Holding out Hope in Dharavi

‘My son had cow’s milk from birth. He looks healthy. What is so great about mother’s milk?” Sabawn’s voice resounds in a narrow, cramped lane in the heart of Asia’s largest slum, Dharavi. A local priestess, she cuts a dramatic figure in her yellow sari and orange tikka.  Gathered around are a group of women, listening in rapt attention. Many of them are heavily pregnant, some are holding newborns.

Sabawn’s comment is an indication of the challenges that lie ahead for the Maharashtra government, corporates and NGOs who have come together in a first of its kind partnership called the AHAR project. A project that aims to change the face of Dharavi, a densely packed slum, home to over a million people, mostly migrants. A well-known Mumbai landmark, immortalized in the Oscar-winning film Slumdog Millionaire, the slum is a maze of narrow lanes, shanties and overflowing gutters.

Not surprisingly it reports among the highest rates of malnutrition in the city. About 35 % children between the critical 0-3 years are malnourished.  While anganwadis or day-care centers have been set up as part of the government’s Integrated Child Development Scheme (ICDS) to provide nutrition, education and health services, the workers here are overburdened and poorly paid, with the result that many children are left behind.

It is here that the non-profit group SNEHA or the Society for Nutrition, Education and Health Action plays a critical role by training sakhis or community link workers who go door to door and advice women on nutrition, breastfeeding, family planning and maternal health.

“Imagine this is your baby” says sakhi Mangal Shinde pointing to a lifeless doll hanging on one end of a scale used to weigh vegetables.  At the other end hangs an empty bag. “What you put inside this bag decides your baby’s future,” she says adding factsheets with pictures of healthy foods for children. As the bag gets heavier, the doll rises. The women smile and clap. Sabawn still looks sceptical and clearly requires several more sessions!  Convincing her is critical as she wields tremendous influence in the community.

“It’s not easy,” admits Dr Evelet Sequeira, Head of Nutrition with SNEHA. “We tell the mother her milk is for her baby and this milk will help in brain development. So when the baby weighs 3.5 kgs at birth it has already passed Class 10. If she were to breastfeed exclusively until 6 months, the baby has cleared Class 12. For every mother her child’s intelligence is very important and this helps drive home the point.”

Simplistic though the approach may sound, it is showing results. Rates of exclusive breastfeeding have gone up. So has immunization. “More and more women are delivering in institutions,” says Priya Agarwal, Senior Advisor with SNEHA. “ Earlier women would register at the local health center in the last trimester of pregnancy. Now it’s in the first trimester.”

Another critical service SNEHA provides is crèches where working mothers can leave their babies. Now mothers no longer leave their infants with neighbors or older siblings when they go back to work. Instead they drop them off at the crèche where their health is closely monitored and they are given supplementary meals.

SNEHA believes the Dharavi experiment will lead to a sustainable model which can be replicated in urban slums across the country. “We have the government and ICDS on board and we are looking at global protocols that have been tried worldwide to see how we can adapt it to our settings”, says Dr Sequeira.

Words that hold out possibilities to thousands of children like Mehboobi, who at 2 years weighed 8 kilos, the healthy weight of a 6-month-old. When she came to the crèche last year, she would not lie down. Tests showed she had spinal TB and suffered from severe back pain. Today she is nearly 3 and weighs 10 kgs.  She has a long way to go.  Watching her perky, shining face shout out alphabets, there is hope she will get there.

For a vdeo link to the Dharavi project visit

http://www.ndtv.com/video/player/news/republic-of-hunger-malnutrition-plagues-in-maximum-city/222383

Bringing in a change, the Tostan Way

Marieme Bamba

Born in Soudiane in rural Senegal in West Africa, Marieme Bamba was 13 when she got married. At 14, she gave birth to her first child. Today she is a solar engineer who has helped set up sustainable and low-cost electricity in many villages in her country. And has trained many other women to do so. Her story, and that of hundreds of women like her in countries in West Africa, is a testament to the efforts of Tostan, an NGO that has helped bring about sustainable development and social change in these parts. In Tostan’s approach, lies a valuable lesson for India, which is grappling with similar problems.

Tostan, in the Senegalese language Wolof, means “breakthrough” as well as “spreading and sharing”. It was founded by American Molly Melching who decided to stay on in Senegal while pursuing her degree in African studies in capital, Dakar. Through its “Community Empowerment Program”, started in 1995, the NGO offers “participatory human rights education to adults and adolescents who have had no access to formal schools.”  It helps them devise their own solutions to their struggles.

Molly Melching

  At the core of Tostan’s approach lies Respect. Essential when it comes to communicating ideas that    involve change. Take female genital cutting, practiced widely across parts of Africa. Melching prefers to call  it  the less judgmental term, cutting. “Cutting”, says Mulching “was practiced because mothers loved their daughters. They did not want to hurt them. There is great social stigma attached to not cutting and mothers wanted to protect their daughters from this.”  Despite the pain, families forced their daughters so they would not be seen as “unclean” or “not marriage worthy.”

Through community meetings on human rights of women and children, the health risks they faced due to cutting were highlighted. Eventually some villages adopted resolutions to put an end to the practice.

To ensure the impact is widespread, Tustin adopts the “social diffusion” approach, the brainchild of Demba Diawara, a respected religious figure and community leader.  African villages are closely linked and Demba realized it was important to create a network of villages for a change to take root. With a team of community leaders, he visits different villages to talk about the benefits of banning FGC . Today 6000 communities in six countries in Africa, apart from Senegal, have abandoned the practice.

Young girl at Kieur Simbara village, Senegal

Tostan’s efforts in other areas like ending child marriage, community micro credit programs, promoting maternal and child health have been widely acknowledged. Issues large parts of India grapple with even today.  There are a few NGOs in India whose approach is similar to that of Tostan, and their successes are acknowledged worldwide. Organizations like SEARCH in Gadchiroli in Maharashtra and the Comprehensive Rural Health Project in Jamkhed, Maharashtra have been able to make a breakthrough where government programs have failed.  Rather than a blanket Central scheme which benefit a few, engaging with communities to understand their specific needs could help find a long term solution.

To learn more about Tostan, visit http://www.tostan.org/

 

Latur Notes

           We reached Latur on a Monday morning to find the entire city virtually shut down. At Hotel Manas where we had a booking, not a soul materialized for the first 30 minutes. Finally a man emerged, gave us our keys and shuffled off. Refusing, despite our several pleas, to serve up any tea. The kitchen staff, we were told, had the day off.
          Many hours later, a explanation. It was Velu Amavasya, a harvest festival, big in this part of Maharashtra.  A day farmers celebrate, first by praying to their fields and then, hosting a sumptuous lunch for the community.Everything shuts down – schools, colleges, offices. Never mind that Velu Amavasya figures nowhere in the list of official public holidays.
         Not the best start to our trip. But we decided to ahead with our visit to Hasegaon, to a shelter for HIV+ children. We were headed there for a documentary on community initiatives to fight stigma against people with HIV.
        Hasegaon had other plans. Minutes after we reached we were told we had to participate in the festivities. Our host for the afternoon, a farmer, 70 year old Kumbhkaran Gawde. An unusual name given the reverence the Hindu god Rama has in these parts. Kumbhkaran, for those unfamiliar with Indian mythology, was brother to Ravan, the demon king who abducted Rama’s wife, Sita. 
        Kumbhkaran was one of Ravan’s generals. Famous for his long, long naps and huge appetite. With his shocking pink turban and curved walking stick. this Kumbhkaran cut a rather imposing figure. He took us to his sugarcane fields, to this makeshift shrine. We paid our respects and started digging into the thali. A simple, but varied spread as you can see in this picture
       There was the Pitle, traditional dish made of gram flour, a side dish of spring onions and Unde, which are steamed dumplings made of jowar (type of cereal). Followed by the piece de resistance, khichda. Not the mutton and dal version many of us are familiar with. This was vegetarian, prepared with two different cereals.  Very simple and light food, but the whole experience of eating in the midst of the fields was quite something.
       To round it off, we had something akin to the sakhrai pongal, a traditional Tamilian dish served during festive occasions. Here, the rice is cooked in sugarcane jaggery instead of sugar, and the milk poured on the rice just before it’s eaten. Unlike Sakhrai pongal which is cooked in milk.
       As we drove out of Hasegaon, villagers stopped us at different points to invite us to their homes. Really heartwarming. We remembered them even more later that evening. Because back in Latur city, not a single hotel was open for dinner!