August 19, 2005

Two children

Excerpts from a report about a field trip, from a doctor I know.


Gadlagir, in Bhadora block of MP's Guna District, is a remote village with two settlements – the main village and the Sahariya settlement. We reached the village in the early afternoon.

Almost all under-five children seemed to have diarrhoea and were passing loose stools around the huts, and there were clouds of flies everywhere. We saw several malnourished children:

    Prahlad s/o Lalaram. 2 yrs male. Sick for the past three months. Weight December 2004 – 7.9 kg, April 2005 – 7 kg. August 2005 5 kg.

    Halkesh s/o Hariram 1.5 years, weight not recorded. Sick for the past five months with recurrent diarrhoeal episodes.

Both these children had been given referral slips by a doctor who visited earlier. They had been given ORS (Oral Rehydration Solution) by an earlier medical team. Mothers said they had been told to mix one spoonful of powder in one cup of water and give to the child.

Met the anganwadi worker (AWW) of the village. Growth register was not available with her (she has been working for three years and her husband helps her keep records as she is illiterate). Weight recording was done in April during the Bal Sanjivani drive but no follow up provided to malnourished children. Immunisation was done regularly (catch-up rounds organized in Guna from April to July 05).

AWW also distributes iron tablets to adolescent girls on Tuesdays, but has no records, does not know how many tablets she has received or distributed. Says most girls do not take the tablet as they feel nauseated.

The severely malnourished children Prahlad and Halkesh had been given a tin of protein supplement "Prosup" (Rs. 120/-) and a bottle of multivitamins "Grovit" (Rs 51/-). The parents could not recall any instructions about how to give these supplements to the children.

We took Prahlad, his parents and his younger sibling (6 months old) with us back to the paediatric ward in the Guna district hospital for treatment. He had pneumonia and diarrhoea and was severely anaemic and lethargic.

At the district hospital he was given antibiotics to which he responded well, but no investigations were carried out. The child was not weighed either at admission or thereafter -- till the third day when I insisted that the weight be taken. Other severely malnourished children in the ward were also being treated only for infection and not beyond. Immunization was incomplete in some of these children but this had not been looked into. No dietary advice was given to the parents, nor any arrangements made for a high calorie diet for the children.

DPHN Mrs E.T. is also a dietician and volunteered to prepare a diet sheet for these children and to prepare the food (khichdi, etc) in her house for now and to demonstrate to the mothers how the food is prepared. Discussions were held with the CMHO about space for nutritional rehabilitation of malnourished children. Two health workers approached our consultant on the 11th asking if they could bring some sick and malnourished children from their villages to the hospital.

Clearly, even doctors are not aware of the correct management of severely malnourished children. Training doctors and nurses is crucial for handling these children properly. Providing protein supplements and multivitamins is a waste of resources and should be stopped immediately.


Annie Zaidi said...

Dilip, I suspect the local doctors know how what to do... I have been to Sahariya areas in Chhatisgarh. 11 children died - allegedly of malnourishment related causes. The govt doctor claimed otherwise. District authorities refused to admit there was any starvation amongst the Sahariyas. Refused to certify it. Said, "these tribals just want to collect compensation money, when their kids die'
.... what to say, eh?

Dilip D'Souza said...

Annie, that remark about tribals is one I've heard too, in different forms. "What to say?" is right.