MEDICAL SERVICE VOL. 40 No. 4 APRIL-1983

Item

Title
MEDICAL SERVICE VOL. 40 No. 4 APRIL-1983
extracted text
-

COMMUNITY HEALTH CELl

326, V Main, I Block
Koramangala
Bangalore-560034
India

health within reach • in ^aise of the dai -.-> useprieatiye talent >
do ,youl<hearV me
news and notes. • proce$^?puljses for better
nutritibh

WmSL_

april 1983

medical
service

official house journal
of the catholic
hospital association of India

"the love of Christ
urges us" 2 cor 5 : 14

vol 40

contents

editorial board

dr c m francis
dr ravi narayan
dr prem chandran john
dr daleep mukarji
mr augustin veliyath
fr george lobo sj

1

editorial

2

2

health within reach
future, unicef

3

in praise of the dai
future, unicef

15

use your creative talent
maithily jagannathan

21

do you hear me
ajay kothari

23

6

chai news and notes

29

7

process pulses for better nutrition

39

3

editor

4

fr john vattamattom svd

5

cover design

april 1983

no 4

p m isaac bangalore

published by the catholic
hospital association of India
c b c i centre, goldakkhana
new delhi-110001
printed at kalpana printing
house new delhi-110016

"Articles and statements published in this journal
do not necessarily reflect the policies and views of
the catholic hospital association of india"

EDITORIAL
A big gap
"The constitution of India envisages the establishment of a new social
order based on equality, freedom, justice and the dignity of the individual.
It aims at the elimination of poverty, ignorant and ill health and directs the
State to regard the raising of the level of nutrition and the standard of living
of its people and the improvement of public health as among its primary
duties, securing the health and strength of workers, men and women,
specially ensuring that children are given opportunities and facilities to
development in a healthy manner."

These were the opening words of the statement on the new National
Health Policy of the Government of India. After thirty three years and more
of the promulgation of the constitution of India, many a thing given in it
remains still a dream for millions of people in the country. There remains
always a big gap between what is envisaged in the constitution and what is
in reality.
Our health care delivery system is one of the sectors where this gap is
seen conspicuously. With doctor centred and sickness centred allopathic
system of medicine enjoying a privileged position in our country at the cost
of indigenous system, and the multinational drug companies thriving under
this system, the constitutional provision of establishing a healthy society will
always remain a dream for millions of poor people particularly in the rural
areas, unless some drastic measures are taken by all concerned, in the health
care delivery system.
India is one of the biggest democratic countries in the world. But the
question to be asked is, does it reflect in our economic system or are we
still in a capitalistic system ? In the new health policy the government
envisages a new social order and a new approach in the health care delivery
system. But one may be inclined to ask, will the government at various
levels have the courage to implement it. History will tell us that it did not
happen in our country in the past, and common sense will tell us that it is
not so easy, unless the common people become aware of their rights and
responsibilities and start to demand their rights in a responsible way. And
then only this gap can be reduced if not completely bridged.
What has been said about the government can also be applicable to
various Voluntary Sectors, particularly the Church groups. No doubt the
efforts made by the Church in the past are certainly significant in themselves,
but they have not helped very much to bridge the gap. Maybe it is time
for us, or rather already late, to take the common people into serious
consideration particularly the poorest of the poor and the voiceless, lest we
miss the boat altogether. After all that is what Christ taught and did, so
also the early Christians.

Health Within Reach
Some missing links in development

Can health be promoted independently of
other human needs and goals ? How do
social and economic factors interact in a
condition of deprivation ? Can service
and research be combined in a single
thrust ? How well do nutritional feeding,
health education, primary health care and
community work training complement
each other ? What roles do local groups,
government support and external funding
play in health for development ?
The report that follows is based on im­
pressions of a visit to the Child-in-Need
Institute, not far from Calcutta. It sheds
some light on answers to questions such
as raised above, based on the experience
of an engaging experiment.
Change is a law of life even of institu­
tions. And the role and character of CINI
seem likely to change with the experience
of its own response to children's needs
in impoverished communities.

The small but compulsive beginnings of
CINI are half its story. An Indian doctor
working in the paediatrics outpatient depart­
ment of a hospital in Behala in outer Calcutta
threw up his hands because medicines did
not work on malnourished children taken ill.
Indeed conventional drugs appeared to do
them more harm than good. About this
time, an Australian nun teaching at a school
in neighbouring Thakurpukur was foxed by
the incapacity of malnourished children to
absorb or retain their lessons; the effort
seemed a waste of time. Something had to
be done about this hopeless state of children
from poor families.
S N Chaudhuri and

April 1983

Pauline Prince thought something could be
done, together. That was in 1974.

A three-day visit to CINI revealed how far
afield the original impulse of a nutrition
intervention has propelled itself. It has
evolved into a complex project of almost
daunting dimensions—low-cost supplement­
ary food which mothers could themselves
prepare, inexpensive health care including
immunization, and treatment of common
ailments, plus nutrition and health education.
But soon this concept of integrated child
care proved simplistic I
For, if mothers were to be trained, the
trainers have first to be trained. If children
were not to be born malnourished, antenatal
care had to ba organised, and if they were
not to die as infants post-natal attention was
as necessary. Serious cases of malnutrition
compounded by infection needed intensive
care and hospitalisation, and thereafter a
period of rehabilitation fully involving the
mother.

Looking a little beyond, the mothers had
to be enabled to look after their children—
maybe through their own independent contri­
bution to the family income. For, an incre­
ment to the father's earnings did not always
lead to better nourishment for the child.
Thus, income generating activities have had
to be organised.
For making the mother aware of her pro­
ductive potential and her rights in society, as
well as for imparting to her health and
nutrition education, functional literacy was
an obvious means. For this, community
organisations, like women's groups (mahila

3

mandals) and youth clubs, have had to be
organised and activated.

With every successful step it took, CINI
found itself deeper in new responsibilities,
natural but challenging, covering the gamut
from nutrition and health, through training,
to community organisations and income
generation. In the process, it found itself
setting up a demonstration farm at Samali.
When the 1978 floods ravaged the bowl of
Moyana in Midnapore district and govern­
ment doctors were not easily available to do
relief work, CINI's help was asked for and
gallantly given. But as the floods receded
and CINI was withdrawing, the villagers
asked it to stay on—and the Moyna project
was born. For good measure, demands have
been made on and met by CINI. Its director
had to rush in 1979 to the relief of childre-n
among Kampuchean refugees in Thailand and
during 1980-81 to help the very young in
famine sticken Uganda and in the refugee
camps in Somalia.
As the target population of children en­
larged on CINI's horizon, its finances and
facilities have had to be built up. It increa­
singly needed staff and storage space,
vehicles and garages, office blocks and
residential quarters, in short the parapherna­
lia of a modern expanding administrative
set-up.

Some of this has come up. Presumably
more will be established. But who pays the
costs, initial and recurring ? If CINI is essen­
tially a community-oriented project, operating
in an environment of steep poverty, will its
steadily growing size and costs not put a
distance between itself and the common
people ? Will they not remain at best reci­
pients rather than partners ? Will it succeed
in transferring most of its functions to
community organisations, as it apparently
wants to, and become, in the long term,
4

basically a training institution ? These and
other questions arise as precedents pointing
the wrong way are not wanting. The most
hopeful aspect about CINI is that it is itself
conscious of these vexing questions and is
striving to find answers consistent with its
avowed aims. The following discussion of
its present activities seeks to keep the focus
on options of the future.

Personnel
CINI does not find it easy to get doctors.
The workload is heavy (8 a.m. to 1 p.m. or
beyond), the remuneration is not much, the
conditions of work are uninviting, and the
degree of social commitment demanded is
high. Nurses are, it is said, easier to get
than doctors. Not all medical men who show
initial interest get down to the job. The
problem of getting doctors to work in villages
remain—though West Bengal has more than
an eighth of India's registered doctors. The
answer may lie, not in putting all medical
graduates compulsorily through the grind,
but in locating and motivating the more
human among them to set examples. CINf
seems to have found a few.

This problem is there also in respect of
other professional personnel needed. Dr.
Chaudhuri says: ''With no job security and
low salary scales, it is difficult to attract
personnel with leadership roles. It is very
hard to implement a service as well as a
research programme without professional
expertise in the field of behavioural sciences,
medicine, bio-statistics, management, and
agriculture."

Health and Nutrition
CINI's clinics for under-six children are
held every week at five centres—at the
Daulatpur headquarters (Thursday), Samali
(Monday), Thakurpukur (Saturday), Baruipur
(Wednesday) and Behala (Tuesday and

Medical Service

Friday). The Daulatpur and Samali clinics
were observed in operation. The attendance
was about 700 and 300 respectively. The
services rendered consist of treatment of
ailments, nutrition supplement, immunization,
updating the health cards, and advice to
mothers on nutrition and health. A registra­
tion fee of Re. 1 is charged on the first visit
and thereafter 70 paise per visit. The food
packet, if given, costs another 50 paise. At
both Daulatpur and Samali, the generality of
mothers and children looked famished.
Nearly all were ill-clad and barefoot.

There is currently an effort at organizing
more clinics in remote villages. This is done
by training personnel from youth clubs and
village women's groups (mahila mandals) at
CINI. Initially CINI staff such as doctors,
nurses and paramedical workers help out,
but most of the work is now being done by
the villagers themselves. CINI subsidises the
running costs of these clinics upto 25 to 50
percent. But over the past few months the
subsidies have shown a declining trend. In
some situations, homeopathy is being inte­
grated with immunization and other services.

Kasimul Khatun's husband died and her
child Rija, a year and a half, was too mal­
nourished to stand up. The doctor prescribed,
and she was given, carminative mixture,
multi vitamins, vitamin B Complex and a
packet of CINI Nutrimix to last a week.
There were many Rija's. There were some
tubercular cases. Surveys of the area put
the incidence of this disease at 6-8 per cent
of the population, which is disturbingly
high.

Food supplement

Clinics
The clinics are thoughtfully organised and
the stages a mother and child have to go
through have a logical time-conserving
sequence. The stock of supplies and the bare
facilities appeared adequate.
But not the space. At Daulatpur, the
clinic extended beyond a portion of CINI's
main building to a long and narrow cowshed
where mothers were shown posters on nutri­
tion as they waited in queues for their babies
to be weighed in spring balances. The
crowding at Samali within a ramshackle
bamboo shed set in a waterlogged field was
excessive even by village standards. Clinics
at more locations, rather than enlarging the
existing ones, may be the better solution,
though either calls for fresh investment.

April 1983

CINI Nutrimix is a blend of powdered
wheat, lentils and milk. 500 grams yield
1920 calories, 110 gms. of protein plus
other nutrients. It is expected to fill the gap
in a village child's food intake for seven
days. Less than 300 calories a day, it is not
a replacement of the usual diet.

CINI's policy in this regard has evolved
over the years, and is evolving. At first
selected mothers trained in the making of
Nutrimix went out to the villages and orga­
nised, in a week-long routine — roasting,
crushing and distributing, followed by nutri­
tion lessons and home visits. Then in 1978,
the Nutrimix programme was woven up with
functional literacy classes — the mothers
were given raw wheat/dal at village centres
where functional literacy classes were held:
they brought back the stuff, roasted and
crushed, on another class day when the milk
powder was added. This did not work out
quite well, especially after the functional
literacy course ended. Since 1979, Nutrimix
is being prepared and packed at CINI head­
quarters by paid employees* for distribution
to the mothers of needy children or clinic
days.

This last bit obviously is no example of
community involvement or self-reliance.
5

mandals) and youth clubs, have had to be
organised and activated.

With every successful step it took, CINI
found itself deeper in new responsibilities,
natural but challenging, covering the gamut
from nutrition and health, through training,
to community organisations and income
generation. In the process, it found itself
setting up a demonstration farm at Samali.
When the 1978 floods ravaged the bowl of
Moyana in Midnapore district and govern­
ment doctors were not easily available to do
relief work, CINI's help was asked for and
gallantly given. But as the floods receded
and CINI was withdrawing, the villagers
asked it to stay on—and the Moyna project
was born. For good measure, demands have
been made on and met by CINI. Its director
had to rush in 1979 to the relief of children
among Kampuchean refugees in Thailand and
during 1980-81 to help the very young in
famine sticken Uganda and in the refugee
camps in Somalia.
As the target population of children en­
larged on CINI's horizon, its finances and
facilities have had to be built up. It increa­
singly needed staff and storage space,
vehicles and garages, office blocks and
residential quarters, in short the parapherna­
lia of a modern expanding administrative
set-up.

Some of this has come up. Presumably
more will be established. But who pays the
costs, initial and recurring ? If CINI is essen­
tially a community-oriented project, operating
in an environment of steep poverty, will its
steadily growing size and costs not put a
distance between itself and the common
people ? Will they not remain at best reci­
pients rather than partners ? Will it succeed
in transferring most of its functions to
community organisations, as it apparently
wants to, and become, in the long term,
4

basically a training institution ? These and
other questions arise as precedents pointing
the wrong way are not wanting. The most
hopeful aspect about CINI is that it is itself
conscious of these vexing questions and is
striving to find answers consistent with its
avowed aims. The following discussion of
its present activities seeks to keep the focus
on options of the future.

Personnel
CINI does not find it easy to get doctors.
The workload is heavy (8 a.m. to 1 p.m. or
beyond), the remuneration is not much, the
conditions of work are uninviting, and the
degree of social commitment demanded is
high. Nurses are, it is said, easier to get
than doctors. Not all medical men who show
initial interest get down to the job. The
problem of getting doctors to work in villages
remain—though West Bengal has more than
an eighth of India's registered doctors. The
answer may lie, not in putting all medical
graduates compulsorily through the grind,
but in locating and motivating the more
human among them to set examples. CINI
seems to have found a few.

This problem is there also in respect of
other professional personnel needed. Dr.
Chaudhuri says: "With no job security and
low salary scales, it is difficult to attract
personnel with leadership roles. It is very
hard to implement a service as well as a
research programme without professional
expertise in the field of behavioural sciences,
medicine, bio-statistics, management, and
agriculture."

Health and Nutrition
CINI's clinics for under-six children are
held every week at five centres—at the
Daulatpur headquarters (Thursday), Samali
(Monday), Thakurpukur (Saturday), Baruipur
(Wednesday) and Behala (Tuesday and

Medical Service

Friday). The Daulatpur and Samali clinics
were observed in operation. The attendance
was about 700 and 300 respectively. The
services rendered consist of treatment of
ailments, nutrition supplement, immunization,
updating the health cards, and advice to
mothers on nutrition and health. A registra­
tion fee of Re. 1 is charged on the first visit
and thereafter 70 paise per visit. The food
packet, if given, costs another 50 paise. At
both Daulatpur and Samali, the generality of
mothers and children looked famished.
Nearly all were ill-clad and barefoot.

There is currently an effort at organizing
more clinics in remote villages. This is done
by training personnel from youth clubs and
village women's groups (mahila mandals) at
CINI. Initially CINI staff such as doctors,
nurses and paramedical workers help out,
but most of the work is now being done by
the villagers themselves. CINI subsidises the
running costs of these clinics upto 25 to 50
percent. But over the past few months the
subsidies have shown a declining trend. In
some situations, homeopathy is being inte­
grated with immunization and other services.

Kasimul Khatun's husband died and her
child Rija, a year and a half, was too mal­
nourished to stand up. The doctor prescribed,
and she was given, carminative mixture,
multi vitamins, vitamin B Complex and a
packet of CINI Nutrimix to last a week.
There were many Rija's. There were some
tubercular cases. Surveys of the area put
the incidence of this disease at 6-8 per cent
of the population, which is disturbingly
high.

Food supplement

Clinics
The clinics are thoughtfully organised and
the stages a mother and child have to go
through have a logical time-conserving
sequence. The stock of supplies and the bare
facilities appeared adequate.

But not the space. At Daulatpur, the
clinic extended beyond a portion of CINI's
main building to a long and narrow cowshed
where mothers were shown posters on nutri­
tion as they waited in queues for their babies
to be weighed in spring balances. The
crowding at Samali within a ramshackle
bamboo shed set in a waterlogged field was
excessive even by village standards. Clinics
at more locations, rather than enlarging the
existing ones, may be the better solution,
though either calls for fresh investment.

April 1983

CINI Nutrimix is a blend of powdered
wheat, lentils and milk. 500 grams yield
1920 calories, 110 gms. of protein plus
other nutrients. It is expected to fill the gap
in a village child's food intake for seven
days. Less than 300 calories a day, it is not
a replacement of the usual diet.

CINI's policy in this regard has evolved
over the years, and is evolving. At first
selected mothers trained in the making of
Nutrimix went out to the villages and orga­
nised, in a week-long routine — roasting,
crushing and distributing, followed by nutri­
tion lessons and home visits. Then in 1978,
the Nutrimix programme was woven up with
functional literacy classes — the mothers
were given raw wheat/dal at village centres
where functional literacy classes were held:
they brought back the stuff, roasted and
crushed, on another class day when the milk
powder was added. This did not work out
quite well, especially after the functional
literacy course ended. Since 1979, Nutrimix
is being prepared and packed at CINI head­
quarters by paid employees* for distribution
to the mothers of needy children or clinic
days.
This last bit obviously is no example of
community involvement or self-reliance.
5

More so, when part of the wheat comes
from the Catholic Relief Centre in USA and
the skimmed milk powder from the European
Economic Community. The next phase in
CINI's experiments with nutrition supplement
could be—and CINI is said to be considering
it — to organise and enable mahila mandals
to prepare and distribute Nutrimix, training
mothers and giving them nutrition education
in the process. Here is a case of a sound
idea awaiting an equally sound channel of
implementation.

There are signs of this beginning to
happen. The composition of Nutrimix has
lately undergone a change. Milk powder
has been dispensed with, without signi­
ficantly lowering the nutritive value —
because milk powder is not locally available
except at a high price. Also moong dal has
made way for the cheaper Bengal gram. It
is admitted that mothers believed Nutrimix
was effective because of its milk content.
So, the educative process has to be stepped
up to convince village mothers that even
the new version of Nutrimix was worthwhile
as a food supplement; in terms of calories,
proteins and the net price. The cereal-pulse
mixture is considered adequate to provide
the deficit in calories and proteins. This
blend, now the sole content of CINI Nutri­
mix, provides, in 500 grams, 1723 calories
and 90 grams of protein.
. How does Nutrimix actually reach the
child ? Nutrimix is fed to the children at
least 3-4 times a day by the mothers. In
rare instances when the mothers live far
away from CINI and cannot come to collect
the food packets once a week, Nutrimix is
fed once a day. During home visits it is
emphasized to the mothers that Nutrimix
should be given to the child for whom it has
been taken and not shared with other
children. But very often in these povertystricken families it is shared resulting in the
packet being used up within 3 days.

April 1983

Imported foods
Apart from Nutrimix given to nutritionally
needy children turning up at the clinics, CINI
distributes blended food, bulgur wheat, soya
bean and peanut oil, and skimmed milk
powder— mainly because they are made
available by "relief organisations" from
abroad. Over 2500 under-six children and
around 50 pregnant and lactating mothers
are currently being given fortnightly rations
of this food supplement. At the time of the
visit, neither blended food nor oil was actually
available; so they had to make do with wheat
and milk powder. Irregularity of supplies
apart, to the extent the distribution is linked
to immunization, it may come to a stop when
the schedule for the latter is completed.
Efforts are made to associate youth clubs
and other local organisations with the distri­
bution programme, to have trained health
workers visit homes, to monitor the health
and nutritional status of the beneficiaries and
to maintain health cards for them. A packet
to last 15 days is charged 80 paise. In spite
of these procedural refinements aimed at
community participation, the programme
seems not to have yet outgrown the donor­
recipient ethos.
CINI's own perception is clear: Distribu­
tion of imported food stuff to malnourished
children is fulfilling an immediate need. It is
also a tool in delivering health education,
getting children together for immunization
and provision of primary health care.

Health results
What is the combined effect of nutrition
supplement, health care and health education
on the malnourished child ?
An earlier study, confined to a CINI spot
feeding programme showed that, after 45
days' feeding, over 84 percent of children in
7

2nd grade malnutrition gained 400 grams in
weight on an average; and over 91 per cent
in the 3rd grade category improved by an
average 790 grams.

At present a detailed record is being
maintained of changes in nutritional status,
measured by weight for age, of all children
in CINI's care. The register entries are still
being made, but on the showing of data so
far filled in, a decisive trend for the better is
not evident. For example, the rural villages
of Keyatola and Mondalpara show more
deteriorations than improvements, while in
the urban slum of Italghata results point the
other way.
There is a plausible explanation for this:
in Keyatola and Mondalpara the children
belong to very poor families. They belong
to a minority community (Muslims). Keyatola
is a rural area where the families are landless
and mostly survive as seasonal agricultural
labourers, beggars, beedi-rollers, etc. In
Mondalpara, a typical Calcutta slum, the
parents earn their living as unskilled labour.
There is high morbidity in both these areas
amongst children. This probably is due to
the vicious interaction of malnutrition and
infection which prevails in these children due
to their poor nutritional state. For many
children, the nutritional supplement given by
CINI is a major source of food which only
partially meets the child's requirement.

Italghata, also a slum, is slightly better
off socio-economically. The fathers work as
unskilled or semi-skilled labourers, while
mothers get regular work as housemaids in
the houses of richer Calcutta citizens. This
may be one of the reasons for the reverse
trend here.
When the programme was
subsequently withdrawn from Italghata, the
weights of these children improved slowly
or remained static.

8

While a clearer picture would emerge
when the data for all the areas served by
CINI are entered, the point is driven home
that social and economic inputs have to be
ensured together for either to have effect.

Training
This function is basic to the concept of
CINI and even if it is able, in time, to trans­
fer its various other responsibilities to the"
local communities, its role as a practical
trainer may rightly be expected to continue.
Indeed, CINI has earned a reputation as a
training institution for child health workers,
originally for engagement by itself and then
for other voluntary organisations.

The training programmes undertaken by
CINI have expanded very rapidly. From
about ten health workers trained by CINI in
1975, during 1979 and 1980 over 1,500
maternity and child health workers have
been trained directly and indirectly by CINI
training team. The latest phase is the
supervisor's course of anganwadi workers
under the countrywide government suppor­
ted programme of the Integrated Child
Development Services (ICDS). This pro­
gramme is presently trying to qualify itself
as a genuine community-based low-cost
scheme with demonstrable public account­
ability.
CINI is concurrently conducting
both anganwadi and supervisor's courses.
This rapid expansion underscores CINI's
basic concern over the paucity of trained
mother and child health workers in West
Bengal.

A training centre which will accommo­
date upto 100 trainees and provide adequate
facilities for training is under construction.
This was one of CINI's long-term strategies
to improve child care services in eastern
India.
Medical Service

Sishu Kalyani’s
In 1979, CINI was called upon to train
some 1500 Sishu Kalyani's and supervisors
for the mother and child care programme,
sponsored by the West Bengal government
with UNICEF support, in 30 flood ravaged
blocks of the state. Lacking facilities as
well as time, CINI trained the personnel for
two blocks and trainers for the rest. Inci­
dentally the comments heard from diverse
quarters on this one-time mother and child
care programme were that (a) not all the
project officers were in position even after a
year, (b) the organising effort was not
geared to meet the physical or spending
targets,
(c) the Shishu Kalyani's (paid
Rs. 100/- a month) were reluctant to go out
into the field of work, and (d) the future
of the programme, once the UNICEF role
ended, was uncertain.

All this is not a reflection on CINI. Yet
it i s of seme consequence to it if its training
effort does not bear full fruit. The answer
to this situation may be to re-found the
programme in the village communities, to
reduce its dependence on the bureaucracy
and to make the Sishu Kalyani's accountable
to a community organisation, if not belong
to one. The problem however is that there are
no community organisations ready; for even
the panchayats (local self-government insti­
tutions) take after the government in culture,
style and impact.

The components of this dual effort be­
come clear in the experiences discussed
below.

Family help
With the help of money from the Chris­
tian Children's Fund, a scheme has been
started in 1979. A sponsor provides affixed
monthly amount to a child in need and his
or her family. CINI does the selection of
deserving candidates in association with
panchayats, schools, etc. About half the
amount goes direct to the child (clothing,
books, school stationery, fortnightly food
supplies to prepare nutritious snacks,
medical check-up, emergency help to the
family and small savings). About a third of
the donation goes for community program­
mes like repair and reconstruction of schools,
educational aids to teachers, food supple­
ments at school, health check-up for all
school children, brotochari (action songs),
mobile library, and so on. The rest of
the donated money goes for administra­
tive expenses. Under this scheme some
500 children are directly benefited. As a
dispenser of funds, CINI follows democratic
procedures, enlisting the participation of
teachers and parents.
The strategic aim of the Family Help
Project is long-term. It helps to improve the
socio-economic status of the family, thereby
reducing the need for future food supple­
mentation.

Community action

Income generation

CINI has two wings, one for community
action and the other for community organi­
sation. The two are linked in that the aim
of the former— to transfer programmes to
local groups— can succeed only if local
groups come into being through proper
organisation.

As part of the Family Help programme,
as well as outside it, CINI has made a small
start in income generation in poor families,
through initiatives in kitchen gardening,
farming and fishery, sewing, weaving, um­
brella making, book-binding, mat-making,
fish drying, etc. The initial investment is

April 1983

9

provided as loan or grant. Materials, equip­
ment and marketing outlets are found
wherever possible.
The move is unexceptionable, but the
organizational structure for the effort is yet
to be built up with roots in the village
community.

ject areas. A few of them already run day
care centres.
CINI's faith in community based action
groups (youth clubs are mahila mandals) is
fairly firm.

Functional literacy

Mahila mandals and youth clubs
The panchayats in West Bengal have
been reactivated, but they seem busy with
concerns more of a political-governmental
than social-developmental nature. In any
case, Daulatpur (CINI haadquarters is located
there) seems to be in the grip of illicit liquor
brewers who are not on the same wave­
length as health promoters. So the search
is on, by CINI, for representatives of the
community of the poor, for identifying or
organising women's forums, who can shoulder
the responsibilities for mother and child care
and supportive measures at the village
level.
A few mahila mandals have been formed.
A 10-point guideline has been drawn up to
help this process, with the focus on the
well-being of the child. The progress appears
modest. Pre-schools centres (balwadis) are
being run by mahila mandals at fourteen
villages. CINI has extended an initial work­
ing grant to these women's groups pre­
paratory to their registration with the
(government) block development offices as
autonomous societies.

CINI's director clarifies: CINI has always
regarded itself as a catalyst and a 'facilita­
tor". Some of CINI's programmes like food
distribution are already being handled by
youth clubs. A continuous dialogue is going
on to increase their [ participation. Mahila
mandals are being organised in CINI's pro­
April 1983

This has rightly been identified by CINI
as the missing link in village development.
Sessions are conducted at three or four
places, for 20 mothers each, three times a
week. The emphasis is on discussion, the
aim is to enhance awareness, the focus is on
topics like health, sanitation, adulteration,
money-lending, middlemen, etc.
Some
successful Bangladesh experiments have
been adapted to fashion the syllabus.

Development agents
More than anything else, CINI needs
young motivated workers for community
development. It now has some 17 of whom
9 are men and 8 women. The men help in
promoting income generation activities,
pumpsets for irrigation, fish-rearing in leased
bonds, etc., while the women do health
promotion work, take literacy classes, orga­
nise mahila mandals and so on.
These development agents are selected
from among those suggested by the local
community but it cannot be said that the
system is working very well. At first the
remuneration was food-for-work, then
Rs. 100 per month and now Rs. 200. Its
adequacy apart, the lack of security of
tenure seems to sap their enthusiasm. CINI
is looking for a more viable arrangement—
for example, a community organisation
having its own development agents whom
CINI can train.

11

Finance
CINI's 1980 budget was of the order of
Rs. 2.2 million of which Rs. 100,000 came
from UNICEF, Rs. 30,000 from the Central
Government and Rs. 47,000 from the State
Government. The Samali farm yielded
Rs. 120,000 (which was slightly less than
the current investment in it) and the contri­
butions from the beneficiary community add
upto Rs. 50,000. That is to say, about
Rs. 1.8 million came as foreign donations,
of which nearly Rs. 6,50,000 was being
awaited with transparent anxiety.
On the expenditure side, construction,
establishment, transport and administration
accounted for over Rs. 950,000. That left
Rs. 420,000 for health programmes,
Rs. 150,000 for training and Rs. 440,000 for
family help and community action.

Of this picture, CINI makes no bones:-

Budget outlays for health care (curative)
have increased due to high medicine prices.
There has also been an increase in living
costs, forcing a raise of salaries by 15 per
cent. There has been no expansion of
curative health services.

This is a constant source of a feeling of
insecurity to CINI staff. The Government is
also suspicious of voluntary organisations
receiving foreign funds. Government grants
are difficult to come by when foreign funds
are received.
Thus two points emerge : (a) Depen­
dence on foreign funds will reduce when
domestic response increases.
(b) CINI's long-term strategy calls for
current investment in infrastructure, including
the build-up of a professional team.

12

Lately, government funds have been made
available on a liberal scale, for the training
programme.

The future
According to its director, CINI's growth
5 years from now is envisaged in the follo­
wing areas, in an order of priority as below:
Training

For all categories of workers both in the
voluntary and governmental sectors
desiring to fulfil the international commu­
nity's call to achieve "Health for all by
2000/' CINI is developing innovative
training strategies, setting high standards
in motivation resulting from the natural
empathy that exists for those who are
poverty stricken and weak.
Family centered integrated socio­
economic programme

Primary health care services adequately
supported and integrated with develop­
mental activities benefiting needy families
will be the pivotal point of CINI's activi­
ties. Community participation needless
to say has to be ensured from the
beginning. Proper records will be main­
tained to share this experience with
others. The mother and child care
services will be used as an entry point.
Identify voluntary action groups in West
Bengal and other parts of India in order
to replicate integrated mother and child
care services.

Review
CINI started eight years ago as a volun­
tary agency for promoting child nutrition.
While this focus is unchanged, today it has
transformed itself into a community developMedical Service

ment organisation, not yet full-fledged, but
evolving to reach a viable shape.
A personal discussion with Dr. S.N.
Chaudhuri, CINI's founder-director, could not
take place, as he had just left for Uganda,
but a lengthy interview he gave not long
ago yielded certain insights:

— malnutrition cannot be treated with
medicines
— the causes of malnutrition are many—
lack of purchasing power, non-availa­
bility of food, ignorance
— rpalnutrition in the first two years has
an irreversible effect through life
— malnutrition
interacts
with infection

dangerously

— a malnourished child can be helped
only via the family and the local
community
— the mother should be enabled to pro­
vide at home nutritious low cost food
for her child.
— motivating the child-health worker
and training the mother are crucial
tasks.
— functional literacy is important for
building a bridge between the deve­
lopment agent and the community,
on an equal footing.
— an integrated programme of nutrition,
health care, health education and
functional literacy cannot be sustained
without generating income over which
the mother has some control.

These insights are easier commended
than translated into practice. CINI has made
April 1983

a valiant attempt and finds itself in the
process expanding rapidly and in diverse
directions, supported largely by foreign
munificence. Yet it has not been able to
show solid positive achievements in terms
of health and nutrition, or lay practical em­
phasis on every aspect of supportive action—
in spite of the dedication and team spirit of
its members. For example, sanitation and
hygiene seem to have received little atten­
tion at CINI's hands— for no fault of its.
Will not dewormed children soon be getting
their worms back ?
The stage has probably come when poor
village mothers have to be organised into
self-reliant groups and CINI's responsibilities
transferred to them slowly one by one. The
trend of dependence on foreign supplies has
to be reversed faster. On the other hand,
CINI will have to expand its own capacity
for training workers deputed by the village
community in all departments of child deve­
lopment. These trainees will have to orga­
nise the mahila mandals (which will
eventually support and superwise them) and
hasten the process of transferring CINI's
various non-training functions to these local
bodies.
With appropriate arrangements
worked out, possibly with the Government,
for a minimum of basic medical supplies and
regular supervision by medical personnel and
other technical experts, CINI's emergency
ward, nutrition rehabilitation centre and
headquarters clinic could be maintained and
developed as demonstration service centres.
This way CINI may service a larger area than
its neighbourhood, maybe the whole of
West Bengal and beyond, by training,
teaching and demonstrating to the local
people that child health and child develop­
ment are within their reach.

Courtesy : FUTURE. UNICEF
13

In Praise of the DAI
as a promoter of primary health care
In most parts of India, the traditional
birth attendant (who is called dai in
several states) is the source of support
when a women is in labour.

With his experience in community health
promotion, VIJAY KUMAR explains that
the dai's present lack of knowledge,
equipment and even literacy, should not
lead to underestimating her demonstrable
potential.
Given a little training, and their country­
wide presence, dais can, he illustrates,
not only bring down the unacceptable
rates of infant and maternal deaths but
also make the rudiments of primary
health care take root in the family where
it matters most.

Shanti was expecting her first baby.
One day the female health worker from the
neighbouring village visited and examined
her. She was advised that she must have
her delivery at the health centre, because
her 'case' was not normal. She was told
that having the baby at home might be risky
for the baby and for her too. Shanti, of
course, listened but the family did not give
heed to the advice.

Familiar story
When the pains started, the family called
in the dai, the traditional birth attendant.
Shanti had a long and difficult labour. She
managed to survive but she delivered a dead
baby. The family consoled her, and itself,
by believing that this was God's will and so
nothing could have been done about it
April 1983

anyway. Shanti remained sad and disap­
pointed for she had looked forward to
starting her own family.

A disastrous outcome of pregnancy for
mother and baby is common in India. This
is borne out, year after year, by health
statistics which show a high death rate
among women during pregnancy or after
child birth and among babies in the first
month of life. These mortality rates are
considerably more than in most developed
countries and in several developing coun­
tries.
There are many reasons for intercountry
differences in infant and maternal mortality
rates, but a major risk relates to the fact that
in India (as in many developing countries)
delivery is usually conducted at home by an
untrained traditional birth attendant or a
similarly ill-equipped relative.

Dai in the house
The logic behind this practice is not diffi­
cult to understand.
— It is more convenient to get the dai
home than travel to the health centre,
the dai being easily available day and
night.

— Cost is an important consideration for
poor people and the dai does not cost
much. Indeed she accepts com­
pensation for her services in kind, like
clothes and foodgrain.
— The dai has a strong cultural affinity
with the client family : she is known

15

and local. She indentifies herself
with the family because of her
familiar dress and speech, she per­
forms the rituals and observes the
taboos as convention decrees.
— Finally, the dai saves the family a
good deal of trouble and possible
dislocation. She washes the clothes,
prepares tea, bathes the baby,
massages the mother, disposes of the
placenta, cleans the delivery room. In
fact she does jobs that a scientific,
trained full-time person does not do.

Dais learn their art from elders by acting
as apprentices. They are usually unlettered
and seldom would they have received any
formal training in midwifery. Inevitably,
they lack the necessary skills. Many dais
are without even the basic equipment
needed for conducting safe delivery at home.
In the caste-ridden professional structure in
rural India, birth attendants mostly belong to
the “lower*' castes and often are traditionally
responsible for sweeping and scavenging.
And that enhances the chances of introduc­
ing infection if simple hygienic needs are
neglected.

They are here to say
If we take stock of the overall situation
in India, it seems unlikely that the services
of dais and the practice of delivery at home
will be replaced in the measurable future by
trained midwives and hospital delivery.
Resources are not in sight to provide trained
midwives to most villages. The public policy
to let dais have the essential training, skills
and equipment, is therefore realistic. Also,
it is a prudent decision to provide a small
incentive for the dai to supply to the health
centre vital information on the cases she has
handled. The question remains : Can the
dai deliver the babies and help bring down
16

the high rates of infant and maternal deaths ?
The answer is yes, on two counts :

— these deaths are preventable through
simple precautions at the community
level; and
— they could be prevented
timely action by the dai.

through

willingness to train
In 1978, our team identified 82 dais
active in the villages of a development
block. We conducted detailed interviews
with them to find out their current attitudes
and practices relating to care during pre­
gnancy, at the time of birth and in the few
weeks following delivery. They were en­
thusiastic in participating in the interviews
and they were willing to learn from us
voluntarily. The urgent need for trasfer
of essential skills prompted us to start a
training programme for dais. \Ne designed
it with a view to imparting some skills,
improving their practices and changing their
attitudes in a socially valuable direction.

The methods we used were justified by
our experience. In consultation with a few
perceptive dais, the more important topics
were selected; and these were in conformity
with government recommendations. During
the first year, and after, the training was
organized at the primary Health Centre once
every month. The sessions were organized
by a team comprising a doctor, a nurse and
staff from the PHC. The learning during the
first year was through open sessions of
discussion. It took the form of a two-way
exchange in which simple scientific know­
ledge and skills were communicated. The
dais were encouraged to articulate their
current beliefs and practices on each topic
in its turn. The material generated has been
incorporated in subsequent training pro­
grammes. Based on the experience during
Medical Service

the first year, pictorial material was deve­
loped to strengthen and smoothen the
communication process. Presently, dais are
receiving ongoing training on a voluntary
basis, once every month at three centres.
The teaching sessions focus on :

— essential antenatal care;
— nutrition
lactation;

during

pregnancy

and

— high-risk pregnancy;
— anaemia in pregnancy and lactation;
— clean delivery and resuscitation of the
newborn;
— breast feeding;
— prevention of neonata tetanus:
— post partum care of the normal new­
born;

— sick newborn babies;
— care of low birth-weight babies;
— family planning;
— importance of maintaining records.

Results of training
The dais have sustained their enthusiasm
for training. They now come neatly dressed,
and they observe greater personal hygiene
than previously. All of them, even the
illiterate, bring notebooks with records of the
deliveries they have conducted the preced­
ing month. They maintain them by giving
the information to a literate person in their
village who notes down the data. Vital
information on birth-weight, sex of the baby,
outcome of pregnancy and tetanus toxoid
immunization is known by this technique.
Illiterate dais have also recorded informa­
tion on pictorial cards by making a mark in

April 1983

front of the picture in the square for that
particular month of pregnancy : This again
has helped generate useful information on
pregnancy. It also reminds the dai of her
role in providing essential care during
pregnancy. This includes identifying indivi­
duals 'at risk' and referring them to the
health centres. Dais can now recognize low
birthweight babies. They have learnt to
weigh newborn babies and to read the
weight range by looking at the colours on
the weighing machine. So too, they check
the height to know the 'risk' that short-statured mothers run — they use a bamboo
painted with different colours below 145 cm,
between 145 and 150 cm and above
150 cm. A notable achievement is the
adoption by dais of a disposable 'dai pack'
with a sterile razor blade, cord ties, cotton
swabs and antiseptic solution. They use
this pack while cutting the umbilical cord.
This procedure combined with promotion
of tetanus toxoid immunization has led to a
dramatic decline in cases of neonatal
tetanus, which is a major killer of babies in
many parts of India, from 90 per 100,000
births to 10 per 10,000 births in three years.

Increasingly, dais recognize and refer
'at risk' cases to the health centre or hospital.
There is also a welcome change in their
attitude towards upgrading the mother's diet
during pregnancy, feeding colostrum (the
first milk) to the newborn, avoiding injec­
tions to hasten labour pains, and recognizing
the importance of providing care throughout
the period of pregnancy. The success rate
of breastfeeding in our rural area is 95 per­
cent. Dais have been alerted against the
usual practice of rejecting colostrum and of
giving instead prelacteal feeds. While they
have understood the importance of colos­
trum, its acceptance by the community is
slow. Not more than 25 percent of the
women breastfeed their babies on the day
of birth.

17

The range of their support
The role of the dai in the delivery of
health care in India is crucial. She is called
upon, not only to conduct the delivery, but
also to take care of the mother and child
for the first few weeks after delivery. This
is a decisive period in human life, posing as
it does risks which threaten survival and
have no parallel in the rest of life.
The constant interaction of our team with
dais has helped us realise that it is the dai
who is responsible for resuscitation of the
newborn, making him breathe or cry if he
fails to do so. Besides cutting the umbilical
cord, she provides the cord care necessary to
prevent tetanus. It is she who provides
warmth to the newborn and prevents babies
from dying, as sometimes they do, from
exposure to excessive cold or warmth in the
atmosphere. She gives the first feed, delay
to which may lead to low levels of blood
glucose. She encourages breast feeding to
avoid the rejection of the first milk which is
known to protect the baby against infections.
She gives the baby its first bath. She pro­

vides the mother with essential health care.
She participates in the functions and celebra­
tions related to child birth and maintains
close ties with the family. More than anyone
else, she can mark the beginning of bringing
to the family the concept and practice of
primary health care.

A future for them
It is important that dais continue to enjoy
the confidence of their village communities.
For this they must be encouraged to retain
their pre-existing profession and source of
income, while equipping themselves through
training with the simple skills and tools they
need. Health workers and doctors can help
strengthen the role of dais in two ways :
by assisting in their training and equipment
and secondly in providing prompt care to the
cases referred by them. That way, rather
than through cost-intensive ventures of
short-lived value, the presently high death
rates relating to the pregnant and the new­
born, may climb down faster than we have
been trained to think.

Courtesy: Future, Unicef

April 1983

19

Use your Creative Talent
Maithily Jagannathan

Ask anyone what a hobby is, and he or
she will tell you that it is something apart
from your regular work, something (they
may give here a shrug and a smile) that can
be expressed in the Tamil phrase, is
"pozhudu pokku"; a way of passing the
time.

The sharp differentiation between work
and hobby is rooted in our minds, and the
roots go deep down into our social ethics,
religion and philosophy. Work is some­
thing sacred and noble, it is a duty to one's
society, Scriptu res, like the Gita and teach­
ings from Buddha to Gandhi have told us
so.
But a hobby — well by definition is only
pozhudu pokku, and so it may be anything,
cooking, babysitting, loafing, any other
interesting or uninteresting activities you
may be indulging in, between your hours of
study or work, in South India and some
parts of Eastern India there is formal, tradi­
tional sanction for some hobbies for girls,
such as singing, playing instruments, classi­
cal dancing; in north India, they are kindly
permitted to stitch and embroider for all
they are worth to show their worth to pro­
spective in-laws Fine-arts do not get much
encouragement anywhere. For boys, the
only acceptable hobby, as far as one can
make out, is to stand in groups at street­
corners, a ctually they seem to take to it like
drakes to the water or politicians to public
offices, and perhaps even make it their
permanent employment.
Assuming that you have enough time on
your hands, and creative ideas in your head.

April 1983

and take up, say, journalism or flute playing,
it remains, by definition a mere pastime, a
whim or a fancy, it can be thrown or retrieved
like a rubber ball whenever you want; you
may use it like a ladder, run up and jump
off when your are tired. You can change
your hobby, or have ten in a row. It does not
matter. No one is surprised, no one disap­
proves. They are not even amused. They
would be even less amused if they know
what a loss this is to them and to the
country.
It is well known that the period between
16 and 22 is the most creative one in the life
of a human being. The world's master­
pieces have been written, sung, painted,
produced or composed at this stage of life.
Later on, you may know more of work
harder, but you will never have the immense
energy and pure inspiration of these years.

In our country, we spend this invaluable
time in studies, which are mostly a slavish
imitation of other peoples' ideas. This is
supplemented by feeble and insincere at­
tempts at a few subjects like arts or langua­
ges sometimes in science and crafts. The
terrible national waste affects the national
character. People with time on their hands
are prone to envy, jealousy, are easily
frustrated, have poor stamina, less initiative,
become fatalistic. Worst of all, there is a
gradual withering away of the inner resources
which alone can strengthen and nourish the
human spirit.
"Know Thyself" say the Upanishads, and
this is exactly what young people should do
today. They should experiment and realise
21

their talent and creative talents, whether it
is astronomy or archaeology, sciences, hum­
anities, or arts, put in their best creative
effort, plunge into it as the deep-sea diver
plunges into the ocean for the perfect and
priceless pearls. Like him, you will also
find a reward, not necessarily in terms of
money, but definitely in a physical and
mental strength that will help you even in
the long, dark hours which come in the life
of every human being.
Who knows ? By your efforts, your hobby
may become your work, so that you have
both pleasure and profit, or it may be paral­

lel and equal to your work, each comple­
menting the other, adding to the dimensions
of your personality. Most of you would not
hesitate to take up a job if it seemed to suit
you; similarly, if something interests you,
don't be afraid to take it up as a hobby.
Very often, we do not have the choice of
selecting a job in which we can achieve
something great, but we can always take up
a hobby which develops the creative instincts
to the highest level, which releases the store
of energy that is within us, which makes us
into complete and happy human beings.

— Courtesy: HOME SCIENCE

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Income Plan.

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Chairman

22

Medical Service

Do you Hear Me ?
Ajay Kothari
"When the hair turn grey near the
temples, eyes demand reading glasses, your
child enters into a college and you miss the
mumbling, that is the time, Man refuses to
accept the process of ageing/'
You must have noticed (or experienced)
that between the age of 42 and 45, one
feels the need of reading glasses. During
the same period, hearing also gets affected
in higher frequencies. It is not necessary
that glasses and deafness always come
together. Persons with cataract may have
normal hearing whereas in some the
deafness precedes (like a pilot car) much
ahead of his visual problems. It is observed
that early deafness may be hereditary. This
kind of deafness is found earlier in males
than in females.

Diabetes Mellitus, prolonged anaemia
and high blood cholesterol affect the blood
circulation of the inner ear.
Similarly,
excessive smoking, tobacco intake or alcohol
consumption also reduce the inner blood
circulation,
thereby
promoting
early
deafness.

Is it possible to check the deafness
due to ageing ?
To a certain extent — Yes. Control of
contributing and aggravating factors men­
tioned above can postpone and check
deafness. Besides, there are certain diseases
known to affect the sensori-neural compon­
ent of hearing, viz: typhoid, infective hepa­
titis, chicken-pox, mumps and other infec­
tious diseases. Adding Bj—B6—B12 in the
beginning of the therapy protects the nerves
April 1983

to a great extent.
Dihydrostreptomycin,
quinine, salicylates, kanamycin are known
for their otoneurotoxicity on prolonged
usage, over dosage or in sensitive patients.
Bi BG and B12 prevents otoneural damage to
some extent.

The process of ageing produces gradual
degeneration of cochlear hair cells, resulting
into hearing loss for higher frequencies. The
deafness due to ageing can be divided into
three stages.

Stage I
Person finds it difficult to catch certain
syllables like V,D,B, Th, or F. Instead of
'BUT' he may hear 'PUT' but, on hearing the
entire sentence he will correct himself to
catch the proper meaning. The hearing
difficulty becomes acute when the conversa­
tions are restricted to a word or two, when
his reply might flabbergast the questioner or
produce laughter.

Stage II
With the advancing age and further
degeneration of cochlear hair cells, the
individual misses words. Often he has to.
apologise to speakers asking him to repeat.
Gradually, amongst family members, neigh­
bours and relatives, he is nicknamed as
'Duplicator' for his habit of asking to speak
twice. He misses the link in cinema, dramas,
on radio and T.V. programmes. He elbows
his adjoining person for link, gets snubbing
from the other viewers for this disturbance,
accompanied person also loses the concen­
tration, misses the link and gets annoyed.
23

'Keep quiet, and just see. I will tell you at
the end'. A persons loses interest from
such programmes and tries to keep away
from it. He is now labelled as 'Aurangzeb'.

also reduces due to cataract. He cannot
read particularly atter evening, nor the rela­
tives permit him to go out alone. He dabbles
into unnecessary things. Instructs the servant
for cleanliness, cook or daughter-in-law for
recipes, son for business, grandchildren for
Stage III
perfectionism and wife for economy. He
By this time, person has reached the threats everybody with his sudden death and
age of retirement. The deafness increases paints a gloomy picture for them after his
from missing of a word or two to missing of death. There are instances when the aged
a good bit of a sentence. Relatives and
have changed their will out of sheer suspici­
office staff avoid conversations with him.
on due to deafness. The only place he often
He senses 'selfishness' in their attitude since visits to ventilate himself and to narrate the
he is retiring. Inability to grasp the con­
selfishness of the family members, is the
versation makes him suspicious that others
dispensary of his doctor. It is not unusual
are all the time talking 'something about him'. to find aged sitting in the dispensary giving
In fact, he is still able to hear words slowly,
'company' to the patients waiting for their
distinctly and NOT of high pitch but spea­ turn. It is here that the family doctor has to
kers with the fear of being asked to repeat,
understand the psychology of the aged, his
speak in a louder pitch, thereby decrease the
relatives, environment, boost up the morale
listening ability of the aged. On the home
and create the interest in his life, cement
front, he might have become the grandfather.
the cracked relations and to act like a
The frequency loss is such that he cannot catalyst.
hear door bells, alarm clock, telephone bell
and the cry of his grandchildren. Because What should you suggest ?
of the hormonal protection and some unex­
1. Persons with severe sensori — neural
plained reasons, grandmother (his wife) may
loss should face the listener so that
not have acquired the same degree of
besides hearing he can pick up the
deafness. His son, daughter-in-law, daugher
words from lip-reading.
and son-in-law, not knowing these factual
differences, often comment sarcastically.
2. Speaker with cigarette or pipe bet­
"Because you have to keep our children, you
ween the lips, chewing pan or to­
are faking your deafness".
bacco, loses the clarity of the speech,
making
it difficult for the aged to
Persons with conductive deafness speak
grasp. At least the home members
very softly, but those with sensori neural
must refrain from these habits while
deafness have a tendency to speak loudly.
conversing with the aged.
Greater the loss of hearing more is the

loudness of the voice. This is often inter­
preted as anger or annoyance by the nearer
and dearer ones and they try to keep him 'at
a distance'.
He starts feeling loneliness,
depression, inability to ventilate himself, and
often his own wife is not prepared to share
his thoughts. With ageing, his visual acuity

April 1983

3.

Avoid talking loudly.
Instead,
suggest a slow, clear and low pitc­
hed voice.

4.

When the person is asked to repeat,
it means that he has not heard
sufficiently to derive the meaning.
25

Speaker should try and repeat the
sentences, without changing the
phraseology or grammar.
Explain
the process of deafness and the
psychology to the aged and their
relatives for their mutual benefits.

5.

Suggest a hearing aid and its psy­
chological effect on an individual to
prevent avoidance of usage.

Aged and the Hearing Aid.
When the person is asked how long he
has been having the deafness, he detests the
phraseology, but the same sentence when
reframed, ''How long have you been having
difficulty in hearing 1" He starts ventilat­
ing himself. The stigma is for the word
'deafness'. Similarly I feel that suggestion
for a hearing aid should be a matter of tact.
In India, unlike West, hearing aids are not
accepted on first suggestion, irrespective of
the age or sex of the patient. For a diminis­
hed vision, individual immediately accepts
the glasses, but avoids hearing
aid
for a fear of being teased. Some on the
verge of retirement are afraid of losing their
jobs, if they wear the hearing aids. The
attitude of the society is perhaps responsi­
ble for the stigma attached to the hearing
aid.

How often have you heard an interviewer
questioning a job seeker on his eye glasses
(in a routine job) ? but if he sees hearing
aid, his first question is on candidate's dea­
fness rather than on his qualifications or
eligibility. Hearing aid on parents (parti­
cularly mother) or bachelor daughter often
comes in the way of daughter's marriage
with the fear of hereditary transmission of
deafness (?) to the grandchildren.
Well!
This is our society (in marked contrast to
the western world) who accepts the obviou­
sly visible weak eyes but not prepared to
26

accept the 'hidden' weak ears; eye glasses
are accepted as a necessary aid but not the
hearing aid.
Nobody brings the fingers
close to the eye glasses for counting but
tendency is to raise the voice further seeing
a hearing aid, again giving difficulty in
hearing to the wearer. The aged develops
the tendency to demand immediate attention
and instant relief for their ailments.
On
wearing the eye glasses he starts visualizing
clearly, but that is not the case with the
hearing aid, which is nothing but an ampli­
fier. magnifying every sound reaching the
ear. As a result, even when nobody is
speaking, aid wearer gets continuous low
frequency humming in the ear. He gets
annoyed, shuts off the machine or stops
using it, relatives accuse him for wasting
their money and he criticizes the doctor for
advising 'wrong' machine.
To this extent analogy drawn between
eye glasses and hearing aid may be scienti­
fically correct but psycho-socially far from
true.

When you travel first time in a crowded
train, you will find it difficult to converse
with your friend, but to your surprise you
will find other commuters converse freely
ignoring the extraneous voices.
Every
hearing aid buyer must wear aid daily and
make a habit to converse so that gradually
brain 'trains' ear to eliminate extraneous
sounds. The brain training may take a month
or so.

Notions —
Many feel that all imported things are
excellent. The lame belief that they have
foreign hearing aids especially when one of
their progenies settled abroad, ('Can the son
not send a small aid for his aged father ?').
The aids available in India are equally good,
besides repairing of foreign aid wil‘ be
Medical Service

difficult or costly. The other notion that aid
itself increases deafness is baseless.

deafness in provoking laughter in drama,
cinema or literature.

How many aged are partially deaf ?

When WHO has given the theme 'Add
life to years' remember what the aged
feels,

No statistics are available, but it is pre­
sumed that as many aged are with eye
glasses, those many aged are with partial
deafness. As an individual, friend, relative,
member of a social organisation or as a
doctor have we helped them anytime ? In­
stead, society has made best use of such

"I do not hear, my eyes ful I of tears :

I look upon 'you', hoping something you
can do I Can we make their lives, years
without tears" ?
Courtesy : Bombay Hospital Journal

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April 1983

27

CHAI

NEWS

NOTES

Community Health Department of CHAI

Plans Future Action
The Community Health Department of
CHAI had a planning and study session from
7th - 17th April 1983 at St. John's Medical
College, Bangalore. The session was at­
tended by the present and would be staff of
the Community Health Department of CHAI
together with a few representatives from
other organisations. Resource persons from
various organisations based in Bangalore
came and shared their views and experiences
in the field of Community Health and allied
fields. The session was organised with the
help of the department of Community medi­
cine of St. John's
Medical
College,
Bangalore, particularly that of Dr. Ravi and
Thelma Narayan.
It was encouraging for the team when
Dr. G. M. Mascarenhas, the Dean of the
College, extended a hearty welcome to the
team when we began the session on 7th
morning in an informal way.
He also
promised all help from the part of the college
in the future for promoting Community
Health Programme.

The participants spent quite some time in
sharing their own experiences in the field
and also in understanding the very concept
of Community Health in its entirely based on
the teachings of the Church and keeping in
line with the new health policy of the
Government. The input that came, in this
regard, from the resource persons by way of
sharing their views and experiences was of
great importance. At the end of the session
April 1983

it was felt that the team needs an indepth
study of the various documents pertaining to
this new concept of health. Hence it was
decided that the team members would spend
the time till end of June visiting different
projects and studying the various documents.
It was also proposed to have a follow up of
this session in the second half of June
1983. This was felt necessary so that who­
ever is responsible for promoting such
activities can have a clearcut understanding
of the concept of Community Health in its
various aspects.

In order to promote this new thrust,
taken by CHAI, through our member institu­
tions, it was proposed to expand the central
team of Community Health Department by
including a few more people with com­
petence and field experience. Efforts are on
to realise this.
At the end of the 10-day long session of
sharing, reflection and discussion, the
following statement was brought out by the
participants which gives the philosophy.
aims and objectives which would guide the
team in
implementing the Community
Health Programme :

"In the light of the WHO call "Health for
all by 2000 AD", the revised national health
policy of the Government, and in line with
the document by Pontifical Council Cor
Unum on "the naw orientation of health
services with respect to primary health care",
29

the teaching of the Church and of the recent
Popes, and the statements of the CBCI from
time to time, as well as in the light of this
consultation, the working team of CHD of
CHAI concludes that:

1.

Health is the total well-being of
individuals, families and communities
’ as a whole and not merely the
absence of sickness. This demands
an environment in which the basic
needs are fulfilled, social well-being
is ensured and psychological as well
as spiritual needs are met.

30

2.

The concept of Community Health
here should be understood as a
process of enabling people to
exercise collectively their responsi­
bilities to maintain their health and
to demand health as their right.
Thus it is beyond mere distribution
of medicines, prevention of sickness,
and income geneiating programmes.

3.

In a country like India, so vast and
varied, where 80% of its population
live in the rural areas and about 90%
of the country's health care system
caters to the needs of the urban
minority, a new orientation and re­
thinking of the whole health care
system is the need of the hour.

4.

The present medical system with
undue emphasis on curative aspect
tends mainly to be a profit-oriented
business, and it concentrates on
selling 'health' to the people, and is
hardly based on the real needs of
the vast majority of the people in the
country. The root causes of the
illness lie deep in social evils and
imbalances, to which the real answer
is a political one, understood as a
process through which people are

made aware of the real needs, rights
and responsibilities, available re­
sources in end around them, and get
themselves organised for appropriate
actions. Only through this process
can health become a reality to vast
majority of the Indian masses.
In the light of the above conclusions,
we identified the exploited and the
unorganised masses, particularly in
rural areas as our target group. We
intend to reach this group through
the existing health institutions in
the country, especially through the
member institutions of CHAI and
other individuals and groups enga­
ged in the field of people-oriented
programme. In this process, pos­
sibilities of collaboration with other
voluntary organisations which up­
holds similar philosophy and objec­
tives will be explored to the
maximum.
We also felt that the Church in India
should take a clearer stand on our involve­
ment in the health field based on the
documents mentioned and this stand should
be made known to all our health care institu­
tions and others concerned. In order to
facilitate this we also felt that the study of
the documents dealing with this new
concept of health should form an integral
part of the curriculum in seminaries and
religious formation houses. The same, we
felt, holds good for all our educational
institutions.

The team will study this statement further
with the help of resource persons during the
follow-up meeting planned for June 1983.

STAMPS RELEASED ON
ST. FRANCIS OF ASSISI
A one-Rupee denomination stamp on
St. Francis of Assisi commemorating his

Medical Service

800 birth anniversary was released in a
simple but impressive ceremony held at
9.00 a.m. on Monday, April 4th, here at
CBCI Centre, New Delhi, by Archbishop
Angelo Fernandes of Delhi in the presence
of Shri V.N. Gadgil, Union Minister for
Communications, and many other State and
Ecclesiastical dignitaries.
Fr. Saturnino
Dias, the newly-appointed Dy. Secretary
General of the CBCI accorded a warm wel­
come to the chief guests and others. While
releasing the stamp Archbishop Angelo
Fernandes in his message emphasized the
relevance of the life and inspirations of St.
Francis of Assisi to the present-day world
particularly his message of Peace.

The chief Guest Shri V.N. Gadgil, Hon.
Minister for Communications, gave a short
but very impressive reflection on the life of
St. Francis of A; sisi in the following words :
"I am happy to be associated with this
function organised by the Catholic Bishops
Conference of India on the occasion of the
release of the stamp of St. Francis of Assisi.
The issue has been made possible largely due
to an interest taken by our Prime Minister,
Indira Gandhi. St. Francis was a remarkable
person—a Saint in the tradition of Indian
Rishis.

Assisi, an experience of poverty during a
pilgrimage to Rome, where in jrags he
mingled with the beggars and begged aims;-*
an incident in which he who had always
felt a deep repugnance for lepers not only
gave alms to a leper but also kissed
his hands. One day at the ruined chapel
outside the gate of Assisi he heard the
crucifix above the altar command him to go
back. He hurried home, gathered much of
the cloth in his father's shop and rode of
to a nearby town where he sold both cloth
and horse. Angered, his father kept him at
home - and later brought him first before the
civil authorities and then before the Bishop.
Before accusations could be made, Francis
without a word removed his garments even
down to his breeches and restored them to
his father. Then he said, "Until now I
have called you my father on earth. But
hence forth I can truly say : Our Father
who art in Heaven". The astonished Bishop
gave him a cloak and Francis went off to
the woods beyond the city.

On February 24, 1208 he listened at a
mass to the Gospel account of the mission
"of Christ to the Apostles, "Take no gold, nor
silver, nor money in your belts, no bag, nor
the tunics nor sandals nor a staff; for the
labourer deserves his food, and whatever
village you enter, find out who is worthy
Born of a cloth merchant in Italy, very
in it and stay with him until you depart".
little is known about his early life, in 1202
(Mathew 10.9.11) Although a layman, he
he took part in a war between Assisi and
began to preach immediately thereafter.
Perugia and was held a prisoner and on his
His fraternal charity, total poverty and
release fell seriously ill. After his recovery
magnetic personality drew thousands of
in 1205 at Spoleto he had a vision that bade
followers to his side. Soon thereafter he
his return to Assisi. On his return he gave
became the leader of the religious move­
himself to solitude and prayer so that he
ments of the early 13th century that were
might know the will of God for him.
attempting to reform the medieval church,
morally scared by its struggles with civil
A number of episodes very similar to the
rulers.
episodes in the life of Lord Budha - make
up what is called his conversion - the vision
Love of poverty is basic to his spirit and
his contemporaries wrote about his poverty
of Christ while he prayed in a grotto near
April 1983

31

as his "lady" in the allegorical Sacrum
Commercium or as his "bride" in the fresco
of Giotto in the lower church of S Francesco
at Assisi. It was not, however, mere external
poverty he sought, but the total denial of
self. He considered all nature as the mirror
of God. He called all creatures his "bro­
thers" and "sisters" and in his "Canticle of
the Creatures" he referred to "Brother Sun"
or the "Sister Moon", and even "Sister
Death".
In the summer of 1224 he went to the
Mountain retreat of Verna to prepare for a
40-day fast. As he prayed one morning he
beheld a figure coming towards him from
the height of heaven. St. Bonaventure, an
important thinker of the 13th Century wrote :
"As it stood above him, he says that it was
a man and yet a Seraph with six wings ....
The face was beautiful beyond all earthly
beauty, and it smiled gently upon Francis.
Conflicting emotions filled his heart, for
though the vision brought great joy, the
sight of the suffering and crucified figure
stirred him to deepest sorrow. Pondering
what this vision might mean, he finally
understood that by God's providence he
would be made like to the crucified Christ
not by a bodily martyrdom but by confor­
mity in mind and heart".

His whole life is thus the life dedicated
to the service of humanity, a service based
on denial of all worldly pleasures - a tradi­
tion which obtains in (ndia from time
immemorial. I am sure Mahatma Gandhi
and Vinobaji had Saints like Saint Francis in
their minds when they preached the concept
of "Asangraha".
The last two years of his life were very
painful. He became blind. In the words
of H.F.B. Mackay "As Sunset on October
3rd drew near, Francis sang his last song.
It was the 142nd Psalm, "I cried unto the

32

Lord with my voice". Loud and clear rang
out the last verse. "Bring my soul out of
prison", sang Francis, "that I may give
thanks unto ihy name, which thing if thou
wilt grant me, then shall the righteous
resort unto my company". Then there was
a long silence, while within and round the
little hut the brothers knelt.
The sun sank to the horizon and the dark
of the October evening fell upon the forest
lands of Umbria. Silence lay upon the little
darkened hut.

Then all the larks of the forest rose and
soared. Stretching their wings and tuning
their voices they gathered in a company
above St. Mary of the Angels, and rose into
the evening sky a circling crown of song.

In the heart of the circle the veil of the
temple of nature was rent for Francis Bernardone and he entered into the joy of his
Lord.

As Father Cuthbert wrote, "He was not
of the world, and yet the world loved and,
in its blundering fashion, worshipped him.
It was so in his life; it was even so in his
death".

May I paraphrase his message in my own
way : "To die for love is a great adventure.
To live for love is a far greater adventure
and that means bringing love meet love
eveiy day in the common things of life".

I am glad that my Ministry is today
issuing a stamp to commemorate such a
unique personality. I earnestly hope this
stamp will travel all over the world and help
in strengthening the spirit of peace and
service for which he devoted his entire life."
The way he has paraphrased the message
of St. Francis is certainly thought-provoking
and challenging for all of us today.

Medical Service

The function came to an end with a vote
of thanks by Msgr. Hippolitus Kunnumkal
OFM. Cap., Prefect Apostholic of Jammu
and Kashmir.

REPORT OF THE JIVODAYA HOSPITAL,
ASHOK VIHAR, NEW DELHI FOR THE
YEARS 1980-83
Sisters of the Destitute have been
engaged in the medical service Delhi for the
last 16 years. They first started with the
Holy Angels Nursing Home on 2nd October,
1966, in a rented building in Kailash Colony.
With the cooperation of the Government, the
Archbishop and other benefactors the con­
struction of this Hospital was made possible.
Several agencies and individuals have helped
in this noble adventure. On 19th March,
1980, Jivodaya Hospital was inauguarated,
and it started functioning in a small way
initially, with the only two Departments of
Obstetrics and Gynae , and Paediatrics. In
course of time as the needs of patients
became more demanding, the Departments
of Surgery, Medicine, ENT, Opthalmology
and Orthopaedic were started.

Administration and the staff
Jivodaya Hospital has 12 specialised
doctors, two junior doctors, 6 sister nurses
and 13 lay nurses. There are also 5 other
sisters who look after the administration of
the hospital. In addition to this, it has one
sister who is in charge of the clinical
laboratory, two assistant technicians and 17
nursing assistants.

Facilities in the Hospital
In order to provide adequate medical
treatment for patients efforts are being made
to make the Hospital well-equipped and
self-sufficient. The hospital has the provi­
sion of accommodating 50 inpatients. It
also has a well-equipped operation theatre.
April 1983

neonatal unit and a clinical laboratory. The
radiology unit which has been recently
added will be put to use shortly.

Patients and treatment
The total number of patients including
inpatients and outpatients treated in the
hospital in the year 1980 came to 5511.
This number increased to 12,241 in 1981
and to 24,276 in the year 1982.
The Hospital is forced to depend on the
medical fees collected from the patients for
the hospital expenditure. However, in order
to help the deserving poor, a special clinic
has been opened which functions on all
week days. These poor patients are mostly
from Jahangirpuri, J.J. Colony, Wazirpur
Village and surrounding areas. Although
the treatment is the same as that given to
the paying patients, it is subsidised in
favour of these poor patients. Under this
clinic 2450 poor patients were treated in
1980 and this number rose to 8980 in the
year 1982.

Jivodaya Extension Programme
Goaded by the keen desire of service of
the poorest and under-previleged, the
Sisters started a dispensary in 1978 at
Jehangirpuri, a resettlement colony, about
8 km. from the Jivodaya Hospital. Jehan­
girpuri is inhabited mostly by the poor,
afflicted with poverty, ill-health and unem­
ployment. The 1978 floods had heightened
the misery of the people in this area. With
the starting of the Jivodaya Hospital,
medical help to these people has become
much more organised and a boon to them.
Health Camps and Health Care Programmes
have been conducted. The trained com­
munity health workers are the liaison
between the community and the dispensary,
which is the nucleus of the work of the
Sisters in Jehangirpuri, covering 15,000
families.
Q
33

DAMIEN SOCIAL WELFARE CENTRE­
BRIEF REPORT OF 1982
Total number of registered cases of the
Centre is 19120.
3224 voluntary cases were reported in
1981 and 3588 voluntary cases reported in
1982.
More emphasis is given for Health Edu­
cation at the Centre's clinics presently.

Laudable achievements and remarkable
progress have been reported briefly under
the following headings:-

A)

Hospital Services: Nirmala, BMP,
Bhowrah — 200 beds for leprosy
patients.
Admissions— 1485, surgery — 166,
physiotherapy — 879,
MCR shoes for 961,
laboratory—8303 skin
smearsand 1168 ge­
neral tests.

B)

Leprosy Control Project:

I)

Health Education for Communities

Health Education Department, Damien
Social Welfare Centre, approached Health
Education with a different strategy in the
year 1982 to root out leprosy in the district
of Dhanbad. The programmes varied depen­
ding on the type of population, i.e. rural,
urban and also the capacity of people to
grasp the message. A campaign was laun­
ched in January '82 to educate the people
about leprosy. More than 50 institutions
collaborated with the Health Education
campaign. The Health Education efforts
gained momentum as the Centre employed
a full-time Health Education Officer, Health
Educator and four Assistants.

Anti Leprosy Year 1982 — activities :
1.

An article giving the facts of the
disease, the importance of regular
treatment and giving details where
treatment was available in the dis­
trict, was published in a local daily
having a circulation of 35,000
copies.

2.

78,000 pamphlets were distributed
at bus terminals, railway stations,
places of worship on important feast
days, the court, office compounds
and bazars.

3.

Five advertisements on the facts of
leprosy were published in a local
daily newspaper.

4.

A public meeting was arranged in
February under the Chairmanship of
the Deputy Commissioner at Muni­
cipality grounds.

5.

6500 people attended Leprosy Exhi­
bitions held at 5 localities.

6.

On 243 days small exhibits and mike
announcements from an eye-catching
rickshaw were done at 396 locations.

68,000 people were examined and
1156 cases detected.

Newly registered cases in 1982 :
Lepromatous cases

— 398

Non-infectious cases

— 2263

Borderline cases

— 1474

Total

4135

C)

Leprosy Workers' Training Centre

D)

Rehabilitation Centre

E)

Welfare Department

F)

De Britto Hostel, Gomoh

G)

Nirmala Hostel, Govindpur

H)

Other Activities

April 1983

35

7.

Seven leprosy stalls were held in the
year with the assistance of voluntary
and religious agencies.

8.

Anti-leprosy slides were screened at
17 cinema halls on a regular basis
with the assistance from the Deputy
Commissioner.

9.

26 slide shows were held for an
audience of 4680.

10.

68 film shows on leprosy were held
for an audience of 19,100

THE FIRST INTERNATIONAL CONGRESSFOR
THE FAMILY OF ASIA AND
AUSTRALIA JANUARY 26TH FEBRUARY
1ST, 1983, MADRAS
The first International Congress for the
Family of Asia and Australia was held at
Madras from 26th January, 1983, to 1st
February, 1983. The Inaugural Session on
26th evening highlighted the profound
human values that can be promoted through
the family.

H.E. Cardinal James Robert Knox gave
At 5 places roadside display on the inaugural address referring to Familiar
Consortio as the 'Magna Charta' for anyone
leprosy was held and 1500 people
involved in the apostolate of the family; Dr.
took benefit of it.
John J. Billings gave the keynote address
12. Two anti-leprosy hoarding boards cautioning the pro-contraceptionists about a
were fixed at two important places
drastic and acute reduction in population; and
in the area.
Mrs. Margaret Alva gave the presidential ad­
dress which was one of challenge as to the
13. Eight puppet shows were attended by
role of each individual and each Christian in
2300 people.
regard to his/her responsibility in society and
14. 3610 wall posters on leprosy were as a member of the country.
pasted on walls.
The deliberations of the Congress were
15. 25 orientation lectures on leprosy grouped under the following sub topics:were given to doctors and nurses of
27th January : a) The change and challenge
seven big hospitals, four big govern­
of the family in the 80's
ment institutions and different groups
of teachers and social workers. This
b) The fracturing family
is besides the many schools covered
c) The world round up.
by the PMWs in the field.
28th January : Challenge of the family in
16. 73 group discussions were held in
the Church.
villages.
29th January : Family Pastoral Ministry
11.

36

17.

There were group discussions for 8
Professional groups.

18.

Students participated in an Essay
Competition and in a campaign to
make known the facts of leprosy.

19.

132 leprosy cases were
during H.E. work.

detected

30th January : The latest research findings
in fertility regulations.
31st January : The family and natural family
planning programme.
1st February : Facing the future. The satel­
lite programmes of the Con­
gress.

Medical Service

24 countries— India, Bangladesh, Singa­
pore, Malaysia, Sri Lanka, Thailand, Korea,
Pakistan, Ghana, U.S.A., Tanzania, Philippi­
nes, Australia, Indonesia, Papua — New
Guinea, Italy, England, French Polynesia,
Burma, Guatemala, Mexico, Kenya, Fiji,
Poland — participating in the Congress was
a historic event. The evaluation highlighted

the high quality of this Congress, as also the
spirit and atmosphere of the warmth, love
and cordiality that prevailed among the
participants.
Mrs. Hima Balachandran of India gave
her evaluation as "Impressed by the orga­
nisation and spiritual values and attitudes it
focussed on.

Payment of Membership Fees
Though we have made a record in the payment of membership fee this year, there
are several members who have still to pay the membership fee for 1983 ; there are a
few who have also to pay previous dues. As payment of membership ree is a major
criterion for the success of any organisation, I request all those who have not paid the
fees to do so before the end of June, 1983.

May I also take this opportunity to appeal to all the members to make it a point
to pay their membership fee in the month of January itself of each year without wait­
ing for any reminder. This will save a lot of money, time and energy for our organisa­
tion which could be used for other purposes.

Executive Director

April 1983

37

Process Pulses for Better Nutrition
Grain legumes, popularly known as
pulses, are the most common food articles
in the diets of all the segments of the popu­
lation.
Bengal gram (Chana), red gram
(Tuvar or arhar), green gram (Mung) and
black gram (Urd or Masa), are the four
pulses which are important both in terms of
production and consumption. Legumes are
rich in protein quality; hence their role in
diets based on cereals and millets is well
recognised. They are good sources of
minerals and vitamins also. Two major
problems which limit the use of legumes are
(1) the presence of certain antinutritional
factors in them and (2) the long periods of
time needed for cooking. Before they are
consumed, pulses are generally subjected to
simple processes like dehulling as dhal,
germination, roasting, fermentation, cooking,
etc.
Most of these household practices,
though primarily developed to satisfy the
palate of the consumer, confer certain nutri­
tional advantages and help improve the food
value of these grains.

Use of pulses after decortication to dhal
is a most common household practice. The
outer seed coat of the pulse grain which
constitutes about 15 per cent of grain
weight, is composed of complex polysaccha­
rides, and certain pigments. Except perhaps
as roughage, the seed coat has very little
nutritional value and the nutrient composi­
tion of the dhal is not different from that of
the whole grain. Recent studies have shown
that the polyphenolic compounds such as
tannins which interfere in the absorption of
iron, are mostly located in the seed coat of
the pulses. Bioavailability of iron in pulses
(as judged by the ionisable iron content)
was therefore found to be about 2-4 fold
higher in the dhal when compared with
April 1983

whole grain in case of bengal gram, red
gram, green gram and kidney bean.
Soaking in water overnight and then
germination or sprouting of the grains is yet
another very common household practice for
processing of pulses. During germination it
is well known that several enzyme systems
become active and bring about profound
changes in the nutritive value of pulses.
Vitamin C, which is practically absent in the
dry grains of the pulses, appears in signi­
ficant amounts after germination; similarly
folic acid and other B-group of vitamins
show 2-3 fold higher values in germinated
grains than in raw pulses. Antinutritional
factors such as phytates and tannins which
adversely affect the bioavailability of bivalent
ions are broken down on germination. By
just soaking in water overnight, about 50
per cent of tannin is lost from bengal gram
and red gram; while in green gram and black
gram the loss was about 25 per cent. Ger­
mination for 24-48 hours, further reduced
tannin content by 10-25 per cent. Phytate
which constituted over 60 per cent of the
total phosphorus in the raw grains of bengal
gram, was only 44 per cent in the 48-hour
germinated grains with no change in total
phosphorus. The beneficial effect of these
changes is seen in the two-fold improvement
in the bioavailability of iron from pulses
after germination.
Germination also modifies the starch
component of the grain and improves its
digestibility.
It is well known that con­
sumption of pulses leads to flatulance.
Inclusion of legumes in the diet at levels
which provide 20-25 per cent of total calo­
ries results in manifold rise in the amount
of gas produced in the intestines. Bengal

39

gram is more gas-forming than other pulses.
One of the factors associated with this
fiatulance phenomenon is the high amounts
of certain oligosaccharides of the raffinose
family present in these two grains. These
sugars, due to absence of suitable digestive
enzymes in humans, are not absorbed. But
in the large intestine they are acted upon by
the microflora, resulting in gas production.
Studies on commonly consumed pulses
namely bengal gram, green gram, black
gram and red gram have indicated that there
was a continuous fall in the oligosugar con­
centration with increasing period of germina­
tion. In grains germinated for 24 hours, the
oligo-sugar concentration was 50 per cent of
the initial value. By 48-72 hours it was
below 25-15 per cent. This suggested that
sprouted pulses probably are less flatus
producing.

Another conventional method of pro­
cessing pulses, particularly in case of bengal
gram and green gram, is roasting and puffing.
This results in imparting a desirable flavour
and taste. It also destroys the antinutrients
which are thermolabile. Paste thickness of
the flour of roasted pulses is reduced signi­
ficantly and the calorie density is higher.
This is an important factor in chlid feeding
where bulk is of concern.
The commonest process of preparing
pulses for consumption at the household
level is to cook them by boiling in water.
This obviously inactivates most of the heat
labile antinutritional factors present in the
pulses. Some of the minerals are leached
out in to the medium of cooking. In the case
of red gram, it was observed that the loss of
riboflavin on cooking varied from 5-25 per

40

cent depending upon the variety. Recent
studies on tannin content of the pulses have
shown that over 80 per cent of this anti­
nutritional factor is lost from the grain after
cooking. It was also observed that in the
case of red gram dhal as well as rice, bio­
availability of iron in terms of ionisable iron
content is not affected by cooking.

Fermented food products are important
components of the diets in several parts of
the world. In many cases, the final product
makes an important contribution to the diet
as a source of protein, calories and vitamins.
In India, idli, dosa, dhokla, vada, are most
common preparations in which pulses are
used. As in the case of germination, nutri­
tive value of the ingredients is also modified
by the process of fermentation. Vitamin
content particularly thiamin, riboflavin and
niacin is shown to enhance on fermentation.
Breakdown of phytate and inactivation of
trypsin inhibitor are also noted. Studies on
bioavailability of iron indicated that ferment­
ation of rice and pulse mix, used for idli
preparation did not alter the ionisable iron
content, when compared with unfermented
mix.

Legumes will continue to occupy an
important place in the diets of large seg­
ments of our population. Their therapeutic
value in the treatment of severe cases of
protein calorie malnutrition is important in
the face of poor availability of other protec­
tive foods. Significance of different methods
of processing at home level for consumption
of various pulses in the context of nutrition
is of great relevance.
—Courtesy HOME SCIENCE

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