Thursday 1 November 2012

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


  1. You and this program are doing a lot of good. Thanks for the info in this post and God bless you and your efforts.

    1. Thanks Terra. The program is amazing, I am so proud to even have the tiniest part of it.

  2. Thank God you and the others are there to help. With a young son of my own the little lad in the last pic brought tears to my eyes.

    1. Thanks for reading Jane. Yes some of the cases do break your heart. But our dedicated staff work hard every day to eradicate malnutrition at these sites through education and consultation....I just hope we can expand the programs to other areas where we are needed. Watch this space!

  3. I have been reading your blog with avid interest over the last couple of days - am thinking of moving to india in Jan for a new job and would love to chat if that is possible....

    1. Hello Bindi, thanks for reading! Please do contact me with any questions by clicking on the 'contact me' link in my profile. I have helped a few people moving to Bombay so it's not a problem! Kind regards, BombayJules



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