As I stepped into the NRC ward of Tilda, I was greeted by the cheerful children playing around. In one corner, mothers were sitting in a group making toys out of scraps of clothes and used medicine bottles, their inquisitive eyes following me. The ward looked colorful with pictures of cartoons all over the wall. While it rained outside, I could feel the warmth in the kids’ smile inside.
For the uninitiated, NRC or Nutritional Rehabilitation Centre is a health facility, mostly in district hospitals, where malnourished kids are admitted along with their mothers. The height, weight and mid-upper arm circumference are measured and compared with the WHO guidelines. Children with Severe Acute Malnutrition (SAM) are admitted for a period of 15 days and are given special diet, called feed,to increase their weight. The staff at NRC comprises of a Feeding Demonstrator (FD), a cook, a staff nurse and an attendant. The primary function of NRC is to provide feed and medical care to the children and counseling to the mothers. Since, in most cases, mothers are also the earning members of the family, they are paid Rs 150 per day for the time they stay at NRC. After 15 days, the weight of the kid is measured again to see if there is any improvement. At the time of discharge, mothers are given feedback as to how they can continue to give the nutritional diet to children at home. They are also required to come for a follow-up for four times at the interval of 15 days so that the health of the child can be monitored.
Counselling Session in NRC
There are 60 NRCs in Chhatisgarh. And my organisation, Centre for Learning Resources (CLR), works with 6 of them. CLR has trained the FDs of these NRCs through a module called Svasthya Sneh Dhan Payo. This training is based on the concept of Love, Talk and Play. In this training, FDs are encouraged to be more participative and friendly, so that the mothers feel more comfortable. They also learn about the activities which can be carried out throughout the day so that the bond between the mother and the child is further strengthened .They are encouraged to make a timetable and display it in the ward. FDs are also given training on how to counsel the mothers. They are given pictures related to various topics like family planning, benefits of immunisation, how to take care of the child etc. Importance is given to building personal rapport with the mothers and feeding the children while talking to them so that they finish their feed.
On talking to the FD about the challenges, she said that since there are only two people, herself and the cook, it is difficult to manage the ward. Sometimes both of them are busy, so there is no one to make sure that the timetable is being followed. She also mentioned that there is no staff nurse to take care of the medical needs of the children.
Malnutrition is a major problem in India. The 2015 (GHI) Report ranked India 20th amongst leading countries with a serious hunger situation.India is home to the world’s highest number of underweight children.Malnutrition affects the most valuable resource of the country: its children. Amidst all this, NRCs are a ray of hope to thousands of kids out there.