After School Program - Health Week

Working with the children is always a pleasure. We never fully know what to expect or which kids will show up, but it is exciting and the kids are always so eager to learn. The Punjab team maintains an ongoing After School Program that focuses on different topics each week, ranging from Math to Sports. The title of our program is a bit of a misnomer because most of the children do not in fact attend school. Most of the children do not know how to read or write, and they range from 2-17 years old. This forces us to be very creative in our delivery, and also with how we communicate. Since the children are migrants from other parts of India, they often speak either Rajasthani, Punjabi, or Hindi. None of them know English, which forces us to quickly brush up on our Hindi skills!

My week for this month involved planning activities for Health week. We reviewed body parts in Hindi, good foods to eat, and which activities are good and bad for our health. We also showed them a hand-washing video and talked about when we should wash our hands. Images are key to communication and games as well. I found that our week was very successful, the kids loved to learn and share what they knew! I find that they are receptive to what we have to say, but changing behaviour is a very long and difficult path. Even though most children know walking around barefoot in the camp where there is trash can cut their feet, they still choose not to wear shoes even if they have them.

I think we also have to focus on spreading these messages to the adults in addition to the children. That requires catering our message to a different audience but educating both of those groups together will really help us in improving the health outcomes of the community as a whole.

- Margaret Arzon, USA

Women Empowerment Project Manager, Punjab

Attending a Vaccination Workshop

A few weeks ago John, the final member of my original Punjab team, left to go home to Canada. After 8 months spent working in the migrant camps on health and the young men’s association he was going back to the great white north. Despite his excitement, he had one big regret. For the past few months he had been establishing contacts with the District Immunization Officer from our area, in hopes of having a workshop with him to learn about vaccination outreach programs in India. In addition to having a workshop, we would be gaining a valuable resource, who could introduce us to many other National Rural Health Mission employees. Despite all of his work, a last minute cancellation meant that John was unable to attend the workshop, but luckily we were able to have it even without him.

The workshop began with some background information on some of the health issues that India has faced in recent years. Things like malaria, malnutrition, polio have all affected the country and have featured heavily in national and international news about the country. The goal of the National Rural Health Mission has been to decrease the prevalence of such communicable diseases, as well as to increase access of all people in rural areas to healthcare services. One of the primary ways that the NRHM does this is through Accredited Social Health Activist (ASHA) workers and Community Health Workers (CHWs). Both of these groups provide some basic health needs to rural communities, as well as encouraging communities to seek healthcare services from government hospitals, rather than eschewing it for home medicines or expensive private hospitals. These workers are the ones who have most direct access to communities, and thus are an important bridge when trying to prevent disease through things like vaccines.

In Hoshiarpur District alone there are (at least) 26,000 children under 5 who are low income. These are the children being targeted by the government hospitals to be vaccinated for things like polio. India has had an incredibly effective polio vaccination program, so successful that polio has been recently declared eradicated in India. One of the main takeaway’s that I had from this workshop, though, was that India needed to remain vigilant about polio, and all diseases preventable by vaccination. Migration across borders from countries without extensive vaccination programs like India, are the most likely culprits behind any possible polio infections in the future. That is why every few months the government holds migrant polio vaccination days. These are days where health workers go around to the most vulnerable populations and vaccinate all children under five. Being one of the only links between the migrants and the government hospitals, this program is incredibly important and will hopefully continue to be successful in the future.

Despite my sadness that John was unable t witness the fruits of his labor, the vaccination workshop was an incredibly informative ones. In the workshop we were able to learn more than I ever could have by browsing the internet. We hope that we will be able to do more such workshops in the future, but for now we have gained a valuable resource and a lot of incredibly valuable knowledge.

Dr Bagga's vaccination workshop

Poster in the civil hospital

District Immunization officer Dr Bagga showing us the case where they store vaccinations

Alexanne Neff, USA

Public Health Project Manager / Punjab Cluster Supervisor

Utilizing Technology!

Recently I have been using Youtube videos as a way to educate and motivate the migrants in regards to health topics such as hand washing, nutrition and immunization. The use of media is interesting because in a way it has been a paradox between a hurdle and a tool.

First to start off with context, the migrants in Paro, Punjab live on government land. The insecurity of their future looms down at them as a government building is being constructed meters away. The construction is taking place on land which they lived on until they were forced to move.

Their lives are an enigma in many ways, a condition of acceptance of their status is inherited. Their children play and spend time on the construction site where there camp once stood. Although it’s not just the children who spend time here, the adults from the camp could be found here wasting time as well. As the construction takes place, in a small brick room adjacent to the construction there is a television hooked up to a satellite.

The children and some of the adults could be found here. This small room with a small television proved to be a problem at times, in particular when we wanted to work with the children. Parting them from the television became a bit of a chore.  

This in turn became another small hurdle in our work with the migrants, along with communication gaps.

As time went on it was suggested to me that some people in Naddi had found videos in Hindi, which they use. With some simple research I managed to find videos which were able to convey ideas in concepts that I had long wanted to get across but couldn’t due to language gaps. When utilized the videos proved to be quite a successful tool to overcome hurdles. Here enters the paradox of how media and technology can be both a hindrance and a tool. I hope we can find other ways of using technology and media in creative, educational ways, which allows as certain degree of independence and control.

John Vargas, Canada

Health Project Manager, Punjab

Drinking Water at Migrant camps

For most people in the west the quality and safety of drinking water is often not a huge concern. The water from the tap is often deemed drinkable and there’s rarely any concern of severe illness or death. For impoverished people around the world the quality of drinking water is very much a matter of the quality of life and in many cases a concern of life and death.

 

Water quality is a major concern for the migrants. The migrants from the Hariana camp have reported that if the pump is used for a while the water that comes out is of a strange colour. While at the Paro camp the water is obtained from a concrete tank with a build up of algae where water sits stagnantly.

 

One of the main concerns in regards to drinking water is high levels of nitrate in the water. Nitrate effect on human health can be quite harmful with infants being at the highest risk. Infants may face issues such as problems breathing, blue baby syndrome and death.

 

For the migrants in Punjab high nitrate levels is consequently a three fold issue.  High nitrate levels has been shown to be an issue of concern in Punjab due to heavy use of pesticides as a consequence of the farming practices created during the Green revolution. The Green revolution was implemented by the India government in the 1960s-1970s in order to increase food production. A second issue in particular with the Hariana camp is an accumulation of nitrate from the trash dump which located just below the camps tents. The camp also has about 30 pigs or so, this is a third potential source of nitrate in particular because of the disposal of animal waste.

 

As for the Paro camp the main health concern in regards to drinking water is the fact that the source of the drinking water comes from an outdoor concrete open air tank  that is stagnant and filled with algae. Stagnant drinking water has shown to be of concern primarily because the stagnation provides a good incubator for many different types of parasites and bacteria. A long with being a good environment for bacteria and parasites to flourish, the blue-green algae can sometimes have certain level of toxicity which could cause skin irritation, stomach cramps, vomiting, nausea, diarrhea, fever, sore throat, headache, muscle and joint pain, blisters of the mouth and liver damage, depending on the toxin.

We are working on getting the water tested and finding solutions to improve the quality of water. Water testing can be done by the district health department. With this in mind it is important to look at other testing options as well, in order to get the most accurate results. Solid results will help us in finding solutions to improve the quality of water which are practical and sustainable for the migrants.

John Vargas, Canada

   Health and Community Care Project Manager, Punjab

Nutrition and Hygiene Workshop with Kids in Naddi

A few weeks ago, RuralhealthCARE India ran a workshop in Fun Club (the after school program in Naddi) to help kids learn about nutrition and hygiene.  The workshop started off with a science experiment showing what happens when a drop of soap is placed in a plate filled with milk and food coloring, and how the soap seems to ‘push away’ all of the colors in the plate.  The experiment was followed with a conversation about soap and hand washing.  The kids discussed why washing hands is beneficial, and when they felt it is most important to wash hands: before cooking food, before eating, and after using the toilet. 

Watch a video of the Science Experiment!

            Next, we talked about nutrition.  The kids learned about how it is important to eat a variety of different foods: grains and pulses, fruits and vegetables, oil and nuts, and foods from animals.  Everyone called out foods from each of the different food groups to write on a poster.  For ‘grains and pulses,’ they mentioned dal, channa, rice, chapatti, and rajma.  Under ‘fruits and vegetables,’ they brought up mangoes, bananas, apples, tomatoes, cucumbers, and several others.  ‘Foods from animals’ included milk, cheese, yogurt, eggs, chicken, and mutton.  Lastly, ‘oil and nuts’ included butter, ghee, and peanuts.  The kids learned why each type of food is important.  At the end of the workshop, everyone drew the silliest pictures they could imagine that included at least one food from each of the food groups.  Before they went home, each of the kids got to eat some fruit- but not before washing their hands!

            Overall, the workshop was very successful.  The kids learned a lot about how to make healthy choices and why they are important, and the science experiment proved to be a great way to get everyone engaged.  The kids also had a lot of fun drawing pictures- it gave them a chance to be creative and show their artistic sides while exploring food and nutrition.  Using science and art as tools for teaching and engaging kids seems to be an effective way to get everyone interested in the topics, and the health workshops in Fun Club will hopefully have positive implications for the kids in the long run as they grow older.  Our hope is that by maintaining a presence of RuralHealthCARE India in the community and continuing to promote healthy decisions, the kids will adopt more healthy behaviors that they will keep up throughout their lives.

Craig Rothenberg, USA
Rural HealthCARE India
June - August 2013

Steps towards a Healthier Rajol

After building trust and community relations with the migrants in Rajol over the past 3 months, we have now gained the confidence to talk to them about more sensitive topics, such as health.  When we first began working in the migrant camp, we feared that they would resist health interventions.  Through interactions with other migrants from Rajasthan, our Director learned that the migrants did not trust the hospitals or allopathic medicine in general.  Although traditional medicine can be effective at times, we were dismayed to hear that they refused vaccinations, instead boiling the hair of certain animals to treat or prevent disease. 

Fortunately however, our recent health survey in Rajol only revealed good news – a willingness of the migrants to seek and accept health care.  The migrants in Rajol do not practice any traditional medicine, and therefore feel very dependent on the chemist (pharmacist) down the road.  Whether for headaches, work injuries, or disease, the migrants accept all drugs recommended by the chemist without question, paying him their hard earned money for ineffective and temporary solutions.  We advised them to go the government hospital instead, where they could see a doctor, receive a diagnosis, and get prescriptions for any necessary medicines.  Although they said they did not trust the government hospital – claiming that the only good hospitals were ones you had to pay money for, the private ones – they agreed to visit the public hospital with me this week.

A few days ago, I went to the government hospital in Dharamshala with the village leader, his wife, and their son, Rajesh, an adorable 9 year-old boy with Down’s syndrome.  After a very long day waiting for and speaking with doctors, we left the hospital feeling successful – diagnostic tests scheduled for next week.  We are unsure what solutions we will find for Rajesh at this hospital, but this is a great first step in their pursuit for health care.  Through this visit and subsequent visits, I am hoping to show the migrants that the government hospitals are accessible, affordable, and trustworthy.  And we are hoping that this will result in continued use of hospital services, instead of blind obedience to a money-hungry chemist.  In the end, our influence as MCE and health interns could result in a healthier, more financially empowered community. 

With the pediatrician

Outside the hospital

Betsy Hinchey, United States

Rural HealthCARE Project Manager

March – July 2013

Nutrition Workshop with the Paro Community!

During the month of June great steps have been made towards improving health habits in the Paro community. After becoming aware that some nutrition habits of the community are a problem leading to health issues (such as weakness, shakiness, fevers, etc.) we decided to work on this. Therefore, Iria and I, the health interns in Punjab, organized a nutritional workshop with the girls in the office and with the women at the camp. The workshop was carried out in two different days and it was a great success: we all had a lot of fun and learned different things related to diet and health. The first day we talked about their nutritional habits and how they could be improved, using some flashcards and giving them some tips (such as drinking at least six glasses of water everyday, highlighting the importance of diet when breastfeeding or the importance of eat a variety of food).

                                   Sajana, at the camp, with one of the flashcards with some tips.

We also covered the properties of the different vegetables and fruits that they can find in Paro using as well flashcards for each vegetable (its name and picture), its properties, its price and how can it be cooked.

                      Omti, Jamna and Nura going throw the flashcards of the different vegetables and fruits with Iria.

This flashcards are now in the office and the girls can look up the information whenever they want. We also played a game in which they had to guess which food they tasted without seeing it. It was so much fun!

                           Geeta and Chandas at the office, playing the ‘guessing game’ with Iria and me.

                                          Omti and Nura playing the ‘guessing game’ at the camp.

Last, we worked on the Indian food pyramid and we compared their habits to what it is recommended (what food do they eat and in what amount). Finally they created their pyramid, which is now in our office!

                                     The food pyramid that they created, which is now in the office.

Iria and I carried out the workshop without help on translation (and we understood the women and they understood us pretty well)! We end up talking about different health issues (related to pregnancy, diet, and hygiene). We are developing a trusting relationship in which we can talk about different issues and relate hygiene and nutrition with health problems. I think that this is a great step!

Besides the success of the nutritional workshop in Paro, we have more good news here in Punjab: a new health intern has arrived, Ouma, who will be working in Harianna. Now, Ouma and I are going to work to improve the health situation of the communities in Paro and in Harianna. This next month we are going to keep doing more educational activities, as we think it is very important to promote health through education.

Carla Andrés Viñas, Spain

Health Project Manager

June 2013