Finishing up our baseline surveys, on to the real work

Now that the training of our Community Nutrition Educators (CNEs) is complete, Real Medicine Foundation Team India has started our field surveys in 500 villages in Southwest Madhya Pradesh. The CNEs are going door to door to find out about nutrition levels among all children under 5 and ask the thousands of families about livelihoods, access to healthcare and public services, and available food. This is the first time a survey of this size and scope is being conducted in these areas.

Our goal is to gain a better understanding of the level of malnutrition for our interventions and acquire as much information as we can to really understand the underlying causes of malnutrition in the villages. Once our surveys our complete, we will have a comprehensive list of which children are malnourished where, data on pockets where malnutrition is especially prevalent, and some understanding of why malnutrition is particularly bad in these areas. After the surveys, our CNEs, who are really the foot soldiers in RMF’s battle against childhood malnutrition, will know exactly where to focus their efforts and which families are most in need of nutrition education, support, and follow up.

These baseline surveys will also be extremely important for monitoring the success of our program. Our program includes stringent monitoring and evaluation of the initiative, with our CNEs submitting weekly reports on their activities in the field. By having a clear picture of where we started, we’ll be able to accurately measure the impact that RMF activities have had in our villages. This is important not only to prove our effectiveness to our donors, but also to gauge the effectiveness for government and other partners so that our program can be replicated throughout the country.

While in the villages, the Educators are also diagnosing and referring cases of Severe Acute Malnutrition (SAM) to treatment facilities throughout the state. In India, cases of SAM are treated in Nutritional Rehabilitation Centers in district and block hospitals. Over 14 days, the children are given micro-nutrient rich therapeutic food at regular intervals of 2 hours under the close supervision of nurses and doctors. The child’s parent, usually the mother, is also given tips on preparing nutritious food, sanitary preparation of food to prevent illness, and guidance on correct breastfeeding. So far the CNEs have referred dozens of children to the centers for care.




Over the past week I met with every district team to get a sense of how the surveys are going in the villages. All of the women were pretty positive, but also shared some of their concerns and difficulties with me, and each other. Actually, I didn’t have that much to say, or much of a chance to say anything at all. By sitting in a room together, and realizing that their peers shared many of the problems they had faced individually, all of the CNEs engaged in problem solving discussions without little guidance. When a problem was raised by one woman that another had faced, and solved, everyone took notes on the new strategies and enthusiastically applied it to their own difficulties. The hardest part of the training process was predicting the nearly infinite local problems that would hamper the surveys, however, team-building exercises such as role-playing gave them some of the tools they would need to handle situations in the field. Combining these skills with on-the ground experience, and conversations about lessons learned with each other, has empowered our CNE’s even more.

Building off of each other, and combining the vast array of talents and backgrounds of our team is the cornerstone of our “Eradicate Malnutrition” program. As we begin the intervention phase of our program we are all confident that we are about to affect some real change in an area deeply in need of it. Our confidence will be tested, however, as the job ahead of us is a daunting one.

RMF Inaugurates our first Nutrition Rehabilitation Center

After months of negotiating the bureaucratic maze of India; acquiring form after form and signature after signature; tireless hours spent on renovation and beautification by our dedicated staff and volunteers, RMF and its partner, Jeevan Jyoti Health Service Society, who operate Jeevan Jyoti Hospital, proudly inaugurated its Nutritional Rehabilitation Center (NRC) in partnership with the state government of Madhya Pradesh.

After the requisite ribbon cutting and speech by the district’s Chief Medical Officer, we immediately admitted our first 12 patients, who had been waiting (while being looked after by our staff) for hours to be officially admitted.

This Public-Private Partnership (NRC) is one of a handful of its kind in all of India. The Government of Madhya Pradesh will provide the funding while RMF and JJHSS provide the facilities, the staff, and technical support for the difficult task of treating patients with Severe Acute Malnutrition (SAM).

With the capacity to treat 20 children at a time, this center will offer round the clock care to children suffering from the worst forms of malnutrition. The NRC provides the serious patients identified with a 14 day treatment consisting of regular feeding with micronutrient rich food and required antibiotics, de-worming, and treatment of underlying illnesses. Upon referral, the child’s height and weight are measured, a Mid-Upper Arm Circumference Test is performed, and if SAM is present, the child is admitted.

Cases of SAM in Madhya Pradesh are treated with two types of therapeutic food depending on the severity and complications of their condition, and are eased back on to a normal diet by receiving specific amounts of formula, based on weight, during regular feedings every two hours. We have a resident pediatrician regularly assessing the children and providing treatment for any complications, such as respiratory infections, diarrhea, or other illnesses.

Our dedicated staff of one pediatrician, 3 nurses, 3 caretakers, a cook, and a feeding demonstrator, will not only cater to the medical needs of these acute patients, mostly under the age of 5, but will also work closely with the mothers to address the root causes of malnutrition in their child. The mother’s will stay with their child at our center for the course of their treatment and recovery – usually 14-21 days.

Our staff will take full advantage of this time by offering mothers one on one and group counseling and training on important nutritional issues such as breastfeeding, supplementary feeding, local recipes, sanitation, hygiene, and other topics the women want to learn.

Our goal is that each child treated at our center not only recovers from SAM, but also stays well.

The opening of Jeevan Jyoti’s NRC closes the circle of the Malnutrition Eradication program. At the field level, we work in 100 villages in the area, have already identified hundreds of children in need of treatment, have provided referrals to other facilities in the area, and followed up with children who have already received treatment.

Now, our Community Nutrition Educators have a closer facility that they can work with, can familiarize themselves with the treatment procedures at the NRC to better explain the services in the field, and will participate more closely in the follow ups with treated children to prevent relapse.

While all of our activities are linked closely with government practices already in place, we hope to go a step beyond current activities and to set a standard of excellence that will be adopted by other NRCs in the state.

The opening of the doors of this facility was a real victory for the children of Jhabua and RMF’s staff. Through the hard work of everyone, twelve children started on the road back to health today.

For more information on how SAM is treated in the NRCs in MP and to learn about opportunities to contribute to this program, please visit our website for more information: www.realmedicinefoundation.org

Absentee blogger - with good reason!

It has been a hectic past few months since I last posted. We hired, trained and re-trained the staff, finished our exhaustive baseline survey across 500 villages, measuring over 60,000 children, finding and counseling thousands of malnourished children and referring over 100 children to NRCs for treatment. We also inaugurated and admitted our first patients into one of the first Public Private Partnership Nutrition Rehabilitation Centers in the state. Now that we've got the system set up, the intervention really begins. I promise to blog more regularly on our operational experiences in combatting malnutrition at the community level.

For now, here are a few blog entries from the RMF website on what we've been up to.