Health promotion with a non-governmental organisation in Calcutta

Jayati Das-Munshi accompanies a team on its day to day duties

I spent my elective at the Indian Institute of Mother and Child, a small non-governmental organisation operating in the rural villages on the outskirts of Calcutta. Like many volunteers I had read about the project on the internet before making contact with the coordinators in the United Kingdom. With their encouragement, I set off to see how the newly established health promotion team was faring.

Monday clinics are busy; the queues fill the entire courtyard, and mothers with their babies pile into the consulting rooms. While doctors see patients, members of a busy health promotion team carry out antenatal checks, weigh babies as part of the malnutrition programme, distribute food and interview "sponsored mothers."

Health worker visits slum in Calcutta (SEAN SPRAGUE/PANOS PICTURES)

Patients saw doctors before picking up free prescriptions or getting nursing treatment. We sat in these clinics and then helped nurses with their duties, but frequently "vitamin injection," as the doctors would direct nursing staff to do, seemed a woefully inadequate solution to the patient's problems. Almost all of the health problems dealt with by the project workers result from poverty--for example, malnutrition, frequent diarrhoea, as well as skin conditions such as scabies, not to mention an untapped reservoir of tuberculosis. At times, we felt like we were just treating the symptoms of a greater problem.

It was with some relief that I was then able to see the work of the health promotion team. I looked on one morning as a young pregnant mother came for an antenatal visit. In the ensuing interview it emerged that she was feeding herself and two other children on about 40 pence each week. Although her husband was in employment as a labourer, he drank most of his wages away. Later on that day we visited her living quarters, and the community workers assessed her for possible "sponsorship." I was not surprised that she qualified; her home consisted of one small room, which she and her children, as well as her in-laws, shared. Her mother-in-law was distressed: "What am I to do? He [The husband] is always drunk."

The sponsor-mother programme was set up recently in an effort to curb mother and neonatal deaths during pregnancy and childbirth. It has been known for a long time that improved mortality in the West during childbirth is a result of improved socioeconomic standards and not of heroic measures by medicine.¹ Sponsored mothers are therefore given rations of food throughout their pregnancy, as well as any medicines, free of charge. Food provisions continue while the mother is breast feeding and until the child starts weaning. Health workers visit homes regularly to make sure that the pregnant mother is actually eating the provided provisions.

Malnutrition does not always occur because families cannot afford food, although undoubtedly this is the case for some. I learnt during one of the team's many "mother awareness" talks that edible plants grow around the villages. Kumro shak, or pumpkin leaves, are rich in folate and fibre, and other root vegetables and beans are freely available. One afternoon I watched the team teach mothers how to make poustic roti, nutritious chapatis made out of wheat, potatoes, and leafy vegetables. A batch big enough to feed about 25 people was made out of staples costing around 20 pence. The team hoped that mothers, after learning such methods of food preparation, would then be able to go on and teach others to do the same.

In conclusion

So what was my role in all of this? Thankfully I did not have to perform any life saving surgery, most practical duties being safely confined to the basics. Clinical shadowing, baby checks, and occasional clerking duties were interesting, but the most rewarding experiences were with the health promotion team, as I accompanied them on their routine day to day duties.

I may have suggested a few ideas to the members of the team, who were always interested in what I had to say, but most of my work was done in the fields of fund raising and liaising with supporters abroad who were interested in the work of the team. In retrospect, I'm glad that my presence gave no more than encouragement and friendship. The attitude "in England we always do it this way" may have created a dangerous situation of dependency. I was lucky enough to see how a project set up and run by Indians for Indians works.

1. Werner D, Sanders D. Questioning the solution: the politics of primary health care and child survival. California: HealthWrights 1997. (Currently out of print.)