Use Krishnakatha,mythology and improve child survival !

Dr. Hemant Joshi & Dr. Archana Joshi.

Joshi Children's Hospital Virar. Tel. 0250 2502710.

Health education is important part of every doctor's practice.

Give some one a fish & he eats once. Teach him fishing & he eats fish for ever.

Treat a patient once & he improve once. Teach him about health & illness & he cares for himself forever. Educating masses about child health & diseases is most cost effective way of improving child health,& survival. This is called as health education.

Begin with what people know and build on it. Literate & illiterate, grand mother to grand son,every one knows mythology. It is dear to every one's heart. When our message comes with mythology they enjoy, understand, inculcate it & propogate it happily. Try it. Child Lord Krishna's story is especially suitable to teach child care. He had threat to his life right from birth, but he survived them all, grew into an, ideal popular God.

30 % children are malnourished when they are born. But 85% children are malnourished at the age of 3 years. 85%, means almost all children. Children of all people including rich, poor, literate, and elite. This tells that as a nation unknowingly we starve children.. Majority children who die are malnourished. If we eliminate malnutrition, majority deaths will be eliminated. Krishna katha can help us to teach child nutrition, child care and reduce malnutrition and childhood illnesses and mortality.

"Make your child like child lord Krishna (Slogan for parents)."

In Maharashtra and in many states of India, at the time of marriage, an idol of child Lord Krishna is given to bride,hoping that her son will be like lord Krishna..

Vaishnavs begin and end their day saying "Jai Srikrishna." When they meet anyone they greet saying "Jai Srikrishna".Jagannath Puri's God Jagannath is child lord Krishna. Many classical dances in India are based on Krishnakatha and Krishna is a popular God. Krishnakatha is liked by all and is a very good tool to teach child care.

7 girls born before Krishna were killed by Mama Kans.But 8^th child Krishna survived.This incidence has following lessons.

1. A history of death of previous babies at birth, is called as bad obstetric history.It worries every one whether next baby too will die. Tell this story and give them hope.

2. Lord Krishna survived because his father was present at birth to transfer him to the safe place Gokul. In any delivery there can be risk to the life of the mother and the baby. Today in India about 1000 women die during child birth/abortion. So the father and the head of the family must be present at the time of delivery to help & consent for emergency procedures like caesarian section, or transfer of baby or at the time of birth. Tell this story to ensure presence of father /head of the family at the time of delivery.

3. Lord Krishna was born at midnight. He had risk of life. Studies show that quality of services at midnight is not the best, increasing the morbidity & mortality of babies born late in the night. Extra efforts are needed to change this scene.

4. Lord Krishna's story also draws attention to the fact that even today neonatal mortality is many times more than maternal mortality. Neonatal mortality about 50,& maternal mortality 5 per 1000 live births. Obstetricians fear neonatal morbidity & mortality most. Neonates deserve at least as much if not more care, attention, space and resources, than the mother. Those assisting delivery need as much good training in care of newborn as they get for care of mother.

5. Lord Krishna was born at midnight.It was a dark night.It was raining heavily,River Yamuna was in full spate. But Mama Kans would have killed lord Krishna next day. So Krishna"s father shifted him to a safe place at midnight. He did not wait for sunrise. The baby was transferred immediately and safely.

When a newborn with risk of life needs transfer to another place tell this story. Ensure safe transfer.Stabilize the baby, prevent hypoglycaemia,hypothermia, shock,infection during transport. Use a transport incubator. Ensure that every ambulance in your area has a transport incubator & functional oxygen cylinder. When sophisticated transport incubator is not available Dr. S.R. Daga recommends use of thermocol box as a transport incubator.

6. Krishna's mother Devaki was in Jail. He was reared by Yashoda & Nand. He grew on Yashoda's breast milk.Use this story to give milk of one mother to baby of another mother with less milk. Use it to promote wet nursing and breast milk banking.

7. Nand had numerous cows. But Krishna did not grow on cow milk. He was not bottle fed either. Putana was a demon who tried to kill Krishna with poisoned milk. Milk feeding bottle is a modern Putana mausi, that causes diarrhea, infections & kills babies. For educating masses, Indian Medical Association at Virar Maharashtra & at Gandhidham Gujarat publicly put feeding bottle in HOLI (fire) in the holi festival. You too should do the same and educate people.

A custom of "SOYAR" was observed. "SOYAR" AVOIDS "SOOTAK"

"Soot" in Sanskrit means Son. The grief of death of a son is called "Sootak" .To avoid Sootak, they followed "Soyar". "Soyare" means relatives." Soyar" means keeping all relatives away from the baby & the mother for 45 days. This is important even today as India,s maximum child deaths today occur in first month of life.Many of them occur due to infections like diarrhea, pneumonia. Most infections are unknowingly given by relatives who come to see the baby and carry the germs. Isolating the mother and baby from flood of visitors will help mother & baby. All maternity homes should have a board saying "No entry to sick people near baby & mother"

Kardhani Good qualitative growth monitor

On 5^th day of life they tied a thread around the waist of baby Krishna. It is called as Kardhani, kardoda etc. Even today this thread can be used as a good growth monitoring tool.Teach parents that as a baby grows the thread becomes tight and needs change. If baby becomes weak, it becomes loose. If the thread ever becomes loose they should consult doctor as the child is getting malnourished. He is either starving or sick or both. All including illiterate grand mother notice this change. Thus it is a very good qualitative marker for growth monitoring. This is important as Growth monitoring is not done, height weight are not measured & growth charts are not used for most of the 40 crore Indian children.

This thread around the waist can help us fight syndrome X, Indian's biggest forthcoming epidemic. Every one should wear a thread around the waist. Neither too tight, nor too loose. If one gets central obesity ,the abdomen grows and the thread around the waist becomes tight and warns to reduce food intake and increase exercise.

Thus thread around the waist is a good LAXMANREKHA that we all should have lifetime.

Krishnakatha helps us to fight malnutrition as follows :

Annaprashanam sanskar at 6 months.

Like all children, child Lord Krishna had Annaprashanam Sanskar at 6 months. Annaprashanam is a Sansksrit word. Anna means food. Prashanam means eating. San means good Karya is work. Sanskar means good work. There are 16 sanskars. Marriage is one. Annaprashanam is another. At the age of 6 months soft mashed home food like sheera,sooji halwa or soft rice,dal with ghee or oil,mashed fruit, is fed ceremonially for the first time to a baby. This is called annaprashanam. There after every time the baby is hungry before breastfeed he is fed soft mashed home food a little,and then baby is breastfed. Adding little breastmilk to every spoon of this food makes it more tasty and acceptable to the babies. Acceptance of breast milk added medicines also is always better. Gradually the amount of home food increases, the need of breastmilk reduces. Like a relay race, the child gradually shifts from breast milk to solid home made food and learns to eat everything from the family pot.

Tell this story and introduce home made solid food at 6 months. Ensure that every child is fed homemade food like Sheera,rice dal etc before each breastfeed. Some oil or ghee must be added to each feed. A hungry baby may taste sheera or any home made solid food. A fully breastfed and satisfied baby may not open mouth to taste anything.

Since last many years we give sheera to every child who comes to our hospital or clinic. In our clinic, we do public function of annaprashanam & give 1^st sheera to every baby at 6 months of age.

This has significantly reduced malnutrition in our practice. The growth failure that occurs in second half of infancy is avoided by this practice. Annaprashanam is vaccine against growth failure in second half of infancy.

We must promote annaprashanam so that people know and improve introduction of home foods, and reduce malnutrition.

In Satyanarahan puja idol of child lord Krishna is worshipped,Prasad of sheera is made.In every home, the child in family is true lord Krishna of the family. Ask parents to make sheera daily and feed it to the baby before every breast feed.

Give him/her sheera daily,as many times as he/she wants, say 6-8 times a day till18 years of age. Children like variety.So different dishes can be made in place of sheera. This is good complimentary feeding.

. Lord Jagannath of Puri,Orissa, is actually lord child Krishna.He is given food 6 times daily.56 tasty dishes are made for him every day.If we ask everyone to do this for our children,malnutrition will disappear.

Krishna & Sudama ate pohaL:earn fromthis story. Have a pocket to each dress of every child. Keep it filled with poha (puffed rice),roasted grams (chana), roasted groundnuts, or any available snack round the clock. If there is nothing else keep rice, roasted, sweetened or just raw. Our. experience shows that children eat raw rice well,digest it well and have no problem, no stomach pain.

A gap between food & children causes malnutrition. Close the food gap with food corner & food /snack filled pockets

Food / snack filled pocket is treatment of malnutrition. Food / snack filled pocket is vaccine against malnutrition.

Lord Krishna ate Makkhan.

This has 2 lessons.

Lesson 1 This story helps us to increase oil & fat consumption in weak,malnourished babies.Tell parents as follows. " Lord child Krishna ate makkhan.Your child is "your lord Krishna", give makkhan or add oil or ghee to everything he eats." Parents will happily listen to you.

And will add a spoon of oil to each weaning feed that a baby takes.

Lord Krishna is called as Makhan chor. He & his friends had to steal Makkhan. Mumbai's biggest festival of Dahi handi is celebrated on Janmashtami, the birthday of lord Krishna. It reflects the sad shocking unbelievable truth that Lord Krishna, King's son, God Himself had to steal food. This explains why 85% of Indian Children are malnourished. It reflects the sad truth that in most of our houses the food and the water are beyond the reach of our children. They do not get food and water ad lib,i.e.at liberty,i.e.,when they want. They have to depend on others. And any one who has to depend on others, fails & suffers. In our homes, the children are on the ground, and the food is on the table. Drinking water is on the table, Makkhan in fridge. We keep food & water, beyond the reach of children.Let us keep food and water with in the reach of children in all houses.

Fortunately children are not required to ask for air. They take air as they want. So there is no malnutrition of air in children. Like air if food and water are made liberally available to the children with in their reach malnutrition & diarrhoea/sunstroke deaths will decline.

In Satyanarayan pooja in Maharashtra idol of child lord Krishna is worshipped.The idol is kept say in one corner of a room. All fruits,Prasad of Sheera (also called sooji halwa) & water etc are kept in front of the idol.The child in the home is true child Krishna of that family.For him, the family should keep a corner of the house.Name the corner as "baby corner or Krishna corner.". The family should always keep snacks, fruits, water etc. which the child can reach & take independently, ad lib.and can feed him self.

This may spoil the floor. But it is good to have good children in a spoiled house than having spoiled children in good house.

In Gujarat every house terrace has a corner for birds celled CHABUTARO.It has food and water kept for birds.

We need similar food corner for children on the floor in every house.

This child corner /Krishna corner eliminates hunger,thirst and malnutrition and majority of child deaths in 2 ways.

Chicken in poultry farm live in bondage. But are free to eat at liberty.They grow 1 kg.per month.Children are born free but are not free to eat at liberty.They have to eat what parents give, when parents give.This is one reason for malnutrition. Make a child corner in each house & eliminate malnutrition. Children,like chicken should eat round the clock.

When a child gets free access to food, he feeds himself. If he does not get food, he remains hungry. He starves & then gets malnourished. Give free access to food to children. This eliminates hunger, starvation and malnutrition.

If a dog's or cat's baby gets thirsty It goes to the water hole and drinks water. If it is more thirsty in summer or due to diarrhoea, it has the option of drinking more water. This eliminates dehydration. Each house should have a waterhole or a water bottle on the ground which a thirsty child can access independently at lib.

When a child gets diarrhea, he loses water, and becomes thirsty. If he gets enough water to drink he does not get dehydrated. A diarrhoea child gets thirsty first, dehydrated next and dies last. Keep water within reach of a child. If he is thirsty he will drink water himself. Thus if thirst is eliminated, dehydration and diarrhoea deaths are reduced..Water kept in the baby corner/Krishna corner does this job.

In summer children get dehydration fever & heat stroke.If water is available with in reach,they will drink it and sunstroke & dehydrataion fever will decline. Dr.Babasaheb Ambedkar said each village should have one water source for every one. We want one water source for a child in every house within the reach of children.

Use Krishnakatha to promote exercise & dance : Krishna & Balram did wrestling,exercise and went to gymnasium. Promote exercise that we & children sadly miss

Dance is the best exercise.

Our dances are based on Krishna katha T.V.is the best dance teacher available in every house. Lord Shankar ,Lord Krishna,Lord Ganesh are all"DANCING GODS"

*(Photo 16)Use Krishnakatha to teach music: Krishna's flute(MURALI) is famousUse it to teach music and instruments to children.

Promote adoption with Krishnakatha:

Krisna's parent were in jail.He was adopted by Yashoda & Nand.So he survived.India's census 2001 shows that every 10th family has no baby .On one hand childless families live miserably. On the other hand babies in orphanages live miserably and many die.Let us use Krishnakatha and promote adoption.Let us Make adoption laws simpler.Let us Make "give baby take baby club / Krishna club & promote adoption.

Krishna & Karna both were adopted at birth. So they survived. Use this example for early adoption ,as soon after the birth as possible, because risk of death is highest in unwanted babies.

Learn Chivalry from Krishna

Krishna liberated many women from jails of Narakasur. He helped Draupadi.. This should teach chivalry .He helped his friend Arjun. May every one help his friend in need.

Learn Evidence based medicine from Krishnakatha: Krishna"s famous dialogue, "This is Sun and this is Jayadratha" reminds us of evidence based medicine. It reminds us to get necessary evidence with tests like cultures while treating patients.

Learn saving patients from Krishna: We battle to save every serious patient.We should follow Krishna"s advice given in Geeta, "Do your best, not worring about the results,or returns."

Like Krishna become Puroshottam, the best man .May every one become Purushottam like him.He told Geeta and tought principles of living. Gandhiji, Lokmanya Tilakji, Vinoba Bhave etc. lived Geeta. May each one of us understand and live Geeta.

Krishna lifted Gowardhan. We have to lift the Gowardhan of childcare taking each one's help. Reach Krishna katha to all in all languages of the help sms /email/story telling t.v., radio, newspapers and improve child health.

Lord child Krishna's photo with "Bal Devo Bhava"
written below it, the logo of our hospital. It should be the logo of all persons and associations working for children.

Use Krishnakatha to reduce neonatal and childhood morbidity,mortality and malnutrition. Use krishnakatha to improve baby care at birth, to transfer babies, promote breast milk, burn bottles in holi, keep water and food on ground within the reach of children, keep pockets filled with snacks, promote exercise, dance, chivalry, friendship and good moral values, making all children into very good human beings.

More mythology for better child care

Coconut a day keeps malnutrition away : Lord Ganesh & lord Hanumanji are offered coconuts.Coconuts are rich in fats & calories.When possible. Offer coconuts daily to children and see their malnutrition disappear.

Lord Hanuman is also offered oil.This example is useful to increase oil consumption when needed in malnourished children.Lord hanuman is also God of exercise.He is immortal,never falls sick,is very intelligent and ideal god to promote health & exercise. The hill in his hand with medicinal plants reminds us of polytherapy done by confused physicians,& reminds us of avoiding polytherapy.

Lord Ram:

His Ramban reminds us of correct monotherapy, & rational drug therapy.

2. Shabari tasted every fruit before giving to lord Ram.We too should taste every medicine before giving it to children.

3. Avoid Aids.Live like Ram Seeta.Avoid extramarital affairs.

Lord Shankar,Gangajal and O.R.S. .

Lord Shankar has river Ganga on his head.Ganga saves many children of King Sagar,who probably were dehydrated.Gangajal is the right name for oral rehydration solution. Tell even an illiterate grand mother that adding ORS powder to water makes gangajal that will save the child,and ensure total compliance in ORS therapy & improve survival.

Lord Shankar and Yogasan sits in padmasan.Padmasan is a yogasan. Yoga and Yogasans help you to gain control on your mind & body and prevent or postpone ailments that come with aging.Yogasans is one of the 8 parts of Patanjaliyoga. Patanjaliyoga is Indian Text of psychology & mind control. All currently prevailing yoga schools are born out of Patanjali yoga. It claims to makes you Superman/superwoman Gives you 23 siddhis,i.e. superhuman powers.Gives you control on your mind and body.Keeps you young for many years. Each one of us should read Patanjaliyoga & learn firsthand.

Durga has 16 hands Ravana has 10 heads &. If all the brains & hands of our colleagues & assistants act in cohesion us we have the power of Rawan & Durga. This will improve child survival.In emergency always call for help.Then you have many hands and brains to help. Call colleagues,and share the medical ,social and medico legal burden of emergencies.

Draupadi"s thali, Arjun's Akshay Arrow stock, and child's Akshayapatra : Draupadi had a thali that could feed any number of guests. Arjun had a stock of arrows that would never get exhausted. Similarly each child should have one food/snack filled Akshayapatra, kept within his reach. It should be Akshay, means parents should refill the contents before it is emptied. It can be a plastic transparent jar carrying snacks like roasted grams, groundnuts, puffed rice, or any available home food or snack. This will prevent, treat and reduce malnutrition.

Karna: Karna is a good example for all doctors.

Karna and Continuing medical education:

Karna forgot Bramhastra.& lost the battle and life. This reminds us of continuing medical education, so that we do not forget our science or lose our skills.

Karna and maintainance:

His chariots wheel got jammed in earth.While attending to that he died.This reminds us of effects of bad maintainance of instruments. If our all instruments are well maintained, only then they will work during emergency.Else when a baby is serious,you will have to look after instruments first, and precious time is lost.

Karna and Vaccination

His father gave him Kavach Kundals.that protected him against all arms. Vaccines are modern Kawach kundals.All fathers should give all vaccines to all children on war footing. Karna gave away his Kawach Kundals and died. If people do not give vaccine boosters, their children can suffer. We must give all,100% vaccines to all 100 % children on war footing,round the clock, and make our nation VACCI" NATION"

Karna and teen age pregnancy:

He was born of unwed mother.Use his example to give sex education to adolescents to avoid teen age pregnancy & pregnancy before marriage.

Karna and child adoption at birth:

He was adopted at birth.Use his example for early adoption.as soon after the birth as possible as risk of death is highest in unwanted babies.

Karna and human relations:

In the war of Mahabharat his driver Shalya,always cursed him.This reminds you to keep good working environment by avoiding unnecessary nagging of colleagues & co workers.

Use mythology,empower people with knowledge about childcare and reduce India's childhood morbidity & mortality.This is the best service of the nation that we all can and must do.

Bibliography: 1 .Nelson text book of pediatrics (18^th edition) 2008

2 Dr.Harish Kumar. Child health in India. Academy today 4:19-27,2008

3 Agrawl DK,Agrawal KN,Indian Pediatrics 31:377:413,1994

Dr. Hemant Joshi

Dr. Archana Joshi

Dr. Renuka Joshi

Miss Radhika Joshi

(Makers of maternity + breast feeding leave of 6 months)