Infant & Mother Health in Nepal's Arsenic Areas

by Filters for Families
Infant & Mother Health in Nepal's Arsenic Areas
Logistical Team
Logistical Team

Infant and Mother Health in Arsenic Areas of Nepal

  1. Building the Nutrition Team (Feb. 18th)
  2. Workshops & Filter Distribution in Sano Kunwar, Nawalparai  (March 4,6,9)                                                                                                                                               

Before discussing the four Nawalparasi Workshops, I would like to mention the special people who donated materials or assisted in making the program successful in Nawalparasi.  Our office moved the Terai a couple years ago, so the Hessad Café, a lovely Korean donut shop in Lalitpur, became our meeting point.  Dr.  Karuna Shakya, the Health Officer at UNICEF provided colorful Child Immunization Schedule posters for workshops in Nawalparasi and Bara districts.   Bikash Lama, the Sales Executive at Associated Enterprises, dodged Kathmandu traffic to deliver the Hach Arsenic Test kit for the Bara program.   My favorite tailor in Kupondol, painted and sewed the Nutrition game on his day off to facilitate our tight schedule. Clair Lin, the director and owner of Lovely Lady Pads taxied her way from Boudhanath to Hessad Café with 100 washable sanitation pads,  patterns and other pad designs.  The manager of the photo copy shop on Kupondol copied and bound the Infant and Mother Health Manuals and laminated cartoons and photos of vegetables, protein, fruit, infant health, safe water solutions, and good hygiene practices for the Nutrition Game. Gita and Sarita helped locate 100 soft wash cloths and the blue gift bags for the workshops. Gynu ordered 100  bars of soap and healthy snacks. Mini and Ramesh shopped with me at the Parasi market for vegetables, salt, fruit for the Nutrition workshop food gifts.  Wendy Gillen provided WIC Infant Health Materials, Sumai Kurmi the Chief  technician built 95  filters in record time and organized filter delivery to the villages. Dil Kumari, the Nutrition/Health/Hygiene Instructor who trained the Nutrition and Health assistants and led the workshops.  Ramesh Aryl the Office Coordinator, brought all parts and people together.

The Nutrition & Health Team Training was held on Saturday Feb. 18th from 9 am to 5 pm. The Team Leader was Dil Kumari, a veteran Health/Nutrition Instructor in the Health Department at the local college, Pahli Multi Campus. She’s a wonderfully informed and engaging teacher, the other trainers were Dr. Smith and Ramesh Aryl.  The 1-Day program covered; nutrition for infants and pregnant women, nutrition game, proper hygiene habits, immunization schedules, measuring infants, safe water options, social mapping, community mobilization, and arsenic awareness. Classes were held  at the A. Kumari Academy in Swartikar and lunch was provided at the  nearby FFF Nepal  office. The Nawalparasi Nutrition Team Training included participants from 6 villages (Photo Set 2).  Three of the seven participants are students and will assistant Ms. Kumari over the next 2 years in tracking growth patterns of the infants.

Sano Kunwar Nutrition/Health/Hygiene Workshop March 4th, 2017.

The day of the Sano Kunwar Nutrition Workshop,  half the trainers peddled their bicycles to the meeting from their villages, Ramesh and Mina drove a motor bike and Dill Kumari and Linda brought all the workshop materials, vegetables, fruits, scales, and gift bags by a local electric rickshaw,  the only taxi in Parasi. A  welcome change from the old, small and unstable rickshaws of the past.  The original plan was to share a meal with all the women and children after the workshop,  but the logistics of such an event became too difficult with restless babies and the large number of additional family members attending the workshop.  We decided to give all the  vegetables and fruit  to the women during the Nutrition Game and one orange to each mother/child after they were  weighted and measured.   As each woman signed in  for the workshop, she was given a blue cloth bag with rehydration salts, jasmine/almond oil soap, soft baby wash cloth, Washable Lovely Lady Pad and a small spoon to feed the baby solids. At first only 13 women carrying their young babies walked into the room and sat cross legged on a plastic tarp. Within 15 minutes the room was overflowing with grandmothers, mothers, babies, children and other relatives. Ramesh introduced the program and trainers and then Dil Kumari began with the Nutrition segment. In the midst of her teaching a man with one leg and a crutch entered the room and showed Ramesh pictures of a group of handicap people who are helped by a local organization, quietly Ramesh ushered him out of the room – Dil Kumari didn’t miss a beat- her lecture continued. The women were very attentive, answering her short questions and agreeing with her comments. Mina taught the section about caring for the washable sanitary pads. Hira, one of the students, explained the immunizatons and their benefits  listed in the large poster. Ramesh stepped in a few times to assist her when the babies became restless and over powered Hira’s soft voice. We passed out biscuits and milk tea to help quiet everyone. During the Nutrition Game,  I left to help set up the scale and measuring center located outside near a large tree. The Team said the nutrition game was a success, everyone had fun and loved getting the vegetables and fruit. The crowd slowly gathered around the scale which was hanging from a large branch near the a large wooden table. Two students coordinated the weighting, Mina wrote down the numbers, Seema and Dil Kumari measured their length and I handed out the oranges as each woman and child finished. Since the group was twice as large as expected, we ran out of oranges.  Luckily, there were extra eggplants and green peppers. At the end of a busy 4 hours the Team shared a cup of tea and discussed the workshop.

Arsenic Awareness Workshop March 6th

Another workshop was held 2 days later in the late afternoon (4pm). This was a shorter program to discuss the health effects of arsenic contaminated drinking water and the importance of  using filter water for drinking and cooking (Photo Set 3).    

Filter Training and Filter Distributions March 9th

43 Sono- mini Filters were  brought from the FFF Nepal office to Sano Kunwar by a tractor with an attached bed lined with straw to protect them on route.  Sumai Kurmi, instructed about 8 women at a time on the use and maintenance of the filter. They also received a strong warning that the filters will be checked in one year, if the filters are found unmaintained they will be re-gifted to another family.   

 

Comments

Among the 60 plus infants and children measured, there may be two children who need to be closely followed over the next 2 years for potential developmental issues. They will be referred to the Health Clinic if there are health issues. To my surprise the washable sanitation pads were a great success, all the women were very interested in making more. The next meeting with the mothers and children will be in June.

Bara Workshops and Filter Distributions were completed March 17-23 - report will follow shortly

Trainer Workshop
Trainer Workshop
Sano Kunwar Nutrition Health
Sano Kunwar Nutrition Health
Sano Kunwar Arsenic Awareness & Filter  Wks
Sano Kunwar Arsenic Awareness & Filter Wks
Child Mother Photos
Child Mother Photos
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Field Report #1
Field Report #1

Dear Friends,

Below is a short glimpse into living and making filters village style in Nepal. We should the filters finished by the end of the week. Then we will start training with the Nawalparasi Health Students and in two weeks training with the Bara Team.

Welcome Back Linda

Maybe it was the thick fog covering the city in the early morning or the seven hour crazy drive watching trucks, buses, jeeps, and cars weave in and out of a two lane road at full speed to Parasi, that made me decide to fly to Bhairahawa. An easy 35 min flight then another 30 minutes in a taxi to our office. On Jan. 13th I arrived in the Sahuwatikar office minus a suitcase that I imagine is having a merry time flying from Denver to Doha and back several times. Luckily the suitcase with the donated children’s cloths did make the connecting flights. This is the first time in 14 years my bag has been truly lost- they couldn’t even track it- “not in the system, mam” replied the Qatar baggage claim attendant. As I write this report, another 17 days have passed and no bag, “but all the papers have been filed mam” said the same attendant yesterday.

I arrived in Sahuwatikar on the eve of a holiday. The landlord and friends were preparing a goat to take to Kathmandu where his wife and family are living. Goat prices in Kathmandu are 300 rupees (~$3) per kg higher than in the Terai, it’s becoming a delicacy.  However, my main concern was getting to the outside toilet through the maze of large pots of boiling water and avoiding the slain goat lying on the cement near the water pump, the only route to the toilet. After a few leaps and shuffles I made it to the immaculately cleaned western toilet with my pack of Kleenex safely tucked in my pocket. Following a few hours of meetings with staff and Ramesh the Principal at the school across the street, who has been helping us, I decided to head to bed. Up the 450 outside staircase to the bedrooms and the landlords rooms. I barely took notice of the large catch of fish lying on newspaper on the floor in his kitchen, all I wanted was my bed. Fumbling with the lock on my door I was pleasantly surprised to see the room clean and the bed covered with fresh linens. I dumped by backpack and fell into bed, still suffering from jetlag I woke up around 4 am to make the journey down to the toilet when I realized the landlord had gone with fish and goat to Kathmandu on the night bus. He locked the hall door from the outside forgetting I was there and happily set off to visit family. I was stranded upstairs with some rather urgent needs. I waited for Gynu, a lovely young mother who lives next door, to make her way the well for morning washing. Luckily my window faces her direction, when she arrived at 5:30 am, I yelled “Gynu help, door locked”. Off she ran to get a key from the landlord’s brother and with the help of a few more people I was unlocked and my needs taken care of.

End of First day in the field.

Our first mission was to get the materials for the filters, this includes buckets, lids, basins, taps, nylon net, charcoal, iron, sand, gravel, clay bowls and a host of small items.  Sumai, my main technician and I bicycled to the vendors—we could only buy 30 buckets on this trip but managed to order the other 110 which would arrive a week later. We’ve gone through a lot of adjusting this year, our old office was turned into a school so we’re learning how to manage “filter making” without our little factory, challenging but not impossible. Our new location is just across the street from the old one, where plastic bins now hold sand, gravel, and charcoal instead of our lovely large cement bins. We will be able to recycle some of the materials from the factory; tin roof, iron, wood and bamboo beams, 2,000 liter water tank, pipes, and other smaller items. We were there 12 years – at a cost of $3500 it was a well used space and very functional especially after Ray Beard and his team preformed a miracle by removing the old straw roof and installing a solid tin roof on a not so square frame.

End of Day two.

 

The fog was so thick this morning only faint images could be seen 10 feet ahead. I was up early – sharing a cup of tea with Bali, Gynu’s father. We walked around the village with our cups of lemon tea. Everywhere goats were seen, baby goats leaping with no effort and adult goats. I laughed and called the village : Bakhara Gaur (goat village). Not long after returning to our gate, we saw a group of men circled around someone. It was the “honey” man, they were discussing the cost of his fresh honey. He climbed up a tree across the street, and brought down the hive. He was squeezing honey out of the comb into large pans right in front of us. I ordered 750ml for about $ 4.50 with a bit of wax and a few bees included. I’m not sure if this process is bad for a hive but it doesn’t seem to bother the bees. The hives are huge, over 4 feet in height. It was an exciting morning, all before the office opened. Around 8:30, two local women arrived to sieve and clean sand for the filters, while Sumai, my technician, drilled holes in the basins and buckets. In the afternoon we collected the rest of the materials for the filters, nylon thread, nylon net, and taps. Sumai collected charcoal from the local entrepreneur, it’s about $1 for a tin of charcoal, maybe 3 gallons. The weather is foggy and cold, we drink a lot of chia (tea) and tato pani (hot water) to warm our bones. At the end of the day most of the materials are collected.

End of Day 3.

 

Another cold morning, with thick fog. I could barely see the women sieving the sand from the office door. Sumai and I headed to the iron mystery (machinist) to check the iron supply and to confirm he is only giving us the dry filings, nothing processed with oil. In the afternoon the women, Mira and Santoshi, sewed the nylon net onto the basins for the pre-filter that fits on the upper bucket. They can sew about 10 in half a day. I spent time cutting the large circles of nylon net for the basins. Sometimes we hire 5 women to sew these in their homes, but this order is a bit smaller so it’s easier to keep everything in the office. I was invited to dinner at Mini and Ramesh’s home, but I’m still struggling with jet lag and can barely stay awake but the dinner was delicious, chicken, sag (green vegetables) roti, and potato curry. I fell asleep by 7:30 pm only to be awakened by a loud angry brawl between men and women in the village. This time I’m happy to be on the second floor. A few women picked up wooden boards and were going at a man—but I couldn’t see what happened only the wailing and crying and men yelling. Later, I learned there was roski (rice whisky) involved. Ugh--- landlord locked me in AGAIN, only 4 hours this time. I’m prepared, a big bucket and water in my room for emergencies this time. I’ll have a stern talk with him tomorrow.

End Day 4

 see photos

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We're almost to our 40 donor number--- we have 36 out of 40 needed for the accelerator project.

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Some of the reasons nutrition and health workshops are needed in Nepal.

In general 46% of children age 6-59 months have anemia and 41% are stunted with 29% underweight. 

 

Morbidity and Nutrition

Percentage of children aged 6-59 months with anemia  46 %
Percentage of children under-five with symptoms of ARI in the two weeks preceding the survey  5%
Percentage of children under-five with diarrhoea in the two weeks preceding the survey  14%
Percentage of children under-five with fever in the two weeks preceding the survey  19%
Percentage of babies with low birth weight        
(36.3 % of all births had a reported birth weight)  5%
Percentage of babies with low birth weight (as perceived by mothers - babies not weighted )  16%
Percentage of children under-five stunted (-2SD)  41%
Percentage of children under-five wasted (-2SD)   11%
Percentage of children under-five underweight (-2SD)    29%
Percentage of children under-five overweight  1%
No Data Available
Source: Nepal DHS

Trend in nutritional status
Morbidity and Nutrition
Source: Nepal DHS 2011

Notes:
Stunting = children under age five that fall below minus two standard deviations from the median height- for- age of the NCHS/WHO standard (moderate and severe)
Wasting = children under five that fall below minus two standard deviations from the median weight- fo-r height of the NCHS/WHO standard (moderate and severe)
Underweight = children under age five that fall below minus two standard deviations from the median weight- for- age of the NCHS/WHO standard (moderate and severe)
Overweight = children under age five that fall above plus two standard devliations from the median weight-for-height of the NCHS/WHO standard (moderate and severe)

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Organization Information

Filters for Families

Location: Wheat Ridge, CO - USA
Website:
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Project Leader:
Linda Smith
Executive Director
Wheat Ridge, CO United States

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