My Himachal Jibhi CHAI Child Health Mela 2009

The annual Child Health Mela is conducted by Lady Willingdon Hospital with the financial support of My Himachal. This programme has been running for the last five years in the Saraj valley of Himachal Pradesh. This year’s mela has brought the total number of children who have benefited from the programme to approximately 2050 children. The 5th annual Child Health Mela was conducted from May 25th to 29th, 2009 in two Panchayats of Banjar Block: Saraj and Chanoun. There are 5 Primary schools and 10 Anganwadis within these two Panchayats and we targeted 452 children between the ages of 0 and 12 years.

Our objectives for the Child Health Mela:

• Provide health check-ups for all the children in these 2 Panchayats aged 0-12 years.

• Create increased awareness and knowledge about nutrition, and hygiene through our Kala Jatha (street theatre) programme.

• Build a good relationship with the communities as well as the community based organisations, NGOs and government departments working in this area

We had the following members of staff aid in the organization and implementation of this year’s Child Health Mela:

• Dr. Philip Alexander (Medical Superintendent LWH & Convener)

• Dr. R. Christopher (Hospital Administrator LWH)

• Dr. Susan Passah (Doctor-In-charge-Community work-Jibhi-LWH)

• Dr. Dennis   (Medical Officer-Health Mela-LWH)

• Dr. Kaaren Mathias (Community medicine advisor-Health Mela)

• Mr. Padam Singh (Project liaison officer & Coordinator-Camp-Jibhi-LWH)

• Mrs. Kanta Devi    (Community Staff-Jibhi Clinic-LWH)

• Dr. Gagan & Dr. Niyatee (Dental Interns-CDC Ludhiana)

• Ringzin (Dental Assistant-LWH )

• Allison Pierce (Volunteer-Canada)

• Tiffany Pierce (Volunteer-Canada)

• Manju  (HW- Manali)

• Uma (HW- Manali)

• Nimu Thakur (CHW-Jibhi-LWH)

• Shakti  Chauhan (CHW-Jibhi-LWH)

• Manorma Devi   (CHW-Jibhi-LWH)

• Vandana Devi (NP-Jibhi-LWH)

• Payari Devi (NP-Jibhi-LWH)

• Sita Devi    (CHW-Jibhi-LWH)

• Javitra Devi (CHW-Jibhi-LWH)

• Rewa Banti (NP-Jibhi-LWH)

• Rakesh Sharma     (Kala-Jatha & Community Motivator-Jibhi-LWH)

• Nihal (Kala-Jatha & Community Motivator-Jibhi-LWH)

• Tilak (Kala-Jatha-Jibhi-LWH)

• Suresh (Driver & Helper-LWH)

• Tej Ram (Cook and Helper-Jibhi)

After a slow start on the first day, May 25th, we drove the bumpy and winding road to Gada Gushaini. From there we walked 30 minutes uphill and reached the village of Alwah which is perched on a ridge overlooking the valley of Gada Gushaini. There were over 20 people in our team, including Mr. Payson Stevens from My Himachal who joined us for the opening day. We started the programme by welcoming and thanking Mr. Payson for his help and by welcoming Dr. Kaaren once again to this programme and to this valley. After the welcoming and a brief introduction of LWH and the Child Health Mela programme itself, our Kala Jatha people performed their health awareness skit. The drama is performed in local Pahari dialect and always keeps the audience very interested and engaged. The children roar with laughter at the slapstick antics of the drunken man who disrupts a village committee health meeting and at the halting gait of elderly Dadu, the grandfather whose grandson faints at school because he has not had enough food to eat. Everyone enjoyed and understood the messages about the importance of regular eating for children, and how to have a healthy and balanced diet. The food pyramid was used to illustrate these ideas as part of the drama.

The teachers at the school were supportive of the mela and assisted us by providing desks and areas for examining children as well as marshalling children to and from their classes in turn. The next 2 hours were spent performing health screening and check-ups for the children.

During health mela we provided the following things:

• General check-up by Doctors
• Dental check-up
• Eye check-up
• Height & weight
• De-Worming
• Vitamin-A
• Iron
• Zinc
• Medicine as needed
• Kala Jatha
• Games
• Prize

We covered 63 kids in Alwah village. It was a good start to the mela.

On Tuesday, May 26th, we drove 23 km towards Gada Gushaini and then walked 45 minutes from the road, arriving at a pretty little village called Pattan. Here the school teacher was very cooperative. He was really happy with our work and that we had come to this village to do health check-ups. He has some knowledge about working with disabled kids and offered assistance for our disabled kids programme. Following the same pattern as the first day, we had our drama performance and health education time, after which we did clinical and health check-ups for all the children. In this village we covered 65 kids.

On May 27th, we drove 18km, again up the winding road, to Bahu and a small settlement Dhimacherri where we left the cars. After walking uphill for 1 hour 20 minutes we reached a village called Gashini. This is the most remote village in this Panchayat and also has a larger low caste population. Since they rarely have people walk to visit and support their community, the villagers were especially happy to have our team there to try to improve the health of their children. Here we saw 64 kids of the 67 children who are enrolled for that area.

The next day, May 28th, we went to the village Katora, which is 18km away by road and an additional walking distance of 35 minutes. This village has the highest number kids in the Panchayat and 108 children were seen by our medical professionals.

Friday, May 29th, was the last day of the health mela. We went to a different Panchayat called Chanoun. This time we drove down the valley from Jibhi, for around 25km and then walked 50 minutes uphill until we reached the village Dandhaar. This is the most needy and poor area of this Panchayat. Here we found lot of problems such as scabies, worms, and severe malnutrition. One child was found with marasmas (a severe form of protein energy malnutrition) while another child had a severe eye disease which would result in imminent blindness if left untreated. In this village a total of 106 children were checked.

Table – Summary of Child Health Mela statistics for 2009

The total number of children in the administrative areas we visited was 452 but due to school absenteeism we reviewed 408 children. This was a very good result with over 90% of possible children having received benefits of the health mela. One of the factors that contributed to the success of our programme was though our connection to the Anganwadi teachers. They were supportive of our program and agreed to bring their children to the government schools located in the target villages which made delivering the programme easier. Also of importance was the fact that we have a strong connection to the communities through our community health workers (CHWs) and Nutrition Promoters (NPs) who went door to door to inform the villagers of our programme.

However, it is very difficult to carry small kids up the steep Himachali hills and that hindered a few families from being able to attend the mela. Also, May and June is a time when there is a lot of work to do in the fields with the harvest of garlic, barley and wheat occurring. It is also planting time for cabbage and beans.

On the other hand it is also a time with good weather and when there are no school or national holidays so we have found this to be the best time to hold the mela. Despite being the harvest time, we can see though the number of parents and relatives who came to the mela that local people obviously care for their children’s health enough to prioritize attending the health mela at the cost of a days’ work in the fields.

There was also very good attendance of the mela by village adults as most days there were an additional 20 to 30 adults supporting this community event. It was really great to have their interest in our Kala Jatha programme as well as to have their help during the health checks where parents were often able to supply more detailed information about their children.

We are incredibly grateful to have reached over 90% of the target children as this is the highest percentage we have achieved over the last five years of running this programme.

How we delivered the programme

Kala Jatha

Our Kala Jatha (street theatre) programme utilized music and skits in the local language to promote ideas of nutrition and hygiene. We have two local community motivators, Mr. Rakesh and Mr. Nihal and they are both very good artists. They have worked with our health workers to create an entertaining and informative programme. .

The Kala Jatha team’s hard worked paid off and their performance was excellent. It was highly appreciated in the community and everyone understood the messages we were trying to convey.

A nutritional song was sung in local language… “Ye aay se kotke ye aay saraji Naye dhana re nouli kree hare shaga ree bhaji”

… and spoke in part about the people in the two valleys coming together to celebrate the first harvest with a meal of red rice and green leafy vegetables.

We worked to promote local food which is inexpensive, nutritious and easily available in their own fields and villages. We gave particular emphasis to having a balanced diet complete with green vegetables and fruits; the foods which are essential for the children’s growth and are less consumed in the average diet in this area.

General check ups – Health check ups were provided by our Lady Willingdon Hospital doctors for all the children that came for the mela and medicines were distributed as needed.

Eye check ups – Eye check ups were provided for all the children over the age of two. Any one in need of glasses or had any additional eye problems were referred to Jibhi Clinic on June 13th (our next bi-weekly clinic) for follow up.

Dental check ups – Dental check ups were provided for all the children. Our dentist also gave a small talk on the importance of brushing and demonstrated proper technique.

Medicine distributed – All children received vitamin A, folic acid, zinc and iron capsules. In addition, those over the age of two also received Albendazole. Other medications were given as the doctor prescribed them.

Opportunities for learning

Each mela is a chance for us to reflect on what we have done well and to examine areas we can improve on. A particular unexpected success we had this year was with the Kala Jatha team playing music during set up. This not only got the audience excited but also drew in more people from the village itself as they came to see what was happening.

Areas in which we can improve for next year include bringing more medicine for different illnesses such as eye drops and medicine for scabies. In addition we also need to develop a way to do a vision test of children under the age of 2. Also, while children with any disease are treated on the spot during the mela we need to ensure that there is a follow up done for these cases. Lastly, holding a meeting the day before the mela would allow the team to come together and make sure everyone was on the same page.

Apart from these few suggestions the team worked really hard and the Mela itself was a success.

Outcomes of the project

As well as providing the children with health check-ups and screenings we also achieved following things:

• We built a good relationship with the community. Medical facilities are a big concern in the Seraj valley of Banjar and many of these communities lack the proper facilities. Therefore the communities we visited were grateful for us bringing some basic medical services to them.

• We also strengthened our relationship with the school teachers, Anganwadi teachers, local self help groups and the Panchayat.

• We were able to promote health particularly nutrition and hygiene through our Kala Jatha (street theatre) programme.

• We were able to see our own team grow and further develop their skills, both individually and as a group, through their participation in the Mela. Their work ethic was impressive and their performance was unforgettable.

• We were able to work collaboratively and further develop our relationship with the local government officers, especially the Block Medical officer and Block Primary Education officer.

Acknowledgements

• I would like to thank Dr. Philip Alexander, Medical Superintendent of Lady Willingdon Hospital, Manali, for his direction, motivation and co-operation in conducting this programme. Also, thanks to Dr. R. Christopher and Dr. Susan for their guidance, help with obtaining government permissions and logistical and staffing decisions.

• I would like to give thanks to Mr. Avnish Katoch, President of My Himachal, and also to Mr. Payson Stevens for their genuine concern and financial support for our annual Child Health Mela. I appreciate Mr. Payson taking the time to accompany us on the first day of the Mela and the encouragement he gave. I also appreciate My Himachal’s continuing support for the communities in the Seraj valley of Banjar Block. We have been receiving financial support from My Himachal for the past 5 years.

• Special thanks to our volunteers, Dr. Kaaren Mathias and Allison, for their untiring efforts during the Health Mela.

• I also want to thank each participant, staff and volunteer from Jibhi and LWH Manali for their wholehearted participation which was instrumental in making this Health Mela a huge success

Reported with inputs from Allison Pierce, Volunteer, Jibhi Project, LWH

Padam Singh