IMNCI through the eyes of a middle-class mother in Andaman islands
By Patralekha Chatterjee
Port Blair: Chitra, a young mother of two at Bathuvasti village in the outskirts of Port Blair, capital of the Andaman and Nicobar islands , would qualify as "educated, middle class" in the Indian context. She has a post-graduate degree in library science; her husband is a senior clerk at the Central Agricultural Research Institute and she lives in a housing complex meant for government employees. But till recently, the 25 year-old was not that different from the average unlettered rural woman in the country on one score: No one had shown her how to hold a baby to ensure effective breastfeeding nor impressed upon her the importance of giving only breastmilk first 6 months in a baby's life.
“I visited the house soon after the newborn baby arrived from the hospital – my first post-natal visit. The grandmother was about to give the baby water mixed with honey when I intervened. I told the mother not to give any food or fluids to the baby apart from breastmilk and then demonstrated the correct way of feeding a child. I also showed her , illustrations from my health worker’s chart booklet. I explained to the grandmother and other family members why a baby should not be given anything but breast milk for the first six months and the harm and infections that come strike the child if other fluids are given at this stage," recalls C P Nalini, the anganwadi worker.
Ironically it was a natural calamity that ushered in the newborn-centric child survival strategy in the islands. UNICEF did not have an office in the Andaman and Nicobar Islands when the tsunami struck in December 2004. However, it was the first humanitarian agency to arrive in the disaster zone and establish its presence across the archipelago consisting of 572 islands of which only 38 are inhabited. With much of the health infrastructure decimated and traumatized medical staff coping with their own personal losses, there was a need to strengthen community-level health care. The tsunami recovery programme turned out to be an unique launching paid for IMNCI which equips village-based anganwadi (nutrition) workers and auxiliary nurse and midwives(ANM) with a set of skills to assess and classify sick infants and children below five, provide the first level of treatment when doctors are not available and refer the child to the nearest healthcare facility as soon as a displays clinical signs of danger. IMNCI was launched in June 2005 in Car Nicobar, the worst-affected. In the next stage, all the health and nutrition workers in Andaman are being trained.
Access is a big issue in many of the islands in the archipelago. In these far-flung islands, the major challenge in ensuring survival of a child is to reach all newborns.
“IMNCI is the first programme that I know where the anganwadi worker will be treating the patient. They have been given the necessary drugs to deal with coughs, fever, respiratory infections. Tribal populations in remote areas donot usually bring their infants to hospitals. The first hurdle is identification of the illness . A baby may be acutely ill, and not suckling. But the mother does not necessary understand the significance of the situation and therefore does not do anything till it is too late. Then there is the topography of these islands --- to get from one place to another is often not easy. Anganwadi workers and ANMs trained in IMNCI are now able to identify the problem , and assist the child by bringing the first level of treatment to the door step, ” says a senior official at the Directorate of Health Services, Andaman and Nicobar.
It is too early to gauge the impact of IMNCI on the infant mortality rate of the islands, but there are encouraging indicators. For example, promotion of correct breast feeding practices among middle class women like Chitra as well as among tribal mothers in the far-flung islands. "Now, the anganwadi worker is empowered. Because she has the necessary skills to save a baby. The IMNCI training has taught her not only how to treat the baby at home, but also to detect early signs of danger and to refer a baby to a child when it is beyond home-based care. In the traditional health delivery system in the country, an anganwadi worker did not send a baby to a health facility with a referral slip. But that is happening now after the launch of IMNCI. Many babies have been saved due to timely referrals in the Nicobar. " adds the health official at Port Blair.