New Delhi: Ten years ago, two researchers working in Uttar Pradesh tweaked the ancient practice of mothers holding their newborn baby close to their bodies. In the process, scientists from Community Empowerment Lab (CEL) helped cut neo-natal mortality—death before the age of 28 days—by a massive 54% across a cluster of 300 villages in Rae Bareli district.
This week in Seattle, US, the two scientists—husband and wife Vishwajeet and Aarti Kumar—won the Bill and Melinda Gates Foundation’s Grand Challenges award for the innovation, which is known as Kangaroo care.
The award gives the researchers an initial grant of $100,000. Winners can receive up to $1 million in additional funding if they are able to demonstrate scalability of their projects.
The Kumars’ simple community-based innovation is the technique of establishing skin contact between the baby and the mother, without wrapping the baby up in a blanket. Putting the child next to the mother’s chest immediately after birth allows the newborn to be colonized by the same bacteria as the mother’s, which limits infections and stabilizes temperature and the breathing of the child, and thus improves survival.
Kangaroo care is practised in India and other parts of the world.
Scientists, engineers, inventors from across the world have gathered in Seattle to celebrate the 10th anniversary of this Grand Challenges programme that has now funded more than 1,600 such projects in 80 countries.
Founder and CEO of CEL Vishwajeet Kumar explained that apart from skin-to-skin care, beneficial traditional practices included delayed bathing, keeping the newborn warm and breastfeeding within an hour of birth.
“Babies require four simple things—food, warmth, love and security, and Kangaroo care accomplishes this. Through CEL we try to leverage already existing practices in the community and tweak them slightly so they resonate with scientific wisdom,” said Vishwajeet Kumar. “The innovation addresses four crucial risks to cognitive development, inadequate nurturing, nutrition deficiency and premature birth.”
The scientist couple will now trace back nearly 3,500 babies, who are now 10 years old, to gauge the impact of Kangaroo care on the neuro-development of children.
“This was never simply about making the child survive. We want to see these babies thrive. We had always planned to see if these babies survive, what will be their quality of life. We have put together all the tools needed for neuro-development assessment in simple games on Android tablets,” said Vishwajeet Kumar. “We play with the children and keep a track of their scoring. In case of simple video games, we can see the cognitive development, motor function and emotional assessment. These games have some in-built logic, which test the child’s memory, attention span, how they plan the next move and flexibility in case of unforeseen circumstance.”
The Indian government recently launched an Indian Newborn Action Plan (INAP) to bring down the neo-natal mortality from 29 per 1,000 live births to single digits. Every year, some 756,000 children in India don’t live to see their first month—among around 1.35 million children who die before the age of five years, according to the health ministry.
One small social experiment in Tamil Nadu is changing the way mentally ill patients are treated. The experiment revolves around a fledgling de-institutionalization movement where mental health patients are rehabilitated in the community, reducing the chances of human rights violations and mitigating suffering while potentially de-stigmatizing mental illness.
As per conservative estimates, nearly 40% of India’s homeless suffer from a range of mental illnesses. The country has a total of 2,500 psychiatrists; 30,000 psychiatric beds and 43 government-run hospitals cater to the mental health needs of 1.2 billion population.
“It does not take long to come to the conclusion that we have next to nil infrastructure to support our mentally ill patients,” said K.V. Kishore Kumar, director of Banyan, an non-governmental organization working with mentally ill, homeless people in Chennai.
“We are looking at long-term care options where patients do not need to be institutionalized. Instead of locking up patients in a psychiatric hospital, we have started three clustered group home projects, where 5-6 partially recovered patients are housed with a trained care giver. The patients can hold jobs, function in mainstream society, interact with people with dignity and also have some degree of institutional support. Given how overwhelmed our hospitals are, we have to look at viable options to treat our mentally ill patients.”
The project is another winner of the Grand Challenges award this year—for bringing about a paradigm shift in how care can be delivered while de-stigmatizing and mainstreaming partially able and functional mental health patients.
According to the health ministry, life time prevalence of mental disorders in India ranges from 12.2% to 48.6%. Around 6-7% of the country’s population suffers from mental disorders, of whom 1% suffer from severe mental disorders.
While Banyan has a 300-bed hospital, many patients do not exit the system once they are admitted, said Kishore Kumar. “In most cases, patients’ identities cannot be established so we cannot sent them home. In other cases, the families don’t want them back. These patients remain stuck in our hospitals. The idea is to integrate them in society by giving them some degree of freedom with some supervision,” he said.
Banyan is now looking at shared housing options within the mainstream community by tying up with government housing projects. The Grand Challenges grant will be used to collect evidence to support this model of social innovation.
According to a recent study conducted at the National Institute of Mental Health and Neurosciences in Bangalore, a month’s stay at the hospital costs up to Rs.30,000 per patient. If the Banyan model were applied, the cost could be brought down to Rs.4,000 per patient.
“There is such a serious problem of over crowding in our psychiatric hospitals that group housing options seem very viable. They are a good alternative to institutional care, which invariably just locks up the patient and takes away the chances of him or her getting better,” Kishore Kumar said. “Living in the community, on the other hand, improves patients’ functionality, gives them a chance to live a productive life and reduces stigma.”