As many of you know, MEDLIFE is expanding to India! We will be holding our first mobile clinics in India May 7-15 and May 14-22, 2016, in New Delhi India. MEDLIFE will partner with Mamta (MEDLIFE always uses local medical staff) to bring our Mobile Clinics to the community of Nihal Vihar, an urban slum made up of mostly migrants that began to grow rapidly in early 2000. Information on this community is difficult to come by, so I held a Skype interview with Sonali Maheshwari, Senior Program Manager at Mamta to find out more about Nihal Vihar and the work they do there.
*Not an exact transcription, edited for brevity and clarity.
Jake: How do the Urban Slums in Nihal Vihar differ from India and New Delhi’s other slums?
Sonali: It is a highly and densely populated area. Nihal Vihar has a highly migrant population, it is full of migrants, because of the nearby industrial areas, the nearby options for employment. So it majorly consists of migrants. We see that health and development indicators, like low birth weight, chronic malnutrition, anaemic pregnant women, which has not changed much over the last many years (last two decades).
Jake: But the population has grown substantially over the last 20 years right?
Sonali: Yes the population has swelled.
Jake: What kinds of employment opportunities are there?
Sonali: With Nihal Vihar being surrounded by so many small industries- options for semi-skilled opportunities, semi-skilled employment are many, so that’s why people are migrating there but still there is low- it is inadequate. Health complications are there, poor environmental conditions are there, you can say that people are migrating from villages where there are lesser opportunities for employment to tap these opportunities… manufacturing electric equipment, slippers, shoes, these types of small-scale industries that surround Nihal Vihal.
Jake: Is there environmental pollution from industry?
Sonali: Typical industrial pollution is not there, factories are not prominent in the area. Small scale making of shoes and electrical equipment with their hands, not through the machines is being done. So that kind of environmental pollution that you get with industry is not there. But yes, environmental conditions are not good for so many other reasons.
Jake: Yes, I have read that hygiene and sanitation are a big issue in New Delhi slums, because there are no sewage systems, people have to use open toilets.
Sonali: Yes, their practices are not that healthy and safe, all that adds to the poor environmental conditions. They all are like big families staying in one small, small area, because they can’t afford bigger spaces, so many people staying in one room, creating those poor environmental conditions.
Jake: I know that there are lot of public health challenges, a lot more than we have time to talk about, but what are the main public health challenges that you see in Nihal Vihar.
Sonali: The Major health issues prominent in Nihal Vihar are malnutrition, diahria, anemia especially in pregnant ladies, malaria, typhoid, skin infections, and there is one more that we have recently seen is people complaining of pain in there joints.
Jake: What is the public health system like? What kinds of access do residents have to healthcare?
Sonali: In the last five or six years since Mamta has been intervening there, access has improved but there is a lot of room for improvement, the population being migrant. We have been continuously doing those practices and strategies to bring access. But because the population is migrating, seasonal migration is happening, the kinds of changes you want after five or six years of intervention is yet to happen. Facilities are there, facilities are operational, facilities are fairly equipped also. But because of not having that safe behaviour attitude, people don’t go when they should. Working with the public health function, we are training them, making linkages, but access is an issue that still needs to be focused on.
Jake: What do you mean by safe behaviour attitudes?
Sonali: Safe behaviour attitudes means that when you have symptoms, without any delay one should go (and see a doctor) without delay- for example if someone is having continuous fever for four to five days. Malaria and dengue fever being prominent diseases there, people don’t have that attitude of getting a test as soon as possible. They will try home remedies or something.
Jake: So people know what is available to them in the public health centers but don’t use it?
Sonali: People know, but because of that attitude they don’t go when they should. But many people who are (recent) migrants don’t know.
Jake: What kinds of stuff do you do to improve malnutrition in children. I’ve seen in my research on India that it is a huge problem.
Sonali: As I said that our program is mainly aiming at behaviour change, so we tap on their knowledge, attitude, practices through educating them on different components of nutrition, how it matters when it is a pregnant lady, lactating, infant, adolescent. And by linking them to the government schemes…. The government has programs that give out iron supplements, or supplemental food to lactating pregnant women or adolescent girls.
Jake: So you impact nutrition through education. Is part of the problem then that people don’t know how to effectively use the little money they have to buy nutritious food.
Sonali: That is one, how can they change their diet patterns out of locally available food. Not telling them options that are not available to them, and then, telling lactating women how they can ensure child nutrition through exclusive breastfeeding. How important it is, exclusive breastfeeding for 6 months, then the supplementing (of the diet with breastmilk) after. This is where there are a lot of myths and misconceptions in the community that we are working on. To teach them how they can ensure their nutrition and their children’s nutrition.
Jake: What kinds of places are these migrants are coming from? It sounds like living conditions are very difficult in Nihal Vihar, so I’m wondering what was life like for these migrants in these places? What made them decide to move to somewhere like Nihal Vihar where life is still very difficult?
Sonali: Delhi being centrally located, there are a mix of people from each and every state… But majorly from states like Rajasthan, Uttar Pradesh, Bihar… They come to Nihal Vihar, come to Delhi, get into some kind of technical or non-technical occupation, grow in that. It is the major reason why they are migrating, especially focusing on the informal sector. Plus, it’s easy for them to manage their families, they come here they get a job, Delhi being an otherwise reasonable place to eat, to live, they can send a good amount of money back to manage their overall needs.
Jake: So a lot of migrants are sending money to their family in other parts of India?
Sonali: Yes usually when they come, they come alone. They first get themselves aligned in some kind of job and set themselves there. In some case then they get married there.
Jake: So even though these people are very poor the work they are doing in Delhi still pays a lot better than what they could do back home? Which is mostly farming right?
Sonali: Yes back in their hometowns, mainly their family would have the occupation of farming. If the next generation doesn’t want to continue with the occupation of farming and they want to learn some kind of skill then they come (to New Delhi). This is a suitable place to get those kinds of skills and join a different sector. Many of them seasonally go back to help their families with the harvest.