Sanjeet BK is a 10 month old boy from Chidipani, a small village on the outskirts of Tansen. He came to the Community Health Department’s (CHD) Mother and Child Health Center (MCHC) with his grandmother who is trying to care for him as best she can. She works as a day labourer in the fields of local landowners. She has a sad story to tell.

Sanjeet BK is a 10 month old boy from Chidipani, a small village on the outskirts of Tansen. He came to the Community Health Department’s (CHD) Mother and Child Health Center (MCHC) with his grandmother who is trying to care for him as best she can. She works as a day labourer in the fields of local landowners. She has a sad story to tell.

Sanjeet was born into a family that was in discord. His father is a mason/laborer who works in another District. His mother cared for him for a few months and then left the area to marry another man. She has not returned. He currently lives with his 42 year old grandmother and 2 aunts. They are all day labourers. Sanjeet was born at home and had a good start in life. At 6 weeks old he weighed 3.3 kg. At his 8 month checkup his weight was only 5 kg which is well below the normal for his age.At today's visit (10 months old) he is still only 5 kg and is starting to show signs of 3rd degree malnutrition. Thankfully he has received all of his baseline immunizations.

The grandmother says that when his mother left, Sanjeet had a rapid deterioration. She and her 2 daughters need to work just to survive so Sanjeet was left alone in the home during the day. Now his grandmother carries him to the fields when she goes to work. But it is difficult to care for him because she needs to work. Often he was hungry or thirsty but there was no one there to help him. If he cried she would try to come. If he didn't cry she didn't come. Soon he stopped crying a lot. He would lie in his cot and defecate and urinate with no one to help or clean him. He would sometimes stay all day in his cot. His health is deteriorating.

The grandmother is tired and running out of strength. She tries to feed him dhal bhat (rice and lentils) but he is not interested. She has even tried to feed him from her own breast and after a while she began to produce a small amount of milk, but it is not enough. Sanjeet looks ill, has a poor appetite, is irritable, unhappy, and is not playful. She brought Sanjeet to the MCHC for a check up.

We talked with her about the best way she could care for him. Caring for the nutritional needs of a baby with malnutrition is different to caring for a healthy child. The staff of the MCHC gave her specific education about the special needs that Sanjeet has during this difficult and dangerous time. We gave her some sarbottam pitho (super flour) and told her how to make it at home. We also gave her some multivitamin drops in an attempt to stimulate his appetite. We talked for a long time about the importance of food and what foods are best for Sanjeet during this time.We hope that she will be able to provide better nutrition for Sanjeet in the future.

For many years the problem of poor nutrition has been identified as a causative factor in increased morbidity and mortality for the children of Palpa. It is estimated that upon admission to the Tansen Mission Hospital (TMH) that 40-50% of the children have some degree of malnutrition. Some of these malnutrition cases are severely malnourished and have required, at times, 6 or more weeks of hospital admission in order to begin the process of nutritional rehabilitation.

In the coming months the CHD will be opening a new Child Nutrition Rehabilitation / Community Health Center in Tansen. The main objectives of this center are to reduce the nutrition-related morbidity and mortality of children in Palpa, to have a place where the TMH and other health facilities can refer malnourished children and their caregivers for appropriate nutritional rehabilitation/training, and to provide a venue where the people of our area can come to learn about many other preventative health and nutritional topics.

If you would like to help the malnourished children and their families please consider sending a gift specifically marked for the CHD's Nutrition Center. It will be used to help families and children like Sanjeet who could benefit from concentrated nutrition education and assistance as well as a good dose of love and affection.

Glen Anderson PA-C
Chief of the Community Health Department