From Goldman Sachs to the Delhi Slums

Nicholas Tiffou shares his thoughts during his first week in India 

Sunday: Romee, from London

Next week, Romee, our youngest son, is turning 6. Our family (my wife, 3 other children and me) will gather around him to celebrate this event in Delhi as we are spending 4 months here at the end of my secondment from Goldman Sachs to Save the Children. I am helping Save the Children India build their crucial newborn and child survival campaign and after 7 months in London  helping  to build  the global campaign ,  I am finally here working with the team on the ground in India – the country with the highest number of children dying anywhere in the world.

Sunday: Asif, from Delhi

Last Saturday, we meet Asif. He lives in a large building in North Delhi and he is also probably 6 years old but looks much younger.  Asif greets us with a big smile and by touching our hands, which he keeps on doing during our day together. He also does not stop smiling. No one can be quite sure of his age because he lives in an orphanage, well catered by nuns, where he was taken 3 years ago. Police brought him here after finding him on a train abandoned by his parents.  The reason why he keeps touching our hands is that he is blind.

Romee and Asif

Our exposure so far to the every day suffering of children around the world had been largely theoretical, through various reports or the media. By just being in India we could not be blind to the reality of children begging, being undernourished, out of school, working in the streets as tea-wallah or on the construction sites. However meeting Asif is a revelation for us all because it gives a name, a voice and flesh to all those injustices Save the Children and others are working to fix. It also shows, through the care he is receiving in the orphanage, that what I could possibly imagine as a 'worst nightmare' (being abandoned on a train by your parents, aged 3, blind) is not the end of the road. Asif, in the most desperate of situations is receiving help.

For my children, no need any longer to for lectures about 'how lucky they are'. Asif is their brother.

Monday: En route to Sanjay colony

It’s Monday and my first day at work in India. I am with a team of Save the Children staff heading into a slum cluster in north west Delhi called Sanjay colony.  On the way, there is a gigantic rubbish tip with trucks coming to unload bags of rubbish that have been produced by some of the 16 million inhabitants of Delhi.  From our car we can clearly see the silhouettes of people, many of them children, following the trucks to the unloading station in the hope of gathering something ‘valuable’. I hear that, as usual in India, there is a hierarchy even for the rubbish seekers: those that get first access to the bag are high up the list and may even be able to send their children to school.

Inside a day care centre

Sanjay colony is one of the worst slums in Delhi. About 10,000 people live amongst piles of rubbish, patiently grazed by skinny cows, and made worst by the monsoon season: mud, stagnant puddles, blocked sewages, unclean water, and viscous mosquitoes carrying Dengue fever.

We start our visit by a day centre (a small 6sqm room) where a Save the Children supported female health worker from the community is teaching 6 women with their babies the basics of post natal care, how to spot signs of a disease, how to breastfeed etc…  These women all gave birth in an institution and their babies are healthy. They are doing very well but I find out later that one of them, here with her only child lost her first 3 babies in pregnancy. We also hear that sometimes, if they believe their sick baby’s condition to be benign, they opt not to go to the doctor simply because of the cost.

Back from school

Just before leaving the slum I see a boy walking past us. He must be 7 years old; he wears a school uniform, hair well combed, shirt buttoned up and tucked in, tie knotted; and on his back a heavy school bag.  He is on his way home from school. Home is amongst the junk piles and his playground is the rubbish dump.

The mobile clinic

In the afternoon we visit Save the Children’s mobile clinic. It is here for 3 hours and 2 doctors give 2 minute consultations to a queue of women carrying their babies, waiting in the scorching heat to be called on to the bus. The babies are displaying similar symptoms, diarrhoea, pale, feverish. The bus visits once a week for 3 hours and at this rate 180 people are receiving treatment. The bus goes to 10 different sites in a week; 1800 people; in a year that is 90,000 visits. Of course, that is inaccurate. There are repeat visitors, queues vary -  but still, it works. Those people that I saw there waiting are receiving advice and free treatments and lives are being saved. Six more of these mobile clinics will be funded and operational from November. I know my maths are wrong but I can’t help thinking 90,000*7= 630,000. And this is only a part of Delhi.

Wednesday: Advocacy 101

It’s now Wednesday of week one and totally new décor. This is the posh Constitution Club at Patel House in Delhi.  Upon learning that the Indian Prime Minister is not going to go to the forthcoming global UN summit, Save the Children India has managed - in about 10 days – to rally around a table 22 NGOs, key health and nutrition activists, eminent pediatricians and the most senior government official in charge of child health. At the end of the day, there is wide consensus among the NGOs to capture the essence of the Asks to the government in an open letter.

It is remarkable to have staged this gathering so quickly, to manage to talk to the government in a frank but constructive tone and to converge on actionable points. Obviously, the problems described are daunting. Worn-out generalities about focusing on the poorest and the most excluded will not change their fate, but there seems to be some level of understanding of the task at hand.

By the end of the week we hear that Sonia Gandhi will be leading the Indian delegation to the UN Summit. This is great news and shows real commitment from the Government to the tackling child mortality in India.

Friday: Child Mortality and Save the Children

This week has been a wake-up call. It is at grassroots that the campaign is happening and must be supported. The task is not just a lofty ambition to ‘help get the world back on track to achieve MDG4 to reduce child mortality’. It is about saving those children in Delhi, and Bihar, Rajasthan, one by one, every one and work constructively and humbly here in the community and in partnership with others to do it.

I want to thank Pradeep and the Delhi Save the Children team for showing me how the campaign really works.

Nicholas Tiffou is on secondment to Save the Children from Goldman Sachs 

Commonwealth Games: Has India got its priorities right?

By Kathryn Rawe, Media Team, Save the Children UK

Delhi was tense before the Commonwealth Games opening ceremony. Roads were blocked around the big tourist sights and armed police stopped the drivers of the yellow and green auto rickshaws from dropping their passengers outside key landmarks.  The popular Lodhi gardens, normally thronging with Sunday strollers and family picnics, were almost deserted bar a few guards and a handful of western tourists. The city waited with bated breath for the games to begin.

But later watching the opening ceremony, it became clear that Delhi was about to host an event that India would be proud of. The organizing committee had managed to put all the negative reports behind them and the opening ceremony went off without a hitch with fireworks, drumming and more than 7,000 athletes trouping into the stadium.

As an NGO worker in a country that is celebrating its position as global host, you could be seen to be a bit of a killjoy when trying to draw attention to what is going on away from the flash and ceremony of an event like the commonwealth games. But you do have to question whether India has got its priorities quite right.

On the Friday before the opening ceremony I went with one of Save the Children’s partners to the east of the city where hundreds of families had seen their homes destroyed when the Yamuna river flooded. As the roads were the only high ground, the pavement had become a ramshackle campsite. Crammed tightly together, roughly erected tents ran along both sides of the dual carriageway.  Crawling along at Delhi-traffic speed meant any passerby could stare into these families’ homes and see just how they were living. Children sat on the bare concrete by the side of the road with no possessions, no safety and nowhere to play.

And a few kilometres away on a road that would be used by commonwealth traffic the story got even worse. Families in that part of town had also moved onto a roadbridge for higher ground. But a few days ago they were reportedly forced by the police to move off the road back to the sludge of the river bed so those travelling to the games would not have to witness their destitution.

“Even if you said you would take me to stadium to watch the games, I wouldn’t go,” said Salman, (who was unsure of his age but was likely eight or nine). ‘The games have  been bad for my family. There are 12 of us and our tent is knee-deep in mud.” He used to get handouts of food from passersby, but out of sight on the river-bed nobody has come to his family’s aid for days.

Eight million people – half of Delhi’s population – live in slums and shanty towns and almost two million children die every year in India from diseases that are easy to prevent and treat. While the political will to host the games has been found, along with $6 billion to build stadiums and improve infrastructure, that same will to save children’s lives so far has not.

The budget for India’s national scheme to tackle childhood malnutrition – the Integrated Childhood Development Scheme – is only a quarter of what has been spent preparing for the commonwealth games.

Killjoy or not, it’s shameful and unjustifiable that in a country that is ecnomically booming, children like Salman are suffering the consequences. The effects of India’s growth are not reaching its poor.

Child Mortality: Does it actually matter what the middle classes think?

- Ben, EVERY ONE campaign director

A new survey published this week tells us that eight out of ten among the middle-class in cities across India underestimate the levels of child mortality. If you consider yourself middle class then apparently there is a high chance you are unaware that after 20 years of high and sustained economic growth, nearly 2 million Indian children still die every year of conditions like pneumonia and diarrhoea, and of complications related to pregnancy and child birth. Though nearly 60 per cent of those surveyed felt that the problem of child mortality was “very serious” in India, a staggering eight out of ten did not know that nearly 2 million children under the age of five die every year.  This is the highest anywhere in the world. 

This is a crucial insight for Indian organisations like Save the Children who have made it their mission to build a campaign to tackle the high levels of child mortality. But does it actually matter what the middle classes think? Well we think it does. The middle class in any country hold an influential role in society. And at the moment there is very little pressure from this group for action largely because of the lack of awareness of the scale of the problem. There is also little knowledge of how simple the solution is. We do not need a major expensive technological breakthrough for India to tackle the high rates of child mortality. We need skilled personnel available to support mothers during child birth, early postnatal care, preventive and curative treatment for pneumonia, diarrhoea and malaria; and support for nutrition, including exclusive breastfeeding.   Other countries, many of them poorer than India, are making dramatic changes. And the performance of some of India’s states, like Kerala and Tamil Nadu, shows what others could accomplish by pursuing similar approaches.

However those campaigning and working to tackle child mortality in India have yet to gain real traction on the issue among this influential section of society. We might now be saving tigers or turning off our lights once a year but we appear to have still not taken to heart the fate of our own children – this is unusual for a nation that prides itself on its love of children.

For campaigners this is a challenge if we want child survival to become a key metric by which India judges its success in development. We need to bring child and maternal survival in to the discourse on inclusive growth and national pride as rates of mortality are a much more telling indicator of development progress (or the lack of it) than per capita income. We need to be linking the child and maternal survival cause to questions like ‘what are the rewards of economic growth, if not creating a better society?’ or, ‘What kind of India do we want to become?’.  In many ways, India stands at a crossroads in respect to child mortality so can high rates of mortality be consigned to India’s past, or will they remain an indelible stain on its future?

The United Nations Millennium Development Goal Review Summit in September is the right moment for India’s political leaders to affirm decisively that it is the former course that they want to pursue, with high level commitment and with urgency. On the table for discussion will be a proposed Global Strategy for maternal and child health put forward by the UN Secretary General. As the country with the highest number of child deaths anywhere in the world, there remains a particular obligation on the part of India to demonstrate leadership on this issue.

But in the end the Summit in September is but one moment.  The change needs to happen in every village, district and state with high child mortality and there needs to pressure for this to be a national political priority. If the middle classes were to mobilise around this issue for all mothers and children  then faster change is very possible. With the requisite political will and the right policies, India can secure drastic cuts in child and maternal mortality and truly shine in the global arena.

This is why organisations working to tackle child and maternal mortality are working together and targeting politicians, business leaders, media, film makers, celebrities and musicians to take up the issue and make it heard. We are trying to link the more affluent communities to those facing the reality of high child mortality. It is encouraging that when faced with the information about the scale of the problem 74% of those surveyed said they would be somewhat likely or very likely to do something about child mortality and 83% per cent had hope that the situation can be improved and or fully solved.

We are seeing evidence of this already. Save the Children’s own Facebook network in India includes thousands of young supporters, our twitter campaign to help children in Leh was supported by Bollywood stars and generated thousands of hits on our donation pages, schools and colleges are starting their own campaigns about the issue and partnerships with media and businesses are building.

With the spirit for progress that currently exists it is truly possible that India can become a child survival champion and show the rest of the world how to bring about large scale changes that saves the lives of mothers and children.  India is playing an increasingly crucial role on the international stage and now has an opportunity to be a respected player on the world stage in all fields.

Motherhood at Peril

By Priya Subramanian, Save the Children Media Manager. This article also appeared in The Hindu.

Are the mothers of India safe? A vast majority of them do not have access to basic health care...

Thirty-year-old Naseem Bano is a mother of five who makes a living rolling beedis at home in Tonk district of Rajasthan. Naseem's last child was born in a hospital. Her first four children were delivered at home. She had one miscarriage before her last son was born. According to Naseem, “she was too scared to go to a hospital for delivering her first four children.” Crucially, her husband would not allow her to go to a hospital with a male gynaecologist.

Naseem's story is shared by millions of women in India and across the developing world. Today, the world over, a day has been dedicated to celebrate the mother. Underlying the warm eulogies of the woman donning different roles as mother, sister, wife, etc, there is another subaltern narrative of the woman who has never been to school, who has no control over resources in her own home, and who will be dictated to by her husband and the elders in the family on whether she can go to hospital to deliver her child.

No infrastructure

Every year, 50 million women in the developing world give birth at home with no professional help whatsoever. And every year, nearly 350,000 women die during pregnancy or childbirth. Almost all these deaths happen not because of untreatable complications but because these mothers do not have access to basic health care services or if these are available, they are of very poor quality.

Most of these deaths could be prevented if skilled and well-equipped health care workers were available to serve the poorest, hardest to reach mothers. However, there is a very strong link between whether a woman can access skilled health care and her level of education. Poorer and less educated women, and especially those living in rural areas, are far less likely to give birth in the presence of a skilled health worker than better educated women who live in wealthier households.

A UNESCO report says worldwide, 39 million girls are not attending school and millions more complete only a year or two of schooling. In India, female literacy stands at a disappointing 53.67 per cent. Women like Naseem with little or no schooling lack the confidence and authority to make decisions for their own health and the health of their children.

Moreover, social and cultural barriers often prevent women like Naseem from visiting health providers. Typically, in rural areas, husbands and elder family members often decide whether a woman may go for health care outside the home and women themselves often choose to forego health care if the provider is male due to social stigma. In such circumstance, the presence of a skilled female health care provider could mean the difference between life and death for the mother and her newborn child.

Experience in many countries has shown that modest investments in female community health workers can have a strong impact on mothers surviving in rural communities. Between 1990 and 2008, Bangladesh has cut its maternal mortality rate dramatically by 53 per cent. In 1997, the government launched a safe motherhood initiative aimed at improving emergency obstetric care and training 17,000 skilled birth attendants to work at the community level. Though still more than 116,000 mothers die each year in Bangladesh mainly because of inadequate care during childbirth, a vibrant home-grown NGO sector has shown that health workers with limited education and training can have a significant impact on the survival of mothers.

Recent findings presented in The Lancet indicating a 1.5 per cent yearly rate of decline in maternal mortality since 2005 is good news. In India, the National Rural Health Mission has completed five years this year. Despite good schemes, their implementation leaves a lot to be desired. A recent Comptroller and Auditor General report found that institutional deliveries have not really taken off due to several irregularities in the States where maternal mortality and infant mortality rates are high. Only 47 per cent of women give birth attended by skilled health attendants.

Poor health care

In 2000, India, along with 189 Heads of State and government committed to reducing the numbers of mothers dying by 2015 in their Millennium Declaration. Despite a decline in maternal mortality rate, the question arises if we are doing enough to save the lives of thousands of mothers who are still dying because there is no health care provider nearby to spot complications early on and intercede on behalf of these mothers before it is too late.

A worldwide survey done recently by Save the Children finds India at 73 out of 77 middle-income countries in terms of the best country to be a mother. To paraphrase Nehru, you can tell the condition of a nation by looking at the status of its women. In a country that has glorified women in mythology and fiction, it is incongruous to have a reality where women have no control over their destiny and indeed their lives and, are dying because they cannot access basic health care.

Kunal Kapoor's 'Lamhaa' with EVERY ONE

More than a billion Indians

By Jatin Grover, EVERY ONE youth campaigner from Vinod Gupta School of Management, IIT Kharagpur

I am an Indian. But at the same time, I can be a male Hindu of Pakistan origin, a citizen of USA, working as a photographer, interested in poetry, a supporter of gay rights, follower of extra terrestrial objects wanting to have a conversation with them in a language predominantly French. All these identities can have their own relevance. For example, at the time of dinner, country of my origin is not relevant. What matters is whether I am vegetarian or a non-vegetarian. But what will happen if my identities start overlapping? What will happen if my choice of food is seen through the prism of religion? What will happen if my support for Gay rights is rejected for my being a Pakistani origin? And what will happen if these multiple identities are multiplied over a billion people?

The answer to all these questions is a gigantic problem which India is facing today. Heterodoxy has always been the most striking feature of our country. Any attempt to homogenize our society has been thwarted. Plurality and tolerance has allowed diverse cultures, religions and traditions to co-exist peacefully in the past. But now the equations are changing. Parochialism and sectarian mindset is making its way in the civil society. And this is not despite the billion people but because of it. Every group is trying to become a dominant force not because of its ideologies but because of its size. Everybody living in the illusion of identity feels neglected and wants to fight for its rights.

Root cause of every evil present in the society lies somewhere in the size of billion plus people. India has one of the highest food stocks in its warehouses in the world but is also home to 20% malnourished children of the world (worse than the Sub-Saharan Africa). Why? Because it is almost impossible to take food to everyone in a country of billion people. More than 50% adults in this country are illiterate because it is almost impossible to give education to everyone in a country of billion people. India is home to one of the highest ethnical and sectarian violence in the world not because of its heterogeneity but because of its sheer size. China has done better than India in almost every parameter of GDP or Human Development or Happiness Index in past 2 decades because it has tried to solve the root cause of every problem, that is, population growth.

This gigantic problem has a very simple solution - education. Education not only means a technical training of Science and Mathematics, but understanding the perspective of life. Education makes people empowered and helps them take informed decisions which are beneficial to the sustenance of a society. In 1990s when China launched its one couple- one child program it had the national fertility rate of 3.0 comparable to Kerela at that time. And today both have their fertility rates under 2. One followed a draconian path of autocracy and other followed the path of education and empowerment. Population of any country is an asset which has to be nurtured but when it grows out of proportion, the problems can become gigantic and costs too high.

Will you save me?

A poem by Jaideep Singh a management student from Narsee Monjee School of Management, Mumbai. EVERY ONE youth campaigner


As Sun rises in the east,
And I see sky thru wink,
With wish to be sleepy,
With wish to see more night,
I don't wanna rise,
I don't wanna open my eyes.

But Sun ll be on my head,
And I' ll walk on my knees,
I'll smell only waste,
I' ll eat with the flies.

So I start to raise my voice,
to beg enough and suffice,
As I see those gifted kids,
who wipes morsels from the lips,
I see up to the sky
to ask the question ''Why?"

Now, they see my bare chest,
they see my broken legs,
they see my dusty hands,
they see my shabby face,

With the eyes full of pity,
finally they offer me a penny,
World changed for them,
but for me,
It remained the same.

With handful of pennies,
With pennyful of belly,
I am now weak to be wild,
And I' ll turn to die,
Before I breathe my last,
I just wanna you ask,

"Will you save me?"