By Zeina Makhoul
Tuesday morning, I met with the nurses and the child development workers to learn about the clinical care at BSSK. Children are measured regularly (weight, height and head circumference). Growth charts, similar to the ones used at VCT, are used to track growth. Hemoglobin is measured every 3 months. All children at BSSK, whether anemic or not, receive iron supplements and a calcium/vitamin D/B12 supplement. When needed, the child development workers conduct an evaluation of the motor and mental development of infants and young children and an IQ test for older children.
Child development worker demonstrating IQ test
The staff kindly translated their menus from Marathi (language spoken in Pune) to English. They had a menu for each of season, winter (October-February), summer (March-June) and rainy (June-September), because of the seasonality and therefore market availability of the fruits and vegetables. For example, summer is the season for mangos and sugar cane so the menu included fresh mango, mango juice and sugar cane juice for snacks. During the summer, children are also given buttermilk (yogurt drink) instead of curd (yogurt) in an attempt to replenish fluid lost in the very hot summer months. Winter is the best season for most vegetables. As for fruits, oranges, grapes, papayas and strawberries are in season. During the rainy season, the staff avoids serving leafy greens as they hard to digest and tend to harbor bacteria because of the rain. All seasons and every single day, children are served dhal and rice, chapatti (or a variation) and most times a vegetable (such as cabbage, green peas, okra, carrots, spinach) for lunch and dinner. The diet is for the most part vegetarian, except for certain Sundays when chicken or egg curry is served. The menus need to be further analyzed to determine if children are receiving nutrients in amounts that are adequate for their growth. It’s important to keep in mind that certain factors may increase the risk for undernutrition even if dietary intake is adequate.
Infants waiting patiently to be fed
I headed to the infants’ room and found many of them lying on a mattress on the floor waiting patiently for their turn to be fed. Caregivers sat on the floor with crossed legs and a pillow under one side of their body to get in feeding position. They picked up the children one by one, fed them, burped them and put them in their cribs. With some help from a couple of the nurses, at least 8 infants were fed and burped in less than an hour. The children with cleft lip/palate were fed with a spoon. I asked whether they had ever used cleft bottles, the nurses said that they used to have them but not anymore. The caregivers seemed to be comfortable using the spoon.
Sister Ashaa helping caregivers with feeding
Caregiver feeding a child with a cleft lip
After an extensive discussion with the nurses around the medical charts, growth charts, and the use of supplements, the staff gathered in the conference room for a presentation on the nutrition screening tools that we plan to pilot test at BSSK among other sites. The staff had very helpful and important feedback.
Explaining the Nutrition Screening Form to nurses
As Jennifer and I were wrapping up for the day, Roxana and the staff surprised us with a cake celebration and beautiful hand-made gifts by women in their community center program. The celebration was really in honor of Jennifer. As part of her new job, as Holt’s initiative director, she will not be involved with BSSK and VCT in the same capacity and so will be not be traveling as frequently, or not at all L, to India. The staff wanted to say thank you and not goodbye but “see you later”! I will definitely miss her the next time I’m in India. I set the timer on my camera and we all gathered for what might be a last photo with Jennifer at BSSK.
Roxana presenting Jennifer with a gift
The next morning, we joined the children and staff for morning prayers, 3 OMs and a number of spiritual songs. I couldn’t help but smile when I heard the children’s sweet voices.
I joined the cooks in preparing lunch. I observed as they pressure-cooked the dhal, chopped the tomatoes and cilantro using a traditional, dangerous looking, chopping knife. When I asked if I can help, they brought me a regular knife and a cutting board! Chapattis were freshly made right before lunch. Right next to the kitchen, in the storage room, there were canisters of whole wheat, homemade infant cereal, cracked wheat, several types of lentils, ghee, and a 4-foot pile of sugar bags.
Traditional chopping knife
Cook making cabbage dish
That’s a lot of sugar!
Every Wednesday afternoon, a group of foster moms bring their children to BSSK to be examined by Dr. Sarda, another pediatrician at BSSK. The foster moms reported whether or not they had concerns about the child’s health or feeding. I asked again about feeding practices in India and Dr. Sarda confirmed that the introduction of rice cereal and cow or buffalo milk at 2-3 months is a common practice. Cow milk is usually recommended because it resembles breast milk, he said, but when it’s not accessible, buffalo milk is used instead. Dr. Sarda and I exchanged business cards and he promised to send me a book on nutrition that he has written.
Foster moms waiting to talk to Dr. Sarda
It was time to say goodbye to the children, the staff and Roxana and take the 3-hour drive to Mumbai and then a 27-hour trip back to Seattle. Sigh! In the next few months, I will be processing all the information that I learned at the Village in Haiti and VCT and BSSK in India and using it to customize a nutrition screening system that works for all sites. I’m hoping to return to Haiti and India around May to launch the pilot phase. When I return, I will not see many of the children I met, a bitter but sweet feeling as I know they will have joined a loving family.