Friday, January 8, 2010

Slumdog Survivors

Veena (29) and her sons are third- and fourth-generation residents of the Janta Colony – a community of 14,000 people that butts against the limits Chandigarh, the capital of Punjab and India’s most modern city. But you won't find Janta on any state or city map, an oversight that allows all levels of government to consider it a temporary slum or bustee in local slang.
Situated on India’s northern planes, the bustee is hot – temperatures can soar to 45°C or more – and dry much of the year. 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.

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.

Navigating through the bustee invariably means passing within inches of wide expanses of open swamps (nullahs) or equally contaminated creeks that flow between rows of tightly packed houses.

Most troublesome is that the nullahs also attract bustee animals. Pigs pose a particular health risk; after wallowing in fecally contaminated water, they wander through bustee streets carrying on their hides the eggs or larvae of Taenia solium - pork tapeworm.

Children who pick up this pig-borne parasite can contract cysticercosis or neurocysticercosis, infections that cause cysts to develop under the skin, within muscles, or in the eyes or central nervous system. Severe infections can result in blindness or brain damage.

Sanjeev (25) and Sangeeta (22) were also born and raised in the Janta Colony, each of their parents having emigrated from the provinces when government jobs were plentiful in the new capital.

Every morning at 9:00 sharp, Veena, Sanjeev and Sangeeta join 13 other bustee residents for 20 minutes of yoga. It is a time to put some distance between their daily lives as “slumdogs” with their roles as agents of change.

Developing Indigenous Resources (DIR), the NGO that has trained this team of Health Promoters (HPs) over the past five years, believes that bathroom scales, stethoscopes and blood pressure gauges are all the equipment needed to monitor the general health and well-being of 14,000 people. One of the main jobs is to track, on a monthly basis, the weight of every child under the age of five years.
DIR’s HPs are recognised for more than their blue jackets. Almost half of each working day is devoted to attending lectures/demonstrations on health and nutrition. Bustee residents, particularly those with little or no education, have come to view the HPs as local experts and welcome their arrival.

As in most slums, general poverty makes malnutrition a primary concern; but high rents in the Janta Colony contribute to a higher incidence of severe cases. This woman (22), together with her second baby (2 months), barely pushes the needle on the scale to 34 kg.

Although the bustee has several relatively wealthy areas, most homes have only one or two rooms. As a result, much of daily life transpires outdoors and even young children are exposed to the elements.

Yet the combination of weakened immune systems and cramped living conditions allows contagious conditions, such as scabies, to spread quickly.

Other effects of malnutrition are more individual and more devastating. Chandigarh doctors attribute this young girl’s blindness, at least in part, to her mother’s severely malnourished condition during pregnancy. In addition, she was born at home in a remote village with no immediate access to medical care.

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. More often than not, their visits are a kind of “community health” as friends and neighbours listen in.

HPs also counsel women to have pre-natal examinations and give birth in the hospital rather than at home, particularly as pre-mature births are common for malnourished mothers. Baby Charanjeet was born on 12 December 2009 (one week before this image was taken) at 32 weeks gestation and weighed only 750 gm.

Life in the bustee undermines the natural tendency for children to rely on a helping hand from mothers or grandmothers. Many women work as cleaning staff or sell food or other goods in Chandigarh, and are gone from early morning to late evening.

It often falls to the eldest child, who may be no more than seven or eight years of age, to take care of the household chores.

Eldest children are also responsible for the care and feeding of younger brothers and sisters.

The most prevalent risk to bustee children is contracting diarrheal diseases from 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 in the bustee how to prepare an oral re-hydration solution from basic kitchen ingredients: boiled water, salt, sugar and lemon or lime.
When DIR recognised the responsibility older kids carry, it began an after school “child-to-child” (CTC) health programme for those aged nine to thirteen. The aim is two-fold: to give these kids a chance to have fun; and to use fun and games to teach basic health and hygiene.

The CTC kids are expected to teach what they’ve learned – including how to mix and administer the oral re-hydration solution – to their families and neighbours.

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 0.03).

DIR statistics, confirmed by an independent assessment, show that the HP strategy is working. By 2008, the incidence of severe malnutrition amongst children had dropped from 85% to 54% and almost 100% of bustee women gave birth at the hospital – compared to the national average of only 41%.

HPs 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.

Other signs of success come in the kitchen. Bishkawa’s birthday party 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. They’ve since stopped buying processed foods and watched their collection of eight children move from the “red” to “green” categories on DIR health charts.
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 government-run schools in the bustee, which are seriously lacking in facilities and equipment.

DIR’s “School with a Difference” prepares pre-schoolers to win scholarships at the best private schools in Chandigarh.

Three years ago, Kamal Preet Sharma (15) was placed at the satellite campus of St. Steven’s, the best school in the city. Now in 8th class, she says she has better teachers and opportunity to develop a much wider range of skills.

Some women in the bustee continue to practice traditional crafts, but the income opportunities are limited. It may take this woman up to two months to complete her basket; the largest size will fetch about 250 rupees (CDN 5.00 or EUR 3.80)…if she can find a buyer.

DIR has launched two programmes that allow women to balance income generation with childcare and household chores. DIR loans sewing machines and distributes donated fabrics for women to stitch into small purses or gift bags for wine bottles, which are then sold in retail outlets or to DIR supporters.

Similarly, donated newspapers are transformed into shopping bags. As Chandigarh recently outlawed the use of plastic bags in retail outlets, the market potential for this cottage industry is significant. But the market price for recycled paper has risen dramatically and acquiring enough old newspapers to meet demand is a growing challenge.
DIR recognises that these jobs are menial and the pay is low, but they provide vital extra income to women with few skills. And DIR makes a point of paying cash on delivery of the goods.

DIR still faces multiple challenges, some associated with culture and traditions. A new baby is cause to celebrate, but as this makes four daughters in a row, the family will likely continue to grow regardless of the parents' ability to sustain more mouths.

For older “slumdogs”, sedentary lifestyles and a life-long diet rich in ghee and other saturated fats can lead to high blood pressure.

But each child who achieves a healthy weight has a better chance of either making it out of the slum, or helping make the slum a better place to live.

According to CEO Dr. Frederick Shaw, the key to the DIR model is that it empowers people to solve their own problems – even through simple measures such as making sure children wear shoes when playing in bustee streets. If DIR disappears tomorrow, the skills and knowledge it has taught HPs and residents will remain.

At the end of the day, Veena and other HPs stop to visit their colleague Rani and her family, who have been ill. To a person, they agree that DIR has done more than give them a job they love: it has created a sense of family and community across the bustee.

Outside, a new generation is on its way home.

Health Promoters - Yoga in the morning