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Monday, June 25, 2018

The ‘arms’ and the men

Anganwadi workers back in the village begin the first line of treatment, with regular feeding of porridge, halwa and milk.

Written by Sweta Dutta | Updated: October 5, 2014 12:00:05 am
Children at the centre’s sole ward. Experts measure width of their ‘mid-arm circumference’; (bottom) Churakhadi village, where two children died Children at the centre’s sole ward. Experts measure width of their ‘mid-arm circumference’. (Source: Express photo by Maqsood Ahmed)

In the bustling 15 ft by 12 ft room with 13 harried staff, 65 children and their parents, a small metal plate atop a white body with a red dial, kept in a corner, occupies the pride of place.

Nodding towards the weighing scale, auxiliary nurse midwife Sangeeta Verma says, “This is the most important machine here. An increase in a patient’s weight is great news. It shows our treatment is working.”

Great news is rare at the Shahbad malnutrition treatment centre, one of 10 in Rajasthan’s backward Baran district. Lately it is under even more pressure since two children from Chaurakhadi village, 25 km away, died of suspected malnutrition in August. With Baran falling in the constituency of MP Dushyant Singh, Chief Minister Vasundhara Raje’s son, and the Congress making the deaths an issue, children with signs of malnutrition are being brought to the centre in rising numbers.

From barely 15 malnourished children, the count has gone up to 65 and counting, all children of Sahariya tribe younger than 5. The 10-bed centre has pulled out its stock of 30 metal cots, which had not been used in a year. Still many of the patients, their mothers and siblings lie on mattresses in the corridor, battling flies and mosquitoes. Those lucky enough to find room in the only ward though have bright paintings of children and animals for company.

The Sahariyas, a Scheduled Tribe, have reported many suspected starvation and malnutrition deaths over the past decade.

The employees, including eight clinical staff, two nurses, a doctor and two helpers, are not used to so much activity. For the past two weeks, their work hours have comprised at least six-hourly day shifts and 12-hourly night shifts on rotation, with the doctor required to make at least one round at night and to be on call for any new admission.

With their living quarters (mostly one-room spaces) on the campus, the staff use the breaks for a quick dash back home for a nap or a bite.
A child’s nutritional status is determined by his/her “mid-arm circumference value”. A value of less than 12.5 cm gets a child earmarked as malnourished; 11.5 cm means “severe malnourishment”, with the child set aside for close observation.

Anganwadi workers back in the village begin the first line of treatment, with regular feeding of porridge, halwa and milk. If parents do not return for the feed to the centre, anganwadi workers go to the child’s house.

Those children who contract diarrhoea, pneumonia or other infections are referred to the malnutrition treatment centre. The children are “treated” for 10-15 days and then sent back to the anganwadi for a follow-up. While VIP visits have spurred a rash of cases, there are few referrals to Shahbad centre most part of the year.

For 25-year-old Mallo Sahariya, the centre is a blessing. Her one-year-old son is admitted as he is suffering from diarrhoea but her two other children are also both frail. “At home, we manage to give them only rotis. Here he is getting a thick milky mixture. It is quite tasty,” she says.

Even as she is talking, her eyes are on the extra cots being laid by the staff. “I am waiting for our turn to get a bed,” she admits. Mallo and her children have to manage on a mattress placed next to a large desert cooler in the corridor. She can manage with the Rajasthan heat, she says, but the cooler’s hum doesn’t let her rest.

Block Chief Medical Officer Lalit Rathore, overseeing the preparation of the “milky mixture”, explains that it contains milk, puffed rice and boiled rice with a dash of edible oil. As he inspects the stocks, Rathore says: “The mixture is administered every two or three hours to the children. Those with diarrhoea are given medicines too.”

These days 30-40 litres of milk is delivered daily to the Shahbad centre, while the rest of the rations such as puffed rice, oatmeal, rice and oil are bought on a weekly basis depending on the number of patients.

“It is not that the number of children admitted to the centre has gone up this year or that more deaths of Sahariya children are being reported,” Rathore adds. “Every year, between July and September, during the monsoon, there is an increase in illnesses. Malnourished children are prone to catching an infection.”

At the malnourishment treatment centre, officials say, the mortality rate is very low. Recently a one-year-old, after being breastfed by his mother, choked on his vomit and died. “Children who make it to the centre usually go back healthy,” says Rathore, though there have been cases of children being brought back due to relapse.

Krishan, the one-year-old who died on August 28 in Chaurakhadi, was never brought to the centre.

The staff claim shortage of hands, and so most mothers are handed the feed and expected to tend to their children. However, many parents don’t see the point of being at the centre, despite being given a daily allowance of Rs 200 to make up for loss of pay at work.

Kani Sahariya from Bhoyal village, whose youngest son, 2, has diarrhoea, can’t wait to get home. “I had to bring my three other children besides the one being treated as there is no one at home. My husband is out to find work. Why can’t they give us whatever they want to feed our children at home? It won’t be such a hassle,” she says.

Mallo, who is still on the neighbouring mattress for want of a bed in the ward, now appears to agree with her. “Children do fall sick now and then, it is common,” she says.

Ask her about Krishan, and both Mani and Kallo shrug. “So many of our neighbours have lost their young ones. If it is fated, it will happen.”

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