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Reduce Infant & Maternal Mortality in the Himalaya

by Aarohi
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Reduce Infant & Maternal Mortality in the Himalaya
Mobile Health Clinic
Mobile Health Clinic

Dear Friends,

Greetings from Himalayas! We are happy to report 3 months of work of our community health project involving extension to 35 more villages in the Okhalkanda Block of Nainital District. A new office has been set up in Patlot and 12 new health supervisors hired. Concomitantly, we also launched the Mobile Health Clinic in July, a joint venture with the Government of Uttarakhand. This has brought succor to 500-600 additional patients in extremely remote villages. The mobile clinic is equipped with a lab, and X-Ray machine. We await bureaucratic clearance for use of the ultrasound machine, also part of the mobile clinic.

Three of our smokeless chullah (improved cookstove) masons went to ARTI (Appropriate Rural Technology Institute), Pune for an exposure and training on different technologies for cooking and heating for rural areas.

We hope you find the attached report informative. Should you have any questions at all please do not hesitate to contact me (sushil@aarohi.org).

Happy Reading!

With warmest regards,

Dr Sushil Sharma

Patients waiting
Patients waiting
Making a chullah 1
Making a chullah 1
Making a chullah 2
Making a chullah 2
Making a chullah 3
Making a chullah 3
Making a chullah 4
Making a chullah 4
Making a chullah 5
Making a chullah 5
A smokeless chullah burning well
A smokeless chullah burning well

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Khasti with her three daughters
Khasti with her three daughters

Dear Aarohi supporters,

Greetings from Himalayas! It was in April I had written to you last. The past three months have been as enthralling as ever and we have been doing some vital groundwork for phase III of our health project, also called ‘Arogya Phase III’. As you already know our health work focuses on the ‘mother and child’. To complement our main work, our secondary objective is to   address issues of (to a limited extent albeit)- women hygiene, sanitation, clean drinking water, promoting smokeless cookstoves or chullahs and addressing social taboos. Funded by Sir Dorabji Tata Trust, by the end of Arogya phase III we would have covered 105 villages in the remote Okhalkanda Block- a region where no other organization has undertaken health related work so far.

Hope you find the attached report informative. Should you have any questions at all please do not hesitate to contact me (health@aarohi.org).

Happy Reading!

With warmest regards

Abey John

Health Coordinator

Our very new Mobile Health Van!
Our very new Mobile Health Van!
Aarohi team
Aarohi team

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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
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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
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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           &nbTraning health workers to do Haemoglobin estimate

Traning health workers to do Haemoglobin estimate
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Organization Information

Aarohi

Location: District Nainital, Uttarakhand - India
Website:
Project Leader:
Jyoti Patil
An organisation committed to the development of rural, mountain communities
District Nainital, Uttarakhand India

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Combined with other sources of funding, this project raised enough money to fund the outlined activities and is no longer accepting donations.
   

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