Photo by Katelyn Killingsworth.
Nearly 15 per cent of all maternal deaths worldwide occur in India, and the district of Sri Ganganagar, Rajasthan has among the worst maternal and child health outcomes in the world.
In the Indian culture where there is a strong preference for the male gender, women experience incredible pressure to bear a baby boy. In some cases, a mother carries her baby, living with the threat of being thrown out of her home or disowned by her family if a daughter is born. Further complicating matters, there are limited mental health services offered in rural India to support pregnant women and new mothers.
Katelyn Killingsworth (MPH '18) recently completed her practicum with Mata Jai Kaur Maternal and Child Health Centre (MJK). MJK is a non-profit organization dedicated to providing quality, accessible health-care to women and children in the district of Sri Ganganagar, Rajasthan, India.
MJK tasked Killingsworth, a registered nurse, with helping to research, plan, and develop a mental health screening tool to identify women at risk of mental illness.
"We know that healthy moms and pregnancies contribute to healthy babies and a strong environment in which babies can grow," explains Killingsworth, who completed the practicum as part of the requirements of the MPH degree in global health.
Working under the direction of her preceptor, Chief Operating Officer Aneel Brar, Killingsworth consulted with the chief medical officer of health, community health workers, and patients in the clinic to determine whether women would participate in a mental health therapy program involving lay counsellors. The work she did while in India provides some foundation for developing and implementing the program.
Killingworth is now back in Canada, but the work at MJK to support the women and children of Rajasthan continues. "The plan going forward is to train lay counsellors-peer counsellors-to screen and identify women at risk for mental illness, offer support and build a relationship with the mom throughout her pregnancy and the postpartum period" explains Killingsworth." Using a "referral pathway", counsellors will also be equipped to connect the women with other health professionals and resources, if needed.
Lessons learned in the field
Reflecting on her practicum experience and working with the people of Sri Ganganagar, Rajasthan, Killingsworth shared lessons she learned.
- People are resilient.
Killingsworth remembers one patient she worked with who had lost six babies during pregnancy or shortly after her deliveries. "I can't imagine her grief and the pressure she is under to bear a healthy child," she says.
"She helped me realize how important this work is, and if we can help just one person, then this program is a success."
- Laying the groundwork to make positive change takes time.
Before starting the 13-week practicum, Killingsworth anticipated that progress would be faster in setting up the mental health program. "But I learned that it takes time to do things right. It's so important to move slowly and use culturally appropriate ways of interacting respectfully with various groups."
- Everybody wins when we build our network, learn from each other and share resources.
The challenges facing the people of Rajasthan are not unlike some problems in Canada, in particular for Indigenous people living in remote communities. Killingsworth says, "We can learn from what's being done in low resource settings that also experience a lack of transportation, education, and mistrust in the health-care system."
- The practicum provides invaluable preparation.
According to Killingsworth, the practicum was an essential component of her learning in the MPH program, providing her with the tools and foundation she needed.
"During my practicum, I was able to apply what I learned and adapt it to the setting I was in."
The practicum setting
Looking back, Killingsworth recalls having a clear idea of what she was looking for in her MPH practicum setting.
"I knew I wanted to work with an organization that I believe in, and which is locally run and sustainable," says Killingsworth. "MJK is all about providing care and meeting the needs of the women. They are working on the ground at the community level."
"I'm proud to have been part of the work they are doing in India."
Katelyn Killingsworth received funding or other support to complete the practicum from the Canadian Institutes of Health Research, the School of Public Health and Mata Jai Kaur Maternal and Child Health Centre.