Study of Malnutrition as a Primary Care
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- Title
- Study of Malnutrition as a Primary Care
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Community Health Cell
Community Health Learning Programme
March 2010 to November 2010
REPORT
Mr.Madhappan M
intern, Community Health Cell
Journey through community health internship
About me
I am M. Madhappan, born in agricultural family in a small village in Dharmapuri district,
Tamilnadu. I did masters in zoology in 2009 from government arts college, Dharmapuri and
prior to that I have completed bachelor’s degree in zoology and a bachelor of education. All my
studies except B.Ed were from the government institutions. I have an elder brother working in a
voluntary agency and my sister in law is a staff nurse.
How and why I joined CHLP
MYRADA/PLAN, a voluntary organization implementing many developmental projects in
Dharmapuri district, has supported my education also. During the period from 1999 to 2003, I
had interactions with the staff of MYRADA. I admired the dedication and skills of those staff. I
developed interest in social work from them and I was waiting for an opportunity to work in
rural areas. When I heard the CHLP program through Mr.Shankar,Convenor of Dharmapuri
Voluntary Agencies Network Initiative, I applied for the internship and got the opportunity to be
part of the program.
Orientation program
I would like to elaborate my experience during orientation program. The initial orientation
program lasted for forty days. The initial days of the orientation were difficult phase in my
Internship life, since I could not understand the subject and language and social work is a new
sector. But at later stage I found place for my self in internship and in the community health field
as I realized community health field is not only related to health care but it is interlinking all
development aspects in which I am comfortable with. I developed deeper understanding about
many aspects through the orientation program. I am mentioning few of them here-
Community: Community means a group of individuals from various backgrounds like caste,
class, tradition, culture, political ideology and gender living together and which differences will
have direct influence in their health status
Health system: I understood the importance of an effective health system, its functions,
importance of area specific health schemes and the limitations of the existing health system from
various sessions.
Environmental health: Health means many things include environmental health also. I have
learnt few aspects of environmental health, its importance and the factors supports and destroy
environment stability and protection, its impacts on various aspects and linkages between
globalization and environmental related problems.
Indigenous medicine: The importance of promoting Indigenous medicine, especially herbal
medicine was discussed in detail.
Mental health: I have understood the meaning of ‘Health’ through a detailed discussion on
mental health. Learning on how to identify mentally ill people and how to approach them are
very new to me.
Disaster Management: Through workshop on disaster management I learnt about disaster,
disaster preparedness, management and essential measures to be taken during the relief phase
include first aid and psycho social support to the victims of a disaster.
The biggest learning from the forty days orientation was understanding health from a broader
perspective, linking the determinants of health under community health.
Learning objectives
After many discussions with mentor and team the following objectives were finalized for my
internship. I belong to a agricultural family and primary source of employment for people in
Dharmapuri is agriculture. But in recent years due to various reasons the agriculture sector has
not been providing enough employment and income for poor people, which are important
reasons for mass migration, and leading to malnutrition. Since I was disturbed with this fact, I
wanted to explore this aspect further and decided to take study of malnutrition as a primary
objective for my internship.
1.
2.
3.
To study about the government’s supported nutritional schemes.
To learn about National Rural Health Mission (NRHM) and community participation
through involving in Community Action for Health (CAH) project.
To know more about Village Health, Water and Sanitation Committees (VHWSC) and
strengthen committees understanding on nutrition schemes.
Field work
I have designed my field work in such way that it will cover all my objectives. I was placed in
Development Education and Environment Protection Society (DEEPS), voluntary organization
headed by Mr.Shankar.
Water shed management: DEEPS is involved in water shed management activities in
Pennagaram block of Dharmapuri district. During my field placement I got an opportunity to
involve in activities like mobilizing community, finding suitable place for building bund, finding
appropriate beneficiaries through Participatory Rural Appraisal techniques.
NRHM - VHWSC: In Dharmapuri the NRHM-CAH project is being implemented in three
blocks. The project activities includes mobilizing village people to form committees, orienting
committee members on various aspects of health system, entitlements of people and motivating
them to take part in community monitoring. I involved in all these activities along with DHVANJ
staff and the facilitators of the project. In specific I gave training to many VHWSC members and
involved in selection process of VHWSC members. I attended many block and monthly review
meetings where the success and difficulties of the process were discussed, I have learnt many
things though these meetings.
Awareness rally: The project has organized awareness rally to reach out village people to make
them aware about NRHM and monitoring. I took in charge of this rally which lasted for five days
and covered few hundred villages of Dharmapuri district. This experience was a distinct
experience in my life and it helped me in developing leadership skill.
Study on Nutritional schemes: In order to understand the nutritional security in Dharmapuri
district I have collected various document related to the government funded nutritional schemes
which are mentioned below. The information collection experience has taught me varieties of
things like, approaching government officials, meeting subject experts, strategies to collect
information, difficulties in colleting information, filing Right to Information petition etc. Most of
the information was collected in government offices and some information were collected
through Right to Information Act.
1.
2.
3.
4.
5.
6.
7.
Noon meal scheme
Public distribution system
Dr.MuthuIakshmi Reddy maternity benefit scheme
Old age pension scheme
Program for Vitamin A solution
National anemia control program
National program for iodine deficiency control
The information collected on all the above schemes was printed as a separate booklet.
Filed work during last three months of my internship: During the formation of my learning
objectives linkages between all the three objectives were created. As per that the purpose for
studying the nutritional schemes is to orient the VHWSCs on these schemes. As I had developed
better understanding through my field work on the VHWSCs of CAH project area, orienting
VHWSC members on nutritional schemes was also done effectively. In the last three months I
had involved in four activities,
1.
Preparing booklet on Nutritional schemes: Based on the collected data on the various
nutritional schemes I had prepared a booklet with details of schemes, entitlements of
people, avenues to avail the schemes with higher authorities phone numbers for each
scheme.
2. Strengthening the ICDS center’s function: I have chosen Nallamapalli Anganwadi,
which serves for dalit children. I assessed the nutritional status of the children and other
issues in the centre. I found poor community participation in ICDS center as the major
problem. I had convened ICDS children’s parents meeting and various aspects to improve
community participation and children’s nutrition level were discussed.
3. Training for NRHM CAH project animators: I have trained the NRHM CMP project
animators of Dharmapuri district on the nutritional schemes. This will help them to
improve the services and to train the VHWSC members.
4. Training for VHWSC & village health committee (VHC) members: I have conducted
a training session on nutritional schemes to the Nallampalli block VHWSC and VHC
representatives.
Understanding about primary health care system in Dharmapuri district
As we know health is determined by many other factors including social determinants. In recent
years though health care industry has grown phenomenally still many villages are left without
basic health care. As per my understanding the poverty, illiteracy, misconceptions, privatization,
thrust for more huge profit by private companies and governments’ own rules like giving low
importance to rural health care, limited control on private practices of government doctors are
the major cause for the poor health care in Dharmapuri.
Though in general, Primary Health Centres, Sub centers and government hospitals are
functioning well in Dharmapuri district, measures like compelling antenatal mothers to do check
ups and deliveries in PHCs as precondition to avail the benefit of maternity benefit schemes such
as Janani Suraksha Yojana and Muthulakshmi reddy scheme are producing negative results on.
These measures bring adverse effect on health care seeking behaviour of people and lead to
tragedy in few incidents. Since government has narrow understanding of health by restricting
with health care the other determinants like education, housing and transport facilities are not
integrated with the health sector,which lead to restricting poor to access the health care facilities.
These limitations affects Dalits in great depth is a real concern. Apart from these, gender
insensitivity, communities own misconceptions and poor participation in health services are the
major problems in Dharmapuri district.
After NRHM is implemented in the district the VHWSCs are taking positive measures to
improve the health services. As steps to improve the situation, first strong linkage between
community and health care department has to be established, quality health education has to be
provided from the primary school, sense of being responsive citizen has to be taught from school
level. The health department has to concentrate on health education and providing psycho social
support to the patients to create a health society.
Government has to develop its own context specific health policy with the integration of other
department is the need of the hour.
Overall learning
I have learnt many things through class rooms, filed work and through interactions with other
interns and mentors. Dr.Ravi’s session on approaching society with the concept of “Namtna Nimma”; Mr.Premdas’s session on developing positive attitude to do social work, working along
with community’s interest, Ms.Shoba’s session on personality development, in which the
concept of win-win situation was discussed and Mr.Sam Joseph’s approach to Participatory
Rural Appraisal are few worth mentioning sessions and learnings.
Through field work I learnt about public hearing, which is entirely new concept to me. The
Pothnal visit provided me opportunity to know about differently abled people’s difficulties and
their own coping mechanisms, Jana Arokya Andholana - Karnataka’s activities and about herbal
medicines.
I have developed essential skills and knowledge about running effective training sessions,
preparations required for trainings like budget preparations, arranging resource persons and
preparing lesson plans etc. Personally I have changed a lot during the last nine months.
Approaching others with positive attitude, listening to others views, confidence in public
speaking, developing confidence in myself, report writing, analytical skills with positive
approach and time keeping are the major personal gains for me in internship scheme.
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