Last Day at CINI

Today is my last day at CINI and I’m so sad to be leaving. I’ve had an amazing experience here and have been so touched at how welcoming the staff and patients and community have been. I’ve learnt so much over the last 5 weeks and it will have a lasting impact on the way I practice medicine. CINI is doing wonderful work all over the West Bengal and I hope this blog has given you an insight into the organisation and that this will encourage you to support CINI in the future.

Hand Painting Fun

This week I had fun with the children in the NRC and Emergency Ward making cards with handprints for CINI UK. The children loved doing this and we all had a lot of fun!

Lactation Managment Unit

Neel was admitted to the Lactation Management Unit (LMU) at CINI with his mother, Maitun, at 2 months of age. His weight was just 3.6kg and had been dropping steadily. Maitun brought Neel to the outpatient clinic, as she was concerned he was not growing properly. Maitun is 20 years old and Neel is her first baby. She began breastfeeding her son from the first day of his life but after 15 days her mother-in-law decided that Maitun had insufficient milk to feed Neel and therefore should start using other milk substitutes in addition to her breast milk. Neel was fed a diet of breast milk and wheat flour mixed with cow’s milk, sugar and water during the first two months of his life.

Following Maitun’s admission to the LMU with her son, she was given advice on how to initiate relactation. CINI health care workers spent time with her, providing explanations of the technique and timings of breastfeeding, as well as physical and emotional support. Maitun told me that her confidence has greatly improved in just one week. She says CINI has helped her greatly, as she now has a lot of milk and her son is feeding well and it clear to all of us that she is far more relaxed and confident.

The World Health Organisation advises that infants should be exclusively breastfed for the first 6 months of life in developing countries. Exclusive breastfeeding not only improves maternal and child health, but also reduces the risk of malnutrition, infection and other health problems in children. Children who are fed formula feed are at risk of infection, as the water used to make up the formula is not clean; and of malnutrition, as parents may not be able to afford the formula and often use a packet sufficient for only 1 month over 3 months. Therefore CINI works hard to promote breastfeeding and to provide as much support and advice to mothers on feeding practices as needed.

Danesh

Danesh, a tiny baby aged only 3 months, had a tragic start to his life. His mother died during childbirth and his father was unable to cope with caring for him, so his auntie, Meera, took on the role of primary care giver. During the first few months of his life, Meera tried her best to provide adequate nourishment for her nephew but sadly it was not enough and Danesh’s weight dropped dangerously low. The local village health worker found Meera with the baby and advised her to go to the NRC at CINI so that the baby could have proper nutrition. Danesh was admitted to the NRC with third degree malnourishment, weighing only 2.7kg at 3 months of age. Whilst at CINI, Danesh was given powdered milk so that he is could receive adequate nourishment. Meera was given advice on how to appropriately feed Danesh without breast milk and how to keep him healthy after leaving CINI. After two weeks Danesh’s weight had gone up to 3.2kg and Meera and all the health care staff at CINI were very happy with the progress he was making and hoped he would continue to make progress with love, commitment and care of his auntie.

Over 78,000 women die each year from childbirth in India alone. This shocking figure leaves many children without mothers and often without a family. These children are at risk from all sorts of dangers including malnutrition, psychological scars, sexual exploitation, drug addiction, abuse and child trafficking. CINI’s projects such as ‘Adopt a Mother’ aim to reduce the incidence of maternal death through providing adequate antenatal and postnatal care, as well as other projects which help children at risk of malnutrition, sexual exploitation and child trafficking.

Munia and Rushi

Last week we visited Munia and her 6 day old infant, Rushi. Rushi was born 3 weeks before her due date and had a very low birth weight. She was born in a government hospital, which is unusual for this area, as most women living in rural areas give birth at home with the help of a ‘Dai’ or local midwife. After Rushi was born, she and her mother were transferred to a nursing home so that she could be monitored. Sadly, the nursing home cost more than 40 pounds a day, which is far more than Munia and her husband can afford and they decided to go back to their village and look after the baby at home.

The CINI health care worker who frequently visits the village to carry out antenatal visits and child health checks alerted CINI docotors to Munia and Rushi’s plight. We were particularly worried about Rushi’s state of health as her weight at birth was just 1.5kg. On reaching the village, we found a beautiful, healthy although very tiny baby and happily Rushi’s weight has already increased to 1.9kg. The biggest killers for low birth weight babies are hypothermia, infection and malnourishment. So during the visit we took time to make sure Rushi was showing no signs of these problems. Munia was given advice on how to keep her child warm, breastfeeding and hygiene amongst other things, in the hope that this will prevent any problems developing.

The doctor decided with Munia, that it would be best for mother and baby to stay at home, with weekly visits from CINI health care workers to monitor their progress. It was really nice to see how well Munia was looking after Rushi, with the support of her extended family and I felt that with the support of CINI, the outcome of this potentially desperate situation would be a good one…

Field Visits

The rest of the week was spent on field visits to rural villages. Here we could see first hand how CINI is helping families. We followed a CINI health worker to carry out health checks on a number of children around the village. The main aim of these visits is to ensure the child is growing and gaining weight properly; to find out if there are any health concerns and to make sure the child has been immunised. Each child is given medical record card in which the weight of the child is monitored on a growth chart and all immunizations are recorded. These visits are carried out monthly from birth until the age of 5.

We met one mother, Deeti and her 8 month old son, Arup. The health workers were very happy with the progress of Arup’s growth and felt he was developing into a healthy, strong child. However, at 5 months Arup had a bad episode of gastroenteritis and his weight dropped as result. Thanks to his mother’s vigilance and his medical records, CINI’s health workers quickly identified that he had developed Grade 2 malnutrition. Deeti and Arup were admitted to the NRC for three weeks and Arup’s weight was stabilised with the help of his mother and staff at CINI.

We also met a few pregnant mothers who are visited regularly by CINI health care workers to ensure the pregnancies are progressing well and to identify any problems which need to be referred for medical attention. We met Sarita, who is 8 months pregnant with her third child. She told me that CINI health care workers have visited her regularly during her pregnancy. At 5 months, she sought the advice of a health care worker as she was experiencing abdominal pain. She felt confident that CINI would be able to help her and was seen by a CINI doctor who referred her for further medical treatment at a government hospital. The problem was treated and she returned home shortly after and is now looking forward to the birth of her third child. Sarita told me she was very grateful for the support of her health care worker and from watching the two women talk; I could see that Sarita had great trust and confidence in her Didi.

CINI ASHA

Last Monday we visited CINI ASHA which cares for urban deprived children. They run all sorts of projects to help children affected by poverty, drugs, abuse and exploitation. It was a very humbling experience to visit areas where families survive in little shacks and to witness the health care and education CINI provides for these children and mothers. We also visited a night shelter near Sealdah train station which provides safe shelter and education for deprived children in Calcutta. Some of these children were as young as 6 years old and it really is heartbreaking to think that they have no home or that home, for whatever reason, is too unbearable for them to stay. It made me realise how lucky I’ve been throughout my life to have had a safe, comfortable place to sleep at night; a quiet, safe place to study; access to education; and a chance to be a child. These are luxuries that many of the children I met have never had, but now through the projects of CINI ASHA, they are able to experience some of the stability taken for granted by so many of us in the Western world.

Our First Days At CINI

We spent most of our first day in the Nutrition Rehabilitation Centre (NRC). It is here that CINI looks after malnourished children, helping the children through education and enabling the mothers to help the child themselves. The mothers, who are often malnourished themselves, will stay at CINI for 10 – 28 days. Mothers are actively encouraged to take an active role in facilitating her child’s nutritional rehabilitation. They are taught how to cook healthy, balanced meals which they can afford once back at home. This approach equips these families for the future and means the mothers can share their knowledge with others.

Last Friday, we went on our first field visit with three other Indian university students, who are studying social work and business management. It was really nice to speak to them as they were able to explain a lot of the customs and traditions we were witnessing. We went to visit a rural village where a Health Education ‘Mela’ or festival was taking place. There were all sorts of games being organized for hundreds of excited children and a number of stalls with information about sexual and reproductive health. The aim of the mela was to raise awareness of these issues for all age groups from children, to adolescents to adults and it seemed to be a great success with the whole village community getting involved!

Arrival at CINI

We arrived in ‘sunny’ Calcutta on Tuesday 6th January…which apparently is far from sunny at this time of year! Everyone is dressed in winter coats, balaclavas, scarves and gloves…which is actually quite funny considering it’s still about 70 degrees here!

We're staying in the small town of Pailan, about an hour outside of Calcutta. This is where the main hub of CINI is situated and where we’ll be spending our time over the next month or so. After meeting the staff, buying our salwar kameez from the local market and becoming accustomed to taking a bucket shower, which are surprisingly nice, we settled into our new home...