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Treating malnutrition among infants and children in Ranta, Sindh

Soni is a thirty-eight-year-old mother of ten who lives with her children and husband, Sadla, in the Sadla Surjho[1] village of Sujawal district in Sindh. Her husband and eldest son together earn a total income of PKR 8000 (Approx. 65 USD) through local farming.

Meeting the needs of all of her children and running the house with just PKR 8000 a month was always a challenge for Soni. She was always struggling to complete the month with the finances she was handed; there was never enough food and health expenses were often sidelined. Traveling to Daro city, to avail even the most minor health assistance would cost money which made it nearly impossible for Soni or any of her family members to consider.

Very little or no money was saved for healthcare in our house. My youngest son who is two-years-old now was very weak since infancy. He could hardly walk. He did not eat well and was thus very thin. I then decided to take him to a clinic in Daro city to consult a doctor about his decreasing weight and health. The hour’s travel to Daro city alone  cost us PKR 1500 each time. Yet, for a year we kept taking him to the doctor in Daro regularly, but his health did not improve, nor did he start working. This kept me extremely worried, shared Soni.

Early this year some women from Lakhano Surjho, a nearby village, told Soni about the MNCHⁱ centre operating in Ranta village, which is a half an hour walk from Soni’s home village. They shared their good experiences with the health staff at the centre and assured Soni that the medical support provided there has been effective and consistent.

The MNCH is only near my home. I first visited the health centre in June, 2018.  The medical officer at the centre diagnosed my son with anemia. His weight was only 4kgs when he first visited the MCNH, narrated Soni.

The doctor at the MNCH prescribed iron tablets to my son and in addition provided a diet chart to me supported with a health awareness session on how to improve food intake and maintain a clean environment at home.

 Soni was quite satisfied with the treatment provided at the MNCH and she observed a significant improvement in her son’s health. Within fifteen days of the treatment, he had started walking.  Soni had visited the MNCH six times in a month to ensure consistent treatment of her son through routine check-ups as advised by the medical officer.

Soni told her neighbours and other women at Sadla Surjho about the MNCH and her experiences. Since then, a number of women from Sadla Surjho have visited the centre to seek treatment for viral illness treatment and antenatal and postnatal care. Some women have also taken ultrasound tests at the centre too.

My son is healthy and is walking well. I strictly follow the diet as advised by the doctor for all my children to ensure their good health. I want to request the health team to establish a health center in Kot Alam union councilⁱⁱ as well so that we can have access to economical, primary healthcare services only a few minutes away from our doorsteps, concluded Soni. 

Maternal, Neonatal and Child Health Centre Project implemented in District Thatta with the support of Church of Scotland (CoS).

ⁱⁱ Sadla Surjho is located in the Kot Alam union council of Sujawal district

Rashidan and her husband have always wanted to provide a quality life for their four children. A stay at home mother, looking after her children, feeding them and making the most of their menial income, Rashidan had always remained optimistic and full of life for her family. However, with Rashidan’s repeated pregnancies and subsequent miscarriages, her health started deteriorating, restricting her from being the happy and energetic mother that she had always been.

Thirty-five old Rashidan is married to Ramzan, together they live with their four children in village Ranta located in District Sujawal in the Sindh province of Pakistan.

My husband, sells biscuits in Bello city in Umerkot, 30km away from home, through which he earns an income of PKR 600, on a weekly basis. This is insufficient to feed a family of six. We hardly have any money saved for healthcare, when the need arises,

 shared Rashidan.

Whenever health needs would arise, Rashidan and Ramzan would travel to the city hospitals in Daro or Sujawal; both almost one and a half hour away from their village, Ranta. The round trip to the hospital, including the medical expenses, would typically cost them PKR 2000.

I suffered two miscarriages after I had my youngest daughter. My husband took me to the city hospitals. We could not afford the regular treatment there or buy medicines due to which my health worsened. In May 2017, I had another miscarriage (third), this time I visited the Maternal Neonatal Child Health Center (MNCH) set up here in Ranta. I was in severe pain and was bleeding all night. The lady doctor at the MNCH conducted a thorough check-up of me and diagnosed me with anemia.  After she conducted an ultrasound, she informed me that I had lost my third child, who was eight weeks old.

I realized then that I had experienced three consecutive miscarriages due to being anemic. The doctor prescribed medicines to me, including pain killers, intravenous fluid (IV) and vitamin B complex injections. She also advised me to take complete bed rest for three days. I went back to the MNCH after three days for a check-up. After an ultrasound, the doctor affirmed that the report was clear. She further prescribed iron and multivitamins tablets to overcome my weakness.

After a week of letting Rashidan rest, the lady doctor provided an awareness session on family planning to Rashidan.

I was not familiar with the concept of child spacing before. I have been taking tablets for child spacing for almost 10 months now. My hemoglobin (Hbg) has improved considerably. My health has become a priority after the tragic losses I have experience. I want to be healthy for my children and family. It is great to see that the MNCH is providing primary healthcare and the staff is very cooperative and responsive. The facility of ultrasound has brought ease in our life, especially for pregnant women here in Ranta. It is very expensive to avail good health services at city hospitals. Most of us here in the village live in poverty which is why many of us ignore the importance of good health. We have mostly relied on finding traditional remedies which is not enough in many cases. The affordable services at the MNCH are continuously providing effective treatment to many mothers and children in Ranta village.

We live a happy life in the village. I have five daughters and one son. All my children are married. My husband is a farmer who earns PKR 250 on a daily basis. The money earned is mostly consumed in food and household expenses. The income is therefore not sufficient and is difficult to make ends meet,

shared sixty year old Fatima, wife of Tayab, residing in Phul Jakhro village, Union Council Bijora, Tehsil and District Sujawal. Their son and his wife are mostly dependent upon them as well, as he only earns Rs. 50 per day.

I came to the Maternal Neonatal Child Health Center for my foot injury. While visiting my daughter who lives in a nearby village, I was attacked by a wild animal, which injured my foot very badly

shared Fatima. Fatima’s husband initially took her to Bello and Sujawal city for treatment, travelling far distances was costly and the additional treatment costs in the hospitals were burdensome.

After 15 days of treatment and medication, my foot was no better

she recalls,

I was in immense pain. My husband then took me to Sujawal city and the doctors advised me to get it operated upon, as the infection had grown worse and they wanted to amputate it.

Fatima and her husband were very worried and had lost hope. Her son advised her to go to the Maternal Neonatal Child Health Center (MNCH) in Ranta,

My son’s wife has visited the MNCH for healthcare and therefore he was very satisfied with the services the health center was providing,

said a satisfied Fatima. The Maternal Neonatal Health Center is providing basic health services for the villagers residing in nearby areas, with special focus on women and children.

The MNCH provides good health services at very minimal cost of fees. The doctor treated my foot. The doctor treated me with injections, medicines and daily intra-septic dressing. I was treated for 15 days on regular basis. I then visited the MNCH once every week for a month. My foot healed completely and I was able to walk without pain again. The health staff at the MNCH was very cooperative and active.

Fatima fully recovered and she recommends every villager residing nearby to avail timely treatment at the MNCH in Ranta village.

The team of Community World Service Asia and PDMA conducted a meeting with the families of food assistance project implemented in district Tharparkar.

Community World Service Asia has signed a Memorandum of Understanding with the Provincial Disaster Management Authority (PDMA) in Sindh. The core components of the agreement focus on:

  1. Disaster Risk Reduction and Response
  2. Advocacy on Climate Change and Disaster Risk Reduction
  3. Quality and Accountability

Through this agreement, PDMA Sindh and Community World Service Asia will consort together on strengthening disaster risk reduction and response mechanisms in the province and advocating and acting together on climate change adaptation, emergency response, and relevant recovery activities to help Sindh’s disaster affected communities.

Ajay Kumar, Assistant Director Operations of PDMA Sindh, with his team, conducted a field visit to oversee the projects in Sujawal, Badin, and Tharparkar districts this August. The team first visited a community-level Emergency-Operating Center (EOC) and met with the Disaster Management Committee (DMC) established in Rahim Dino Thaeem, a village in Sujawal. The committee briefed the functions of the DMC and Emergency Operation Center. Ajay Kumar suggested that the EOCs needed to be linked with each other as well as connected with the district EOC through a wireless system.  Community World Service Asia assured to work on the suggestion and analyzed how this would further strengthen the role of the EOC in the community.

PDMA Sindh team then visited Community World Service Asia’s Food Security and Livelihood project in Abbas Thebo, Badin. There, their team along with our staff, me the farmers, enrolled in the project supported, Farmer Field School (FFS). FFS promotes sustainable agricultural practices. It examines most appropriate methods of irrigation water use, role of Macro and Micro Nutrient trends in plants growth, weed management, land preparation, sowing methodology, demarcation of acres, and determining seed quality.

Abbas Thebo farmers shared that the involvement in FFS has enhanced their working capability in the agricultural fields.  Approximately 12,000 fruit and forest trees have been allotted to and planted by the farmers, and kitchen gardening kits were distributed to women-headed households. Farmers participated in different festivals including the Farmers Festival recently held in August and took part in exposure visits to increase their knowledge on the subject.

The team’s next stop was at Baghtani village in Chachro, Tharparkar where they met drought affected families supported by PDMA Sindh in 2015. The Baghtani community still remembered the team members and praised the organization for visiting the village again. They told PDMA Sindh that its’ food assistance, given every seven months during the drought in 2015, helped the villagers survive the peak of the drought season. The food rations received were sufficient in quantity for their families. The community these days is very grateful to the rains they have received as it has brought their rain-deprived homeland some relief.

Upon the end of his visit, Ajay Kumar expressed,

“I commend the efforts of Community World Service Asia’s field team and the opportunity given to me to meet communities that have benefited from the various projects. It was nice to observe the enhanced capacity of communities in disaster risk reduction, early warning, sustainable agricultural farming, and strengthening of community institutions. This will all ultimately help communities to depend less on external support.”

Nisar Ahmed Memon, a 43 years old headmaster at the Government Boys Main Sindhi Chandia School, in Sujawal, Sindh, has always been passionate about bringing change through education. With this resolve, he joined the field of teaching in 1992 and has since then been engaging children to learn through play and active learning.

Community World Service Asia visited our school in 2015 introducing the DRR component under the Christian Aid supported project. I was instantly interested in the idea as it was a new concept and people in a rural area like Sujawal were not aware of disaster management before. We shared our profile with the team and a Disaster Risk Reduction Training was organized. Two DRR trainings were held for two consecutive years starting in 2016. Fifty students participated in each training. Participants were taught to analyze and build on knowledge to identify and prepare for major disasters and on how to cope afterwards. These skills were particularly important given the large-scale flooding that Sujawal experienced in 2010 damaging many of our houses, crops and savings.

The training focused on six disasters; earthquake, fire, flood, heavy rainfall and cyclone. Sessions on measures to take pre, during and post the various disasters on minimizing its destruction and the after effects were conducted. Being the first training of its kind, teachers and students at Nisar Memon’s school showed keen interest and enthusiasm in learning through group and drill activities.

As an outcome of the training, DRR groups were formed at the Main Sindhi Chandia School. With six groups in total, two students from each class were selected to represent as members in the groups.  The groups have been divided as Flood Group, Cyclone Group, Fire Group, Earthquake Group, First Aid Group and Planning & Coordination Group and each group has a representation of fifteen to twenty students. A faculty member is assigned to each group to supervise them. These groups then train other students on specific DRR practices so that the knowledge is shared with everyone in school. Every week, these DRR groups brief students of a selected classroom on possible natural hazards and the measures that need to be taken. A drill activity is conducted as a demonstration for the students to clearly understand the measures, use of equipment and their role if any such emergency situation arises. All students get the opportunity to equally participate in the drill activities, enabling each student to apply their knowledge on DRR to real situations.

We encourage students to share their learning at homes as well which enhances their understanding and strengthens their involvement in the community. In addition, the whole school, including teachers and students, are aware of the six main disasters and the measures to be taken. This is a great achievement for us as an institution because in rural areas this kind of skill development is not generally found.

In school curriculums, the topic of natural disasters is touched upon under the subject of Social Studies but that does not provide students with DRR related knowledge or skills. Nisar Memon has introduced drill activities as part of the teaching curriculum supporting the Social Studies lessons on disasters.

After covering the chapters on natural disasters, the teachers then engage students in drill activity of the disaster taught, which allows students to develop a complete understanding of the disaster and of the measures that need to be taken when it occurs,

explained Nisar.

A DRR Carnival was organized to provide an opportunity to young children to present their DRR work. The main purpose of the event, celebrated on 25th May, 2017, was to engage teachers and students from different schools to hear about their experiences; how they implemented DRR in their schools and how it contributed to making their schools safer.

Our students participated in the event with great enthusiasm. They prepared plays and skits to perform at the carnival which displayed various disasters and the role of men, women and children in tackling these disasters to reduce loss.

A total of five hundred guests, including students and teachers from various schools, government officials and other stakeholders, actively participated at the event. DRR themed paintings made by students of GBPS Main Sindhi Chandia, Sujawal were also on display.

The active headmaster, Nisar Memon, also participated in a four-day training on Emergency Preparedness and Contingency Planning which was conducted to train government and other relevant institutions staff on effective DRR methods.

Falak Nawaz from Network Of Disaster Management Practitioners (NDMP), lead facilitator at the training, conducted an effective and productive training which enhanced our knowledge on international strategies for Disaster risk reduction and contingency planning. We were briefed on the difference between contingency planning and disaster risk management planning. In addition, we were oriented on the importance of contingency planning.

Students in rural areas readily welcome whatever new learning opportunities they are offered as it allows them to further enhance their knowledge, intellect and skills.

We have displayed a school map in the school which shows different exits and placements of various equipment that are to be used in times of various disasters. We have hanged bottles filled with little sand outside some classrooms. In case of no warning, the movement of the bottles will indicate earthquake or strong winds of cyclone. This way the teachers and the students will be able to take immediate measures required for the safety of all. In addition, fire extinguishers are placed in the school premises and their locations displayed on the school map. We want to ensure maximum safety of our students therefore we implement brief revisions of the map and drill activities on a weekly basis as well. We have also installed emergency bells which will ring at the time of the disaster to alert everyone in the premises.

Students are trained to react accordingly to different disasters and escape routes are identified. The disaster groups are actively involved with students on how to respond to emergencies on a weekly basis. This has enriched the knowledge and developed DRR skills of around 850 students in the GBPS School.

In future, these children will grow up and be in different places. If any disaster occurs, they will be able to protect themselves and the communities around them. This thought motivates me everyday to further work on this cause,

expressed Nisar contentedly.

With more of these trainings and DRR activities conducted in school, the interaction between teachers and students has increased, strengthening their relation and building student-teacher trust. Many students at the school were afraid of their teachers at first and were hesitant to express themselves. After participating in the training and drill sessions, students have become more expressive and vocal with the teachers, making the learning environment in school more friendly and productive.

I am happy to announce that our enrollment has increased from 723 to 850 students in just a year. Our students and teachers have shared their learning and experiences at homes and communities. This has raised our standard of learning which has attracted many parents to enroll their children in our school. The families completely trust us with their children.

Recalling the floods in 2010, Nisar shared that most of Sujawal drowned in the floods. By the time the flood warning was announced, many women and children had already drowned in the rising waters as preparedness measures were not in place and there was no awareness on DRR.

As the schools reopened after the flood water receded, families feared to send their children to schools. The interest in education decreased due to the overwhelming fear of the floods. Similarly, they feared of other disasters like earthquakes and cyclones hitting their homes and villages. This DRR initiative has increased the confidence of students as well as their families. They are fully aware on how to react when a warning is announced and at times of emergency situations.

Lives are secured and that is a great improvement on its own. We have started a continuous process as these children will grow up and have families one day. They will share their knowledge with their children. This initiative will save lives of generations to come,

beamed Nisar.

Group photo of all participants of the Disaster Preparedness and Contingency Planning Training Course.

Considering the susceptibility of the Sujawal District in Sindh, Pakistan, to natural and anthropogenic disasters, a lot of work still needs to be done to promote and streamline disaster risk reduction (DRR) approaches and activities among the local communities. Contingency planning in the wake of natural disasters in this newly established districts needs to be developed and improved.

To make the communities of Sujawal, and other disaster prone areas of Pakistan, more resilient to onset, recurrent disasters Community World Service Asia conducted a four-day training on Emergency Preparedness and Contingency Planning in Murree. The training held in June, was participated by nineteen representatives from line Departments of Sujawal, Provincial Disaster Management Authority (PDMA) Sindh, Provincial Disaster Management Authority (PDMA) KPK, National Disaster Management Authority Pakistan (NDMA) and Health and Education Departments.

The training aimed to enhance the skills and capacities of government staff in responding effectively pre, post and during emergencies (disasters) and to prepare the communities for such situations with effective and immediate contingency planning. The key agenda of the training aimed  to equip local authorities, who are focal points in their respective regions, to be well prepared for and respond to disasters, and mitigate its’ damages, efficiently and promptly. The training enabled the organizations and their staff to review their existing plans and make improvements where required.  It provided an opportunity to provincial institutions to share information and best practices among each other to promote mutual learning and extend cooperation.  The lead facilitator, Falak Nawaz, from Network of Disaster Management Practitioners (NDMP), explained the  project objectives and the process involved to ensure implementation of activities and plans. He encouraged participants to be proactive and raise questions during the training and urged them to exhibit ownership to make such workshops successful at district levels.

The standard terms and concepts developed by the United Nations International Strategy for Disaster Reduction (UNISDR) were introduced in the session on “Basic concepts and terminologies using in Disaster management”. These were taught through a group activity using charts and pictures of a Disaster Risk Management (DRM) cycle. The participants were oriented on global, regional and national environments of disaster risk situations. A historical timeline of past disasters and its impacts on local, regional and global levels were briefly explained. Examples of The Greatest Eastern Earthquake and Tsunami in Japan, 2011, were cited and discussed.

A detailed session on contingency planning was conducted. The participants were briefed on the importance and uses of contingency planning and its differences to disaster risk management planning.

Towards the end of the training, a formal closing ceremony, which was chaired by Director Operations, PDMA Sindh was held at which all participants were awarded certificates. The DO appreciated the efforts made by Community World Service Asia towards disseminating knowledge and skills amongst government officials of PDMA’s, NDMA, academia and district administration of Sujawal and urged the participants to take lead in disaster management activities at local levels through close coordination among each other and the communities.

According to the American Camp Association (ACA), youth development experts agree that children need a variety of experiences in their lives to help them grow into healthy adolescents and adults. Summer camps for children, under our Girls Education project supported by Act for Peace, are exclusively planned to facilitate developmental needs of school-going children through physical exercises, activities on self-definition, meaningful participation and creative self-expression.

“The mock elections at the summer camp were a great learning opportunity for all of us. I had to work really hard to win the elections. I prepared a strong, impactful speech which promised to develop an advanced and clean society. I felt very proud on winning the elections as it is the most important achievement for me up until now,”

said Kainat, a Grade 3 student at the Government Primary Sindhi Chandio School.

Kainat belongs to a village in Sujawal District and lives there with her parents and eight siblings. Attending the summer camp and interacting with other students from different schools was just the kind of opportunity Kainat had always waited for and looked forward to.

“My father has always encouraged me to go for my dreams and doesn’t want any of his children to clean cars like he does for an earning. He wants us to study and grow up to be intellectual professionals. I come to school to learn new things from my teachers and want to grow up to be a commando one day,”

voiced Kainat excitedly

“I did not know that as a citizen of Pakistan, I had certain duties to fulfill to be a good citizen. We got to know the difference between a good and a bad citizen at the camp. I specifically shared this learning with my class fellows. I also went to other classes of my school and told them about good citizenship. We have to make our country a better place and for that we have to play our role actively.”

Disaster Risk Reduction (DRR) trainings were also conducted as part of the summer campts at Kainat’s school. According to her teachers, Kainat has been a proactive student in conducting drill activities.

“The DRR trainings have increased our knowledge in relation to emergency situations. Our school has trained all students to take measures for various disasters which come unannounced. I have shared my learnings with my family and friends in my community. My community appreciates my knowledge and commends the school on giving such diverse opportunities aiming to equip intellectual students  with all lots of skills.”

 “People from my village are mostly uneducated. I am educating myself so that I can set an example for others, highlighting the importance of education for a progressive society. My eldest sister supports me a lot in education. She helps me in my homework and studies as well.”

Kainat is determined to bring a positive change in the unbending and recessive community that she belongs to. She aims to  free the  future generations of her village from poverty and illiteracy.