Reduce Infant & Maternal Mortality in the Himalaya

 
$10,307
$9,693
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Apr 7, 2014

REDUCE INFANT & MATERNAL MORTALITY IN THE HIMALAYA

Hema of Karayal with her smokeless chullah
Hema of Karayal with her smokeless chullah

REDUCE INFANT & MATERNAL MORTALITY IN THE HIMALAYA:  January - March 2014

 

1  COMMUNITY HEALTH

After conducting a baseline survey in 15 villages, we started collecting information from the 35 villages in which we will be working in the first year. The villages are Okhalkanda Malla, Okhalkanda Talla, Khansyu, Chyurigaad, Pokhari, Kulori, Putgaon, Reekhakote, Tanda, Surang, Sui, Jamraadi, Takura, Karayal, Rekuna, Tushraad, Paitana , Ramela, Putpudi, Bhadrakot, Herakhan, Dewli, Kalaagar, Kwerala, Gargadi Talli, Gargadi Malli, Galni, Teemar, Chamoli, Jhadgaon Malla, Jhadgaon Talla, Saal, Badoun, Thalaadi and Bagor.

Highlights of the past 3 months work with the community

1.1  Exposure visit

From 18-23rd January Aarohi health staff visited Jan Swasthya Sahyog (JSS), a voluntary, non-profit and registered society founded by a group of health professionals committed to developing a low-cost and effective health program that provides both preventive and curative services in the tribal and rural areas of Bilaspur district in Chhattisgarh. The objective of the visit was to gain exposure to JSS’ activities. Those of note that Aarohi would consider replicating or adapting to their own work environment, include:

-meetings in which creative learning materials are used to raise the awareness of adolescent girls of issues such as personal hygiene and menstruation

- forming self-help groups amongst local villagers to address health or social issues

- organising fairs at the local market to spread awareness of health and social issues

- providing supplementary food when giving medicine to patients to boost their immunity

- colored thermometers for illiterate health workers to identify if a person is running a fever and provide medicine with the help of diagrams.

1.2  Training Camp

Dr. Ramani Atkuri, a consultant, trained senior Aarohi staff and trainers on Ante natal care, Post natal care, Neonatal care, sepsisin neonatal, nutrition, malnutrition, diarrhoea and growth monitoring. The training took place from 26th-30th of January and occurs twice a year as a means of updating Aarohi’s staff’s knowledge.

1.3  Health Management information System (HMIS) training

Mr. Ganga Singh and Mr. Nain Singh trained the 13 Aarohi health supervisors on HMIS tools that they use in the field. Sessions focussed on how to use HMIS tools and their importance for the project – the recording of essential data in progress reports, daily activity schedules, and child growth monitoring charts. This provides a refresher for most supervisors and is a necessary introduction for new supervisors.

1.4  CommCare Programme

Since March 2013 Aarohi has been running a pilot project using an innovative job aid tool for mobile health workers. The tool is a free, open source mobile phone application that Aarohi developed in conjunction with Dimagi Inc, an American not-for-profit. Ten Accredited Social Health Activists (ASHAs) have tested the application in the Okhalkanda Block of Nainital district in their door-to-door ‘safe motherhood’ educational visits to families. The results have been a win-win-win, benefiting the women and families to whom the health awareness work is targeted, the ASHAs themselves as well as their managers. The novelty of a multimedia questionnaire using sounds and images on a mobile phone sustains the interest of the woman interviewed as well her whole family allowing the ASHA to provide health awareness more effectively to her target groups. The mobile-phone application questionnaire also ensures that the AHSA does not forget to transmit crucial information during her health education exchange with the women and their families. The application is a lighter and more efficient way for the ASHA to record and manage the information she collects (rather than recording it all into countless paper notebooks) from each visit. Given that the data is automatically uploaded onto a cloud server each time that the ASHA has internet access, real-time information becomes available to managers allowing evidence-based change to strategies in order to respond to needs. The availability to managers of the information on the interviews conducted by ASHA also makes remote supervision far easier. In light of the positive results of the pilot, Aarohi intends to expand its use of the application to all health workers in the area and make it available for use by other organisations.

1.5  ASHA selection

Aarohi’s proposal to train ASHAs in Okhalkanda Block was approved by the Uttarakhand Health and Family Welfare Society, the state government body. This training, which will start in April 2014, will supplement and provide key additional information and skill not covered by government training. Aarohi thus looks forward to receiving better-quality data from the ASHAs who have been trained; indeed they are the only people collecting such data at the grass-roots level.

During the reporting period, Aarohi identified ASHAs in Aarohi intervention villages who will each be paid Rs. 500 per month and who will benefit from Aarohi’s training and mentoring.

Mother and Child Data*:

Aarohi health supervisors are in the process of weighing all children aged 0-5 years in the project areas and have identified malnourished and severely malnourished children. Further advice on diet is being provided to mothers.

Health supervisors are also visiting all pregnant women in the project areas and encouraging them for undergo regular antenatal checkups.

TOTAL NO. OF VILLAGES:                       35

TOTAL POPULATION:                         17,379

ELIGIBLE COUPLES:                               613

NO. OF PREGNANT WOMEN:                    82

LACTATING MOTHERS:                            54

CHILDREN (0-6 MONTHS):                         97

CHILDREN (6 MONTHS- 1 YEAR)              27

CHILDREN (1-3 YEARS)                          414

CHILDREN (3-6 YEARS)                          341

* The data is incomplete due to the fact that we had a few supervisors who had quit their jobs and therefore no information was collected from the villages in their absence.

 

Mobile health care monitoring comes to a Himalayan village

Just 23 years old, Keshvi represents the typical mountain woman whose life is defined by relentless house work from morning till dusk, poor education and marginalized social status. Keshvi is all of this but a lot more as well. She has been working as an ASHA (Accredited Social Health Activist) in her village Galni, Okhalkanda Block for over two years now. When Aarohi started working in village Galni for the first time, not many women were open to work as health workers. They did not have the time to do anything but housework. Keshvi would have been one of those women as well if her father in law did not encourage her to take up the role. Since then, there has been no looking back for her. Not long after she joined as a health worker, the VHNSC (Village Health, Nutrition and Sanitation Committee) recruited her as an ASHA- Keshvi’s commitment to her work and potential to grow had not gone unnoticed.

During the second phase of the Aarohi Arogya Project when the Commcare application was introduced, Keshvi joined as one of the mobile users. In the beginning she found it challenging to work with a mobile phone as she had never used one before. While the other workers were literate enough to read the instructions and were aware of how to use a mobile phone, Keshvi, a school dropout in class 5, could not use one. Taking it as a challenge, she started learning how to operate a mobile phone first and then how to operate the Commcare application. In just three months, she was able to operate the application without any problems.

Today Keshvi is the best mobile user we have under the Commcare programme for maternal and childcare. She updates and collects information from the village on a regular basis. She even does her own basic troubleshooting regarding the application or the phone.

Keshvi has proven that all one needs to use the Commcare application is just the will to learn.

 

 2  CURATIVE HEALTH

2.1  Routine clincial services based out of hospital in Satoli continued with a fair increase in surgicak wiork done through monthly mulit-specialty camps.

TOTAL PATIENTS TREATED                                      1158

VILLAGES COVERED                                                     49

SPECIALIST CAMPS HELD                                              4  

PATIENTS TREATED IN SPECIALIST CAMPS               460             

SURGERIES PERFORMED                                             41    

ULTRASOUNDS PERFORMED                                        63

DENTAL CAMPS HELD                                                    2       

DENTAL PATIENTS TREATED                                       67

2.2  Mobile Medical Unit (MMU)

Aarohi signed a contract in October 2013 with the Government of Uttarakhand to reactivate the first Medical Mobile Unit  that ran in Uttarakhand until 2012. The reactivated MMU will improve the reach of Aarohi’s clinical services to remote areas in the districts of Nainital and Almora. It will be staffed by a General Physician, a Lab Technician, an X-Ray Technician, a Nurse and a Pharmacist. Specialists and a Radiologist will be made available for 25% of the camps. The MMU will be capable of conducting ultrasounds, X-Rays, ECG, distribution of drugs, blood tests, sputum exam for Tuberculosis and will provide immunisation and family planning services.

The MMU which was lying idle at the Birla Institute of Applied Sciences has been transferred to Aarohi. After inspection of the equipment, the vehicle was taken to Haldwani for repair. The unit will next be sent to Delhi for major repairs and servicing. It should be functional by 1st May.

 

 

 

 

 

 

 

 

 

 

 

Eye Camp in Satoli
Eye Camp in Satoli
After the Eye Camp
After the Eye Camp
Jan 2, 2014

Reducing Infant,Maternal Mortality in the Himalaya

Mother and child at a improved cookstove workshop
Mother and child at a improved cookstove workshop

REDUCING MATERNAL AND CHILD MORTALITY IN THE HIMALAYA:  Oct-Dec 2013

Community Health

The beginning stage of the third phase of our project that is largely funded by Sir Dorabji Tata Trust Mumbai, included a baseline survey which was completed in November and involved randomly selected 15 villages and 430 households from Okhalkanda Block. The villages covered were – Paijaina, Dalauj, Kotla, Kafli, Tanda, Putgaon, Sakalwar, Patrani, Bhumka, Thushrar, Takura, Kotli, Baramdhar, Reekhakot and Soude. The data collected is currently being analysed.

 Highlights of 3 months of continuation work with the community were:

 Training

-       Dr. Ramani Atkuri, a consultant under the project conducted a training workshop at Satoli from the 8th -11th of October 2013. She helped in preparing a roadmap for trainers, shortlisted activities that need to be done in the first year and reviewed schedules for reporting and feedback, baseline survey and monthly schedules for supervisors. She also conducted practical training for the supervisors on Haemoglobin testing and taking Blood Pressure.

-       Training for the building of smokeless chullahs (improved cooktoves) was conducted by Mr. Saulunkhe from ARTI, Pune from 18th- 20th of October 2013 in Khansyu. The villages- Putpudi, Ramaila and Galni were identified from in and around Khansyu and Karayal and training were given to the masons on how to build the chullahs. Follow up was also done on the chullahs that were built in the past to identify the issues faced by the users using the chullahs. The houses using chullahs have had an immediate decrease in smoke inside the house and have also reported a reduction in consumption of wood.

-       A training workshop on mental health was conducted at the Aarohi office in Khansyu by Dr. Mukesh Shah. He gave training to the supervisors on identifying common mental conditions with signs and symptoms of each condition.

 

Monthly meetings

 Regular monthly meetings were conducted with the health supervisors for planning and the sharing of work done and also on discussions about field related problems.

Mother and Child issues

 

The health supervisors are in the process of weighing all children in the age group of 0-5 years in the project areas and have identified the malnourished and severely malnourished children. Further advice on the diet is being provided to the mothers.

All pregnant women in the project areas are also being visited and ante natal checkups are being done.

Data on both will be obtained by January 2014.

VHSC (Village Health and Sanitation Committee) meeting

Twelve meetings of the VHSC were conducted. Issues taken up were regular supervision and monitoring of the ASHAs, their incentives, bank accounts, balance funds with the VHSC, other health related issues of the village and roles and responsibilities of VHSC.

Commcare Programme

-        Commcare is a cell phone based application that aims to enable the community health worker at the field level to provide better and more efficient care while also enabling better coordination as well as monitoring and evaluation of the community health program.

-       The program is running as per schedule and regular reporting and troubleshooting is performed on a scheduled basis. We have got the permission to scale up our operation by increasing the number of the mobile app users. Dimagi will be supporting us in capacity building and funding for the purchase of more cell phones.

 Mobile Medical Unit:

-       Aarohi has signed a contract with the Government of Uttarakhand to reactivate the first Medical Mobile Unit to be used in and around the District of Nainital.

-       The mobile van will help us to improve the reach of clinical services to remote areas in the districts of Nainital and Almora.

-       The van will cover around 50-55 villages in the two districts every month and these are areas where Aarohi already runs its community health program.

-       The medical unit will have the services of a general physician, a lab technician, an X-Ray technician and a nurse cum pharmacist. Specialists will be made available for 25% of the camps.

-       The unit will be capable of conducting ultrasounds, X-Rays, ECG, distribution of drugs, blood tests for malaria, sputum exam for tuberculosis and family planning services.

 Clinical Information: 

A detail of patient care at the Aarohi hospital is reflected below:

TOTAL PATIENTS BENEFITED                                  1366

TOTAL VILLAGES COVERED                                        45

SPECIALIST CAMPS HELD                                             4  

PATIENTS TREATED IN SPECIALIST CAMPS             109              

TOTAL SURGERIES DONE                                           7     

TOTAL ULTRASOUNDS DONE                                     28

DENTAL CAMPS HELD                                                   2       

TOTAL DENTAL PATIENTS TREATED                         141               

 

Post-operative, cheek to cheek with the Surgeon
Post-operative, cheek to cheek with the Surgeon
Oct 7, 2013

Reducing Maternal & Child Mortality in the Himalaya

Devki
Devki

04 Oct 2013

REDUCING MATERNAL AND CHILD MORTALITY IN THE HIMALAYA:  Jun-Aug 2013

Community Health

Our health program focuses on rural Kumaon’s most marginalized, i.e. women and children. Girls bear the brunt of the domestic workload, are married off early, are frequently pregnant and, are given second priority in education, nutrition and social rights. They are also subjected to a host of prejudices relating to menstruation and childbirth. Consequently, they have little time, energy or will to look after their children’s basic needs. No wonder, Uttarakhand’s Infant Mortality Rate is 41 per 1000 live births and Maternal Mortality Rate 188 per 100,000 live births as per the 2011 Census.

Our three-year health project supported by Sir Dorabji Tata Trust (SDTT) closed in January 2013. It sought to create a replicable, community-based health care model to minimize maternal and child mortality while improving overall human health and wellbeing in 30 villages of Nainital District’s remote Okhalkanda Block. The third phase of the `Arogya Project’ has been approved by the Sir Dorabji Tata Trust and will formally begin in August 2013. Funds collected from friends and well-wishers through Global Giving were used to continue basic maternal and child health care services in this interim period.

Our health program focuses on rural Kumaon’s most marginalized populations, i.e. women and children. Girls bear the brunt of the domestic workload, are married off early, are frequently pregnant, and are given second priority in education, nutrition, and social rights. They are also subjected to a host of prejudices relating to menstruation and childbirth. Consequently, they have little time, energy or will to look after their children’s basic needs. No wonder, Uttarakhand’s Infant Mortality Rate is 41 per 1000 live births and Maternal Mortality Rate in Okhalkanda Block of Nainital District, in particular, is 353 per 100,000 live births, alarmingly above the state average of 188 as per the 2011 Census.

Highlights of 3 months of continuation work with the community were:

Training

Nine trainings were organized for ASHAs (Government appointed Accredited Social Health Activists) and Swasthya Karmis (Community health workers) Topics covered were:

  • Measurement of Haemoglobin by Sahli’s method
    Malnutrition in children 0-5 years
  • Commcare (mobile phone technology for data collection by community health workers) follow up – technical and application related problems.       
  • Evaluation of health workers

All 24 SKs attended the trainings.

Monthly meetings

Regular monthly meetings with the community health workers for planning and sharing of work done and on discussions about field related problems.

Mother and child issues

The community health workers weighed all children 0 to 5 years of the all project villages on a monthly basis, and identified malnourished and severely malnourished children. Dietary advice was given to mothers as per protocol.

All pregnant were visited, Antenatal check-ups done

VHSC (Village Health and Sanitation Committee) meeting

Twelve meetings of the VHSC were conducted. Issues taken up were regular supervision and monitoring of SKs and ASHAs, their incentives, bank accounts, balance funds with the VHSC, other health related issues of the village and roles and responsibilities of VHSC.

Commcare program

  • Regular follow-up of the field mobile users according to schedule.
  • Technical and application related trouble shouting of the mobile users.
  • Regular reporting to the Dimagi (US based company supporting the program) team.
  • Field level direct supervision and technical support to mobile users.

 

Life beyond the norm 

Life in the mountainous regions of Uttarakhand is tough for women. Deprivation of basic services such as health and education is rife in the region. Despite their adverse living conditions, rural women of the mountains play a crucial role in their society. They are incessantly engaged in daily activities from looking after their homes to managing the farm. Although they play an important role in family and society, this is barely acknowledged.

This is a story of 53-year-old Devki Devi, whose husband died 10 years ago. She lives in Khansyu Partola, a village situated in the hilly region of  the Okhalkanda Block of Nainital district in Uttarakhand. Her daily routine was not different from other women of the region. It was the routine grind of waking up in the pre-dawn hours, looking after cattle, cooking food, getting children ready for school, going to the forest to collect fodder, cleaning and washing and engaging with farm work until late in the night when it was time to sleep.

Devki has four children. Even during her pregnancies, she had no respite from her daily toil. One day while she was returning from the field with a heavy bundle of grass, she squatted and delivered a baby. Everything seemed normal at that time. But after four months, she started to notice that her uterus had come out. She lived with this problem for 10 years and did not see a doctor or go to a hospital. In August 2013, the problem became worse and she noticed that pus was coming out from her uterus. She then got in touch with Aarohi with the help of her neighbor and got operated at Aarohi’s hospital in Satoli during a surgical camp. She is now well and lives a normal life. She says “I was not able to get treated earlier only because I did not know that this could be treated and neither could I take the time off from my daily routine. I am happy that Aarohi has saved my life.”


 A detail of patient care is reflected in the table below:

Sr. No.                  PARTICULARS                                                          JUN-AUG 2013

           TOTAL PATIENTS BENEFITED                                                                    1088

1         Total patients treated in hospital                                                                       675

               Female                                                                                                      270

               Male                                                                                                          365

               Children< 5 years                                                                                         40

               Indoor patients seen                                                                                     12

               Home visits / Emergencies                                                                             0

               Laboratory Tests                                                                                         240

               X-Rays                                                                                                        21

               ECG                                                                                                             4

               Total villages covered                                                                                  45

2    School children screened for Health problems                                                     0

3    Specialist camps held                                                                                          4

      Total patients screened                                                                                       212

      Plastic Surgery                                                                                                      0

      Pediatrics                                                                                                              0

      Eye                                                                                                                     27

      Gynae                                                                                                                 22

      Surgery                                                                                                               29

      ENT                                                                                                                     0

      Medicine                                                                                                           130

      Skin                                                                                                                     0

     Total surgeries performed                                                                                      11

    Total ultrasounds done                                                                                           42

4   Dental camps held                                                                                                3

       Total dental screenings                                                                                   131

       Dental screening for school children                                                                     32

       No. of dental extractions                                                                                     30

5     Mobile health camps                                                                                          1    

          No. of patients treated48

         No. of children given health checks and de-wormed                                             26

* Decrease due to the absence of our volunteer Paediatrician for the past few months

In these three months, funds from Global Giving co-supported by Aarohi Schwiez, enabled 4 specialist health camps in Satoli. A total of 1088 patients were treated and 42 ultrasound investigations done during these camps with the help of visiting volunteer doctors. A further 131 patients were treated for dental problems. 11 surgical procedures including cholecystectomies and hysterectomies were performed. 

Traning health workers to do Haemoglobin estimate
Traning health workers to do Haemoglobin estimate
Jun 3, 2013

Reducing mortality in Kumaon: Summing up 3 years

Happy mother and child
Happy mother and child

     REDUCING MATERNAL AND CHILD MORTALITY IN KUMAON: A SUM UP OF THE LAST 3 YEARS

Community Health

Our health program focuses on rural Kumaon’s most marginalized, i.e. women and children. Girls bear the brunt of the domestic workload, are married off early, are frequently pregnant and, are given second priority in education, nutrition and social rights. They are also subjected to a host of prejudices relating to menstruation and childbirth. Consequently, they have little time, energy or will to look after their children’s basic needs. No wonder, Uttarakhand’s Infant Mortality Rate is 41 per 1000 live births and Maternal Mortality Rate in Okhalkanda Block of Nainital District, in particular, is 353 per 100,000 live births, alarmingly above the state average of 188 as per the 2011 Census.

Our three-year SDTT[1] supported health project closed in January 2013. It sought to create a replicable, community-based health care model to minimize maternal and child mortality while improving overall human health and wellbeing in 30 villages of Nainital District’s remote Okhalkanda Block.

Key project achievements have been:

  • All 12-to-23 month old children immunized in these 3O villages, up from 87% in the 2010 baseline survey.
  • 98% antenatal care for pregnant women, up from 34% in the 2010 baseline survey.  By Aarohi’s definition, this includes 3 Antenatal Care visits by a competent health care provider consisting of a physical examination, Haemoglobin estimation, 2 TT Injections, and the dispensing of 100 Iron Folic Acids Tablets.
  • No mother has died during childbirth (or from child birth complications) in the last one and half year.
  • Institutional deliveries rose to 42% against a 10% baseline in 2010, and Aarohi-trained Dais (midwives) now conduct 56% of all home deliveries in the project area.
  • Malnutrition in children below 3 years has dropped from 38% (first half of 2011) to 18%.
  • Capacity building of village level health workers (Swasthya Karmis, ASHAs and Dais) in identifying and referring high-risk mothers, in antenatal care, postnatal care, community mobilization on health issues and in treating minor illnesses.
  • Capacity building of organizational staff for better planning and implementation of programs through village committees.
  • Successful community mobilization and sensitization of village institutions on health issues, including Gram Panchayats, VHSCs (Village Health and Sanitation Committees) and Schools.
  • Active participation of school teachers and students in creating health awareness in the project area.

Health partnerships with government and other NGOs have strengthened significantly. There is better networking with ASHAs (Government-appointed Accredited Social Health Activists), ANMs (Government-appointed Auxiliary Nurse Midwives), block NRHM (National Rural Health Mission) Coordinator and PHC (Primary Health Centre) for implementing village level NRHM goals; regular sharing of work and six-monthly reports with CMO, Nainital (Chief Medical Officer); conducting Eye and Family Planning Camps with support from District level medical teams; liaising with the NRHM State Director for possible association with the state government under the PPP (Public Private Partnership) modeL, liaising with the State and District Coordinator of RSBY (Rashtriya Swasthya Bima Yojana) for empanelment of Aarohi Arogya Kendra under the RSBY Scheme; signing an MOU with “Dimagi Incorporated”, Massachusetts Ave, USA to address maternal and child health issues through mobile telephone technology.

The project’s key beneficiary groups are summarized below:

Villages    30

Households    2,058

Population benefited  12,337

 Pregnant women attended to  1,589    (3 years)

Total deliveries undertaken    1,788      (3 years)

Children identified with sickness episodes and consulted / treated by health workers    1,991    (data  for last year)

Target children for primary immunization    (12-23 months)   1,297    (Annual)

Children 0-5 years monitored for nutrition status   1,234    (Annual)

Children in schools for health awareness   2,967  (Annual)

Youth in colleges interacted with    1,062   (Annual)

VHSC members trained   409     (3 years)

VHSC meetings held   511    (3 years)

Total attendance in VHSC meetings   5,893    (3 years)    Average of 14 persons per meeting.

Trainings & workshops conducted   457    (3 years)

Total attendance in trainings and workshops   11,425   (3 years)     Average of 25 persons per training

Happily, SDTT will now support the scaling-up of this project to the entire block, covering 105 villages and a population of approximately 42,000. Funding through GlobalGiving have been extremely useful in filling gaps in funding and maintaining continuity of work.

 

Core competencies of Aarohi

Extract from end term Evaluation Report by Dr Ramani Atkuri (4-8 Dec, 2012)

Aarohi’s main strength lies in its credibility with the community as well as the local health authorities as an organization that is serious about the work it is doing, as well as one which is willing to work in difficult-to-reach areas. The fact that Aarohi has a field office in the project area helps them to understand the situation of the people there and make their own work more relevant.

The team at Aarohi has been able to establish good linkages with Panchayati Raj Institutions at the village level, which is crucial for bringing about sustainable change in the health knowledge and practice in these communities.

Capacity building of health personnel at the village level – of birth attendants as well as of health workers – is another strength of Aarohi. A lot of thought has gone into defining the training curriculum and the training schedule is meticulously followed. The training team is motivated and hard working and has built the knowledge and skills of village level health workers as well as improved awareness levels of the community on various health issues.

The organization has a system in place for regular data collection and collation, as well as for analysis.

The health team of trainers, supervisors, technician and BSPT animators, led by the Assistant Coordinator and Coordinator is young and energetic and motivated. They are able to learn and adapt - amply demonstrated by the number of design modifications that the smokeless chulha (stove) has undergone to make it more user-friendly for the community here.

 

Challenges and recommendations

Adapted excerpts from the end-term Evaluation Report by Dr Ramani Atkuri, M.D., 4-8 Dec 2012 (the full Report is available on our website).

Evaluators’ observations relating to training and supervision

  • The training team’s knowledge of Maternal and Child Care and some other subjects requires strengthening. Also, while the program focuses mainly on maternal and child health, other women’s health issues may warrant attention, especially as uterine prolapse and vaginal infections are a common problem here.  
  • While the team also trains Health Workers, Supervisors and Dais (Traditional Birth Attendants) to refer anything out of the ordinary, quite a few of these conditions can be handled at home or at the village level.
  • Aarohi needs to strengthen Health Worker supervision to ensure that all components of the planned Antenatal and Postnatal care program are systematically carried out.
  • Aarohi has a good system of data collection in place, and it is also collated well. However, analysis of data has remained very basic and a lot of valuable information could be inferred with more detailed analysis of the statistics already available.

Evaluators’ observations on child health issues

  • Monitoring child growth using adult bathroom scales does not give the required amount of accuracy. It is recommended that spring scales (eg Salter) upto 25 kg be used. These are typically present in all Anganwadi centres.
  • While Aarohi reports show under-3 malnutrition reducing (which Aarohi staff attributes to maternal education about childhood diet and safe water, deworming and vitamin supplements), a continuing problem is that children are left to fend for themselves when mothers go out to get firewood or work in the fields.
  • Reduced child deaths are attributed to better health awareness in the communities thanks to 1) children’s teams of village health educators (Bal Swasthya Prachar Teams or BSPT), ii) improved functioning of Village Heath and Sanitation Committees, and iii) Aarohi’s own advocacy with the Government to improve immunization services and hospital transportation. 
  • The BSPT is positively impacting the knowledge and behaviour of children, who will be the future agents for change. It is recommended that this initiative be continued.
  • Aarohi’s health awareness work with adolescents is a very important initiative, though not part of the project. If strengthened and systematized, it will also go a long way in improving women’s health. 
  • Finding over 80% of water sources to be contaminated, Aarohi educated villages on the importance of boiling water and keeping water sources safe. However, Aarohi staff says that diarrhoeal disease continue to occur, though much reduced due to the ORS use and better transport to hospital. Worryingly, 25% of infant deaths appear to be diarrhea-related.

 

Evaluators’ observations on community related-issues

  • Aarohi’s efforts to inform people about the various programs and entitlements under the National Rrural Health Mission and the Rashtriya Swasthya Bima Yojna has been effective in terms of empowering people to access these services. Aarohi can also be commended for its efforts to strengthen Village Health Sanitation Committees and other community process, how well they function is not entirely in the hands of the Aarohi team.
  • Aarohi’s ‘demonstration’ trainings in rainwater harvesting structures, garbage pits and smokeless chulhas are being used well.
  • Aarohi needs to consider whether it wants to tackle alcoholism, and domestic violence against women, two common and serious problems in this area.

 

                                                    The smile that tells a thousand tales

This story is of a family in a small and picturesque village called Karayal, in the remote Okhalkanda Block of Nainital District, where Aarohi works.

Ghanshyam Bahuguna, 36, lives with his wife, Shanti Devi, 32 and his mother, Aama. Pankaj, their son, is one and a half years old. Shanti has been pregnant five times already for the social and family pressure to produce a male child is overbearing in a typical mountain family. And, like her counterparts, her domestic chores are immensely demanding physically. Shanti’s day starts at 5 am and ends at 10 pm. Every Single Day. Yet, she still smiles, for – as she says – happiness finds its ways in little moments, even in a mountain woman’s shattered dreams.

Shanti had a miscarriage during her first three pregnancies, and given the family’s indifference, bore both her emotional and physical suffering alone. The family’s only interest was that she deliver a male child. But, life would give Shanti another chance. She became pregnant a fourth time, just as Aarohi started working in her village, teaching women the importance of ante-natal care and training/organizing Swathya Karmis (health workers) to conduct regular check-ups. Shanti went for a check-up, where the Swasthya Karmi – discovering a breech presentation - advised hospital delivery. However, Shanti was not free to act on this advice, since family elders still typically take all decisions in rural Indian households. Shanti’s conservative mother-in-law, Aama, ruled that her daughter-in-law would deliver at home as she had, assisted by the village mid-wife.

But Aama and the midwife could only get the baby half way out. Lodged firmly inside its mother, the baby died and Shanti lay for hours in a pool of blood - physically and emotionally broken. Yet, the family refused to take her to hospital! Here, Aarohi’s intervention was crucial. The Swasthya Karmi mobilized the village to get Shanti’s family to take her to hospital. Miraculously, she survived, though with the continued stigma of childlessness.

A year later, Shanti was pregnant again. But, by now, Aarohi was well established in Karayal; and its Swasthya Karmi’s made regular home visits to check on expecting mothers and ensure their families gave them utmost care. So, Shanti was closely monitored. Once again, the baby was in a breech position. But, this time the family cooperated, and Shanti delivered a healthy baby boy in hospital by Caesarean Section. Both mother and family were overjoyed.

We ask Ghanshyam how he feels today. Thoughtfully, he says, ‘yadi hamne Aarohi walon ki salaah pahle hi maanee hoti to hamen etnaa pareshaan nahi hona padta…’. (had we heeded Aarohi’s advice earlier, we would not have had to suffer so much).

Shanti tale is not different from that of many rural mountain women. When life presents an unending tedium, happiness finds its ways in little moments. Perhaps that is the secret behind Shanti’s smile. 

 

Curative Health

We continued essential routine outpatient, inpatient, diagnostic, emergency services from the hospital at Aarohi. Multi-specialist camps were conducted on a monthly basis providing surgical, ultrasound, medical, paediatric and eye care. During the year, special camps for reconstructive surgery were organized twice, along with ENT camps, and Cataract and family planning camps were conducted in conjunction with the district government facilities. Mobile camps in remote mountain regions were conducted once in Pindari river basin. One camp was aborted due to heavy monsoons that washed the roads away. These camps were clubbed with school medical check-ups in the local schools with deworming and vitamin and calcium supplements for children. The children were monitored for their growth and advised accordingly.

The table below summarizes the leading performance parameters of our hospital-based services this year:

Health at a glance 

OPD patients treated at Aarohi Arogya Kendra     1,894

Inpatients treated    62

Home visits / Emergencies   10

Laboratory test    1,535

X Ray      113

Ultrasound    269

Total villages covered   50

School children screened for health problems     134

No. of dental camps   11

Dental screenings for school children  102

Total dental screenings   412

No. of total dental extractions    130

No. of dental fillings    27

Other specialists camps    13

Total patients treated in specialist camps   1,116

Total surgeries done in camps   55

Mobile health camps   10

No. of patients seen in mobile health camps   303

Total patients benefited   3,877

 

                                                       Saraswati gets a new lease of life

This story is of Saraswati, from Khansyu village in Okhalkanda Block. Educated till class 5, she is married to a Block Development Committee member and her three sons now live away from them.

Saraswati’s tale is like that of many a woman from the area. She was married at the tender age of 16 and became a mother a year later. During her second delivery, her uterus prolapsed. This fact was kept secret due to an innate hesitancy, ignorance and family constraints. When she delivered her third child, her problem increased in severity and the local midwife informed her husband. Saraswati and her husbannd were caught in the routine of village life of bringing up children, managing livestock and the farm and could not find the time to get proper medical consultation.

With heavy workload, Saraswati’s problem grew worse and she had great difficulty in sitting and passing urine. She was eventually advised surgery 4 years ago by a doctor and again a year later by the Aarohi health team members. On consulting with various hospitals in Haldwani, they found out that the expenses involved would amount to around INR 25,000/-. They were unable to afford this and surgery was once again postponed.

Saraswati was finally operated at Aarohi’s monthly surgical camp in March 2013.  Her postoperative recovery was remarkable and the entire cost of her surgery and stay in hospital was just INR 5,000/-. In her words `Aarohi has given me a new lease of life. You have saved not just me but preserved my family life. The attitude and care of the staff at the Aarohi hospital has been really good. There are many others here who have a similar problem and I will ask them to get operated at Aarohi. God Bless all of you.’

 

 

[1] Sir Dorabji Tata Trust

Shanti and family
Shanti and family
Saraswati gets a new lease of life
Saraswati gets a new lease of life
After a cataract camp at Aarohi
After a cataract camp at Aarohi
Jan 28, 2013

Reduce Infant & Maternal Mortality in the Himalaya

Dr Tanmay Singh (Dentist) at work
Dr Tanmay Singh (Dentist) at work

THIRD REPORT FOR GLOBAL GIVING: AAROHI’S HEALTH EFFORTS JUL - DEC 2012

28 January 2013

Since the month of April 2012 when Aarohi's project to “Reduce Infant and Maternal Mortality in the Himalaya” was posted on Global Giving's website, people from all walks of life have found it in their hearts to contribute. These contributions have had an incredibly positive impact on the project, benefiting and supporting whole communities through Aarohi's Mother and Child health program.

This third report aims to put six months of work from July to Dec 2012 into perspective.

Located in the Kumaon Himalyas of Uttarakhand, India, Aarohi’s project serves a population of approximately 12,500. Funds raised on the Global Giving website have enabled Aarohi to offer extensive community-based training to Traditional Birth Attendants and local Health Workers.

In Feb 2010 Aarohi’s health program received a three-year grant from the Sir Dorabji Tata Trust (SDTT) grant for strengthening its model community based health care delivery system, which aims to reduce maternal and child mortality. The project focuses in on training village health workers and midwives, increasing community awareness about their health needs and rights, and improving access to affordable and ethical health care. The project covers around 14,000 people in 30 extremely remote villages in Nainital district. The project has undergone an external evaluation in Nov 2012, the report of which is attached.

A detail of patient care at the Aarohi hospital is reflected below:

TOTAL PATIENTS BENEFITED                                  1964

TOTAL VILLAGES COVERED                                        45

SPECIALIST CAMPS HELD                                             7  

PATIENTS TREATED IN SPECIALIST CAMPS             577              

TOTAL SURGERIES DONE                                           32     

TOTAL ULTRASOUNDS DONE                                     126

DENTAL CAMPS HELD                                                   6        

TOTAL DENTAL PATIENTS TREATED                         206                

Funds from Global Giving, co-supported by the SDTT enabled 7 specialist health camps in Satoli. 577 patients were treated and 126 ultrasound investigations done during these camps with the help of visiting volunteer doctors. A further 206 patients were treated for dental problems in 6 dental camps. 32 surgical procedures including cholecystectomies, hysterectomies and reconstructive surgeries for post burns contractures and developmental defects like cleft lip and palate were conducted.

A special thanks to all our supporters who have helped plug in the gaps in the larger SDTT funding to bring meaningful maternal and child and patient care to the most marginalized sections of the community of rural Kumaon.

We look forward to your comments and suggestions to help us do better and to bring you a better undertanding of our work.

Dr Nalin Pandey (Paediatrician) with school kids
Dr Nalin Pandey (Paediatrician) with school kids
Dr Prashant Natu (Sonologist) at work
Dr Prashant Natu (Sonologist) at work
Dr Neeraj Dwivedi (Surgeon) outside the OT
Dr Neeraj Dwivedi (Surgeon) outside the OT
Jagdish Nayal (Lab Tech) keeping cool
Jagdish Nayal (Lab Tech) keeping cool

Attachments:

About Project Reports

Project Reports on GlobalGiving are posted directly to globalgiving.org by Project Leaders as they are completed, generally every 3-4 months. To protect the integrity of these documents, GlobalGiving does not alter them; therefore you may find some language or formatting issues.

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Organization

Aarohi

District Nainital, Uttarakhand, India
http://www.aarohi.org

Project Leader

Sara Tiffany

District Nainital, Uttarakhand India

Where is this project located?

Map of Reduce Infant & Maternal Mortality in the Himalaya