Caring for vulnerable children living in the slums and villages of India
 

Health care: The Shravan Health Center 

Thousands of children living in urban slums and rural villages have little or no access to medical care. This means that maternal and early childhood care is often scant and sporadic at best, with the closest hospital a fair distance away. Children often do not receive the vaccinations, vitamins, de-worming and other basic health services that they need. Reports also indicate that over 53% children in India under five years live without basic healthcare facilities, and 66% of the poorest children in India receive no or minimal healthcare – in fact, poor children in India are three times more likely to die before their fifth birthday than children in other parts of the world. 

The results are tragic: preventable illness, injury and death among mothers, infants and children from disease, flu and diarrhea. India has the highest number of children dying as a result of preventable diseases such as pneumonia and diarrhea – 436,000 every year.

GPM witnessed the tragic consequences of the inaccessibility of health care when one of our students, Shravan Shah, tragically died from lack of access to basic health care. (read Shravan's story here).

In response, GPM partnered with the Indian NGO Doctors for You to establish an accessible maternal and children’s medical clinic, for thousands of children in the heart of the Kalwa slum: The Shravan Health Center.

In addition, GPM has partnered with mobile medical services in a rural center to provide regular health check-ups for hundreds of children in 25 villages where GPM has literacy and nutrition programs.  

Since its inauguration in August 2015,
the Shravan Health Center (SHC) has established itself as a premier, community-focused medical clinic in the Bhaskar Nagar slum neighborhood in Kalwa north of Mumbai. The Center provides a full range of medical services to primarily children and mothers in the slums, enabling this 200,000 member vulnerable community to receive accessible, affordable, quality health care for the first time in its history. 

The modest and efficient three-room facility, including doctor care, nursing care, an on-site pharmacy and community outreach professionals, has serves over 1000 patients per month, 40 patients per day, mainly mothers, children and senior citizens. The center's focus is on child and maternal care and has a strong community medical outreach component as well as child vaccination programs. 

SHC, located in the heart of the Kalwa slum and accessible by foot to all the community residents, provides medical care that has, until now, been largely unavailable to this population. It is the first time that a medical clinic exists in the Kalwa community, and is a vital component in advancing a long-term vision for health and hygiene for the members of the community. SHC partners with the community, and has already garnered tremendous good will and support from the community, recognized for this important work that ultimately brings benefit all. 

Services

The Shravran Health Center provides the following services:
  • Minor acute care
  • Treatment for burns and injuries 
  • Immunizations (in conjunction with Indian Medical Services)
  • Health and nutrition education
  • Prescription assistance
  • Preventive checkups
  • Vitamin A and Iron Folic acid supplementation
  • Curative services  
  • Growth monitoring
  • Periodical deworming
  • Referral services (partnerships with hospitals in the area) 
  • Referrals to specialists
  • Health and nutritional education
  • Minor procedures such as cleaning and dressing
  • Preventive health check ups

Ongoing Program Activities
The Shravan Medical Center currently operates the following program activities
  • Daily outpatient services
  • TB DOTS program
  • Children's immunization program
  • Malnutrition control program
  • Antenatal care (ANC)
  • Health status outreach program

Daily outpatient services
The primary activity of the Center is outpatient services, operated by a doctor, pharmacist, social worker, nurse and patient registration staff and conducted on premises. The services operate six days a week, from 10am to 4pm and 4pm-7pm three evenings a week, an average of 40 patients served per day, or 1000 patients per month. The majority of the patients (92.4%) served are women (25.6%) and children (66.8%). Some 21.8% of patients are babies and toddlers, 23.8% are children aged 5-12, and approximately 11.6% of women and men treated were senior citizens. Outpatients pay a registration fee of 15 cents (Rs.10) -valid for 3 days, which includes free basic medicines. Other medicines are provided at 30-40% cost. A special fund is in place in order to cover any patient who cannot afford treatment and/or medicines

Treating Tuberculosis: TB DOTS program
The Shravan Health Center has completed registration with the Government of India's Revised National Tuberculosis Control Program (RNTCP) program and began an immunization program in December 2015. Patients have been identified and are being administered the medications along with monitoring of their condition. The health center's para-medical outreach personnel  refer possible new TB patients as they visit families in their homes, to early treatment at the Shravan Health Center. The medication is provided by the Government of India, and the Center is in regular contact with relevant municipal medical institutions.

The Dr. Gerald J Friedman Infant Malnutrition Intervention Program
The doctors at the Shravan Health Center noticed a crucial problem among their patients: severe malnutrition in infants and babies. This is a harrowing problem in the slums. According to the World Bank, the prevalence of malnourished children in India is among the highest in the world, and has dire consequences for the children. Malnourished children have more infectious diseases, such as pneumonia and tuberculosis, experience stunted physical and mental development and have higher mortality rates than children who receive proper nourishment.

Thanks to the generous support of The Estelle Friedman Gervis Family Foundation,  GPM launched the Dr. Gerald J Friedman Infant Malnutrition Intervention Program to provide emergency nutritional intervention to save the lives of 300 malnourished children per year who are under the age of five. The program is named in memory of Dr. Gerald J. Friedman, a New York-based physician who practiced medicine for over 55 years and specialized in diabetes, cardiology and internal medicine. During World War II, Dr. Friedman served as a young army doctor in the Solomon Islands in the Pacific and was struck by how severe malnourishment affects the growth and development of children.

The Dr. Gerald J. Friedman Infant Malnutrition Intervention Program uses the universally acclaimed Integrated Child Development Program (ICDP) protocol to treat severely malnourished children. Through this program, which is advocated by WHO, the UN, and other emergency relief organizations, children undergo weight and height checks, upper arm circumference measurements and other physical and cognitive development measures, in order to diagnose the severity of their malnutrition. In addition, parents in the Malnutrition ICDP program are provided intensive nutritional counselling in order to help families emerge from dangerous cycles of malnutrition.
The women of the Masala Mamas group received special training on preparing the treatment and now provide the ICDP protocols for the babies in the program. 

Diabetes and Hypertension Clinic
The Diabetes and Hypertension Clinic opened in 2017 thanks to the generous support of Dr. Chaim and Mrs. Audrey Axelrod Trachtman. The Trachtmans were moved to sponsor this project after visiting SHC and understanding the need. Diabetes and Hypertension are emerging as rising chronic diseases in India. Every 1 in 4 persons above 30 years of age suffers from diabetes in India. There is a dearth of qualified medical personnel to treat diabetes and hypertension especially in underserved slum communities.  As a result, people with these diseases do not have access to treatment, and fees in distant clinics are beyond the financial ability of most people in the Kalwa slums. Most people with diabetes are thus left undiagnosed and untreated. The effects of untreated diabetes place difficult burdens on the patient and the family. 

The  Diabetes and Hypertension Clinic, is open one day a week, and offers free doctor visits as well as highly subsidized medicines. The clinic also conducts community outreach and awareness campaigns.

Dermatology Clinic
Skin problems are a rampant and under-recognized problem among the Kalwa community. Skin diseases such as psoriasis and skin cancers can have a severe and deleterious effect on people’s lives. In response to this need, as determined by the experts of Doctors for You at SHC, GPM opened the first ever Dermatology Clinic serving the Kalwa community, run by Dr. Devang Joshi, a passionate young dermatologist who is dedicated to the welfare of underserved communities. The clinic treats all types of skin diseases most of which can be treated on an outpatient level. Along with the treatment of skin ailments, the clinic also performs rudimentary cosmetic surgeries and procedures, and provides medicines at highly subsidized rates.  

Community Mapping
SHC has been engaging in a complex outreach and community mapping program aimed at collecting medical histories, providing basic health services, and conducting recorded vaccinations for residents of Kalwa. The findings of this work are shared with the clinic staff and with municipal bodies. This is a vital service to the residents of Kalwa and is key to improving the overall health of the community. The local government deeply values the long-term impact of the GPM initiative. 

Hygiene  
GPM also introduced the Oral Hygiene project for over 700 children in school in partnership with Humble Smile Foundation. Children received toothbrushes and oral hygiene education, and teeth-brushing is now part of their daily routine in school.  The Center's hygiene partner, Sundara, has also distributed hundreds of bars of quality recycled bars of soap and is launching a community-run hygiene awareness class in the coming months.

Partners
The Shravan Health Center is made possible by partnerships with Doctors For You the American Jewish Distribution Committee, The Estelle Friedman Gervis Family Foundation, Altico Capital India, Awakening Women’s Institute, Modern Trousseau, Dr. Chaim and Mrs. Audrey Axelrod Trachtman, the Humble Smile Foundation, Sundara, and many private donors. 


Click here to read more on the Shravan Health Center.

Click here to read more on the health care provided by GPM in rural villages as part of the Love2Learn initiative.