The work of a Seva Mandir Bal Sakhi
Bal Sakhis are young women from the villages who receive intensive training from Seva Mandir to enable them to work with new mothers in the villages on childcare and health. We went to meet one young Bal Sakhi at her home to ask her about the job she does.
Manju Kumar has been with Seva Mandir for 2½ years. She covers two hamlets in Badgaon block, looking after 45 young children. Her work as a Bal Sakhi involves keeping an eye on babies from birth to five years. She weighs them, assesses their nutritional status, looking particularly for any malnourished little ones who may need extra care. Most of her time is spent checking the children up to six months, because she knows how important the early months are, but she keeps a careful eye on her charges up to five.
Manju uses the MUAC (mid-upper arm circumference) measurement to put children in three categories: normal, underweight and severely malnourished. She is delighted to tell us that in her area there are no children currently in the danger zone, though there are five borderline children, two of them newborns.
In the last few months she has not had to refer any children to the Malnutrition Centre (MTC), though she has in the past. She tells us: ‘It used to be very difficult to persuade parents of the seriousness of severe cases of malnutrition, as it was not seen as a real health risk. If a malnourished child can walk, has no fever and seems fairly normal, parents don’t see the problem.’ But now, with routine monitoring of nutritional status and familiarity with the green, orange and red categories children are placed in, parents are more easily persuadable. This is one of the benefits of regular Immunization Camps where all children are routinely tested when they go for their jabs.
But taking a child to the MTC still poses considerable practical difficulties for parents who already struggle to make a living. It involves staying with the child for the 10-15 days he or she may have to remain at the centre, so others have to look after any other siblings. Manju finds that it can take some time to persuade parents to take their children to the MTC and she uses all means at her disposal, including explaining the dangers to family and neighbours and recruiting them to help put pressure on the parents.
Manju generally goes with parents and child to the MTC to help them navigate the system, and she sometimes stays with them. One year-old girl had to stay in for two weeks, but is now a healthy two-year-old.
Manju gives mothers advice on breastfeeding and recommends nothing but breast milk up to six months. After that she encourages mothers to introduce porridge, rice water and, gradually, green vegetables, mashed up chapattis, lentils and rice.
She also gives advice on hygiene – washing hands after work, before breastfeeding and feeding – and explains the importance of cleanliness to the health of all family members. She says that, as this is also taught in the Balwadis, the combined effect of the hygiene campaign is showing real results.
As a Bal Sakhi, Manju also makes sure parents know when to take their children for vaccination. She tells every family about each monthly camp and goes with them each time. In the past there was some resistance to vaccination, as many parents and grandparents felt that it made children ill. But now, with regular assurances that a little short-lived fever is normal after injections, parents know what to expect and understand the importance of protecting children against diseases which can be deadly.
Manju also offers women advice on contraception and family planning. The pill is the most common form of contraception used, followed by the Copper T or a three-monthly injection. She tells us that women’s attitudes to contraception have changed over time. In her area she says that average families have no more than two children and accept the need for family planning, though there is always the temptation, for a couple who have only girls, to keep on trying for a boy.
Manju impressed us greatly with her professionalism and assurance. It is not always easy to talk about subjects like contraception in front of men one does not know, but Manju handled questions with great assurance and took them all in her stride.
She says, ‘I found out about the vacancy for a Bal Sakhi from the woman who runs the local Balwadi around the time when the previous Bal Sakhi was retiring. I was interested, found out more about it and then applied. I received training from Seva Mandir and then shadowed a more experienced Bal Sakhi to learn about the job.’
Manju looks after about 60 households and goes to one of her two hamlets every day, walking about 3 km a day. She herself is only 24 and has a four-year-old daughter. Another baby is due very soon. She will have her baby in the hospital in nearby Gogunda and then take two months’ maternity leave.
Manju says, ‘I love my job. I get so much satisfaction from seeing healthy, well nourished children in my two hamlets, and knowing that parents are much more careful about what they feed their little ones.’ She is proud that no one in her area is in the danger zone thanks to her hard work.
Manju also says that her own family has benefited from all that she has learned as it has changed their behaviour too. Her family is supportive of her work and proud of her.
She says, ‘I used to be the bride of one house. Now all the people in two hamlets know and respect me. They say “Namaste” when they see me and invite me into their houses to see their children.’ She is rightly proud of her achievements.