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Between December 2014 and April 2016, Samjhana, Laxmi, Kabita and Sakuntala worked as psychosocial workers for the FUSAM project. They provided psychosocial support to 211 mothers and their children. They learnt about their difficulties: relationship issues, domestic violence, misconception regarding Ready-to-Use Therapeutic Food (RUTF), suicidal ideation, lack of family support, high level of stress, long geographical distance to access health care, no one to accompany SAM children to the Outpatient Therapeutic Programme (OTP), lack of time due to household work burden and so on.
All those factors are interrelated with the child malnutrition and the quality of care practices provided. By building trustful relationships, mothers would take the opportunity to share their difficulties and their suffering. Psychosocial workers supported the mothers and explored together positive ways for dealing with their problems and for interacting with their children.
Accompanying behaviour changes
Within the timeframe of the project, mothers and children are offered to attend five psychosocial sessions (one every two weeks), which corresponds to the number of follow up for nutritional treatment. During these sessions, we address topics such as mother-child communication, play, breastfeeding and feeding, psychomotor stimulation, and family sharing. According to Samjnana: ”these five sessions are not enough to totally change mothers’ behaviours but it really helped to change their awareness on malnutrition status of children and hygiene, on appropriate breastfeeding practices, on the importance of mother-child interactions, increment in family support, on health seeking behaviour…”
At community level, there are several factors that constitute barriers to changes: girls’ education, family support mechanism, prevention of early marriage, barriers due to cultural factors, lack of economic activities, and burden of house hold activities upon women. Facilitating behaviour changes would take ample time that was not included in the project but would be necessary considering their needs.
In Saptari district, most of the mothers are not aware about the needs of their children and the importance of child care practices which participate in early child development. By providing counselling on those aspects, mothers start to be more interactive, to give sufficient time to the child, to convince other family members to provide more care and affection. According to Sakuntala: “At first, most of the mothers complained that their child does not properly sleep, eat, and play, they want to stay with their mothers. Mothers showed depressed and irritated moods regarding their child’s behaviour. But when they become aware about SAM, children’s general complaints, and linking it to their child’s present condition, they started to behave positively with their child.”
Integration of psychosocial services within the health system
Health staff had to be educated on the importance of psychosocial support and psychosocial workers participated in sensitizing mothers to nutritional treatment. That made the mothers more aware about malnutrition signs and symptoms, the ways of prevention and treatment, parents’ roles and responsibilities, proper hygiene and sanitation, appropriate feeding and access to health services.
Working as psychosocial worker is a professional experience and a personal commitment
They have been able to identify, deal with beneficiaries’ psychosocial issues and their working experience has brought many ways of positive thinking and self-care. They apply their knowledge and skills into their daily life and that has helped them tremendously. For over a year and despite continuous challenges, they chose to stay and work for their community.
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