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On Aprll 4th, 2014, RMF’s Khargone District Coordinator, Auntim Gupta, alerted the RMF team about a severe case of malnutrition in Galtar village of Jirnia block, Khargone. RMF’s CNE, Neelofar Mirza, had been working with a family of four for months, and both parents were unwilling to take the children to a hospital for care. Despite all of her efforts, the family was insistent that they could not take their child to the NRC, both due to constraints at home but also, more alarmingly, because they did not trust the care provided by the government system.

Both of the children, Prateek (5 years and 11 months old) and Savan (34 months) were suffering from SAM and an undiagnosed respiratory infection. Their parents, Bahadur and Munni, were aware of the gravity of the situation, and had consulted many of the local medical practitioners, including a traditional healer and an unliscensed medical provider. They had spent significant money trying to improve their children’s conditions. The medical practitioner had given the children vitamin supplements, and the traditional healer had performed a ceremony sacrificing livestock in an attempt to cure the children. Clearly, the family was willing to work towards the improvement of the children, but not willing to travel the two hours to Khargone to spend 14 days in the NRC. It’s a story RMF’s CNEs are very familiar with.

Auntim was not willing to let this matter rest, however. Together with senior staff, Auntim met with the Chief Medical and Health Officer (CMHO) of the district to mobilize government health staff. After sharing photos and the details of the children, the CMHO dispatched a local help supervisor and ambulance to Galtar to meet the family. The RMF team was not far behind.

Upon arriving in the village, the magnitude of the children’s malnutrition became apparent. With a MUAC of 7.0 and weighing just 5.48 kg, Savan was one of the most severe cases of SAM ever identified by RMF CNEs. His brother, also SAM with a MUAC of 10.7, was suffering from severe acute malnutrition for a second time. When speaking to the parents about Prateek, it became clear why they refused to go to the NRC: on every trip to the district hospital, the family had been mistreated, ignored, or even chastised for the state of the family, and they had no desire to return to a facility that not only failed to treat their son, but also cost them time, comfort, and took them away from their support structure.

After sitting with the family, Neelofar was able to make progress. Prateek had been one of her first referrals, and now, armed with 3 years of experience, she was able to confidently address all of the families concerns. Auntim, now familiar with the entire district health setup and all of the hospital staff, assured the family that their previous experience was an anomaly. After several hours of counseling, the family reluctantly agreed to go to the NRC.

Once in the Khargone district hospital, the staff of the new NRC immediately rose to the occasion. The new pediatrician immediately visited the family and calmly diagnosed both children, attributing their severe malnutrition to Tuberculosis, one of the more common malnutrition co-infections in Madhya Pradesh. He counseled the family, informing them of the duration of the treatment required, the protocol they needed to follow to treat their TB, the side-effects, and a detailed explanation of every treatment the NRC was providing. Although this seems basic, overburdened health staff often does not have the time to provide this standard of care. In addition, Auntim and Neelofar worked out a schedule to visit the family twice a day to provide them psychosocial support, address their concerns, shop for them in the local market, or communicate updates back to their family in their village.

Two weeks later, both children were stabilized and discharged from the NRC after achieving their target weight gain. Once back in their homes, both the children were regularly visited by the Anganwadi worker to monitor their weight gain and report and problems to both RMF and the local government health staff. The family is adhering to their TB treatment and, although they have a long way to go, both children are on the road to healthy lives.

This is just a one of the stories we have helped co-create; lived by the newly empowered people we have been able to help. Make a donation and pledge to share our vision. Happy holidays!

excerpt from a report by Michael Matheke-Fischer, Santosh Pal & Amit Purohit

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