Basanti from Doti

Many children in remote parts of Nepal suffer quietly from health problems. Parents are either unaware or do not have the time and resources to meet the health needs of their children. In many cases, fathers are absent, having migrated to India to work as labourers. The meagre savings they send back are not enough to sustain their families. In Doti, a district in the far-west of Nepal, because jobs in the district are few and access to India is easy young men from 80% of the total households have migrated to work in India.

In the absence of their husbands, wives are left to tend their land, cattle, and children. In many households, children and cattle live under one roof. In the communities of Doti, where people are dependent on rain water for farming, cattle are the only means of providing food and income so rearing them takes a higher priority than caring for young children, who are often left behind and uncared for, resulting in severe health problems. Such is the case of Basanti, a two and a half- year old child.

Basanti lives with her family in Bajhkakani Village Development Committee in Doti. One look at her and it is clear that she is different from children in her age group. She weighs just eight kilograms and is malnourished. She is the youngest among her five siblings. Her father is a migrant labourer in India and her mother works in the field, looks after their cattle, and takes care of the household chores. At the age of seventeen her oldest sister is already married.

With a busy mother tending to the needs of cattle and collecting firewood as a part of a routine job everyday, most of the time Basanti is taken care of by her older sister, Maichori, who is fourteen. Basanti is not only small but she is also shy. She enjoys playing hide and seek with other young children in her neighbourhood. Her favourite pastime is to tag along with her mother to graze cattle, which is rare because she cannot walk long distances. Her weak legs don’t carry her further than a few metres. Basanti’s mother, Harina Saud, says, “When Basanti was born she was very tiny. After that she suffered from frequent diarrhoea for a year and half. Now it is difficult to feed her. She does not like to eat. She cannot eat more than a handful of rice and milk a day.” At the age of two and a half all that Harina has been feeding her daughter is a little buffalo milk and rice every day. Basanti rarely eats anything beyond that. Her mother adds, “If I try to feed her other things, she cannot digest it and ends up with diarrhoea.”

When neighbours told her to take Basanti for a check-up, she visited the sub-health post where she was provided with superflour, a nutritious mixture of grains and pulses. However she came home only to find that her daughter didn’t like the taste of it and refused to eat the mixture. She had no choice but to give the nutritious mixture to her other children. Harina didn’t bother after that. She says, “I know Basanti is not like my other children, she is much smaller for her age but what can I do, she was born small!”

Harina does not realise that her daughter is almost severely malnourished and needs intervention before Harina can give her a normal diet. With four children and cattle at home to take care of, Basanti’s needs don’t seem urgent to her. Her daily chores takes much of her time. So often, her youngest girl is left unattended and without access to the right nutrition to help her develop good health. It is visible that Harina, a mother of five lacks awareness on proper care and nutrition for young children.

Basanti may have survived the diarrhoea but she may not live to see her fifth birthday. Her wrinkled hands may never hold a book. Her weak legs may never cross the boundaries of her village. She has an urgent need, a need to be cared for and treated for malnutrition, among other health needs which may not be apparent. She cannot wait, child health cannot wait, a child’s health needs to be met now.

Malnutrition is a common underlying cause of child mortality. 2006 data indicate that 38.6 per cent of under-five children in Nepal are underweight (MOHP et al. 2007). In rural Nepal the Nepal Family Health Programme (NFHP) reports a reduction in the proportion of children underweight from 43 to 40 per cent, in the last three years (NFHP 2010). However it also noted a significant rise in the proportion of children having inadequate nutrition, with the proportion of wasted children rising by 17 per cent. These data indicate that achieving the MDG target of a 50 percent reduction in the prevalence of underweight under-fives by 2015 is unlikely, if prevailing trends persist. (Source: Nepal MDG Goals Progress Report 2010).