A Personal Journey Of Revelation And Learning

My name is Shringar Bedi, I hail from a middle class family from Jabalpur, Madhya Pradesh. I am a full time professional in the humanitarian space and a full time mother. I currently work with Action Against Hunger on preventing and treating malnutrion in children. One of the key messages in our prevention-based model is the importance of immediate and exclusive breastfeeding during the first six months of a child’s life. Working with mothers, village leaders and communities at large, I find solace in the fact that I am helping them avoid the mistakes I made early on during motherhood.

I became a mother in 2008. On the day of the delivery, I did not get to see my child since the delivery was cesarean. When I enquired about feeding, I was told that anesthesia administered during a cesarean could be harmful for the child and they were providing him formula milk. I wanted my child to be placed with me, but my family agreed with the hospital’s advice. I was able to see my child and be in physical contact with him only after 2 days. When it was time to breastfeed, my baby could not latch and feed properly, we had to do it via a painful method involving a syringe. I was advised to keep doing it at home, but it did not work. With my family member too clueless about it, my child did not receive breastfeeding and continued to be on formula milk. Before he completed six months, I would sometimes give him water on hot days thinking he might be thirsty.

I learned about complementary feeding through my neighbors. While I did start giving him mashed potatoes and fruits, I was not fully aware about the importance of micronutrients and wholesome nutrition post six months. I learnt about diverse nutrition and its constituents much later. For instance, the fact that carbohydrate rich food may give you all the calories you need but not the micronutrients needed for growth was news to me.

After joining the nutrition sector in 2016, I realized I was not alone in being uninformed about childcare and feeding practices. Mothers and families often do not have access to critical information that could help them to defeat malnutrition and related illnesses. This has started changing now through targeted interventions by ICDS, NHM and POSHAN Abhiyan and various nonprofit organizations. Special days and events such as the breastfeeding week and national nutrition month have been instrumental in spreading much needed awareness. The long-term solution to this information gap in my opinion is including relevant literature on health, pregnancy and childcare in formal education. For now, I am happy that through my work, I am gradually bridging this information gap and helping communities raise healthy children.

Shringar Bedi works with the Advocacy department at Action Against Hunger and has previously worked in the education, WASH, skill development and family health and planning space in the past 16 years.

The Road To A Career Calling

I am Isha Rangnekar and from my very childhood in Mumbai, India, I have always been intrigued by and distressed at the same time by the life children lived on the streets and in the slums of Mumbai. Intrigued by their survival mechanism and distressed by the yawning contrast between their lifestyle and mine. This dichotomy of emotions, further deepened by what I would get to learn from documentaries and through reading, was what drove me to the humanitarian sector. I wanted to see and experience for myself the ground realities, step out of my comfort zone and contribute to the betterment of the disadvantaged population in India.
I completed my Bachelor’s in Nutrition & Health in 2017 from the University of Roehampton and Master’s in Human Nutrition from University of Surrey in 2018. What fascinated me the most was learning how fragile the life of a child and the mother is during pregnancy and early years subsequent to birth. I learned how interventions are designed and implemented to achieve ideal maternal & child health outcomes. It was my Master’s dissertation on management of malnutrition in infants – a public health nutrition data analysis project for GOAL (UK), that gave me the final push and strengthened my plans to join this sector.
I returned to India in 2018 and joined Action Against Hunger as an intern. Through field visits, group discussions and community sessions in the slums of Govandi, I gained a broader understanding of the on-ground realities. I was able to look at issues I had read about previously, through the community’s perspective. Subsequently, I joined the Technical-Research team in 2019 and started working closely with the programme team in Maharashtra, Rajasthan and Madhya Pradesh.
Through my work, I have been able to gain a deep understanding of public health models and nutrition programmes at grass-root level. I have been able to see first-hand the necessity of such programs for vulnerable communities in both urban and rural regions. Many communities have meagre access to health facilities, sanitation and hygiene and earning opportunities. More often than not, they are daily wagers with no long-term sources of income. Nutrition for people in these communities is an insignificant issue. They are quite content with the amount of food they eat, irrespective of its nutritional value. Through the first 1000 days of life programme, we are trying to address this knowledge gap. We work with pregnant women, lactating mothers and their families to ensure a safe, healthy pregnancy and improve the nutritional status of their children.
My journey with Action Against Hunger India continues to provide me invaluable lessons across all domains. Furthermore, it is also helping me move closer to my goal – to pursue intensive research on improving nutritional status of marginalized communities through my PhD studies.

Monitoring Health Through Technology

The key to successfully treating malnutrition in children is early detection. Timely treatment and corrective measures can prevent irreversible damages and growth delays that acute malnutrition results in. But often this can be tricky due to multiple factors. Delay in reaching remote families and human error in conventional way of measurements is often an issue, while children from families on migration are completely disconnected from health monitoring services such as Anganwadi workers. With no way of identifying signs of malnutrition early on, migrating families often find out when it’s too late.

To solve this issue and help parents keep a tab on the health status of children, German non-profit Welthungerhilfe (WHH) joined hands with Microsoft to develop an easy to use app that helps identify malnutrition in children. Known as the Child Growth Monitor (CGM) the app uses an infrared sensor available in smartphones to capture 3D measurements of a child’s height, body volume and weight ratio, as well as head and upper arm circumferences. These measurements then go through an algorithm supported by Microsoft AI solutions and reports the health status of a child.

Action Against Hunger partnered with WHH for piloting this application on the field to improve the algorithm’s accuracy. In the initial phase we conducted 10,000 scans of children across Maharashtra, Madhya Pradesh and Rajasthan. These include both application scans and manual ones to help the app understand deviations from accurate measurements and increase its efficiency through continuos machine learning. All one has to do is launch the application point it to a child so that he / she fits into the silhouette on the screen, scan the front and back of the child and ask the child to rotate 360 degrees and record it. That helps the application capture 13 coordinates points on the body and calculate the child’s growth.

Having gone through improvements fed by large scale data, the current phase of trials in Rajasthan showing promise, the application launch isn’t far. Once launched parents and health workers would be able to track the health of children, save crucial time and provide them lifesaving treatment.

Apart from Action Against Hunger, WHH is working with Mahatma Gandhi Seva Ashram (MGSA) and Darshna Mahila Kalyan Samiti to pilot this application.

Read more about Child Growth Monitor.

Helping Communities Fight Malnutrition

My name is Shailja Patil and I was born and raised in Nepanagar (Burhanpur, Madhya Pradesh). When I was in 6th grade, my father, who was a farmer, passed away. Since then my mother and elder brother ran the household and made sure my two siblings and I completed our education. My mother found employment as a teacher on contractual basis but the pay was irregular. To support her, my elder brother would often take daily wage jobs and somehow managed to make ends meet. We stuck together as a family and managed through those difficult times.

To support my family I started working as an Anganwadi Worker in 2010 while pursuing my Bachelors. Action Against Hunger had a malnutrition treatment project in Burhanpur during those days and I would often engage with their staff as an Anganwadi Worker. Through them, I found out that Masters in Social Work (MSW) could open up various opportunities for me in the social sector. With this in mind, I completed my MSW in 2014 and joined Action Against Hunger as a community mobilizer. I currently work in Dhar district (Madhya Pradesh) for the first 1000 days of life project.

I feel that a large part of our society still does not understand the hidden issues. To understand and implement solutions, we first need to acknowledge the issues plaguing our society. Many communities are not aware about the causes and effects of malnutrition. We are working with them to create awareness around it so that families can raise their children to be healthy. I believe what we are doing will help communities in the long run and I like doing this work.

For Our Children

My name is Thakurlal Koli and I am from Baran, Rajasthan. I live in a large, joint family of 13 members which includes my parents, 2 children, wife, my three younger brothers and their families as well. My father is a farmer and while my mother has been a homemaker, she lends my father a helping hand on the farm too. I completed my schooling in Shahabad (a block in the district of Baran) and graduated from the University of Kota. I got married when I was in my 2nd year of Bachelor of Arts, in 2013.

My first place of work was CECOEDECON where I worked on child rights for a year and then moved on to an NGO called Rachna to work on child growth monitoring. I joined Action Against Hunger in 2016 as a community mobilizer and have been here ever since. The common factor in all my places of work has always been children, a cause that is close to my heart. During my days at CECOEDECON, I worked on education and care for orphans. I have great memories from that time. I felt proud that I am helping vulnerable children and in doing so growing as a person as well.

At Action Against Hunger I work with the Sahariya tribe on making sure that malnourished children receive necessary treatment and the parents receive the knowledge and support they need to keep their children healthy. Apart from good nutrition, I work with families on hygiene, sanitation and child care too. It makes me happy to see children recovering and leading a healthy life. Families too on witnessing this, warm-up to us and everyone in the village identifies me with my work. It makes me feel proud.

Image: Lys Arango.

Dr. Nilambari’s Transition From Rural To Urban Health

I am Dr. Nilambari Salunkhe. I was born and raised in Mumbai. I completed my degree in Bachelor of Homeopathic Medicine and Surgery from MUHS, Nashik University followed by Masters in Healthcare Management. Over the last decade I worked extensively in private as well as public health systems with a focus on healthcare administration.

Through my work, I was able to learn about implementation of national health programs at the grassroots as well as at policy level. I was able to closely observe results of effective implementation of well-designed health programs in rural health set up especially under reproductive, maternal, child health and adolescent health programs.

In June 2019, I joined Action against hunger as Program Manager for the malnutrition treatment and prevention projects in the urban slums of Mumbai. In this job, for the first time I got the opportunity to work closely with urban healthcare delivery system. We work in close collaboration with Integrated Child Development Scheme (ICDS) and Public Health Department of Municipal Corporation of Greater Mumbai in the slums of Govandi and Andheri. Moreover, we are working on a unique program – POSHAN OPDs which involves capacity building of hospitals in Mumbai for malnutrition treatment protocols.

Working with marginalized sections of society in urban areas is an entirely new experience for me. Understanding their needs, socio – economic issues in an urban setting has been quite a learning curve. During the COVID 19 pandemic we worked hard as a team to provide food supplies and psychosocial support to vulnerable families and sanitation and PPE kits to Police department, ICDS department, MCGM and major hospitals in Mumbai.

My journey here continues to help enhance my knowledge in the field of urban malnutrition maternal and child health. In the future I wish to work on similar programs in urban slums of various metropolitan cities of India.

Being A Parent During The Covid-19 Crisis

For 25-year-old Asma Sayyed, her pregnancy had taken quite a toll on her health even as she and her husband Ghulam Moinuddin were struggling with the economic impact the pandemic had on their lives. Before the pandemic hit, Moinuddin had a small factory setup where he and his workers embroidered dresses and frocks. He was forced to close it down and wait for things to improve.

During the first wave, Asma was pregnant with her 3rd child and the financial hardship couldn’t have come at a worse time. Asma was enlisted in Action Against Hunger’s First 1000 Days of Life project in the slums of Govandi during a routine survey in February 2020. At that time, she was nursing 5-month-old Nimra. She received counseling on breastfeeding, complementary feeding and other critical child-care practices. Moinuddin in the meantime started making fabric masks at home to support the family, barely manage to make ends meet.

When Asma turned pregnant in March 2020, she received support from Action Against Hunger mobilizers on pregnancy care, seeking ANC services, medical checkups and birth preparation. But it was easier said than done. With barely any income, her nutritional intake was affected and health services weren’t consistently available because of the lockdown. She received medicines and medical based support from another humanitarian organization working in Mumbai while Action Against Hunger supplied dry rations through food baskets and kept in touch with her though phone-based counseling sessions.

“It was only due to the constant support and follow up from the Action Against Hunger community mobilisers, that I was able to gain better knowledge on how I should deal with the issues post pregnancy, what I should eat so that my health remains good,” Asma said.

As restrictions eased, Moinuddin’s brother was able to restart work as an auto driver and contribute to the family income. Their 3rd daughter, Ayat was born healthy in November 2020 and has since been thriving. The only hiccup, she was born with a heart defect. Fortunately it was diagnosed as a treatable condition and Asma and Moinuddin are able to save money and provide for her treatment.

Image credits – Sudharak Olwe

The Guiding Light

In all folklores, there’s always someone who stands up in times of need, bends the story arc and is celebrated as the hero. 3 year old Aasu from Palghar found her hero and her light, both literally and metaphorically, in her own sister, Roshni.

Aasu’s mother passed away when she was 1 and with her father away for contractual labour most of the times, the burden of caring for Aasu and her 4 siblings fell on their grandparents. As a grandparent, taking care of 5 children and their nutritional needs could be quite a task and soon, Aasu became malnourished. She was diagnosed during a routine screening in her village in November 2018. We advised the family to get her enrolled in the malnutrition treatment program and bring her over to the weekly OTC’s. With the grandparents hard pressed between running the household and taking care of the children, Aasu’s 10 year old elder sister Roshni, took it upon herself to get her treated and save her life.

Roshni would bring Aasu to the OTC every week. She learned to take care of her nutritional needs, maintaining a clean environment, purifying drinking water and identifying common diseases. Every day she’d get up in the morning, fetch water, fix a nutrionally wholesome meal and take care of her 4 sisters. Between all this, she also found time to play her favourite game, Langdi. It was through Roshni’s efforts that Aasu recovered completely in December 2018 and continues to be healthy. It isn’t a surprise that Aasu and Roshni are inseparable.

Often for the hero, bending the story arc comes at a cost. Roshni had to drop out of school and missed out on her education. But if there’s one thing that we’ve learnt about Roshni, it is that she isn’t someone who’d give up easily. She plans to go back to school soon and become a doctor when she grows up. And not only that, she is going to ensure that all her sisters too go to school. A tall ask for a 10 year old? Yes. But Roshni is already quite adept at forging her own path once she as decided where to go.

Standing up when it matters

Sangeeta Ghodeswar, a community mobiliser from Govandi, Mumbai and in her mid-thirties, is a single mother dealing with the anxiety and stress that comes along with the pandemic. She single-handedly manages her household and the upbringing of her daughter who is currently pursuing her primary online classes.

The pandemic has affected her mental health she says and has made her more anxious than before. She gets anxious every time she is out of the house and is very cautious in following protocols. Although this experience and the responsibility of being a mother is what drives her to keep doing what she does – work with mothers on raising healthy children and providing them emotional support.

During the lockdown, she continued to counsel mothers through phone-based sessions Reaching out to pregnant & lactating mothers and parents of children aged below 5 years on telephone, she would discuss maternal and child health, nutrition, precautions during COVID-19, availing health services and much more. She was able to connect with families physically during dry ration distribution drives and gradually as restrictions eased. Venturing out was not an easy task by any means, but Sangeeta dealt with her fears by following protocols and the realization that she is in a position to help out families in need, drove her every day.

She gradually worked out a routine to make time for herself and deal with the anxiety of being at home during a pandemic. “At home I spent time learning new nutritious recipes and being with my children. We would often work together on various school activities and tried to make the best of staying at home” says Sangeeta.

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