After a short flight, we arrived to a warm and sunny Pune (pronounced Poona) on Sunday. Pune is located in Maharashtra state, same as Mumbai. Compared to Bangalore, Pune is warmer, seems to be less expensive (for example, our hotel in Pune is much nicer but for the same cost), less crowded (definitely less rickshaws!), and more polluted, I think. A river separates our hotel from Koregaon Park, where Bharatiya Samaj Seva Kendra (Indian Social Service Agency) is located. This is where we will be spending the next 3 days.

Newborn sleeping in warmer in Neonatal Unit

BSSK, directed by Ms. Roxana Kalyanvala, has been around since October of 1979 and has been working with Holt International since its inception. In 2004, they consolidated their Pune locations into a large, 5 story building. Administrative and social service offices are located on the top two floors, children’s sleeping rooms, neonatal unit, nurses’ and doctors’ station, kitchen, dining area, school, play room, therapy room on the lower 3 floors. They also have an outdoor play area.

Zeina with Director Roxana Kalyanvala in Neonatal Unit

We started the day by a presentation to the staff to introduce the nutrition screening system and SPOON. It was very exciting to have a room full of people (~30 people) from BSSK’s different departments: clinical care, child care, foster care, domestic adoption, child admission, administration, social work, child development, etc. I could tell that the audience was very interested in the topic of nutrition and feeding based on the questions they asked and the enthusiastic discussion we had after the presentation.

Zeina with staff from BSSK

After some tea and cookies, Roxana and a few of the staff gave us a tour of BSSK.  There are 73 children at BSSK, 25 of which are in foster care. The children at BSSK are much younger than the children we met at VCT. The neonatal nursery alone has 8 infants (1 of them is premature). All newborns, except for one girl, were sleeping in their “warmers”. The wide-awake infant was sunbathing by a window and receiving a baby oil massage by her caretaker.  This is a common practice at BSSK as a way for children to get vitamin D.

Infants sunbathing

Newborns in warmers

In another room, toddlers were getting ready to have lunch, which included pureed rice and lentils with ghee, rice with dhal for younger children and/or chapatti mixed with dhal for older children, and curd (plain yogurt).  I tasted all dishes. I have to admit that I wasn’t a big fan of the mashed rice and lentils but the others were pretty tasty.

Lunch!

BSSK has many young children because they handle many unwanted pregnancies (70 pregnancies/year). Pregnant woman, who decide not to parent (mostly because pregnant out of wedlock or unable to take care of child) are referred to BSSK by the Child Welfare Committee. Not licensed to house pregnant women, BSSK refers expecting mothers to a nearby support center. BSSK provide mothers with iron (100% of them are anemic) and calcium supplements. After birth, the infant stays with the birth mother for the first 4-7 days. During that time the infant is breastfed. BSSK’s strong preference is for the child to remain with the birth mother and so social workers provide intense counseling if they are confident in the mother’s ability to take care of her child. The birth mother has 2 months to change her decision. In addition to relinquished children, BSSK also receives referrals from the police station for children abandoned at temples, mosques or other public places.

Children eating rice and dhal with cucumber for lunch

Roxana shared with me that most of the adoption from BSSK is domestic. They had to stop receiving applications because they already have 200 families waiting to be matched. The waiting period for domestic adoption is 18 months! In addition to adoption, BSSK is expanding their foster care and family preservation programs.

Aruna with infant in Neonatal Unit

After a lovely lunch with the staff and the older children, Jennifer and I met with Dr. Navarange, one of the pediatricians who examine children at BSSK, for a very informative interview. Dr. Navarange identified the low birth weight as the main concern at BSSK, although he’s confident in the care and weight gain that these infants are able to achieve under BSSK’s care. All children ages 1 month to 1 year receive iron supplements, he said, and a multivitamin containing vitamin D, vitamin C and B complex. All children older than 1 year receive a multivitamin.  After the age of 2, all children receive deworming drugs twice a year and therefore diarrhea is not commonly seen.

Zeina with Dr. Navarange

What I found most interesting are the feeding practices that Dr. Navarange shared with us. After the age of 2-3 months, whether at BSSK or foster care, infants receive pasteurized cow milk and homemade rice cereal (provided by BSSK to foster parents). Homemade cereal is a combination of rice and lentils (5:3.5 ratio), washed, lightly roasted, grinded/powdered and stored. Before a meal, the cereal is mixed with cold water and cooked for 1-2 minutes with some salt, sugar and ghee (clarified butter) until it reaches porridge consistency. The milk is given in a bottle but the cereal is given in a bowl using a spoon.  Dr. Navarange is aware of the WHO recommendations for introduction of complimentary food and cow milk but believes that families are better able to handle cow milk than follow instructions for mixing formula. As for the homemade cereal, research in New Delhi, Dr. Navarange said, has shown that the cereal recipe has the optimal protein and nutrient level for the young child. The introduction of cow milk and cereal at a younger age seems to be a common practice in India. It would be very interesting to further investigate the reasons behind this practice.

Doctor visiting Neonatal Unit