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How Auxillary Nurse Midwives (ANMs) in Remote Tribal Belts of Andhra Pradesh in India have brought down Maternal Deaths to Zero
The scenic beauty of Araku Valley in Andhra Pradesh is in stark contrast to the lives of indigenous tribespeople inhabiting the region. Living in virtual destitution, these tribals — like their counterparts scattered in remote locations across the rest of India — lack access to basic amenities like safe drinking water, healthcare and education. Till a few years ago, some of these habitations were not even covered in the national census and nobody knew they even existed.
But efforts of a leading NGO over the last seven years have yielded results in 181 habitations around Araku. This is testified by the fact that no maternal deaths have been reported here over the last two years — a giant step forward for a place where maternal mortality was double the national average.
Before emerging as a tourist destination about a decade ago, Araku, 100 km from the port city of Visakhapatnam, was an area that was the redoubt of Maoist extremists. Politicians and officials used to stay away from this forested area in the Eastern Ghats.
The population in scattered and inaccessible hamlets was suffering from malnutrition, leading to high maternal mortality and neonatal mortality rates. Some traditional practices of the tribals and deliveries at home were also contributing to this situation.
When the NGO Piramal Swasthya, the health vertical of Piramal Foundation, launched the Asara Tribal Health Programme in 2011, maternal mortality in this tribal area was over 400 per 100,000 live births as against the then national average of around 200.
No maternal deaths have been reported over the last two years while the percentage of institutional deliveries has risen from 18 per cent to 68 per cent. The neonatal mortality rate too has come down from 37 to 10 per 100,000 live births, say the officials of Piramal Swasthya.
The agents behind this change are Auxillary Nurse Midwives (ANMs) like P. Padma who toil selflessly to help the pregnant women in these remote hamlets. The 27-year-old has been working with the NGO for six years and has attended about 3,000 women. She has seen the transformation.
“The situation in the tribal hamlets was pathetic as women were reluctant to come to hospitals for delivery. A major reason for this was the superstition among tribals. Piramal Swasthya has removed the superstitions and motivated the women,” Padma told IANS.
Padma travels 12-13 km in a four-wheeler and, when the road ends, she goes on a bike driven by a “pilot”, covering another 11 km. When this narrow path also ends, she hikes across mountains and valleys for another 12-13 km to the last habitation of Araku.
This is what she does every day, explains Vishal Phanse, Chief Executive Officer, Piramal Swasthya.
Once in the habitation, the ANM identifies every pregnant woman, conducts basic tests, provides counselling on healthy practices and fixes an appointment for consultation with a specialist at the telemedicine centre. The next day, a four-wheeler is sent to pick up all pregnant women registered and get them to the telemedicine centre, where an expert gynaecologist sitting in Hyderabad provides the consultation through teleconferencing. Free medication, along with nutrition supplements, is also provided to the expectant mother and she is then dropped back to her habitation.
“If a woman can’t walk we arrange ‘palki’ (a kind of palanquin) to bring her till the four-wheeler to take her to the telemedicine centre,” Padma said. Last month, a woman delivered a baby on the palki in Colliguda village. She helped the woman and later safely transported her and the newborn to the hospital.
ANMs support the women and children through their pregnancy, child birth and neonatal period while keeping the government machinery in the loop.
Piramal Swasthya overcame all odds to achieve its goal of ending preventable deaths in 181 habitations, serving 49,000 pregnant women.
Adding some more interventions like training traditional birth attendants and health education of adolescent girls, it is now expanding the programme across 11 “mandals” or blocks comprising 1,179 habitations in the tribal belt of Visakhapatnam district to reach 2.5 lakh population.
It is currently running six telemedicine centres and plans to add five more. The NGO will also be opening two more community nutrition hubs in addition to existing one, where women are educated about a healthy and nutritious diet and trained in the use of traditional and locally available food items.
Based on the learning in Visakhapatnam, the NGO wants to create something which can be replicated in the entire tribal belt of India. More than 10 percent of India’s population is tribal and among them maternal mortality is two-and-a-half times the national average.
“If what works in Araku, works in Visakhapatnam, then we can replicate it in the entire tribal belt of the country,” said Phanse.
Niti Aayog, India’s policy think-tank, is looking at this model with key interest as to how they can scale it up.
“In fact, a lot of people including the United Nations, governments in states and at the Centre are looking at it. We had a lot of visitors trying to understand how we managed to do this. We ourselves are learning every day. Technology is a great enabler if you have to scale it up at the national level.”
Phanse believes that 80 percent of what worked in Araku can be replicated in tribal areas across the country and 20 percent could be local customisation that they have to work on.
What worked for Piramal Swasthya in Araku? “We have doctors, public health professionals and experts with the youngest aged 26 and the oldest 78. That’s the kind of expertise we have with actual feet on the ground. Our actuality to work with them, for them, staying with them and understanding them is what I think has worked best for us,” said Phanse.
“If you want make anything sustainable in healthcare you have to create health seeking behaviour in the community. We were successful because we changed the community,” he added.
Phanse feels that the community engagement and participation in the programme is key to its success.
For Piramal, winning the trust of the local community was the key challenge. As Araku was an extremist stronghold, gaining the trust of locals took time.
Most of the 38 people that work for the organisation are from the local community who are wedded to the cause. Forging the local partnership by using the services of dedicated individuals who can speak the language of the community ensured smooth implementation.
With 4,000 employees in just its health vertical, Piramal Swasthya is prehaps the largest NGO in India, implementing 29 healthcare projects in 16 states.
India ranks 131 among 188 countries on the Human Development Index (HDI) 2016 released by the United Nations Development Programme (UNDP). India was placed behind countries like Gabon (109), Egypt (111), Indonesia (113), South Africa (119) and Iraq (121), among others. The government is working towards improving this rating by creating competition between states to perform better on key social indicators like infant mortality rate, maternal mortality rate and life expectancy. (IANS)
When you become a mother, you tend to forget about your own needs because you are so focused on your child. With the baby keeping you busy all day and night, your skincare takes a backseat. It's not always changes in skin texture and looks post-pregnancy are a bad thing, but not taking care of your skin may lead to acne, melasma, stretch marks, puffy eyes, and even dark circles. Syed Nazim, Dermatologist, Aesthetic and Hair Transplant Surgeon, Royal Lush Skin Clinic Saket, New Delhi, shares simple and easy tips for you to follow, to get a glowing post-pregnancy.
* Cleansing: As you sleep, your skin goes through a renewal cycle, by dispensing toxins and debris. So you only need a light-textured cleanser to wash your face with a face wash that is suitable for your skin type.
* Steam: Take steam for 2-3 days a week, it will help you to open up your clogged pores.
* Scrub & face pack: Use a face scrub, to remove the dead skin cells, scrub your face for like 5 minutes and wash it with normal tap water. It will help you to make your skin softer and radiant, leave the mask until it dries off.
* Toner & moisturizer: Apply toner to your face, look for clarifying toners that rebalance your pH to maintain the pH value of your skin. In the end, you only have to moisturize your face, to give hydration.
* Steal baby products: Baby products are always mild in nature so that the baby's sensitive skin doesn't have to compromise. They are created to lock moisture in babies skin. So, you can also use them. Whether it's a body oil, lotion or cream, apply some on your skin every time you're applying them on your baby. If you do this, you can flaunt your skin, this way, you don't have to dedicate a specific time every day for your skincare.
When you become a mother, you tend to forget about your own needs because you are so focused on your child. | Photo by Jenna Norman on Unsplash
* Keep all skincare needs in one place: Organize all your skincare products in one place, this organization will help you way much better than anything. Make use of your "me time" and devote it properly to pamper yourself.
* Streaming your routine: Make a proper timetable, for your week how many days you are going to deep cleanse your skin in a week.
If we talk about the baby skincare routine this is important too. As the baby's skin is too sensitive and they are interacting with such a harsh environment -- pollution, high temperature etc. Don't worry there are some simple and easy enough tips. Here, what you should know, with regards to bath, diapering, selecting items and that's just the beginning.
* Bath time: Babies need two to three baths a week in warm, not hot water to stay clean. The initial step to an extraordinary child shower is to track down the ideal temperature. Tip: Fill the bath without any more than 2 to 3 creeps of water. To keep your child from getting cold while you wash them, routinely pour cupfuls of water over their shoulders.
* Diaper Basics: There are a lot of things you'll have to do for your little one when they're an infant, like changing your baby's diaper regularly, cleaning tenderly however completely each time with child wipes. Make the surface saturated yet dry simultaneously as well. There are countless myths around diaper rashes that it is caused because of the usage of diapers. But no, it is due to a lack of attention and knowledge about the correct time to change the diaper. Else it will get worse for your child.
* Awareness of Products: Always read the product label before purchasing products for your infant. It's ideal to avoid chemical and alcohol-based products. Use products that are made explicitly for infants.
The baby's skin is too sensitive and they are interacting with such a harsh environment -- pollution, high temperature etc. | Photo by Jill Sauve on Unsplash
Newborn babies are so delicate, requiring a lot of care and attention. A single mistake or slip of mind can make things worse. Keep your infant's skin saturated, as well, so consistently have a stockpile of moisturizers around. But excessive oil can cause cradle caps, and dryness can create painful scenarios. If your child is facing such issues you need to consult a certified dermatologist.
(Article originally published on IANS life) (IANS/MBI)
Keywords: temperature,sensitive,babies, skincare,child,products
A couple of years ago, finding a strand of grey hair meant visiting the parlor to cover it up. Women and men refused to admit their age, and refused to let it show. Be it moustache, eyebrows, or hair on the head, it was dyed a luscious black, or reddish-brown for those who wanted to go natural. Today, the trend of coloring hair has nothing to do with age. Young boys and girls sport bright colors and hairstyles, which is now a marker of how modern one can be.
This notion of modernity associated with neon streaks and an almost gothic look originates from the ancient Egyptian civilization, where it was considered fashionable to look different from the natural features one was born with. Kohl, lipstick, perfume, and makeup were the inventions of those who hoped to live even after death. Likewise, they were the first people to discover hair dye. Initially, they dyed their hair black, to cover the grey. They used compounds that were extracted from plants, but some of them were lethal. So, they took to extracting the color from fermented leeches.
This was when a chemical was discovered to gently lighten hair color instead of completely bleaching it, and since then, there have been varying degrees of blonde and brown hair. Image credit: Photo by Jessie Dee Dabrowski on Unsplash
When bleach was discovered, women used it to achieve a yellow color, which became known as the sign of prostitutes. The focus shifted to naturally red hair when Queen Elizabeth took the throne, as she suffered from a genetic mutation which caused this. Red heads became more common in Scotland and Ireland, and everywhere else, black hair was still the norm.
When William Perkins discovered mauve during an experiment that went wrong, the concept of mixing two or more chemicals together to create a dye became well-known. So colorless chemicals were developed and mixed in varying ratios to dye hair. When the movie Platinum Blonde was released, the trend of having pale hair increased greatly. People began to go blonde everywhere. This was when a chemical was discovered to gently lighten hair color instead of completely bleaching it, and since then, there have been varying degrees of blonde and brown hair.
Youngsters prefer to sport bright, flashy colors, like teal, blue, purple, and even pink. Image credit: Photo by Tom van Kessel on Unsplash
With the arrival of pop-culture and its influence on the world, these mundane colors are reserved for the elderly. Youngsters prefer to sport bright, flashy colors, like teal, blue, purple, and even pink. Every time a new star sports a different color, the trend sparks interest in others, and sweeps across the globe like a wildfire. Hair dye has come a long way since the time of the Egyptians in the first century. Two thousand years hence, it has the potential to grow into so much more.
Keywords: Hair Color, Hair Dye, Egyptians, Perkins, Pop Culture
The history of Daryaganj goes back to the era of Mughal dynasty, and so its history is as old as the old city of Shahjahanabad, now Chandni Chowk. Interestingly, this market was known as Faiz Bazaar in the Mughal era and was considered as an important commercial place.
In fact, at that time this area was very posh, and had beautiful houses on both sides of a stream from a hauz (meaning, water storage tank) flowing down the centre. Not only this, trees were lined up for shade and it looked like a marvellous garden had been turned into a market.
Also, there used to be Lohe ka Pull which used to connect shops lined on both sides of the market starting from Delhi Gate to the Iron Bridge, but now the pull no longer exists. Well, there's no doubt that the old city of Shahjahanabad was beautiful crafted!
One of the most beautiful things about Daryaganj is its famous book market, known as the Sunday Patri Kitaab Bazaar. Sunday is specifically added here because the book market takes place only on Sundays, that, too, from 9am till 6pm.
Booksellers set up their shops on Patri (footpath). Hence, the name is Sunday Patri Kitaab Bazaar. Photo by Flickr.
In this market, you can find all kinds and genres of books at cheapest rates. In fact, some booksellers sell books according to kilos, and this is really astounding to see. From stationery to art supplies, you can find everything here and that, too, in a lot of variety.
It is interesting to see that some of the shopkeepers of Daryaganj book market are selling books from the past 50-60 years. Not only this, Daryaganj book market is also famous for its branded electronic goods and science lab equipments.
Apart from this, you can also find some of the lost traces of British rule, which once existed in India, in this market in the form of coins, photographs, and even their personal belongings. There is absolutely no doubt that Daryaganj book market offers a lot more than books, as it offers glimpses of the past.
So, if you are someone who is not just into books but also colonisation of India, then you must visit Daryaganj book market and experience a mixture of past and present!
Keywords: Daryaganj Book Market, Books, Old Delhi, Chandni Chowk, India, Mughal Dynasty.