Dr Rajan Deshpande:  Working for betterment of malnourished children

Manjunath K. Shresthi

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A country progresses when the overall health of the population is on par with international standards. And the health of the children is the first step in achieving it. A healthy child grows up to healthy adulthood. A healthy child with a healthy mind will help society in having a robust generation for the future. If the health of the child is overlooked and no efforts made to their betterment and welfare, then the nation will be in league with failed countries.  India in spite of having the distinction of progress in other fields, care of the child is not put on top priority in comparison to other development parameters.

Malnutrition has been puncturing the health of the have-nots. If a parent is healthy, then the child also follows in the same footsteps; but if the health of the parents is found wanting, then the child inherits ill health with all complications. Malnourishment has been a stigma on the Indian economy, decreasing the strength of the population during productive age. About 47 per cent of India’s children below the age of three years are malnourished (underweight). The World Bank puts the number at 60 million, out of a global estimated total of 146 million. Further, 47 per cent of Indian children under the age of five are categorized as moderately or severely malnourished. South Asian region has the highest rates of malnourished children in the world.  The UN ranks India in the bottom quartile of countries by under-1 infant mortality (53rd highest), and under -5 child mortality (78 deaths per 1000 live births).  At least half of Indian infant deaths are related to malnutrition, often associated with infectious diseases. Malnutrition impedes motor, sensory, cognitive and social development; so malnourished children will be less likely to benefit from schooling, and will have lower income as adults. The most damaging effects of under-nutrition occur during pregnancy and the first two years of a child’s life. According to the National Family Health Survey (NFHS-3) carried out in 2005-06, child malnutrition rates in India are disproportionately high. The NFHS-3 is the third pan-India survey conducted since 1992 (covering 200,000 people from 15-54 years, and the definitive guide to Indian health statistics). 46 per cent of children under three are underweight, compared to 28 per cent in Sub-Saharan Africa and 8 per cent in China-another country with an enormous rural population. More than 6,000 Indian children below the age of five die every day due to malnourishment or lack of basic micronutrients such as: Vitamin A, iron, iodine, zinc or folic acid.

Dr Rajan Deshpande, MD (Pediatrics) renowned Pediatrician, President of Children’s Academy, and the R.K.Foundation, Vittal Nursing Home, from Dharwad, in north Karnataka contributing with the team efforts of the Research Team assisting him; Dr. Rajan, through his endeavors has been continuously striving for the health of the child and the mother through extensive field visits to slums; mass contact programs undertaken for the benefit of the children through his tireless efforts. He has been the most sought after person; because of his high degree of professionalism and specialization in tackling the problem of malnutrition through his innovative ideas; a source of inspiration for the new Doctors entering the profession, and a beacon of light for the people of Hubli-Dharwad region. Vithal Clinic and Nursing Home is the first private hospital to have a library for children in the area. There are more than 1000 books in the library and inpatients are greatly benefitted by them.

The NGOs addressing the issues of child malnutrition are: The Children’s Academy, in Dharwad was inaugurated by the late Governor of Karnataka B. Ramadevi on Dec 11, 2000.  The focus primarily is on addressing general health problems, like parenting, adolescents and problems faced by the children in schools. The other NGO operating is the R.K. Foundation, an Educational and a Medical Trust established in the year 2002. It has the services of renowned pediatricians, hospital administrators, specialists in intensive and critical care. It promotes and conducts many educational programs for the general public as well as the Doctors. The other initiatives taken for the betterment of children are: ‘Magu ni Nagu’, a strategic pilot project for management of malnutrition among the children of the slums in Dharwad city, conducted under the guidance of the district administration.  Akashvani program in Q & A format held for six months with a time slot in the evening. Also a one month program ‘Swalp Keli Nimma Makkalagagi’ is a self-help five minutes program creating awareness about child health.

The Objectives, Methodology and Intervention used for studying the cases of malnutrition in children.

Objectives: To assess the existing status of the slum children of Dharwad in North Karnataka. Anthropometric parameters sensitive to nutrition such as: height, weight, waist, chest, head and hip circumferences are a prerequisite. Understanding the existing dietary pattern of children and also the family with qualitative and quantitative aspects; analyzing the blood and urine samples of children to understand the sub clinical status of nutrition. Investigating the socio-economic status of target families for intervention; and to investigate the social, and motor development of target children. To support the children with appropriate intervention in terms of drugs to fight infections, supplements in terms of pharmacological and food base. Empowering the mothers and care givers with required knowledge of nutrition, low cost nutritious recipes, care of sick children, sanitation and hygiene through education and demonstrations at household levels.

Methodology: A sincere effort made to address the root cause of the problem.  In January 2013, 50 malnourished children in a bad state from the three slums of Dharwad, were visited for 15 days which covered all the households. Severely malnourished were chosen, based on the basic information provided by the State Department of Women & Children Welfare. In all the cases mothers were anemic.  The group of Pediatricians of the Children’s Academy, Dharwad, clinically examined the selected children and had interactions with mothers and grandmothers. The required biochemical tests (x-ray, blood and urine tests done) for the needy children and the necessary drugs were administered to fight infections if any.

The nutritionist developed a mix of giving 400kcals and 15 gm of protein /100 gm using locally available food grains and prepared laddus using roasting protocol. Each child was provided 50-100gm of laddu per day based on their age. The laddus were prepared by using grains such as: wheat, jowar, ragi, green gram dhal, soya bean, and groundnut in equal quantities.

Intervention: In the first phase antibiotics for cleaning them of infections and de-worming was administered. Iron, folic acids, calcium, pre-biotic and pro-biotic bacteria, immune boosters, digestive enzymes, proteins, vitamins A & D, minerals, and blood forming nutrients were included in the drug intervention. The children have put up weight of 1.9 kgs in six months. On 15-1-13 they weighed 5.7 kgs, and on 11-08-13- they weighed 7.3 kgs!

Hurdles in Improvement of weight among children

Slum dwellers are casual about the health of their children. Visiting the houses of relative’s in different places, and death in the locality was a priority over the child’s health. Poverty may not be the sole obstacle of the child’s health. Ice creams, chocolates, bakery products, fried foods such as chips, and kurkure were regular foods for children in most of the house-holds. Also it was noticed that mothers are not aware regarding how much of the prescribed dose of medicines should be given to the children.  The life-style of the people in the slums is not bad’ but the surroundings lacked hygiene. They have mobile phones, TV sets but no toilets and other basic amenities.  The parents (especially the father was alcoholic, and even in some cases the mothers were known to be alcoholics). Most of the cases of malnutrition were found in the slums than in the villages.

Awards for children: “An annual Healthy Baby Competition (HBC) is conducted, under different captions like the “Baby Girl”, “Girl Child of the Year”. Programs are also conducted for twins, and we once had 75-80 twins participating; and also a program for triplets, where we had 9-10 triplets, any child i.e. disabled is disqualified. But awards are also given to special children. Able among the disabled-mentally retarded, physically retarded, differently abled/challenged children. And these children are in no way to be called as handicaps” added Dr. Rajan Deshpande

The Deshpande foundation and Tata Marco Polo are the funding agencies. The Children’s Academy also contributes with ideas and thoughts and is jointly working with the University of Agricultural Sciences (UAS) for making high protein diet.

Opinions of the Anganwadi workers:  Shamshad Begum Maniyar, an anganwadi worker of Janna Nagar IV, Dharwad. “I registered Tasmiya Diwansab, Afrin and Afiya Morab under the care of Dr. Rajan Deshpande. The children have gained weight every month to an extent of 100gm and Afiya has reached moderate grade. The parents of these children belonged to poor economic status, and were scared to go hospital for fear of spending money. But Dr. Deshpande and his staff, cared the children with love, all the check-ups were free. The mothers of the children were very happy with the results. They received medicines, tonics, and laddus free for a period of six months, and a routine check up every 15 days. We are very thankful to all the concerned”.  Another anganwadi worker H. B. Kabbin, from Jannat Nagar 1, had the same story to narrate, “I registered Aman Jakati, M. Saddique Jakati, Goutam and Pritam Naik, undernourished children under the care of Dr. Rajan Deshpande. The families are very poor economically and not in a position to get their wards treated in a hospital. The Children’s Academy in Dharwad, took care of the children and gave them laddus, medicines and tonics and improved their health. I am happy with the result”.

Dr Rajan Deshpande, has contributed tremendously to Medical Journals like the Karnataka Pediatric Journal; also served on the Editorial Board of Karnataka Medical Journal, an official monthly journal of IMA Karnataka State Branch during 1992-94. He was the Advisory Board member of Indian Academy of Pediatrics (IAP) national conference, “Pedicon” at Bangalore in the year 2001.  Dr Rajan, has also given his opinion in the National Medical Journal on Attire and appearance of Pediatrician: Parents/Guardians opinions. He is a recipient of many awards for professional recognition at the State, National, and International levels. Also contributed towards child welfare activities and took the lead role in Dharwad to eradicate Pulse Polio activities since 1985. As a South India Coordinator for Gift of Life, a project of US Rotary based at New-York initiated in 1975; and the primary purpose is to help those needy children who require corrective heart surgery to secure another lease of life through the miracle of open-heart surgery. On August 15, 2002 all the costs of the operations of more than 250 children with congenital heart diseases (CHD) below the age of 12 years were borne by Gift of Life, Inc.(A Project of Rotary District 7250, Great Neck, New York) and operated free of cost. The screening, evaluation and assessment were done and the children were recommended for surgery. It is a project for children from the poorest of the poor families were picked up.  Dr Rajan, also mentioned that this was possible because of the efforts of Mr. Ravi Bhooplapur, a Rotarian from north Karnataka now settled in the United States.
Mr. Bhooplapur, President in 2004-2005 of the Rotary Club of Great Neck, New York, District 7250, U.S.A.

Dr Rajan, led the Intercontinental Medicare team to Uganda (east Africa) with a team of 11 doctors from the states of Karnataka, Kerala, Maharashtra, and Tamil Nadu. More than 4000 patients were examined and over 280 surgical and 538 dental operations were done. Out of them 500 were pediatric patients. The efforts were greatly appreciated by the Union Minister of Health, Uganda and the High Commissioner of India in Uganda.
Dr Rajan, a globetrotter who has travelled extensively across the globe, and has been traveling after he started his medical practice in the late 1970s. He also has the rare distinction of having rubbed shoulders with celebrities, acclaimed doctors, journalists, politicians, and leaders across from the state, country and across the globe.

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