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Jaimun Khatun's half-pill of trust and remedy

© UNICEF/India/2006/Amitabh Pandey

An anganwadi worker and an auxiliary nurse midwife examine a sick child at the anganwadi centre in Jharkhand's Mandar block.

By Paromita Ukil

28 March 2006: Forty-year old Jaimun Khatun, an anganwadi worker, considers herself to be fortunate that her work requires her to be with children. She lives in Chatwal village in Jharkhand's Ranchi district where her work requires her to weigh children, feed them and give them their first lessons in education.

In May last year, she underwent an "unusual" training which, she was told, would help her in saving children's lives by detecting early signs of distress. By October, she had already helped save the lives of two infants in her village apart from contributing to the well-being of the 50 under-five children in her village. The eight-day training course – the Integrated Management of Neonatal and Childhood Illnesses (IMNCI) she attended has equipped her with the knowledge that makes it possible for her to take those steps which help save lives. UNICEF State Representative Bijaya Rajbhandari says, "Parents and community-level workers are united in their concern for children but often do not know what to do and when”
Jaimun and her colleagues learnt to count the breath of children with respiratory tract infection, to discern the rise and fall of an infected child’s chest.

In Chatwal village, where Jaimun lives, little problems become life-threatening even though a government referral centre is only four kilometres away. In most villages, neither the parents who are mostly marginal farmers, nor the regular village health service providers (the AWWs and the ANMs) have either the expertise or the training to recognize a complication. They therefore cannot take the necessary steps to prevent serious complications in children. The IMNCI training which UNICEF piloted in Mandar block addressed this need. The training was an exercise in systematic learning to identify and manage common illnesses that afflict neonates and infants. Through audio-visual aids and field visits, Jaimun and her colleagues learnt to count the breath of children with respiratory tract infection, to discern the rise and fall of an infected child’s chest. The training was conducted in Mandar’s Holy Family Hospital so the trainees had an opportunity to look at newborns and learn about their illnesses. They learnt to classify common ailments according to age of the child and the severity of infection. The IMNCI package addresses this critical need.

The IMNCI training started in Ranchi district of Jharkhand in 2005, and will be imparted to all the 20 blocks of Ranchi by mid-2007. Simultaneously, it has also been started in East Singhbhum, the district where UNICEF is piloting the "convergence" approach. Health and anganwadi workers who have been trained (in Ranchi district) are using it for the well-being of children).

© UNICEF/India/2006/Amitabh Pandey

A team of anganwadi worker and auxiliary nurse midwife count the breaths of an infant with suspected pneumonia in Jharkhand's Mandar block. The new skills acquired as part of the IMNCI initiative is helping them save lives.

Jaimun recalls the two cases vividly. The first case was of a severely underweight infant. "I guided the mother to breastfeed the baby soon after birth and to hold it close to herself so that the child was warm," she says. The child survived, and is growing up to be healthy and strong.

The second case was of one-month-old Chandni, whose festering red umbilicus had not fallen off. Jaimun gave Chandni half a tablet of co-trimoxazole mixed in her mother’s milk. This was repeated and little Chandni was brought back from infection that could have turned serious. “It was because of the training that I reacted the way I did to Chandni’s pus-laden, red umbilicus," she says.

"Chandni’s mother brought her to the centre for BCG vaccination. The little girl was a month old. The umbilicus should have fallen off two weeks ago, I calculated. The ANM and I examined her infection. We did not have any medicine supply at that time. We tried the violet solution,” said Jaimun, “though we both knew co-trimoxazole would work better under the circumstances."
“It was because of the training that I reacted the way I did to Chandni’s pus-laden, red umbilicus"
Jaimun could not relax after that; she was concerned. When at the end of a week the supply of co-trimoxazole arrived at the health sub centre, the ANM sent word and Jaimun got the medicine from her. She went back to her village, and went to Chandni's house. As she had thought, the tender umbilicus had become worse. Fear not, she told Christina, the baby’s mother, Chandni will be safe.

Jaimun took out a tablet from her bag and broke it in half. She asked Christina to  mix haf a tablet with little of her own milk . Then she fished out a spoon from her bag and gave it to Christina so that she could feed the solution to little Chandni (Jaimun had remembered to keep the teaspoon in her bag because she knew Christina’s humble collection of aluminium and earthen pots would not have a spoon). Jaimun repeated the dose after two days. At the end of the week, the umbilicus fell off and soon there was no trace of any infection.
 
The remedy which Jaimun and the ANM offered little Chandni was simple, but it brought the child back from serious danger. "I am very pleased about it," says Jaimun, basking in the satisfaction of being the saviour of children's lives.