Visiting the Manoshi Project...in an urban slum

The Manoshi programme. It's a community driven MNCH - Maternal, Neonatal, and Child Health programme that recruits community health volunteers from that slum - called Shasthya Shebika (SS). There are about 150 to 200 people to a SS. The SS is trained to do monthly visits, identify possible pregnancies, and detect and manage basic illnesses. There are also trained community health workers called Shasthya Kormi (SK) that can provide antenatal and postnatal care. There are about 10 SS to every SK. The SK works with a traditional birth attendant (or as its known here, an Urban Birth Attendant) during delivery.

 

We first visited the BRAC birthing house in an urban slum and met a young woman, and which I presume to be her relative and child - they were waiting to be seen by the UBA and/or SK. Then we visited Roni's home. She is 3 months pregnant, 23 years old, expecting her first child and has such a beautiful smile! Her mother was with her while the SK performed her first visit. She used to work in the garment factory, but now that she is pregnant, she has stopped working. Her husband is a rickshaw driver, and was not present during our visit. 

 

But let's talk about this slum first. It was my first time visiting a slum - not just walking past it. We walked into this gated area, took a couple of turns down a few small alleys, and the path opened up to rows of tin shacks closely stacked next to each other - the alley between the homes were probably 2 shoulder-widths wide - not even. I didn't realize it till after, but the path I was walking on were just planks on boards - the entire slum is built atop a swamp..held up by chopstick bamboo. And some of the homes are 2/3 stories high. The fragility of these 'homes' is immense. Can you imagine trying to transport a woman in labour from a 3rd story of a 'building' made of tin and perched on chopsticks? No running water, a common "latrine" with no sewage facilities…its overwhelming when you begin to unravel all the challenges that face the 5000 slums in and around Dhaka alone.

 

We visited one expectant mother and she and her mom invited us in while she was getting a check up from the BRAC health worker. The room was small - enough for a double-size bed and a tiny cot. And some shelving along the side. It was tiny but tidy with a few items here and there. I can't recall how many people lived there - but I'd imagine at least 4. Despite her very humble setup, she paused half-way through the conversation, embarrassed that she had not offered any food or tea. And when the electricity went out, and the fan stopped, she grabbed a wicker hand fan and started twirling it around. I said, you're the pregnant lady, I should be doing that for you! She flashed me her beautiful smile and kept fanning.

 

Just outside Roni's home, I  caused a lot of giggles from some of the kids loitering around, probably because of my because of my big old camera and big old goofy smile. I would love to come back with small digital cameras and have the kids take photos from their perspective (what the producer of the documentary 'Born into Brothels' did). The kids were curious and adorable and my mangled bangla could make them laugh.

 

The project I'm going to be working on is an mHealth project - so using mobile phones for health...so we got to see how the SK registered Roni and asked her a series of antenatal questions via her mobile phone. She recorded everything on the 80 USD SMS based phone and sent the information to her programme officer. She did some basic health examinations to check for adema, anemia and blood pressure as well. She recorded some basic information on a check card and left it with the mom so she could keep track of her basic stats. On the wall I saw the BRAC maternal health poster - that had the number to the SS/SK and programme officer for when she goes into labour or has complications. Oh, and within the questionnaire, there were points where the SK took photos of the mom as well as voice recorded additional info as needed. The idea is that all this info will eventually feed to a doctor's web portal where they can review high-priority cases and text back the SK with additional, customized diagnosis.

 

It was pretty neat to see this pilot phase of the mHealth running. Of course there are bugs and improvements to be made, but its neat to see these types of projects in action. This small group of pilot users have adopted quite quickly to the technology (what they initially thought would be a 2 day training on the mobile phone application, turned out to be 4hrs), and apparently it has cut down their work load considerably. For those not on the mHealth project, the manually track all the information, which then gets manually aggregated at the SK level, then again at the programme officer level..and then at some point the manually calculated aggregates get input into a database for regional and eventually national information. So the need for digital recording for reporting reason alone is obvious.

 

Food for thought...

One of the gentleman with me on this site visit was a country officer for certain African country for a certain NGO (this is me being ambiguous for privacy sake). He and I had an interesting conversation on our way back to the office. We were discussing why BRAC was successful in so many of its interventions, and he said it came down to the fact that it's a "Global South" led initiative. "The North comes in with their money and fancy tools, and the South comes in with their hands and stomach". He made the point that because the South lives and breathes this kind of extreme poverty, they are most apt to come up with low cost interventions that are effective. He didn't deny that North-led initiatives weren't effective, but just that they are often very expensive, and so therefore not scalable or sustainable. He  seemed especially frustrated with the 'experts' from the North with their fancy degrees and one year of experience in India and how that qualified them to be heads of projects and influence policy.

 

I asked him, that if he didn't think the folks from the North should be involved in implementing services for the poor, where would the North be effective. According to him, the North has the power when it comes to advocacy and influence in the world. I suggested that perhaps also the North is most useful when it comes to raising funds, and he surprised me with saying that, he didn't think there was too little or too much or just enough aid available…it was more important to see that low-cost solutions are being implemented.

 

This conversation, not surprisingly, has got me thinking. Where do I belong exactly? Is it selfish of me to butt in just because I'm interested in this field?