Notes

Letter to Collector on Anganwadi

Letter to Collector on Anganwadi

26th December 2007

Morning after Ajay’s talk we sat to draft the petition letter and the format for collecting signatures. Based on our initial survey the previous day, we knew that some families had received rations once or twice, and some not at all. Also it appeared that they did not receive the full quantity allocated to them by the program. For example many reported receiving only one glass of dal (150 – 250 gms) while the program provided for 1 kg / month for 15 months.

We demanded that the Collector and responsible officers of the Integrated Child Development Services (ICDS) see that the anganwadi program gets implemented properly, by ensuring full and timely delivery each month of the “take home ration, ” namely rice, dal, cracked wheat and oil to the pregnant women and new mothers, and daily functioning of the anganwadi centers for feeding anble officers d engaging children in learning activities each morning. Furthermore we demanded that they deliver the rations owed to the families from the past. Finally we demanded that each anganwadi display a notice board clearly describing what services the center offered and what each woman and child were eligible to receive.
We took the forms and looked for homes with young children and mothers-to-be. We had no plan as to who should sign first, but we wondered if there would be any hesitation in signing first. Anyway we approached the SC colony and an elderly woman asked what we were doing. We said we were finding out if people were getting anything from the anganwadi.

“ETi lEdu” (not a thing)
“Emi ivvalEdA? garbhini appuDu istAru kadA?” (nothing? but during pregnancy they give, right?)
“mAlalaki istArEmiTI?” (you think they give to mAlas?)

well that is why we are sending this letter to them, we need you all to sign it.

Meanwhile a young mother came and we explained the letter to her. She said she had received nothing from the anganwadi, and she had even gone to ask once but they didn’t give her anything. She explained that because she was from a low caste, she could only ask so much. “mEmu takkuva jAti kanaka mEmu takkuvaga nE aDugutAmu.” But she was ready to sign the letter. We told them that if the officers come and ask you you must tell them the same thing that you are telling us now.
Sure we will tell them, mAkEmiTi bhayamEmiTI? tinTE tinnAmani ceptAmu, tinakapOtE tinalEdani ceptAmu. (Why should we be afraid to state the facts, if we ate we will say so, if we didn’t eat we will say so.)

Emboldened by her response and signature we proceeded to other homes. Not a single person hesitated to sign the letter. Many told us they had come to the meeting the night before. One woman who had spoken up strongly at the meeting talked to us again when we visited her at home. Apparently that morning some officials had visited her house and asked her why she was making all this fuss. Why all this fuss now, when no one raised the issue before? They implied that there may be some ulterior motive, that she was trying to get the anganwadi worker fired. She told them that there was no personal agenda here, and if she did her job right then no one would have any complaint.

Later we learned that the sarpanch had also called our coordinator’s home. So he and two volunteers went to meet him. They came back even more vigorous than before. They explained how we got into this, that while distributing ragi to severely malnourished children we heard from many people that they were getting nothing from the anganwadi, so we are trying to change that.

The sarpanch understood the goals of the letter, and appreciated the part AID India was playing. At least he realized that there was no ulterior motive, no political agenda or affiliation, and nothing against the people occupying the post. But he promised to correct the problems within a day or two, and asked us not to send the letter. Let us see.

A sad fact that emerged as we talked to the women while collecting the signatures was that the anganwadi workers do administer the “injections” though they do not give them the food rations. Giving malnourished children medicine or immunizations may be risky. Even well nourished children can have adverse reactions to immunizations. If they are able to see a doctor who can correctly diagnose that, then subsequent immunizations can be modified – either delayed, separated (giving one at a time rather than multiple innoculations at once), or cancelled altogehter based on the risk to the individual patient. It is highly unlikely that a village health worker would be equipped to diagnose adverse reactions to vaccines. Basic issue is that good nutrition is the primary immune booster.
Looking back it is almost funny how we stumbled into this issue. When I had asked where is the anganwadi for Sravani, I heard that the anganwadi was actually in the house next door to hers, but it never ran. However the next day Varalakshmi told me, the anganwadi is running do you want to go see it? So I did. After chatting a while with the worker as the children trickled in, I said I would go and bring Khiyali. In this way I visited this center three days in a row and all three days it ran for nearly an hour. At the meeting someone reported that because of my visit, some children who were attending some other preschool were pulled to come and attend this anganwadi. And on the day when I was not in the village, apparently the ayah had started to call the children but the worker told her, “no need to call them today there is no visit.”

Notice board seems to be a very important component because people don’t really know how much ration they are supposed to receive each month. Even when we asked the anganwadi workers themselves it was hard to get a simple answer to the question, “how much rice do you give each month?” A clear notice board would fill in an important missing link – right to information went hand in hand with their right to food.

In fact some people expressed surprise when we asked them if they were receiving anganwadi services. “mI pillalu anganwadi ki veLtArA?” “mIku anganwadi ninchi Emi istAru?” we always phrased the questions positively. Some simply answered that they got nothing or that their kids did not go to the anganwadi, but some said, “what anganwadi?” In the weavers colony, one conversation went as follows:

“anganwadi lEdu mA panchayati kE lEdu” (anganwadi? our panchayat has no anganwadi.)
“manaki panchayat undEmiTI?” (panchayat? we have a panchayat, what?
“adEmiTi panchayat unDakapOvaTam EmiTI?” (what do you mean, how can there not be a panchayat?)
“weavers ki panchayat undEmiTI?” (do weavers have a panchayat?)
“wevers ki lEdu.” (no, weavers dont have one)
“mari aTlA aitE lEnETlE” (then it’s as good as not having one.)

I should have probed further as to whom they felt the existing panchayat belonged. Probably notice boards on the panchayat meetings, etc would help. as well.

On the train back from Srikakulam I described these recent events to an elder woman from Bhubaneshwar sitting next to me. She said that the government has very good services, they just do not reach the right hands to implement or benefit from them. I told her how we talked with the anganwadi workers and the supervisor. She said “struggle karna paDega, aur kuch nahin.” (People must struggle, there is no other way.)

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Notes, Uncategorized

Tolapi Meeting on Anganwadi

Tolapi Meeting on Anganwadi

24th December 2007

Varalakshmi went back to talk to the mothers about taking the next step, which would be to prepare a list of all the people within the beneficiary zone of the anganwadi centers and record how much they had received. In a list of 18 names, there were reports of some who had received once, some twice and some not even once. In order to meet a large group of the women at once, we would have to have the meeting in a neutral place, so Varalakshmi suggested the elementary school. This way no single caste would be singled out.

Taking advantage of the presence of guests from the AID conference, including seasoned satyagrahi Ajay from Anakapalle, we called for the meeting today. We gathered about 20 mothers and by the time they all reached the elementary school a crowd of about 20 more had gathered as well. We briefly recapped the issue which was anyway well known to them. Varalakshmi summarized her discussions with the women in their homes, the anganwadi workers at their centers, and also at the sector meeting. The next step was to submit a list of names of those who were eligible but had not received the food. Simple enough.

A young man from the village immediately said that he could tackle the issue, call the press, take videos and meet the required officers. Ajay told him that getting our pictures in the paper was not going to get the results, and could even sidetrack us from our actual goal which was to get the children their food, which was their right. Another said, “ippuDu manaki svacchandi seva samstha undi kada, AID India, manamE Edo cEskovaccu kada, vILLu vALLu cEyyalEdanakunDaga) why harp on the negative saying what government is not doing, we have our voluntary organisation, AID here, why dont we do what we can ourselves and not blame others for not doing this. Reminds me of the words of Archbishop Dom Helder Camara, “When I gave food to the poor, they called me a saint. When I asked why the poor were hungry, they called me a communist

After a lot of discussion and after driving home the point that people had to write a letter, sign their names and be prepared to tell the same truths they told during this meeting at the time of any enquiry, Ajay closed with a song on Ambedkar and reminded people that we do not get our rights by begging.

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Notes

Whose permission?

Whose permission?

21st December 2007

Anganwadi Kinthali Sector Meeting

When we had gone around to distribute the sOLLu pindi (ragi flour) several women asked us why they werent getting anything from the anganwadi though their names were registered. We asked them if they had asked the anganwadi themselves and they said “you think they will tell us anything. They will just push us aside and say who asked you to come here?”

So after visiting the anganwadi ourselves, we thought of meeting with all the anganwadi workers and discussing these issues. I thought before calling them to our meeting it might be good for us to attend one of their meetings so that we could better understand the program and how they ran it. Just for good measure we thought we would also introduce the “READ India” program in which we were collaborating with Pratham, which is also meant to link with the anganwadi to utilise the children’s story cards, etc. The local anganwadi worker told us the time and place and said we could come to the meeting. We went back to the women who had first asked us why they werent getting the rations and asked them if they would also come to the meeting.

There was one woman from the village who was interested in attending the meeting with us, though she too had expressed reservations about coming alone, since then only her caste would be represented and only her caste would face any reprisals. They said that if the entire group was going, including members of various castes, then they were willing to go along. SO we said that day may come later, for the first meeting we werent planning any confrontation, we just wanted to ask basc questions and offer our cooperation, keeping things amicable and low key to start with. In the end the woman chose not to come so I went along with two of the village volunteers, neither being beneficiaries of the anganwadi program.

The meeting started out well enough. As we approached the meeting place, the anganwadi center in Kanimetta, we saw a group of women and a couple of men seated oustide in what appeared to be a construction site. Was this where anganganwaditings were heal. ? We entered via the anganwadi building and met the women. Several had notepads out, it looked like the meeting was in progress. Maybe the current was gone so they went inside, I thought. Actually it turned out that the meeting had not yet begun.

It was well past 11 and the meeting was supposed to start at 10. We chit chatted with a few of the women while waiting for the others. We saw her records of what foodgrains she had distributed in her village. The main headings were in English words or abbreviations, transliterated in to Telugu. THR = take home ration. Spot feeding is the material they cook and prepare for the children to eat at the center itself. P & L = pregnant and lactating, though they only give for the first 6 months of lactation. After that the child is eligible for “spot feeding” which, if actually provided is usually taken home.

All her columns were filled right to the decimal place.

When we asked how much rice do you give to each pregnant woman per month, she replied, 80 gms per day. I asked if she measured it out each day. She said no. I asked when she gave it. There was some confusion and all talking at once. Finally I asked, do you give it every month? They seemed to agree that that was about right. So how much do you give every month, I asked. Again cross talk but no answer. Finally one said, it is 80 gms per day. Multiply that by 25. Someone pulled out the calculator and came up with the grand total of 2 kg. SO again I asked, do you give 2 kg per month? No one answered. How do you measure it out and give them, in bags or boxes, or what? Finally the supervisor said, show them our kg measuring can. One women searched and held up an old, rusty nestle can.  All the anganwadi workers agreed that this was the kg measuring can they would use to take 2 kgs and pour it out. Again I asked, “into what? Do they bring a bag or a box?” Someone said softly, they just carry it home in their sari. Which meant that in all likelihood, the quantity they got was less than 2 kg. Probably much less.

Later we learned that they received rice and dal in large 50 kg packets which they were expected to open, measure and distribute. Similarly oil came to them in 1 kg plastic bags which they were supposed to open and measure out 250 gms per beneficiary (garbhinilu, balintalu or pregnant and lactating women). However some complained that they did not get the oil and for the spot feeding they ended up using their own household oil.
Newly introduced into the program was “bamsi ravva” or cracked wheat which they were supposed to give 9 days’ worth, and accordingly reduce the rice ration to 16 days’ worth. Remaining 5-6 days of the month are “off days” – either Sunday or some other holiday like karthika Pournami, Mukkoti Ekadasi, they said. So they gave only 25 days supply of the rations at the rate of 80 gms / day.

We asked them in general if they got the rations on time and in correct quantity. There was general nodding that they did not always get them on time nor did they get sufficient quantity. We said that we wanted to help them resolve these issues and they nodded.

As we discussed these matters their supervisor arrived. We introduced ourselves and said that we were here to learn more about the program. She said this is our meeting time, but gave us 15 minutes. Seeing the direction of our questions she said, I can give you the complete list this evening. We said ok. We continued talking. I said, in the event that the supplies don’t arrive or people dont get the supplies then whom do they ask.

Immediately the supervisor turned irate. Whose permission did you get to come here? What is your organisation doing? Tell us all the services you have provided and then we will tell you what we have done. This is our valuable time and we dont need you here.
All this and much more we said. I tried to explain – first to her, then seeing that she was not listening, to the assembled workers, that it was not on behalf of any district or department head that we came but on behalf of the mothers and children who needed their services.

The village volunteers were angry.  At the bus stop we sat and reviewed what happened and when things took the ugly turn.

TO BE CONTINUED!

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Notes

Looking to the mountain

Looking to the mountain

20th December 2007

Sravani and her friends were playing on the steps – with what, it was not clear but they were lost in their own little world until we marched in. We gave her her alloted packet of 500gms ragi, as we were giving to all the children who were malnourished according to the latest record of weights taken by the AID India staff. As we left I noticed that she was nibbling on a coconut shell. It had no coconut in it. The image remained in my mind for a long time.

Was she going to the anganwadi? Friends laughed – what anganwadi?

I could not believe that there was no anganwadi. I went to visit the local anganwadi center. Children came to have their daily bowl of kichdi. She brought out some games and said that they would play those games as well. I went to bring my daughter as well. Next day I went at the same time and saw the children sing some songs, do some exercises, and then have their bowl of khichdi. Some children forgot their bowls and so the anganwadi worker gave them small plates or tiffin boxes to use. Friends told me that all this never happened, it was only because I was going there that she was putting on a show. But the first day I went unannounced, I said. Oh but whenever there are visitors then she gets active. I talked with her about how many pregnant women and children she was serving, and saw her weight charts. She said that she did not get adequate supplies and therefore had to keep “adjusting” and rationing what inadequate supplies she got. For example she said that she did not receive oil for the past 6 months and so was spreading the oil very thinly or using her own oil. Also she only received supplies for 8 pregnant women but in fact in her area there were 25. So she said that the people had to adjust and that either she gave less or she rotated and gave in alternate months.

Villagers laughed at all these reports. We’ve gotten nothing, not in alternate months, not every third month, not even one month of the entire nine months of my pregnancy did I get a single packet of rice, dal or oil, though they came and entered my name in their lists. The only time they come around is to write our names in their list and to give immunizations. After that we never see them nor do they answer if we ask for our supplies.

I visited the other anganwadi center, a little farther in the town. If our first center was operating at 1/4 of its intended capacity, this was not operating at all. She told us, “the kids just left” which was hard to believe as there was no sign of kids having been there or eaten – no food crumbs lying around, no cleaning up, etc. We went the next day at the time she suggested, and again she told us that the kids had just left. Why so early? “Oh today is ekadasi.”

The blatant feebleness of her excuse made me alternately angry and also feel pity for her. How could a well-to-do woman be reduced to stealing grains from the poor? We asked her about her salary. Turns out she doesn’t always get that on time either and never in full. She described the math involved – their received part of their salary every month, and the other part as arrears every six months. From that also some was cut. “How can that be?” we asked. “mari anganwADi anTE ante!” [that is what anganwadi is!] she exclaimed.

We are planning to attend the sector meeting of the 18 local anganwadi workers. We went to the village and talked with the women who reported that they had received nothing and asked if one of them would come along to the meeting.

Long discussion ensued. It turned out that the women feared reprisals if they came to attend the meeting. Higher caste members of their own village would boycott them, fail to pay their annual payments (which are traditionally given to the barber community, for example) or worse – literally come and beat them up. It has happened before on some other issue. So in effect she told me, we don’t need the government’s kilo of rice that much.

As we walked back and discussed what approach we could take at the meeting, my friend said that the anganwadi workers would not give up their perks so easily. If they were siphoning off grains every month it would not be so easy for them to give up this income and all the connections it brought them. She said that one could often observe at weddings of the rich, piles of grain bags that had come from the anganwadi program. Why dont you report this to the police? I asked. What is to report – the police already know this, she said.

“konDaki mEsina burra konDa vEpE cUstundi.” The animal grazed on the mountain will continue looking towards the mountain, explained my friend.

I wonder when Sravani will be reaching for the mountains?

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Conversations

Conversations on Birth and Women’s Health

Conversations on Birth and Women’s Health

19th December 2007

Talking about birth …

“ippuDu evvariki normal avaTamu lEdu.”
[No one has normal anymore.]

“noppulu rAkunDAnE tIsupOtunnAru.”
[they are taking them in even before contractions begin.]

“tommidi nellalu mUDu rOzulu avagAnE rammanTunnAru asupatriki”
[they are asking us to come in to the hospital by 9 months, 3 days]

Stirred by these anecdotes of rapid mass conversion from home birth to hospital birth in rural parts of Srikakulam district, I sought to talk in more detail with women about their birth experiences.

I met women in Tolapi and Appalagraharam villages, some of whom were receiving sOLLu pindi (ragi flour) in the AID India nutrition program. I said that child nutrition began before birth, even before pregnancy. A healthy woman would become a healthy mother and a healthy mother would be more likely to have a problem-free birth and be able to breastfeed easily. And so I asked them to share their usual dietary patterns, how these changed in pregancy and postpartum, and in this context asked them to share their birth experiences as well.

Those who had C sections, also known as “pedda operation [big operation]” said that they went to the hospital at the appointed time, often without any contractions at all. Generally people believed that once a Cesarean, subsequent births must be Cesarean and therefore the woman should not be kept at home waiting for contractions to begin but should just go to the hospital on the scheduled date. Other indicators for Cesarean, according to them were malpositioned baby or water breaking prior to onset of contractions. Apart from this since women were asked to come in at 9 months 3 days many went in prior to contractions anyway and for one reason or another had Cesareans. Many who went in after onset of contractions also reported that contractions slowed or stopped at the hospital and therefore they did have Cesareans.

In each village there were also home births and they described their birth experiences as well. I was mesmerised by the detail in which they could recall the progress of labor, indicating at what time contractions began, what they were doing at the time, whom they told (for some time they kept it to themselves so as not to interrupt what they were doing), right up to what time the baby was born.

One of the women who had a home birth reported that she did go into the hospital at 9 months 3 days as requested, and was asked to stay and wait for the baby to be born. However, her mother who went with her said that she was just fine and did not need to wait in the hospital and took her home. A few days later she delivered at home with only her mother to help her. Her mother was experienced in childbirth and was called by others as well. In another case the government nurse actually came home to deliver the baby for a woman.

There was also a case of a woman who delivered at home with a “mantrasani,” or traditional birth assistant, who lost the baby due to incompetent handling by the mantrasani. She reported that the mantrasani tried to pull the baby out by reaching in. The baby died. Another woman reported that because she had high BP the doctors told her that she could not deliver a breech baby and gave her injections to kill the baby. I asked why they did not do a Caserean delivery and she said that because of her high BP they could not do it. This happened in 1994. Since then she reports that she has fits and very poor memory.

After hearing all the stories I shared my birth experience as well. I also described what was happening during the “pains” which is the word used for contractions, and how this indicated that the body and baby were ready for the birth. 3 days past my due date my contractions began but occurred at 1 hour intervals. This continued for 7 days. I did not go to my midwife until the contractions came every 5 minutes. I told them that I was advised not to come in until contractions were 3-5 minutes apart, lasting 1 minute each and continuing at this rate for at least 1 hour. By waiting until this stage one could be relatively sure that the baby was ready to come and avoid unnecessary interventions. I emphasized that even if one had a Cesarean before one could possibly have a normal delivery next time. I asked them how long it took to reach the hospital and they said 30 minutes. This meant that they could definitely wait for labour to begin rather than going in advance “just to be safe.”

Some people asked how long you can wait – can you even wait till the 11th month?
Varalakshmi explained that we don’t always know the month that accurately, sometimes we may miss a period even before the pregnancy and think that we are farther along than we are. Also in case they are going by the lunar calendar, these months are 28 day months, which means that normal term is 10 full months. So entering the 11th month would be fairly common. Some people are counting in solar calendar months but then they should make sure they are not confusing the two.
We also talked about nutrition during pregnancy and postpartum. They reported that they were not getting the supplementary nutrition from the anganwadi as promised and for which their names were registered. We spoke with the anganwadi workers who reported that they were each responsible for 20-25 pregnant women but as their target was 8 women, they received supplies only for 8. Therefore they gave only to 8, sometimes by rotation so that they prengnant women would “adjust among themselves.”

Before coming to breastfeeding I also asked them about postpartum nutrition. I knew this would be an explosive topic. Postpartum dietary restrictions are quite tough on women. Many reported that they ate only one meal / day comprising dilute pappu (dal) or only charu with rice or chapati. Even those who raised a fuss (”goDava”) and ate 2 meals a day were very restricted in terms of what vegetables were allowed, and generally everyone reported feeling very weak and hungry during that time. Some took tonics from the doctor to help overcome this weakness and to produce milk. Some reported that they did not have milk and had to use cow’s milk or dabba (formula) milk. I emphasized that women should eat heartily during post partum without restricting any vegetable unless they personally had a problem with it, not because someone somewhere had a problem.

Some are even limited from eating their fill during pregnancy because they are afraid a big baby will be hard to deliver.

[I was in doubt about the whole peanut issue so I steered clear of it. Peanut was the only food I restricted during the first 2 years of breastfeeding, due to prevalence of peanut allergy in US. But the theory that allergies are likely to affect people in highly sanitary living conditions much more than those living with plenty of germs in the environment made me pause before casting aspersions on the peanut, which is a local crop, cheap and nutritious. ]

It seems that villagers think that rich people are healthier because they eat more expensive, i.e. packaged foods. So when they have a little spare money they try to buy packaged foods.

After learning more about their diets and diets of infants and children, we wanted to make a pamphlet on nutrition that would be locally relevant, written in colloquial language, focussing on the nutritional value of locally harvested food and how to incorporate more into the daily diet. We have made a rough draft and would appreicate help from anyone interested in nutrition and fluent in Telugu.

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