Isn’t a child’s life worth the price of a falafel?
That was the type of question floating through Abhay Bang’s mind as he navigated the streets of New York during this week’s three-day summit at the United Nations on an ambitious set of goals to reduce poverty, hunger and disease.
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A bearded man in a blue jacket and a cream-coloured shirt of rough-spun cloth, Dr. Bang arguably has done more to tackle infant deaths in the developing world than any individual on the planet.
Yet he was nowhere on the official program of events. His trip was sponsored by Save the Children, an international non-profit group, and his summit consisted of a series of panels and meetings on the fringes of the main action.
But in India, Dr. Bang’s insights recently became national policy. His work has been taken up in other parts of South Asia and by four countries in Africa. His studies were seminal, researchers say, in shifting the perception of infant mortality in poor countries to something that could and should be addressed.
For nearly three decades, Dr. Bang, 60, and his wife, Rani, also a doctor, have lived in the Gadchiroli district of India, a rural area with a large number of indigenous tribal people, long one of the country’s poorest groups.
Gradually their focus turned to preventing newborn deaths – an issue that would later come to be known, in UN-speak, as Millennium Development Goal 4. Dr. Bang decided to try something with a deceptively simple premise: It didn’t take hospitals, or incubators, or even doctors to save babies’ lives, just ordinary village women.
He and his organization trained one woman living in each of 39 villages – she had to be literate and a mother herself – to spot problems early and provide rudimentary care when parents couldn’t or wouldn’t take their ailing newborns to a hospital. A physician visited each village every two weeks to supervise the women’s work, but didn’t provide any treatment.
The results, first published in the august medical journal The Lancet in 1999, were astounding. In just three years, the mortality rate for infants in the first month of life dropped by 62 per cent compared with another group of villages where no women were trained.
Nor were such efforts expensive. For each village, there was an initial cost of $155 (U.S.) to train, supervise and equip each woman, and $118 to maintain the program each year after that. The UN uses a formula to quantify such interventions in terms of how much it costs per year of life saved. In this case, that figure was $7, or exactly the cost of “my little snack,” said Dr. Bang, referring to his falafel lunch on Tuesday.
Asked how he can reconcile those two realities, Dr. Bang replied that “really from my heart, I sometimes find it confusing.”
Dr. Bang’s work – meticulously documented in scientific studies – shows that information gleaned from remote rural places can shape thinking in the world’s metropolises. “Evidence is the long lever which, I have seen, can move London, Geneva, New Delhi and New York,” Dr. Bang said.
Jeremy Shiffman, a professor at American University, has studied the way that the issue of newborn survival became a priority in the field of global health. Until about a decade ago, few organizations considered it worthy of focus.
That began to change with a presentation that Dr. Bang gave at Johns Hopkins University in 1999, Prof. Shiffman has written. A physician who attended the talk later told him that “everyone who was there was left with a completely different understanding about how we should start to think about newborn survival.”
This week in New York, politicians, technocrats and other experts were wrestling with how to achieve the UN’s child-mortality goal by 2015. As part of that drive, India has set its own target for infant mortality; Dr. Bang’s work is taking a starring role in the effort to achieve it.
Starting this year, India is rolling out Dr. Bang’s program – which he calls “home-based neonatal care” – to 235 districts across the country, which together have a combined population of 500 million people.
Born and raised in the ashram founded by Mahatma Gandhi, Dr. Bang says that his work was inspired by applying Gandhi’s ideals to the field of health. His research on newborns is just a “small piece of that big jigsaw puzzle – empowering people to take care of their own health and solve their own problems,” he said. “There’s a long way to go.”
I believe very strongly in this type of work and support the work Save the Children does in training village lay-women and midwives in pre and neonatal care.