05 August 2013

Picture imperfect: helping vulnerable families access social services

Naranzul (centre) with her family outside their home in Arbulag soum
© UNICEF Mongolia/2013/Andy Brown
Someone is missing from four-year-old Naranzul’s family. She lives in a wooden house in Arbulag soum (village) with her mother Otgontsetseg, grandmother and 11-month-old baby sister Saranzul. But she has no father. He was killed in a traffic accident over a year ago, when Otgontsetseg was three months pregnant with Saranzul.

“It was a real shock for me when my husband died. It happened so suddenly,” Otgontsetseg says, her voice trembling as she speaks. “My relatives helped a lot in those difficult days. At first Naranzul didn’t understand what had happened but now she is starting to realise. She says ‘my father has turned into a picture’.”

The family was left without a breadwinner. They moved in with Naranzul’s grandmother and tried to make ends meet with her pension plus benefits for the two children. “It was very difficult for us. We struggled to buy enough wood, clothes and food,” Otgontsetseg continues. “When my daughters got sick, we couldn’t afford medication for them.”

Arbulag soum is in a remote area of Khuvsgul province, northern Mongolia. Although it is early summer, the rains have not yet arrived and the landscape is bare and brown. The soum has few facilities – just a handful of general stores, a billiard hall and a petrol station. It is several hours' drive to the provincial capital Murun, through windswept valleys without any roads.

UNICEF is working with Arbulag soum government, and others throughout the province, to provide basic health and social services for at-risk families like Naranzul’s. This is part of our Reach Every District and Soum (REDS) initiative and broader strategy to address inequality by targeting the most vulnerable children and communities.

“We’ve provided training for teams of local officials from health, education, child protection and other services,” Zoya Baduan, UNICEF community development officer for Khuvsgul, explains. “They conduct house-to-house visits and look out for issues in the family. Do they need vaccinations or birth registration? Are the children getting enough to eat? Do they go to kindergarten or school? It’s a multi-disciplinary approach.”

Feeding time

At the health centre, a nurse weighs Saranzul to check her nutritional status
© UNICEF Mongolia/2013/Andy Brown
Otgontsetseg’s family were visited by one such assessment team, including soum doctor Uyanga. She noticed that baby Saranzul was very small for her age. She then measured her height and weight, and found that she was malnourished. Uyanga prescribed a course of therapeutic food, provided by UNICEF to the local health centre. Saranzul has now been taking this along with breast milk for one week.

Although the family is struggling financially, Uyanga doesn’t think this is the main reason Saranzul was malnourished. “I think it was the shock to Otgontsetseg of losing her husband,” she says. “She didn’t pay enough attention to feeding Saranzul in the first few months.”

At the health centre, a nurse weighs and measures Saranzul to see how she is responding to the treatment. She finds that she has gained 150 grams and now weighs 6.3 kilograms. “Saranzul is making good progress but she should be 8.5 kilograms,” she says. “It will take another two months to get her to a healthy weight.”

Arbulag health centre provides primary health care and public health services to everyone in the soum and nearby areas. It is in a well-equipped building, with computers for the doctors, beds for the patients and a vaccination fridge provided by UNICEF. There is even a maternity cottage for expecting mothers to stay in. “We can deliver babies here and do emergency operations like removing an appendix,” Uyanga says. “But for more complex operations we transport patients to the provincial hospital in Murun.”

Back in the soum centre, Naranzul is attending summer kindergarten. She joins an art class with other children and starts drawing a picture. “I like singing and playing with toys or puzzles,” she says. “We went to see the forest yesterday, so today I am drawing lots of trees.”

Naranzul, for one is optimistic about the family’s future. “When I grow up, I want to go to school,” she says, perhaps misunderstanding the question. “And then my sister Saranzul can go to kindergarten.”

Back of beyond

Ulaankhuu with her baby outside the family’s makeshift ger
© UNICEF Mongolia/2013/Andy Brown
Further out from the soum centre, conditions are more challenging. Families live in traditional ‘ger’ tents, spread out over a wide area. The health centre provides ‘bagh feldshers’, mobile doctors who do outreach to the families by motorbike. UNICEF pays for their petrol and travel expenses.

Ulaankhuu is an 18-year-old single mother. She lives with her own mother and two-month-old son, Bayarsaikhan. She doesn’t know who his father is. Ulaankhuu had her first child when she was just 15, but he choked and died while feeding. They are one of the poorest families in the district. “We have a few goats and sell the wool to relatives,” she says. “We mostly live on bread and water. We have meat maybe once a week.”

Ulaankhuu has never been to school. The family live in a makeshift ger, made from rope and animal skins. During the winter they ran out of fuel and burned the wood from their animal shelter. Now they share the ger with their goats. Other families have solar panels, electric lights, radios and fridges in their gers. But there is nothing modern in Ulaankhuu’s ger. It is small, drafty and dirty, with animal hair and dung on the floor.

“It is very difficult to see that human beings live in a place like this,” bagh feldsher Otgonbayer says. “In April we took Ulaankhuu to the provincial hospital to give birth. She needed a caesarean section but every time the ambulance came, she would run away on her horse. We had to come early in the morning and catch her asleep.”

Thankfully, things are at last looking better for the family. “I visit Ulaankhuu once a month to make sure her son is vaccinated and teach her how to feed him properly,” Otgonbayer continues. “So far, he is healthy. His weight is OK and she has enough milk.”

As well as helping Ulaankhuu look after her son, the soum government has bought a new ger for them, which will be delivered in a week’s time. For Ulaankhuu, this will be a life changing event. “It was very hard being pregnant last winter. It was so cold in our ger,” she says. “I am very happy and excited to hear that we will get a new ger. I have never lived in a new ger in my whole life.”

Naranzul draws a picture of trees at the soum kindergarten
© UNICEF Mongolia/2013/Andy Brown
The author
Andy Brown is Communication Consultant for UNICEF East Asia and Pacific

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