By Monalisa Padhee:
After completing my Ph.D. from the University of South Australia (Adelaide), I was told that I had two choices – either take up a postdoctoral position or return to India and work in the development sector. I did neither. Instead, I listened to my heart and went from writing academic research papers to actually working closely with the subjects of these research papers. This I did by embarking on a 13-month long journey in rural India, through the SBI Youth for India Fellowship. Not only was this an opportunity to understand a rural community at close quarters, it also gave me a chance to use my knowledge and skills to help solve some real-time issues.
I have always had a keen interest in women’s health and had read extensively about its state in India. But when I entered my project location in Ajmer district, I discovered that the health condition of adolescent girls and women is far worse than what I had read in articles. These women worked very hard – in the field, milking goats, fetching water and cooking for their families. Yet, health to them was not a priority.
What especially caught my attention was the stunted growth of their children. While government policies are mostly aimed at combating malnourishment in children, I felt it was important to intervene when girls were on the cusp of adolescence, peri-conception (around the time of conception) or in the various stages of pregnancy, so it would help not just the women, but also their children.
I discovered that very few women had had their haemoglobin levels checked even during pregnancy. Thus, there was an urgent need to get them tested. Over a period of four months, I conducted health check-ups for 200 adolescent girls and women in four villages (Chota Narena, Chirr, Tyodh, and Junda) in Silora block, and the results were alarming. Over 95% were anaemic, and over 70% were underweight and malnourished. The most worrying thing was that many in their third trimester of pregnancy were at a haemoglobin level that was life threatening to both mother and baby.
Thus, the obvious next step was to spread awareness about anaemia and the importance of a balanced, nutritious diet. But this presented its own set of challenges. The government provided iron tablets to pregnant women. But due to the unpleasant taste, not many women wanted to take them. Also, in order to save money, most families live on roti and chillies and most can’t afford fruits and other vegetables. Thus, it became more and more evident that fighting anaemia and poor health would not be possible without a nutritional intervention.
I was keen to provide something that is locally available, low cost and appeals to the taste buds of local people, so it would be easily accepted by the community. I was soon introduced to an indigenous product ‘amritchurna’. This mixture had been formulated with an aim to provide a balanced mix of carbohydrates, protein, iron, calcium and magnesium, keeping in mind the macro and micro nutrient requirements. The best part – it has a high iron content, and met all the criteria we were looking for!
The next step was to produce the product, which we did with the help of community members and health workers. For distribution, we did a simple packaging with clearly written instructions on the dosage. This was then distributed to over 50 women and girls who were anaemic, at a nominal price of INR 30 per kilo. The women were instructed to finish a jar in 10 days and then return for a refill. We had regular meetings to monitor consumption, and sometimes I went door to door to talk to the women and the elders of the families (in-laws and husbands) about our intervention.
To test the effectiveness, we measured haemoglobin levels and the weight of the girls and women at regular intervals. Well, it has been close to two months and I am happy to say that the results are encouraging. We are already seeing an increase in haemoglobin levels and soon we shall be doing a complete nutritional analysis. What’s also promising is that some women immediately call the local health worker Mangi Lalji to ask for a refill!
In these villages, mothers-in-law are quite influential. In some cases, they would not allow the daughter-in-law to consume ‘amritchurna’ even if she wanted to. However, a local woman named Sushilaji would get both her daughters-in-law for medical check-ups. She also attended the educational sessions on nutrition and makes sure her daughters-in-law consumed the powder every day. When I visited her home, she told me that she now understands the importance of a good diet. In fact, when her daughter-in-law went home to her mother’s house, Sushilaji sent her son with a refill of ‘amritchurna’!
I have also observed women of the Bhagriya community bringing their daughters-in-law. This is a hugely marginalised community that does not mix much with the local people, and this was indeed a milestone. Another time, I noted down the weight of a young woman incorrectly, and she immediately pointed that what I wrote was much less than the previous reading! For me, in that moment, it became evident that for these women, their health was becoming a priority. Words cannot describe the satisfaction I feel, seeing this change in attitudes.
Going forward, we now intend to teach these women to prepare this concoction themselves and develop a livelihood project around this initiative. At this juncture, I’d also like to share that I found an ally in Meghrajji, a super enthusiastic community health worker, who is always open to new ideas and ready for any work we propose. In fact, he goes door to door with me and sometimes all by himself, to talk to women and motivate them!
This experience, of working directly with these wonderful women, the community workers and health workers from the Barefoot College, is turning out to be one of the most important learning curves of my life. Every evening when I return to my room, after a day of heat and dust in the field, I cannot wait to step out the next day to meet the girls and women again.
We will giggle together on some so-called uncomfortable question on menstruation. We will perform some needle pricking for blood samples, which is no longer painful for them, and finally, ensure that we eat what has come to be popularly known as that “takat wala powder” (powder that strengthens)!