Photo exhibit by Marilyn Smith
Situated on India’s northern plains, the bustee is hot and dry much of the year; temperatures can soar to 45°C or more in the summer. Even in late November, just before the winter cold sets in, it is warm enough at 9:00 am to enjoy being on an open rooftop. Veena joins 15 other bustee residents for 20 minutes of yoga. It is a time to put some distance between their daily lives and their roles as agents of change.
Over the past six years, Developing Indigenous Resources (DIR)* has given this team of Health Promoters (HPs) daily training in health fundamentals, including a strong focus on nutrition and disease prevention. DIR believes that three inexpensive pieces of equipment -- bathroom scales, stethoscopes and blood pressure gauges -- can be powerful tools to monitor the general health of residents, and the need for further intervention.
Each HP is responsible for 200 households in Janta Colony. One of their main jobs is to track, on a monthly basis, the weight of every child under the age of five years. These visits create a natural opportunity to share knowledge on many health-related topics.
As in most slums, general poverty makes malnutrition a primary concern; but high rents in Janta Colony contribute to a higher incidence of severe cases. Champa (22), together with her second baby (2 months), barely pushes the needle on the scale to 34 kg.
For DIR, monitoring child health begins at the earliest possible moment. HPs visit pregnant mothers every month to monitor weight, blood pressure and foetal heartbeat. Often, their visits are a kind of “community health” as friends and neighbours listen in.
The effects of early mal nutrition can be life-long. Chandigarh doctors attribute Prem’s blindness, at least in part, to his mother’s severely malnourished condition during pregnancy. In addition, he was born at home in a remote village with no immediate access to medical care.
DIR HPs are recognised for more than their blue jackets. Bustee residents such as Rangeelie, particularly those with little or no education, have come to view the HPs as local experts and welcome their arrival.
As most homes in Janta Colony have only one or two rooms, much of daily life transpires outdoors and even young children are exposed to the elements.
By mid-day, a self-inflicted blast of cold water on the front porch can be sheer delight, but most homes lack running water so having a bath starts with hauling a bucket.
But water is a serious problem in the bustee. Poor maintenance of limited drainage systems leads to back-up of waste water. Within steps of every doorway, non-biodegradable matter floats atop fermenting organic waste while a variety of insects, including malaria-bearing mosquitoes, skim the surface.
Traversing the bustee invariably means passing within inches of wide expanses of open swamps or equally contaminated creeks (nullahs) that flow between rows of tightly packed houses.
The most prevalent risk for bustee children is contracting diarrheal diseases from poor hygiene, contaminated food or dirty water. For infants and toddlers, severe dehydration can spiral downward to death in a matter of hours. DIR makes it a priority to teach every woman how to prepare an oral re-hydration solution from basic kitchen ingredients: boiled water, salt, sugar and a pinch of baking soda. A pinch of lemon or lime helps mask the remedy's terrible taste.
As HPs got to know the families in their sectors, they realised that many women work long hours cleaning houses or selling goods in the streets of Chandigarh. It often falls to the eldest child to carry out household chores and take care of their younger brothers and sisters.
When DIR recognised the responsibility older kids carry, it began an after-school programme for those aged 9 to 13 years. Child Advocates for Social Empowerment (CASE) uses fun and games to teach basic health and hygiene. Participants like Ruby are encouraged to share their new knowledge with their parents and siblings.
A most subtle aim of CASE is to promote the social and physical development of these pre-teens by making sure they have a chance to have fun – away from the family responsibilities.
HPs devote late afternoons, the most likely time to find women at home, to giving courtyard cooking classes. Menus are carefully prepared by DIR’s nutritionist to derive optimal benefit from locally available fresh produce and to keep prices at less than two rupees per person (CDN 0.05 or EUR 0.02).
Vaishakha’s birthday party was a sign of success. The menu included cake and snacks, but also a well-balanced meal of rice, dal and vegetables. Her mother and aunts used to believe that “expensive” food equalled healthy food. Following HP advice, they’ve stopped buying processed foods and watched their collection of eight children move from the “Red” to “Green” Zones on DIR health charts.
DIR statistics, confirmed by an independent assessment, show that the HP strategy is working. The incidence of severe malnutrition amongst children dropped from 87% in 2004 to 40% in 2010, and almost 100% of bustee women gave birth at the hospital – compared to the national average of only 41%.
HPs also remind mothers about upcoming immunisation clinics held in the bustee and assist government officials. As a result, immunisation rates are 85% to 93% (depending on the disease) compared to 55% to 78% nationally.
Despite these positive gains, deeper analysis showed that DIR's efforts were having the least impact on the neediest children. Monthly visits were not enough to make a difference for those who are "grossly underweight" – a condition that creates high risk for other health problems.
Jyoti is one of the most severe cases: at 16 months, she weighs only 5 kg, yet her stick-thin legs are too weak to stand on. Her pale hair, skin lesions and protruding ribs suggest the onset of protein energy malnutrition. Desperate for nourishment, her body is drawing on its own reserves of muscle and fat.
During one of her visits, Ruby starts by showing Jyoti's mother how to mix the oral rehydration solution. Later, while helping bathe and dress Jyoti, Ruby lectures the mother about keeping the house cleaner and preparing more balanced meals.
To educate more members of the community, the CASE kids write and perform street theatre and puppetshows. Afternoon matinees draw large crowds of all ages.
As DIR began to achieve its health goals, it expanded its programmes to include education and economic development. The first target was creating an alternative to “schools” in the bustee, which are seriously lacking in facilities and equipment.
The photographer · Marilyn Smith is a Canadian journalist/photographer, currently living in Paris (France). She specialises in science and health reporting, and has a keen interest in development issues.
The exhibit sponsors · This exhibit is generously sponsored by the Centre for Indo-Canadian Studies, the BC Regional Innovation Chair and the Global Development Institute, all at the University of the Fraser Valley (Abbotsford, BC, Canada).
To organise an exhibition · Please contact: firstname.lastname@example.org