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Good DRR Practices in Health by PRIsSession objectives:At the end of this session participants will be able to advocate • Adoption of best practices in health for effective DRRKey learning points of the session: • There have been some useful practices undertaken in different areas • Some of these good practices include- Institutional Delivery -Referral Transport, Collection of Water, Keno Parbo Na, DOTS, Fever DepotsHandout for the session:Are you aware that Rs 10000/- is allotted to your Village Health and SanitationCommittee (VHSC) as an untied fund? How has it been spent this year? Last year?How has it been spent in previous years?Good Practice Need Covered BenefitRural Ambulance - from Referral Transport Pregnant Womenmodified Van RickshawsKeno Parbo Na Nutrition 0-3 childrenLocal solutions for Water Collection AllCollection of Water
Oral Rehydration Therapy Diarrhoea All(ORT) CornersDirectly Observed TB AllTreatment Shortcourse(DOTS)Fever Depots Malaria AllLocal Life Jackets made by Drowning Flood ProneSelf Help Groups/ SHGsTable: 1 Good Practices Rural Ambulance converted Van RickshawsModified Van Rickshaw in 24 Parganas Sunderban area- use of van-rickshaw as a ruralambulance that could save hundreds of lives by only being able to transport patientsfrom the households to the local clinic, in the specific region of rural West BengalFigure 1: Rural Ambulance The main feature of this conveyance is that its base/platform is at a considerably lowheight from the ground level than a common rickshaw van. This arrangement is made tocreate more space and reduce the vibration, which otherwise cause discomfort to thepatient in a rugged terrain of an unpaved road.
A stretcher is placed on one side, with proper shock absorbing arrangements. Thishelps in avoiding jerks due to bad road conditions. The stretcher can be removed whileusing the conveyance for a purpose other than carrying ailing patients. Just opposite to the stretcher, the sitting arrangement is made for at least twoattendants. An oxygen cylinder is kept at one corner so as to meet the exigencies. Likewise, a first-aid-box is also kept at one corner. A wash basin is placed beside the stretcher. Arrangements for saline, drinking water, adequate lighting, are made. Battery operated hand mike set is fitted on the top of the vehicle. Provisions for life jacket, life line, stuff, small tent, extra rope, folding ladder, blankets,etc. are there for using the vehicle during calamities. The top of the vehicle is tin-roofed and the sides are also fenced with tin sheets andnets are placed in between to ensure adequate ventilation.It can be used both for delivery patients AND OTHER TYPES OF PATIENTSHand washing
Nutrition - Keno Parbo Na programmeFigure 1: Positive Deviance MascotMonitoring is done by mothers using the Mascot. Each limb represents a step inprotecting the child- such as Measles Immunization
Figure 2: Community MapA positive deviant child is a healthy and developed child in a poor, disadvantagedand distressed family. A positive deviant family is a family which has PD childrenThe special practices of a PD family which enables a child to grow and develop well
inspite of poor socioeconomic conditions are called PD practicesThe attempt is to find out these practices in the community and formulate strategies andactivities which motivate all families with children to adopt these best practices throughparticipatory learning.Making Malnutrition Visible to the families and community through weighing of childrenand using colour-coded charts, maps and other toolsFinding out prevalent child care and feeding practices in the area – both good and badand identifying young children who have good (normal nutrition) or bad (severe acutemalnutrition) nutritional status as a result of these practicesBringing the moderate to severe malnourished young children (0-3 years) and theircare-givers regularly to the AWCs (Angan Wadi Centres) for the Nutrition Counselingand Child Care Session-NCCS. AWWs (Angan Wadi Workers) along with community,positive deviant mothers & SHGs and teach them the correct feeding and care practicesthrough hands-on demonstration and urge them to follow the same care practices athomeClose monitoring and follow upMonitoring is done by mothers using the Mascot. Each limb represents a step inprotecting the child- such as Measles Immunization Local solutions for Collection of WaterCollection of Rain Water by community in jars/ kolshi and using filters of sari cloth havesaved many lives. These are local practices that need to be copied and propagated.Scientific studies have shown how many bacteria are trapped when plankton get stuckin the cloth.
Figure 3:Post Aila Water Collection ORT CornersAt Gosaba Ghat we saw a newly literate man poring over a little booklet on what to doin emergencies. He was reading very slowly- dis..in..fect…….ten…litres..of…waterwith…a 40…milligram ta…blet..of Hala…zone.Figure 4: ORT Corner Gosaba
A little further on, at the ticket office we found Swapna Barman explaining how to makeOral Rehydration Solution to a man with a small child. After she had finished agovernment Male Health Worker checked that the man had understood exactly whatshe had said. Meanwhile Dipankar Dalui gave them the ORS he had just made in abottle they provided.At the local Primary Health Centre Indrajit Hazra was also preparing stock solution todisinfect water. He and Sanjeeb John Makhal had talked to 79 in patients, out patients thand visitors on 10 July. Saturday is a busy day in Gosaba- it is Market Day and thereare people here from as far away as Choto Mollakhali. Mollakhali is three hours ride bylaunch from Gosaba.Swapna is a local volunteer from Manmathanagar working with Anwesha, a local NGO.Dipankar from Satjelia and Sanjeeb from Bali are with Palli Unnayan Samiti (RuralDevelopment Society). Indrajit has been working in West Bengal’s Nadia District for theCatholic Charities there and has been deputed to Gosaba to take part in the relief workbeside the local volunteers after the devastating cyclone Aila that struck West Bengal thon 25 May 2009. They are all literate young people from rural areas.Figure 5: ORT Corner SarberiaGosaba is a block town and administrative headquarters for 11 inhabited islands in the thSunderbans. It was first settled in the 19 century by a man called Daniel Hamilton, who
bought three islands and turned them into an estate. He brought settlers fromneighbouring districts and they started the first agriculture here. Now Gosaba is abustling town of around 50000 people. The islanders also cultivate prawns and catch thfish for a living. The cyclone on 25 May broke the protective embankments around theislands. Sea water has flowed into the fields and fresh water ponds and many have losttheir homes and farms. The storm also destroyed the water pipeline to Gosaba. Many thwere forced to drink contaminated water and a diarrhoeal outbreak started around 30May and continued for over a fortnight. There are still a few diarrhea patients coming infrom the further off islands. TB- DOTSRaiganj- A Panchayat Prodhan followed up a [patient who had been treated underRNTCP. After 2 courses of treatment the man was declared resistant to TB. TheProdhan followed up and filled in a form that was sent to Swasthya Bhavan, The patientwas admitted to the Jawaharlal Nehru Hospital in Kalyani for DOTS Plus treatment. Fever Treatment DepotsDooars- Indian Tea Association has set up Malaria clinics in the remote gardens. Theseare a support to the Fever Treatment Depots where ICDS workers keep Malariamedicines and can take blood for tests Local Life Jackets made by SHGsDuring the CBDP programme in Uttar Dinajpur Self Help Groups learnt how to makecost effective life jackets using commonly available materials.Source of the Reference material:Skills That Save Lives ASHA Module 6 NRHMKeno Parbo Na- http://www.positivedeviance.org/from_the_field/voices-nutrition.htmlhttp://www.unicef.org/india/nutrition_1557.html
Van Ambulance-http://wn.com/InnoAid__Rural_Ambulance_Project__Sunderbans__the_local_rickshawm4vORT Corners UNICEF Press ReportSession plan:Start the session with explaining objectives of the session and the significance of thesession for the entire training programme. Running time Description of specific activities of the session First 10 mins Brain Storming/ Listing. Ask- What are the good practices you have seen? 11-50 mins Presentations (6 mins each): either of their own success stories or of examples provided 51 to 60 mins Discussion on good practices by PRIs.Methods:Handouts, Presentation of case studies of good practices highlighting the scope of DRRin Health sector and the role played by PRIsMaterial required:Pre-designed visual aids on Case Studies. White board, white board markers, flip chartsAnnexure-Case Study on Positive Deviance/ Keno Parbo Na
PD Practitioner: Rupali Haldar (Anganwadi worker)Location: Mala Village, West BengalDate: February 2005My name is Rupali Haldar. Initially when I started my work as an AWW (AnganwadiWorker), and used to weigh children, then many mothers refused to allow me to weightheir children. Many used to make faces, many used to say if you weigh my child theweight will go down but I still didn’t lose hope. Whenever I used to go to the village, thevillagers used to snub me by saying, “There she goes, once again she will try to weighour children.” Many used to comment, “She gets money so she comes here, she musthave some purpose.” Again, some used to say, “Even though some people get moneythey don’t work, they don’t come to advise us”.Slowly, I became much closer to them. My first session started at 1.6.02. There were 14children then. The programme was not initiated in the centre but in a mothers’ house. Ittakes 10 minutes from the centre to reach that house. The programme stopped for amonth due to heavy rains. By 28.8.02, a number of Grade IV, III, and II malnourishedchildren moved to Grade I and Normal. Their mothers were so happy. They startedfeeding the meal at home as well.Another aspect of joy was that the grandmothers used to bring the children to thecentre. If the mothers did not want to come the grandmothers used to persuade them toattend. The grandmothers also reported the cases of mothers who did not prepare themeal at home. In the PD programme, the Hindu and Muslim mothers prepared the mealtogether. The programme started in a Hindu family, but then it also took place in theMuslim families. Even the mothers of the normal children have supported andparticipated in the programme wholeheartedly. Once I asked a normal child’s mother,“Why do you want to attend regularly?” She said, “I want my child to remain healthy andnot lose weight and besides my child loves to eat with all the children.”Initially the Panchayat people did not help me. They wouldn’t even behave properly. Isupplied the fuel till the 8th session. From the 9th session, the mothers’ contributed the
fuel. One of the fathers refused to give polio drops to the child but the grandmothercame to me to give the child the drops secretly. I was so happy.My CDPO and Supervisor told me to work well to get good results. Today I am veryhappy. Now even the Panchayat have come forward. Earlier they wouldn’t listen to me,now they do. Earlier those who would make faces and wouldn’t talk to me, nowconsider me as their own. This is my biggest gift. My work is for mothers and children,and to reduce child deaths. If I am aware, then I can create awareness in others. I feelAWWs should have a mentality of maternal love and affection. I feel even if there is aVHC (Village Health Committee), to back up the AWW, she has to give her best effort.Whenever there is a problem the mothers must be consulted, this helps inunderstanding what each mother wants to say. Once while facing the fuel problem, Isaid I don’t get any money for fuel, how long can I keep arranging for it? The motherswere quick to answer “Didi, these are our children who have the food, so we will arrangethe fuel, don’t worry.”