The Foundation for Mother & Child Health opens in Powai

It has been ages since I mentioned the Foundation.  For new readers - yes I do actually have a volunteering job - when I'm not blogging (or shopping)!

The last time I talked about our work was here.  I explained how FMCH specifically reduces and prevents malnutrition amongst children in the Dhobi Ghat area.  How our staff operate from tiny clinics to improve the lives of hundreds of 'India's future adults'.  I also previously wrote about the opening of a clinic in a 10 square foot room in Sukhawni ...here.

One of new mothers with her daughter outside the Powai centre.

A lot has happened since then and it's quite strange looking back at past posts about FMCH.  Over the last two years, our managing committee has been working on a strategic plan that includes objectives to take our operating model and replicate it (either directly or through NGO and corporate partnerships). 

Our long term ambition is that, with sufficient funding, we can open an Institute for Health & Nutrition where we can intensively train other NGO and hospital staff to run their own malnutrition reduction and healthy eating awareness programmes (through 'Training of Trainers').  Already, we have made some significant partnerships: During the last 18 months we have implemented a successful programme in rural Maharashtra, a regular Saturday clinic in Dharavi and an intensive malnutrition centre at a local hospital. These are just the beginnings of our long term reach.  

Wearing her best dress and extremely happy to be here!

Yesterday was another significant day for FMCH, because we opened an additional centre in a Powai slum (in partnership with two other NGOs who gave us the space to carry out our work).  Powai is in the north of Mumbai - about an hour or two's drive from our existing community in Dhobi Ghat - depending on the traffic. In Powai, the Foundation is now able to conduct its clinics, pregnancy classes (see below) and cooking demonstrations to provide much needed services to a wider audience.  

“We dream of a world where the potential of each child is not restricted by poor early health or malnutrition”

(FMCH Vision)

At FMCH, there is a huge focus on the first 1,000 days of a child's life - so we hold pregnancy classes to teach women about the importance of feeding themselves and their babies correctly (including breastfeeding techniques) - in the hope that a healthy child will be born at the outset.  If a child is nurtured correctly within the first 1,000 days of its life (that's from conception to the age of two), it is more likely to develop properly - both physically and mentally. So this is a critical programme for us and one that can be easily replicated by other NGOs.  

Measuring babies for height against weight to detect signs of undernourishment (per WHO guidelines)

It's been amazing to see how much the organisation has grown over the last two years.  From five members of staff to nearly twenty and new initiatives and partnerships starting almost every month. Exciting times!

Please visit www.fmch-india.org for more information about what this wonderful organisation does to help Mumbai's women and children.  Of course, we are always looking for donations, CSR opportunities, volunteers and health/nutrition/business professionals who are able to give some of their time on a pro-bono basis.  Do get in touch!  contact@fmch-india.org

Our Executive Director Piyasree Mukherjee cuts the ribbon

As soon as the ribbon is cut, women from the new community rush to get inside

Our head nutritionist, Neha Arora checks out one of the first customers! 

Grandmothers welcome!

The women wait their turn.  In the foreground, Piya uses a tablet to enter client information straight to our new database which is 'held in the cloud'.

Jocelyn, one of our Community Health Managers,  talks to a young mother.

Many consultations between FMCH staff and women take place around the room.  The space is a lot bigger than we're used to operating in so it's a nice change.

Pinky, a Community Health Manager can't get enough of this cute baby!

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The Dharavi Cameras - Follow-up News

I received an email today that made me so happy.  It concerned the cameras that were donated by followers of the blog to a Reality Gives project - please read this post and this post.  To cut a long story short - I went to an exhibition of photographs taken by the kids of Dharavi ('Asia's largest slum') and I was so blown away by what they had achieved that I asked readers to donate cameras to the project - so that more children could benefit from photography classes initiated by the NGOs Reality Gives and Bombay Underground. We received nine cameras (successfully brought back in a suitcase from the UK by Mr Jules despite heavy questioning by Indian customs at the airport!) and I took them down to Dharavi last June.

I had been meaning to follow up on what had happened with the cameras - and as it transpires, they have been put to fantastic use.  Because it has not just been the children of Dharavi who have been able to make use of the equipment.  Through this latest project (described below), a select group of women were taught to be self-confident and self-aware through the medium of photography.

Here is a report from Joanna who kindly emailed me this morning with the news and photographs from the programme:

"The project ‘ladies only – stories for all’ was a collaborative venture between myself, Joanna Wingate, and Aqui Thami, from the Art Room. The workshop ran for 10 sessions, 2 hours a session in Dharavi, Mumbai.

The workshop focused on using photography, story telling and interviews, as a way of expressing how to be ‘free’ in a safe environment. The aims were to create positive awareness and raise self-confidence, and to build new relationships between the 5 participants.

We believe we achieved this as far as possible in the short time available. It was the first photography workshop for women in Dharavi. I taught them new skills, using basic camera techniques including: angles, composition, different props such as the use of tripod, and reflector. We followed various themes, such as ‘faceless portraits’, ‘abstracts’, ‘a day in a life’, and environment and street photography. I am certain, that most of the participants, loved ‘portraits’, which was their favourite. They imagined being somebody else - such as a Bollywood star for one session. At the end of the project, we went on a trip to Colaba, looking at different galleries, focusing on ‘Photography’ and ‘Women in Indian Photography’.

I conducted the sessions in English and Aqui, translated the workshop into Hindi for the group. This was the first such experience for me. Our group was a multi language group! English, Hindi, Marathi and Telegu.

One participant told us that she felt ‘young, free, and not having to worry about marriage, life, and children during the session’. For me, that was a positive step, to help the participants to be themselves and relax in a safe environment. Another participant said that she likes to dress up and feel good about herself in the sessions. I was so encouraged that they really enjoyed spending time together. Even though they had much work at home, they still made an effort to come each time, and did not drop out during the 10 sessions, as they created something new.

I hope the audience will enjoy the participants’ images - Amirita, Anuradha, Kaveri, Nirmala and Shobha. You can see them at the exhibition and in our photo book"

The work culminated in an exhibition at the Art Loft in October which I unfortunately missed due to travelling. So I would like to say 'well done' to Joanna and her team for doing such a fantastic job with these women. And it's so inspiring when you hear of other expat women using their skills and doing something so worthwhile with their time. 

The five participants, Joanna and Aqui

Time for laughter and forgetting the stresses of their daily lives

Thank you Joanna and Aqui, you've made a real difference to these women!

Weighing and Measuring (Kids)

It has been a while since I mentioned the Foundation.  And it had been a while since I had been down to one of the intervention sites - as I have mostly been concentrating on the financial and administrative aspects of our NGO from the comfort of a desk and chair in my own apartment.

It's always good to keep fresh in the mind what the end product of our joint efforts are.  To ensure that every child reaches their full potential in life via optimal nutrition and food education.  To this end I would like to share with you some scenes from one of our clinics and show you what goes on there every day.

When you walk on to site, the first thing you see is an Anganwadi school full of cute little children.  An Anganwadi (literally translated from Hindi as "courtyard shelter") is a scheme initiated by the Indian government in 1975 as part of the Integrated Child Development Services program to combat child hunger and malnutrition.  When I get my camera out, the Anganwadi workers get all the children to turn around and pose for me - whilst I try and get them to wave (rather unsuccessfully!).

Anganwadi Cuties

Next door at the clinic itself, it is 10.15am - just after opening time - and there is already a line of 'patients' (we also call them 'beneficiaries') waiting to see the doctor. Our doctor - sometimes assisted by other volunteer doctors - has been a committed member of the Foundation for over five years, coming twice a week without pay in order to help hundreds and hundreds of children and their families.  There are also paid members of the team including a qualified nurse, several nutritionists, social workers and field workers.  They are always smiling and happy and always there to help members of the community who may know little about why they are here.

Dr Rupal - one dedicated lady!

At the Foundation, one of the main objectives is to reduce 'SAM' and 'MAM' children.  Which means Severely Acute Malnourished and Moderately Acute Malnourished kids, usually between the ages of 0 and 6 years old.  If you don't catch poor feeding practices before the age of two, you can not reverse the damage that will have been done to a child's mental and physical development. Therefore a child's potential to do well in life will be forever impaired.  And it's not necessarily about the affordability of food and it's definitely not about food availability (after all, we are not in a famine situation here).  It is more about teaching mothers not to feed their children junk food, the importance and difference between food groups and their nutrient and vitamin content, as well as educating them on how to breastfeed properly.  I have already written about our cooking demonstrations to uneducated mothers here.

The process of assessing whether a child is SAM or MAM involves simple weighing and measuring.  Their height is checked against their weight by plotting it on a WHO (World Health Organisation) chart.  If a child is too short for his (her) age, then he (she) is stunted.  If he is too light for his age then he is underweight.  If a child is too thin for his height, then he is wasted. When a child is first brought to the clinic they have their measurements assessed and marked on the chart and then they are brought in front of the nurse, doctor and nutritionist for further assessment.  The procedure is the same for every follow up visit - if they come back to see us regularly and the parents follow our staff's advice and guidelines, we will start to rapidly see improvements in their weight and height charts.  However, it is a difficult task to gain commitment from some of the mothers as they have social and domestic problems to deal with - or just plain don't have time. That is why we will soon implement a peer education programme which will enlist and educate  'Didis' (Big Sisters) to go forth into the community to spread the word and provide basic nutritional advice.




Measuring the babies - a bit more of a challenge! 

 

Weighing.  This baby is one of our success stories coming in at 'normal' weight.

Whilst our Field Officers are weighing and measuring, our nurse will check children for anaemia using a pin-prick blood testing machine, she will enquire to see if their immunisations are up to date (something that the parents don't tend to keep on top of) and ensure that their medical files are all in order. 

On top of the SAM and MAM issues above, a child may also experience Type I and Type II nutrient deficiencies.  Type I is where basic nutrients are missing in a child's diet leading to such conditions as anaemia (being the most common), rickets, scurvy and beri-beri.  These are the types of ailments that were common in medieval England or amongst sailors at sea in Tudor times.  It is hard to believe that these disorders still exist in the modern day world.  Rickets - caused by a lack of Vitamin D - is especially common due to children living in windowless chawls off dark alleyways where they may also play.  The sun simply does not get to them.

When there is a deficiency of one of the type II or 'growth' nutrients, a child (or even adult) stops growing, the body starts to conserve the nutrient so that its excretion falls to very low levels and there is minimum reduction in the tissue concentration. With continued or severe deficiency the body may start to break down its own tissues to release the nutrient for use by the rest of the body; this process is associated with a reduction of appetite.  Basically the body feeds off itself.  Our staff see plenty of these Type I and Type II cases and our nutritionists will do their best to counsel mothers on a one-to-one basis on feeding practices (breast-feeding, weaning, vitamin and food supplements etc).

WHO weight to height chart

Going back to the clinic.  I should describe this to you - it is a room of about 20 ft x 15 ft in the middle of a marginalised community inhabited by the many workers of Dhobi Ghat, the giant laundry.  There is no furniture save one table and some filing cabinets.  Everyone including the doctor sits cross legged on a mat on the floor.  This is perfectly normal.  Actually it feels quite homely.  There are a few pictures on the walls and randomly, there is a giant Mickey Mouse peering down from one of the shelves.  There is no privacy, no airs and graces, there are no computers, no telephones and there are no windows looking out on to a beautiful view. Each patient has their own paper medical file which is safely locked away when the clinic closes. When you are working to a tight budget, it has to be a no frills operation.  But lives are so greatly improved from this one room.  And the two other rooms like it that the Foundation runs on nearby streets.  Because of the work of all of these committed individuals and the willingness of the community to learn, children who may otherwise turn out to be BMC street sweepers and rickshaw drivers may now one day gain college degrees and become nurses and doctors themselves.  Purely because they've been given the correct 'brain-food'.  




This little boy is another success story - brought to the clinic before the age of 2 when he was malnourished
- now he is on a feeding and vitamin plan that is seeing him grow into a 'normal' sized child.

In the room there is a plastic box filled with children's books and I have noticed that the toddlers like to go straight in there to pull out their favourite book - especially the one about kittens or the one titled "What I Will Be When I Grow Up".  I think to myself..."keep coming here and you will be able to follow your dreams..."



When I Grow Up, I Want To Be.....

Thanks for reading, here are some more photos of the clinic in action:



 

Mickey Mouse watches over the proceedings...



Every patient has their own file.  A future investment will be a computerised system

So you get an idea of the size of the room.  The staff will see perhaps 20-22 patients this morning, spending at least 15 minutes with them all, if not more.  You wouldn't get that service on the NHS!

 



One of our lovely, qualified nutritionists advising on food supplements.



 

This adorable little boy is stunted.  He is three years old but has the height of a 1.5 yr old. 
Our staff can help him as much as they can now but the damage may already have been
done in terms of his long term development. His little sister is the baby in the weighing machine above - brought to us since she was born and after her mother gained better knowledge, she is growing completely normally.
 Bringing awareness to the parents of similar cases is one of the major missions of the Foundation