Good DRR Practices in Health by PRIs

Session objectives:

At the end of this session participants will be able to advocate

Adoption of best practices in health for effective DRR

Key learning points of the session:

There have been some useful practices undertaken in different areas

Some of these good practices include- Institutional Delivery -Referral Transport, Collection of Water, Keno Parbo Na, DOTS, Fever Depots

Handout for the session:Are you aware that Rs 10000/- is allotted to your Village Health and Sanita-tion Committee (VHSC) as an untied fund? How has it been spent this year? Last year? How has it been spent in previous years?

Good Practice Need Covered Benefit

Rural Ambulance - from modified Van Rickshaws

Referral Transport Pregnant Women

Keno Parbo Na Nutrition 0-3 children

Local solutions for Collection of Water

Water Collection All

Oral Rehydration Therapy (ORT) Corners

Diarrhoea All

Directly Observed Treatment Shortcourse (DOTS)

TB All

Fever Depots Malaria All

Local Life Jackets made by Self Help Groups/

Drowning Flood Prone

SHGs

Table: 1 Good Practices

Rural Ambulance converted Van RickshawsModified Van Rickshaw in 24 Parganas Sunderban area- use of van-rickshaw as a rural ambulance that could save hundreds of lives by only being able to transport patients from the households to the local clinic, in the specific re-gion of rural West Bengal

Figure 1: Rural Ambulance

The main feature of this conveyance is that its base/platform is at a considerably low height from the ground level than a common rickshaw van. This arrangement is made to create more space and reduce the vibration, which otherwise cause discomfort to the patient in a rugged terrain of an unpaved road. A stretcher is placed on one side, with proper shock absorbing arrangements. This helps in avoiding jerks due to bad road conditions. The stretcher can be removed while using the conveyance for a purpose other than carrying ailing patients. Just opposite to the stretcher, the sitting arrangement is made for at least two attendants. An oxygen cylinder is kept at one corner so as to meet the exigencies. Likewise, a first-aid-box is also kept at one corner. A wash basin is placed beside the stretcher. Arrangements for saline, drinking water, adequate lighting, are made. Battery operated hand mike set is fitted on the top of the vehicle. Provisions for life jacket, life line, stuff, small tent, extra rope, folding ladder, blankets, etc. are there for using the vehicle during calamities. The top of the vehicle is tin-roofed and the sides are also fenced with tin sheets and nets are placed in between to ensure adequate ventilation. It can be used both for delivery patients AND OTHER TYPES OF PATIENTS

Hand washing

Nutrition - Keno Parbo Na programme

Figure 1: Positive Deviance Mascot

Monitoring is done by mothers using the Mascot. Each limb represents a step in protecting the child- such as Measles Immunization

Figure 2: Community Map

A positive deviant child is a healthy and developed child in a poor, disad-vantaged and distressed family. A positive deviant family is a family which has PD childrenThe special practices of a PD family which enables a child to grow and develop well inspite of poor socioeconomic conditions are called PD practicesThe attempt is to find out these practices in the community and formulate strategies and activities which motivate all families with children to adopt these best practices through participatory learning. Making Malnutrition Visible to the families and community through weighing of children and using colour-coded charts, maps and other toolsFinding out prevalent child care and feeding practices in the area – both good and bad and identifying young children who have good (normal nutrition) or bad (severe acute malnutrition) nutritional status as a result of these practicesBringing the moderate to severe malnourished young children (0-3 years) and their care-givers regularly to the AWCs (Angan Wadi Centres) for the Nutrition Counseling and Child Care Session-NCCS. AWWs (Angan Wadi Workers) along with community, positive deviant mothers & SHGs and teach them the correct feeding and care practices through hands-on demonstration and urge them to follow the same care practices at home Close monitoring and follow up

Monitoring is done by mothers using the Mascot. Each limb represents a step in protecting the child- such as Measles Immunization

Local solutions for Collection of WaterCollection of Rain Water by community in jars/ kolshi and using filters of sari cloth have saved many lives. These are local practices that need to be copied and propagated. Scientific studies have shown how many bacteria are trapped when plankton get stuck in the cloth.

Figure 3: Post Aila Water Collection

ORT CornersAt Gosaba Ghat we saw a newly literate man poring over a little booklet on what to do in emergencies. He was reading very slowly- dis..in..fect…….ten…litres..of…water with…a 40…milligram ta…blet..of Hala…zone.

Figure 4: ORT Corner Gosaba

A little further on, at the ticket office we found Swapna Barman explaining how to make Oral Rehydration Solution to a man with a small child. After she had finished a government Male Health Worker checked that the man had understood exactly what she had said. Meanwhile Dipankar Dalui gave them the ORS he had just made in a bottle they provided.

At the local Primary Health Centre Indrajit Hazra was also preparing stock solution to disinfect water. He and Sanjeeb John Makhal had talked to 79 in patients, out patients and visitors on 10th July. Saturday is a busy day in Gosaba- it is Market Day and there are people here from as far away as Choto Mollakhali. Mollakhali is three hours ride by launch from Gosaba.

Swapna is a local volunteer from Manmathanagar working with Anwesha, a local NGO. Dipankar from Satjelia and Sanjeeb from Bali are with Palli Unnayan Samiti (Rural Development Society). Indrajit has been working in West Bengal’s Nadia District for the Catholic Charities there and has been deputed to Gosaba to take part in the relief work beside the local volunteers after the devastating cyclone Aila that struck West Bengal on 25th May 2009. They are all literate young people from rural areas.

Figure 5: ORT Corner Sarberia

Gosaba is a block town and administrative headquarters for 11 inhabited islands in the Sunderbans. It was first settled in the 19th century by a man called Daniel Hamilton, who bought three islands and turned them into an estate. He brought settlers from neighbouring districts and they started the first agriculture here. Now Gosaba is a bustling town of around 50000 people. The islanders also cultivate prawns and catch fish for a living. The cyclone on 25th May broke the protective embankments around the islands. Sea water has flowed into the fields and fresh water ponds and many have lost their homes and farms. The storm also destroyed the water pipeline to Gosaba. Many were forced to drink contaminated water and a diarrhoeal outbreak started around 30th May and continued for over a fortnight. There are still a few diarrhea patients coming in from the further off islands.

TB- DOTSRaiganj- A Panchayat Prodhan followed up a [patient who had been treated under RNTCP. After 2 courses of treatment the man was declared resistant to TB. The Prodhan followed up and filled in a form that was sent to Swasthya Bhavan, The patient was admitted to the Jawaharlal Nehru Hospital in Kalyani for DOTS Plus treatment.

Fever Treatment DepotsDooars- Indian Tea Association has set up Malaria clinics in the remote gardens. These are a support to the Fever Treatment Depots where ICDS workers keep Malaria medicines and can take blood for tests

Local Life Jackets made by SHGsDuring the CBDP programme in Uttar Dinajpur Self Help Groups learnt how to make cost effective life jackets using commonly available materials. Source of the Reference material: Skills That Save Lives ASHA Module 6 NRHMKeno Parbo Na- http://www.positivedeviance.org/from_the_field/voices-nutrition.htmlhttp://www.unicef.org/india/nutrition_1557.htmlVan Ambulance- http://wn.com/InnoAid__Rural_Ambulance_Project__Sunderbans__the_local_rickshawm4vORT Corners UNICEF Press Report

Session plan: Start the session with explaining objectives of the session and the significance of the session for the entire training programme.

Running time Description of specific activities of the session

First 10 mins Brain Storming/ Listing. Ask- What are the good practices you have seen?

11-50 mins Presentations (6 mins each): either of their own success stories or of examples provided

51 to 60 mins Discussion on good practices by PRIs.

Methods:Handouts, Presentation of case studies of good practices highlighting the scope of DRR in Health sector and the role played by PRIs

Material required:

Pre-designed visual aids on Case Studies. White board, white board markers, flip charts

Annexure-Case Study on Positive Deviance/ Keno Parbo Na

PD Practitioner: Rupali Haldar (Anganwadi worker)Location: Mala Village, West BengalDate: February 2005

My name is Rupali Haldar. Initially when I started my work as an AWW (An-ganwadi Worker), and used to weigh children, then many mothers refused to allow me to weigh their children. Many used to make faces, many used to say if you weigh my child the weight will go down but I still didn’t lose hope. Whenever I used to go to the village, the villagers used to snub me by say-ing, “There she goes, once again she will try to weigh our children.” Many used to comment, “She gets money so she comes here, she must have some purpose.” Again, some used to say, “Even though some people get money they don’t work, they don’t come to advise us”.

Slowly, I became much closer to them. My first session started at 1.6.02. There were 14 children then. The programme was not initiated in the centre but in a mothers’ house.  It takes 10 minutes from the centre to reach that house. The programme stopped for a month due to heavy rains.  By 28.8.02, a number of Grade IV, III, and II malnourished children moved to Grade I and Normal. Their mothers were so happy. They started feeding the meal at home as well.

Another aspect of joy was that the grandmothers used to bring the children to the centre. If the mothers did not want to come the grandmothers used to persuade them to attend. The grandmothers also reported the cases of mothers who did not prepare the meal at home.  In the PD programme, the Hindu and Muslim mothers prepared the meal together. The programme started in a Hindu family, but then it also took place in the Muslim families. Even the mothers of the normal children have supported and participated in the programme wholeheartedly. Once I asked a normal child’s mother, “Why do you want to attend regularly?” She said, “I want my child to remain healthy and not lose weight and besides my child loves to eat with all the children.”

Initially the Panchayat people did not help me. They wouldn’t even behave properly.  I supplied the fuel till the 8th session. From the 9th session, the mothers’ contributed the fuel. One of the fathers refused to give polio drops

to the child but the grandmother came to me to give the child the drops se-cretly. I was so happy.

My CDPO and Supervisor told me to work well to get good results. Today I am very happy.  Now even the Panchayat have come forward.  Earlier they wouldn’t listen to me, now they do.  Earlier those who would make faces and wouldn’t talk to me, now consider me as their own. This is my biggest gift. My work is for mothers and children, and to reduce child deaths. If I am aware, then I can create awareness in others. I feel AWWs should have a mentality of maternal love and affection. I feel even if there is a VHC (Village Health Committee), to back up the AWW, she has to give her best effort. Whenever there is a problem the mothers must be consulted, this helps in understanding what each mother wants to say. Once while facing the fuel problem, I said I don’t get any money for fuel, how long can I keep arranging for it? The mothers were quick to answer “Didi, these are our children who have the food, so we will arrange the fuel, don’t worry.”