Volunteer Speak: Xzavier Killings

If a child does not receive proper nutrition during the first 1000 days of existence, beginning from conception to the age of 2 years old, he or she will not reach their full physical or intellectual potential and is at risk of malnutrition.

This concern is one of the primary reasons why the Foundation for Mother and Child Health (FMCH) organizes and encourages women to increase their knowledge on good pregnancy practices to follow so that they will give birth to healthy babies and successfully nourish the growing infant.

I never would have expected my life to lead to me on a journey traveling through Asia, Africa, Central America, and the Caribbean to learn about healing and healthcare practices across international and cultural barriers. These experiences of joining new communities, experiencing new cultures and learning from doctors and patients alike have truly been amazing!

After graduating from college, I was awarded the Thomas J. Watson Fellowship to learn about unique community initiatives that help patients outside of the hospital. Fortunately for me, my time exploring maternal and newborn health in Mumbai led me to FMCH.

FMCH was established in 2006 as a non-profit, grassroots organization focused on mothers and children in a slum redevelopment area of South Mumbai. Their mission is to encourage preventative health, balanced nutrition and child developmental practices in underprivileged communities. Over the years FMCH has grown and expanded into new communities, increasing their range of programs offered and number of mothers and children served. They provide access to videos showing fetal development during pregnancy, talks on balanced nutrition, personal hygiene, exclusive breastfeeding and much more. FMCH serves over 10,000 mothers and children directly through their various projects.

During my one-month internship with FMCH, I had the pleasure of observing and interacting with some of the most caring people I have ever met. At first I was a little hesitant of how I would be received, being a foreign man exploring a women’s health issue. This hesitation left as soon as I was welcomed by the FMCH team on my first day in office. From the CEO and COO to the clinical and field officers, I felt a genuine atmosphere of hospitality.

 

I started off in their main office and then divided my time between two centers in urban slums of the city. The first center is located in an area called Phule Nagar, Powai. In this area there is an estimated household number of 5,000 which equates to a population around 20,000 residents. Most of these residents have migrated from many areas across Maharashtra, Rajasthan and South India. Migration is a big issue because a majority of residents in slum communities don’t own anything, so they have to constantly move from community to community. The majority of the residents follow Hinduism and Buddhism religious practices and have on average 3 to 4 children. Most men find employment as carpenters, auto rickshaw drivers and daily wage earners while most women find employment as domestic workers or craft workers. During the week, FMCH conducts various clinics ranging from breastfeeding clinics to weighing clinics. Each clinic has a specific target audience and provides specialised information and services. The clinic I found most interesting was the 1000 Day Clinic which follows pregnant women and their child from conception to the age of 2 years old. With the devastating reality that poor nutrition during a child’s first 1000 days of life can cause irreversible damages with life-long consequences, FMCH works hard to provide ample support and education during this critical window of time.

The second center is located in an area called Ganesh Nagar, Dhobi Ghat. Similar to the first center, this area is populated with many migrants. It is estimated that the population is between 80,000 and 100,000 residents. Relatively speaking, the cost of living in these slum communities is high for residents which contributes to high rates of migration. One unique aspect of Dhobi Ghat is that it is a major washing/cleaning center of the city. Every morning on my way to the center I would pass hundreds of laundry items cleaned and hung to dry. One overarching issue of both communities was water availability. Running water is not available throughout the day and as a result of only coming on for certain hours, has led to poor sanitation and the use of open drains.

 After observing and documenting the various activities of the clinics and pregnancy club, I noticed how much individual care and attention each mother and child is given. They are each seen by nutritionists, nurses, clinical officers and doctors. FMCH gives pre-natal supplements including calcium tablets, vitamin D pills and iron tablets. Instead of providing a nutritious meal to just one target beneficiary, they provide nutritional cooking demonstrations to the entire community to teach healthy, alternative food options on what to eat and how to compensate for lack of food choice availability.

Some challenges faced by FMCH include consistent attendance from beneficiaries because clinics are dependent on mother’s housework load and water availability. For example, if a mother’s designated time of running water is 3pm-4pm, she will have to cook and wash clothes and do things pertaining to the use of water at that time instead of going to the pregnancy club. Since water availability is granted at different times for the community this effects who can do what at which time.

One of the most interesting parts of interning at FMCH has been learning about some of the cultural myths associated with pregnancy. They include the notion that the baby’s position in the womb can tell you it’s sex or craving salty foods mean you’re having a boy while craving sweet foods mean you’re having a girl. I shared a really enlightening conversation with the Director of Project Poshan about how certain cultures reinforce myths and the challenges associated with educating and not isolating beneficiaries. FMCH is doing a great job debunking these myths.

I would like to extend a heartfelt thank you to the staff and beneficiaries of FMCH for providing me with a wonderful opportunity to witness the role FMCH plays in helping communities achieve ultimate healing here in Mumbai. I depart from FMCH confident that I am one step closer to learning innovative ways to help bridge the gap between healthcare providers and communities.

My FMCH Story

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In Mumbai, waking up to the sweltering Mumbai heat and sound of pigeons chirping and religious bells in a local temple was a familiar morning for many. As a brief visitor, for just 9 months, I quickly became accustomed to taking the local trains to and from Mahalaxmi, where I was working closely with the FMCH team.

I looked forward to greeting my colleagues at FMCH, in their Dhobi Ghat office. The team’s hard work, enthusiasm, and commitment to the communities they work in intermingled with bouts of jokes, laughter and great food formed some of my most cherished memories as a Fulbright-Nehru Scholar with FMCH (from August 2015 to May 2016). As a fresh graduate from the University of California, Berkeley, I was very excited to continue working with FMCH in Mumbai and deeply explore some issues that the FMCH team was already commenting on regarding maternal and child health in the vulnerable populations and environments they work in.

Starting my work with FMCH was almost like a homecoming– as an undergraduate student at UC Berkeley, I spent summers and winters coordinating an oral health camp with the FMCH team as part of a research and service project I was involved with. Immediately, I was awestruck and impressed with the how the team conducted its clinics, the immense amount of data the team collected, and how they used consistent impact evaluation and reflection to grow and improve their current programs.

When I returned to Mumbai in August 2015, as a Fulbright student scholar, I aimed to better understand and get closer to answering one simple question: what are the challenges that exist when an individual tries to translate “acquired knowledge” into “practice”. In the context of public health, I was curious to learn about how women who receive knowledge, counseling, and guidance at FMCH clinics are able to effectively (or not as effectively) implement these practices in their home environment. What are some key barriers that limit some women’s experiences? What are critical motivators that facilitate and enable women to succeed in caring for their own health or their child’s health? My ultimate goal was to better understand to reduce the gap between knowledge and practice, and provide concrete recommendations to FMCH to capitalize on evidence-based facilitators in the community.

Doing this work would not have been possible without the daily support from the FMCH team members. My research method involved qualitative interviews with mothers who were FMCH beneficiaries. These mothers regularly received counseling from nurses, health workers, pediatricians and dietitians from FMCH. They were the recipients of knowledge, and I wanted to learn about how they utilized these tools at home. I was impressed that FMCH recorded all of its data on tablets– the organization is very technologically advanced and savvy for its sector and this definitely improves the quality of care that women and children receive. The online, cloud-based database allowed me to directly assess and track which women were receiving care, their duration of care, and review their diet recalls and children’s height/weight patterns accordingly. I was also extremely inspired by how holistic the FMCH programs are. Women not only received counseling in weekly clinics but also had the opportunity to attend cooking demos (where they learned how to cook quick, easy, and healthy recipes), pregnancy club (where pregnant women received prenatal support and information) and breastfeeding clinic (where women received specialized care on breastfeeding practices and techniques). With all these resources available, I was thrilled and honored to be part of such a dynamic and thorough program that FMCH executes for these women.

Upon conducting interviews with mothers and some mother-in-laws, I developed a deeper sense of the mothers’ lived experiences in carrying out the knowledge and techniques they learned at FMCH. Many of the challenges were rooted in lack of time, support, and confidence in carrying out activities consistently. Others were based on cultural beliefs, family dynamics, and perceived self-confidence of the mother. I worked with the FMCH team, thereafter, to strategize on how to improve current operations to circumvent the barriers several mothers face in their community.

I walked away from my nine-month experience learning a great deal about my specific research interest, gaining tangible skills, and appreciating the wide range of work an organization like FMCH has to complete in order to produce high-quality outcomes for their beneficiaries. I witnessed the hard work each employee devotes to their position and the teamwork necessary to overcome challenges along the way. I was fascinated by the iterative and forward-thinking approach of the team– it is evident that FMCH is changing the dialogue about children’s nutrition and maternal health in Mumbai because of its in-depth and multi-dimensional programs.

I am fortunate to have had the opportunity to work with them! The memories I’ve formed with the fun-loving team are ones I will carry with me throughout my career in public health and more. If you would like to learn more about my research with FMCH, please contact me at priyanka_a@berkeley.edu

Rita’s Story

rsz_dp_gfRita is a young mother who lives in Phule Nagar community. She visited FMCH during her second trimester of pregnancy, after being identified by the FMCH Field Officers during their field visits. She moved to her village for her delivery but returned to the Mumbai with her newborn. The FMCH team spent a lot of time with Rita once she was back.We made repeated home visits, counseled her several times to explain the importance of our First 1000 days program. But all this didn’t quite work. Rita was skeptical about the program and wasn’t sure if she really needed the support.

The FMCH team then decided to introduce Rita to another mother, who has been a regular participant of all FMCH programs. She shared her experience with the FMCH team, and what she felt was benefitting her by joining the 1000 Days’ program.

Rita was partially convinced and agreed to come to the community center for one week, provided she and her child benefitted. The FMCH team counseled her on on breastfeeding, and her own care during lactation. We focused on her nutrition intake and ensuring she is staking care of both herself and her child. Very soon we found Rita to be a regular at all FMCh activities. In her words – “I didn’t know anything about health and nutrition and for my older children I had to run a lot to hospital and ended up spending a lot of money. I didn’t believe what I was doing for my child was wrong as I was following village remedies. After I visited FMCH for a week and saw changes in child’s weight, my husband and me started trusting them. After coming to FMCH, I gained information and stopped giving gripe water and other things to my child. Now that I see changes I tell other women from community, they refuse but I still continue to visit FMCH as prevention helped to fewer hospital visits and save money”

Sarita’s Story

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In the year 2012, FMCH launched the first Community Support Volunteers initiative in Dhobi Ghat, a step towards bringing sustainable change within the community through change agents from within.

Sarita was one of the first CSVs engaged with FMCH, who took over the responsibility of spreading the word on good heath, hygiene and nutrition practices in her neighbourhood, and also providing support to mothers and families for their ante-natal care visits, FMCH clinic visits or referral visits.

Sarita, a mother of two young adult boys, moved to Dhobi Ghat, Mumbai after her marriage. Due to family issues she had not been able to complete her formal education. However, she had always been interested in working for her community, and when the opportunity to be a CSV came up, she grabbed it with great enthusiasm. She spent an entire year as a CSV with FMCH before the opening for a paid position was announced. And it was enthusiasm and tremendous faith in FMCH’s work that made her the obvious choice for the position.

Since then, Sarita has not just been working with FMCH as our Field Officer but also investing in her own development. She completed a Para-Professional certificate course, a counseling certificate course as well as an English-speaking course and finally her Higher Secondary education (12th standard) while managing the full-time job and family. Extremely popular both in the team and the community for her sense of humour and devotion to her work, Sarita has been an inspiration for the FMCH team.