateful for. I try and mix it up each night to capture how truly blessed we are to have so much.
When I ask Cleo this question, her response is always an immediate, “You first, mama,” and it gives me pause for a moment while I try to come up with something new to say. Because, you see, if I answered that question honestly, the answer would be the same. Every. Single. Night. I’m thankful that my girls are alive, happy and healthy.
In my job at PATH, I’m an advocate for global child and maternal health, so I’m constantly reminded about what I have that other mothers around the world do not. I won’t have to carry my feverish child in my arms for miles to the nearest clinic in hopes of getting treatment in time. My kids have had their rotavirus and pneumococcal vaccines, making it unlikely that they will perish from two of the leading killers of kids. My decision to breastfeed had more to do with IQ points and bonding – not survival. My girls will more than likely make it to see their fifth birthdays.
Mothers in other countries are not so lucky. Each year we lose 6 million kids to diseases like diarrheal disease and pneumonia and 800 moms a day die giving birth. Tragically, these deaths are completely preventable.
But there is reason for optimism. Over the last 20 years, the number of child deaths has been halved and maternal deaths have reduced by one third as programs to save moms and babies have expanded. These programs teach families the importance of healthy behaviors like breastfeeding and handwashing; they provide essential services such as having trained healthcare workers present at births; and they scale up low cost health products such as medicines for life threatening childhood diseases and vaccines to prevent them.
In 2012 governments around the world came together to acknowledge that we had reached a turning point in maternal and child survival. The United States, Ethiopia and India issued a call to action to put an end to preventable child and maternal deaths within a generation. It was a pivotal moment—the first time governments set a radically ambitious goal for child and maternal health and pledged action to meet it.
Reaching this goal is possible if we scale up the interventions we know work. And we can reach it even faster with new innovations – products like a low cost breathing device for newborn asphyxia or new screening devices to test for common ailments and risks during pregnancy.
As the second anniversary of this call to action approaches, commitment abounds. More than 175 countries around the world have signed onto the pledge to end preventable child and maternal deaths. Yet we are at a critical moment where ambition must turn into action in short order. Now is the time for governments to put forward the strategies and resources to achieve the goal.
This month two social media campaigns are being launched to call attention to child and maternal health: Mom and Baby and 5th Birthday and Beyond. Share your photos and help show the world how precious these lives are. But more importantly, call upon your government to follow through on the commitment it has made to end preventable child and maternal deaths.
Ps. If you want to know what Cleo is thankful for, most nights she says ”candy!”
-- Heather Ignatius is a Senior Policy and Advocacy Officer for PATH and proud mom of 3 year old Cleo and 7 month old Lily.Read more