REPORT ON FAMILY ATTACHMENT

PROGRAMME

By:
Miss.Neeraja Sivanesan (2004/FM/34)
Mr.Selladurai Pirasath (2004/FM/41)

This report was submitted to Department of Community

Medicine, as a partial fulfillment for 3rd MBBS Part II
examination.

DEPARTMENT OF COMMUNITY MEDICINE,

FACULTY OF MEDICINE,
UNIVERSITY OF JAFFNA.
 2008.
CONTENTS PAGE

01. Abstract 01
02. Introduction 02
03. Objectives 03
04. Identification 04
05. Socio economical status of family 07
06. Environmental health 08
07. Family nutrition 12
08. Sociological aspects 14
09. Health practices 15
10. Health status of individual family members 19
11. Identified problems and recommended solutions 21
12. Diary of visits 29
13. Acknowledgments 31
14. Annexes

LIST OF FIGURES & TABLES

Figure 01 – Map of kokuvil – kondavil project area

Figure 02 – Area map – PHM Kondavil North
Figure 03 – Pathway to family
Figure 04 – House map

Table 01 – Family particulars

Table 02 – Health problems
Table 03 – Environmental problems
Table 04 – Social problems
Table 05 – Economical problems
 1. ABSTRACT

Family attachment programme is conducted by Department of Community Medicine as a part

of 3rd MBBS Part II examination. A family with in the community medicine project area will
be allocated to each group of students, which contain two or more students.

This is the report of the given family includes our findings, experiences, identified problems,
achievements and possible recommendations.

The family allocated for our family attachment programme is an extended family, resides in
Karaikkal, Inuvil east, Inuvil. It consists of 6 members. The head of the family is
Mr.I.Layaharan, 36 years old man who is having a small welding shop. His wife
Mrs.L.Jeyavathany was a pregnant woman, was on 32 weeks and 7 days of gestation during
our first visit. She delivered a baby boy on 5th of March 2008.

There are several problems were identified in this family. Poor socio economic status, poor
sanitary facilities (no permanent latrine facility, they don’t have own well) health and social
problems are some of those problems identified in our study period which was around nine
and a half months. Their knowledge regarding health aspects such as hygienic habits and
knowledge about infectious diseases are relatively inadequate. Nutrition and child care are
not adequate enough. They are far behind in maintaining a clear environment and waste
disposal. We tried our level best to solve some of their problems and some are beyond our
capacity because of the family’s poor cooperation.

We guide them to solve their medical problems and created more awareness about sanitation,
nutrition and family planning.

Anyhow we made a good rapport with our family members and gained much experience
regarding a family’s daily activities, needs, life pattern and problems faced by community.
We developed proper attitudes and skills in communication with a family.
 2. INTRODUCTION

A family is a basic unit of social organization united through bonds of kinship or marriage
present in all societies. It simply means people living together, is a group of people living
together and functioning as a single household. (usually consisting of parents, their children).

This group of people is closely related by birth, marriage or adoption. Ideally the family
provides its members with protection, companionship, security and socialization.

Types of families are,

Nuclear family
A social unit that consists of parents (2 adults) with their children
Extended family
The family as a unit embracing parents and children together with grandparents or other
relatives such on uncles, aunts, cousins or sometimes more distant relatives.
Single – parent family
In which children live with an unmarried, divorced or widowed mother or father.
Step – family
It is created by a new marriage of a single parent. Here problems in relations between non –
biological parents and children may generate tension.

The structure of the family and the needs that the family fulfils vary from society to society.
The main function of the family is the provision of affection and emotional support by and to
all its members, particularly infants and young children. Others are economic production,
education, religious activities, schooling and recreation.

Health problems can be identified and solved easily in a family and health status of a family
is necessary to achieve a healthy community. Health status depends on environment, diet,
economic status, knowledge and beliefs.
So as medical students we should know the fundamentals of functioning of families. The
family attachment programme provided by the department of community medicine, is an
opportunity for us to improve our skills and attitude towards the community.

3. OBJECTIVES

3.1 General objective

To study factors influencing on a family and how they affect the health status of a
family

3.2 Specific objectives

• To develop good relationship with family members, collect and find out
information and problems from them.
• To assess the nutritional status of family to improve their health.
• To search and suggest alternative ways of economical support to the family.
• To identify and solve physical and psychological problems
• To find out common diseases among family members and solve them.
• To assess environmental health problems and give advice for proper sanitary
facilities such as water, latrine and refuse disposal.
 4.

4.2 Family tree

Sivanadiyan + Pooranam Iyampillai + Pooranam

Sivakumar + Subarnalatha

Nicson Nicsika
 5. SOCIO ECONOMIC STATUS OF THE FAMILY

Food, clothing and shelter are considered as indispensable factors for human living.
Economic status of the family should be good enough to provide these factors adequately and
to maintain a good health status.

The economic status depends on the balance between the income and expenditure of the
family. And it has to be firm to run a healthy family. In our family Mr.Layaharan is the
breadwinner. He earns Rs.5000 – 10000 per month. As he is not having a permanent job, his
income varies from month to month with the situation. Occasionally their relatives support
them financially. They get relieves monthly.

5.1 Debts
They have some debts also, 2 lakhs from bank of Ceylon, with that they got 1 lakh from
pawning to open their welding shop. They settle this from a part of their income (2000-3000
rupees) monthly.

5.2 Expenditure pattern

Expenditure pattern depends on their income. They spend most part of their income for their
food & their children’s needs. Rest is used to settle their debts. They spend money for cloths
only on special occasions such as New Year, birthday. As they are living in their relative’s
land in an own small house, they need not to pay rent monthly. They have a TV, radio and a
bicycle.

But they have own house with land at their native place, Thellipalai. Now here they are
expecting that any NGO’s will help them to build a toilet.

Comments
They spend whole income with out any saving. Due to this habit they don’t have the capacity
to face any critical situation. Mr.Layaharan’s income varies from month to month, so it is
unstable. And it is not enough to meet all their basic needs. We can consider our family under
poor socio economic group. They have no valuable properties, jewels or cash deposits in
bank.
 6. ENVIRONMENTAL HEALTH

Environment has a profound influence on the quality of life. When the adaptation of human
to their external environment fails, they develop diseases or other problems.

Environment should be clean for a healthy life. A home environment with unhealthy
conditions may lead to a lot of health hazards.

6.1 Compound

Area of the compound is 2 larchems. And the land is not their own one. It belongs to one of
their relatives. 3 families are (Mrs.Jeyavathany’s family, her sister’s and brother’s family)
living there in separate small houses. Land is surrounded by fence in all four sides, with an
entrance at the front without a gate.

There are some 5 coconut trees and a jack tree in the compound. But the income from it,
coconut and the other things are taken by the owners of that land.

Comments
The compound is not kept clean and there is a chance for mosquito, fly breeding around their
house. Refuses from their house are kept in front of their house for some days before they are
burnt. We advised them to keep the environment clean. But most of the time they are
incorporative and not followed our advice.

There is a considerable amount of old cycle rims with in their compound. They are still kept
there even after our advice to remove them. We advised to put fence to separate all other
houses and asked them to plant more trees.

6.2 House

That is a small clay built house with asbestoses roof. They built with their own money at their
relative’s land.
It is 610cm length, 305cm width, 230cm height at both sides (front & back) and 270cm at the
centre. It contains a small sitting hall, two small rooms and a small kitchen. That is not
adequate enough to their family.

Even though it contains windows, light and ventilation are inadequate. The floor of the house
is grounded well with clay. There is no chimney at the kitchen for exhaustion of smoke.

Comments
Each person less than 10 year old needs a floor space of 18 sq feet (around 1.62m2) and over
10 years old needs 36 sq feet (around 3.24m2). Area of this house is 18.605m2. So floor area
is enough. But one room is filled with Jeyavathany’s one of the sister’s properties. So there is
no adequate space for that family.

Their bed room is also small and there is a bed to sleep two people and others sleep on the
mat. Jeyavathany’s mother sleeps on a bench at hall. Very small kitchen, cleanliness of the
kitchen and other parts are not satisfactory. We advised them to keep clean in our every visit.

6.3 Water supply

There is no water source in their land. They are using a common well in front of their home.
They fill a plastic water tank with the help of a motor and are using that water for all
purposes including drinking. That is not a protected well.

Their water drainage system is not good, the waste water is directed towards plants in the
compound. The drainage canals are not properly made or maintained. Jeyavathany’s sister’s
husband who is working at Municipality water supply unit, chlorinate the well once in three
month.

Comments
The source of water is good. Toilets of those houses are not situated very close to the well.
They use water from their water tank to drink, not using boiled water.
We advised them to make effective drainage system to avoid small water collections and to
ingest safe water by boiling to prevent water borne diseases.

6.4 Latrine facilities

There is no appropriate safety latrine in their home. They use an unsafe pit latrine for
defecation. It is surrounded by fences made of coconut tree leaves. They do not wear slippers
when they go to defecate. They sometimes wash their hands with soap and water after
defecation.

Their latrine is dangerous because wall of latrine pit is not steady and strong. It is not walled
off by cement.

Comments
We made arrangement with NGO’s to make a safety latrine pit for them. Unfortunately it
failed because, the land was not own to them.

We explained them about the good hygienic practices such as hand washing.

6.5 Refuse disposal

Refuse disposal have important role on health practices. Improper methods of refuse disposal
lead to the spread of communicable diseases.

Our family put all the refuses including green leaves, litter and kitchen wastes in front of their
house, near to entrance and burn after some days. Sometimes they bury in their garden.
Bicycle trims and tyres are kept at the side of the home.

Comments
We explained them that their refuse disposal method is not good and asked to make a pit and
bury. They are not following our advice. But we continuously monitor that whether they burn
frequently or not.
6.6 Pets

They are rearing some hens. They have no dog or cat.

Comments
We asked them to grow more here. It was helpful to their nutrition. They accepted our
advices and they made a small hens farm and growing hens.
 7. FAMILY NUTRITION

Provision of adequate nutrition by a balanced diet is necessary for a good healthy life.
Balanced diet is the one that contains the right amount of energy (calories) and the right
proportion of energy giving nutrients.

In general scientists recommend that a person should eat a variety of food, maintain ideal
weight, avoid too much fat, eat foods with adequate starch and fibre, avoid too much sugar,
avoid too much sodium and drink alcohol only in moderation, if at all.

Nutrient and energy requirements vary between individuals and are related to a person’s age,
sex, level of physical activity and other factors such as his or her state of health and genetic
make up.

Around half of a person’s dietary energy should come from carbohydrate. Fruits and
vegetables have beneficial effects on health (WHO recommends consuming 400g/day).

7.1 Dietary pattern of our family

All our family members are taking non vegetarian diet except on Tuesdays and Fridays. For
breakfast and dinner they eat pittu, stringhoppers, bread or rotti with sambol or curry.

Usually they have rice and curry for their lunch. They add fish, dhal and green leaves often.
The cook brinjal, meet, egg, and potato also in some occasions. They usually cook fish and
one vegetable. They add fruits also with their meals.

They drink milk tea twice a day. They never drink boiled water.

Baby Haricharan was on exclusive breast feeding for 6 months. Now mother has started to
add small amount of well cooked rice, potato, dhal and green leafy vegetables. And she gives
cerelac thrice in a day.
Jasmitha and Mathumitha have the habit of eating snacks in between meals. They usually eat
pittu or stringhoppers with sugar.

Comments
Dietary nutritional intake is inadequate to our family. Eventhough they cook fish and green
leaves regularly, children don’t like to eat those items. Due to their habit of eating snacks,
children are not taking main meals in appropriate amount. Mother is not taking care about her
children’s nutrition. They eat very small amount of food.

This impairs the growth of those children. Their weight is not appropriate to their age and
height.

7.2 Nutritional assessment

By measuring the height and weight of the family members, we calculated the BMI. Except
the adults their 2 children have low BMI (< 18kg/m2). This indicates their nutritional status is
very poor.
 8. SOCIOLOGICAL ASPECTS

8.1 Inter and intra family relationship

Relationship between the husband and wife is fairly good. They discuss all the matters and
problems in between them.

As Jeyavathany’s mother is a mentally handicapped lady, she quarrels with Jeyavathany often
and she is unable to make a good relationship with her daughter-in-law who is living at next
door. But she is maintaining a good relationship with her daughter who is living at next house
with in their compound.

Family members maintain a good relationship with their neighbours and other relatives.

8.2 Education

Educational level of the parents plays a major role in the family’s health and development.
Here both parents studied up to O/L. But their knowledge regarding child care, nutrition,
cleanliness of the environment and communicable diseases is very poor.

When we advise them regarding these problems, they understand, but most of the times they
don’t follow them.

8.3 Marriage and birth

Mr & Mrs Layaharan’s marriage and children’s birth were registered at appropriate period.

8.4 Community participation

They participate in temple festivals, weddings, funeral and other special events of their
relatives or neighbours.
 9. HEALTH PRACTICES

Good health practices prevent the diseases. Health practices include personal hygiene,
nutrition, sanitation, mother, child care and immunization.

9.1 Personal hygiene

Good hygiene is important in taking care of our self physically as well as emotionally. People
often have infections because they don’t take good care of themselves physically, which can
lead to emotional difficulties as well.

Keeping our body clean is an important part of keeping you healthy and helping you to feel
good about our self.

In our family over all personal hygiene is not good. Every day all of them take bath. But
children seem to be dirty all the times when we visited to our family. They use brush or tooth
powder to clean their teeth. They brush their teeth at morning only.

Their cloths also not kept very clear. Adults wash hands after defecation and before meals.
But children are not always monitored for these habits. They use slippers when they go to
toilet.
They didn’t cut their nails regularly. They all are using same comp, towel and soap.

Comment
We gave a health education regarding their personal hygiene and its importance for healthy
life, in preventing diseases. But there is no significant improvement.

9.2 Sanitation

Their knowledge about sanitation is not good. Their house and environment are not kept
clean most of the times. They keep refuses in front of their entrance and burn. They don’t
have a proper toilet, they use barrel latrine.
Comment
We advised about the harm with poor sanitary practices, about proper refuse disposal and
good sanitation.

9.3 Maternal health and child health

Health status of a mother during pregnancy has a great influence on her fetus. Jeyavathany
registered her pregnancy at kondavil antenatal clinic at 8 weeks and 6 days of gestational age
and followed clinics regularly and got one dose of tetanus toxiod, worm treatment, folic acid,
haematinics and nutritional supplementation. She followed the advices given by PHNS and
PHM and took nutritious foods. She had no antenatal, natal and postnatal complication during
her pregnancy. But the last child was delivered by low forceps delivery.

Her last child’s weight gain was satisfactory. At the end of 6 months his weight is more than
double of birth weight. Immunization is given to him appropriately. Mother feed the baby
with breast milk only up to 6 months. Then he developed acute respiratory tract infection and
urinary tract infection at the end of his 6 month of age. He got hospital admission for 5 days
and treated.

Comments
Jeyavathany’s ante natal care was good. But during the preparation of delivery we as well as
the midwives face some problems as she didn’t take much care of delivery clothes and baby’s
needs.

Then we mentioned the importance of cleanliness of the environment in preventing early

infections. Due to their ignorance child might have got those infections.

9.4 Nutrition

The nutritional status of our family, especially in children and knowledge regarding nutrition
is very poor among family members. They don’t have proper knowledge in nutritional value
of individual meals and their important.
Comment
Those children except Haricharan are undernourished.

9.5 Disease and preventive measures

They use traditional medicine and western medicine when they got illness. They use to go
primary health care unit and Jaffna Teaching Hospital to seek medicine. The grand mother
goes to pariyari to get traditional medicine for their children.

They have some knowledge about spread of mosquito bone disease. They use natural
preventive measures such as verupu smoke and mosquito coils to prevent mosquito bite. The
knowledge of family planning and contraceptives is also fairly good.

Comments
The knowledge regarding disease and preventive measures is not so bad in our family.

9.6 Immunization

They follow extended program of immunization (EPI) for their 3 children. We also
encouraged them to follow up EPI continuously.

Comments
They have proper knowledge about immunization and its importance.

9.7 Contacts and use of health services

They use private and governmental health sectors. They prefer private health sector rather
than government sector because of the inadequate care towards patients in government sector
except in some institutions.
The available health services to our family are following:

Services Distance from home

Teaching Hospital, Jaffna 7 km

ANC 1½ km
CWC 1½ km
PHI office 1 km
PHM office 1½ km
District hospital, kondavil 1½ km

Comments
Our family uses all these facilities, if needed.
 10. HEALTH STATUS OF THE INDIVIDUAL FAMILY MEMBERS

Mr.Iyathurai Layaharan

He is 162cm in height and 57kg in weight. His BMI is 21.7kgm-2. He is an average body
built man. And he is clinically normal.

Mrs.Jeyavathany

She was a pregnant mother with 32weeks and 7days of gestation during our first visit. At that
time her weight is about 61.5kg. (During first visit to ANC her weight is 56kg and height is
about 145cm. Her body mass index is 26.63kg/m2).

She registered her pregnancy at kondavil antenatal clinic at 8 weeks and 6 days of gestational
age. She followed clinics regularly and got tetanus toxiod, worm treatment, folic acid,
haematinics and nutritional supplementation. Her expected date of delivery was 8th of March
2008. She gained appropriate body weight at the term. She delivered baby on 5th of March
2008 at J/TH with out any complications.

Miss.L.Jasmitha

She is about 14kg in body weight and 101cm in height. Her body mass index is about 13.724.
She is under weight for her age and height. She has no any medical illnesses. But she refuses
to eat and avoids green leaves, fish and fruits. She is fond of chocolates.

Miss.L.Mathumitha

She is the 2nd child of this family. She is about 10kg in body weight and 77cm in height. Her
body mass index is about 16.86kgm-2. She also has problem with mother to eat. She had
weight loss at the end of 1 year of age and now her weight is improving.
Mr.L.Haricharan

He is the last new born child. His birth weight is 3kg 150g. Height is 53cm. Head
circumference is 35cm. He appeared well, unfortunately he developed respiratory tract
infection and urinary tract infection and was admitted to Jaffna Teaching Hospital and got
treatment. Now at his 7 months weight is 7.5kg and height is 67cm.

Mrs.Iyampillai pooranam

She is a widow. Her body weight is 70kg, height is 154cm and body mass index is 29.5kgm-2.
She is obese and following clinic for depression. She has a lot of worries about here missing
2nd son.
 11. IDENTIFIED PROBLEMS AND RECOMMENDED SOLUTIONS

11.1 Health problems

11.1.1 Mr.I.Layaharan is the head of family. His personal hygiene is poor other wise he is
normal.

Recommended solution
We advised him to improve his personal hygiene by taking bath regularly, by hand washing
after welding works, go to toilet, before eating and reach his children, by cutting and
maintaining nails clean and by wearing slippers. We advised him to take proper care
regarding hygienic measures and nutritional status of his all family members especially on his
pregnant wife and elder daughter (malnourished).

11.1.2 Mrs.L.Jeyavathany was a pregnant mother on our first visit. She had proper weight
gain and didn’t develop any serious complications during or following pregnancy. But she
had mild anaemic features. She hasn’t any idea about family planning methods even after 3
children. She also has poor personal hygiene.

Recommended solution
We advised her to eat more green leafy vegetables such as murungai, sandi and vallarai. We
explained about the importance of good personal hygiene, proper antenatal care, preparation
of breast for lactation, and nutritious food intake. During the delivery time we assisted her in
preparation for it. After the delivery we explained to mother about neonatal care, importance
of exclusive breast feeding, immunization schedule, its importance and monitoring of child’s
weight. We assessed mother’s health problems with PHM and made arrangements for regular
supervision of PHM because the mother is very lazy in responsibilities of her duties to
children as well as her own.

We also discussed with both husband and wife and with PHM regarding family planning
methods. And now intra uterine contraceptive device is inserted to her. And we advised her to
take care about her children’s nutritional status.
11.1.3 Their 1st child, Jasmitha has less body weight than expected. She is malnourished
and has the habit of eating snacks frequently.

Recommended solution
We advised the mother to give more food than usual. We asked to include fish, egg, milk,
green leafy vegetables and fruits in her diet, explained about the effect of frequent intake of
snacks in dental caries and asked to reduce eating snacks. We advised her mother to weigh
her child frequently and to observe weight gain.

11.1.4 The 2nd child, Mathumitha has averagely normal body weight, but there is
marked drop in growth chart during the onset of 2 years. Usually during our visits she was
wearing dirty clothes.

Recommended solution
We made actions to improve this child’s body weight and visited at noon to observe her
eating habit. We asked mother to prepare foods as the child wishes and to spent time with the
child while child is eating. And asked to keep the child clean always, to wash the hand, legs
and face after playing and now we observe that she looks nice with washed clothes.

11.1.5 The last child had developed respiratory and urinary tract infections during 6th
month of age. There was an interruption in his excellent weight gain with that.

Recommended solution
We advised mother earlier to give exclusive breast feeding for 6 months and monitored it
during our family visits. Then after that we talked with mother regarding weaning foods. We
found out baby as sick and advised to take him to JTH in time. We also had some visits to
hospital during her admission. We helped her in many ways, during hospital stay and said her
to strictly follow pediatrician’s advice.

11.1.6 Grand mother is depressed. She has a lot of worries about her missing son who was
arrested by armed forces in front of her. Then she developed sudden upset and a lot of
worries about him. When we talk with her, she easily gets mood out and cries. She always
quarrels with her daughter and her daughter in law. She worries about her poverty. She is
over weight.

Recommended solution
We observed her abnormal behaviour during our visits. We advised to go to psychiatric clinic
for councelling. At first she didn’t accept it. Finally after lot of advices she accepted and we
decided to take her to hospital. We discussed with Dr.Mullai and took her to psychiatric
clinic. We made her sure to follow up clinic. We explained how to take the drugs and about
the drugs she uses. We also requested her daughter to observe her drug compliance. Then
during one of our visit she had suicidal ideations. We gave proper advice to change her mind
and we successfully achieved.

Following that she had better improvement from her abnormal behaviour. Quarrels between
mother and daughter are reduced. We also advised her to reduce body weight by walking and
reducing intake of food intake.

11.2 Poor hygienic practices

They do not wash their hands with soap and water after defecation or before preparing meals
or eat. They don’t brush twice in a day. All family members do not drink boiled water. Some
times cooked meals are kept open at their kitchen.

The children were allowed to play in soil by her mother. She did not take much care.
Children’s not cut and kept clean.

Recommended solution
We advised to practice hygienic methods such as hand washing, brushing (We explained
about the proper method of brushing and hand washing) and cutting nails. Initially they had
difficulties in improving their personal hygienic methods. But now they have corrected to
some extent.

We explained about the importance of drinking boiled water and keeping food items closed in
the prevention of communicable diseases such as typhoid.
We advised mother to wash children’s hands, legs and face immediately after they finished
playing, to change their clothes and to wash and to cut their nails and to keep clean.

11.3 Nutritional problems

The husband and wife are having normal body weight. But their two daughters are under
weight. Grand mother is over weight.

The amount of food intake by those children is not enough. Nutritious foods that are
important to growth such as eggs, meat and milk are not added to their diet regularly.

Recommended solution
We advised the mother to take more nutritional care regarding two daughters. We also gave
advises to improve nutritional status, such as,
• Increase the amount of food consumption
• Reduce the intake of short eats such as chocolates
• More consumption of green vegetables
• Growing hens
• Regular worm treatment
• Regular visit to child welfare clinic and to weighing post
Mother accepted our advices she rears more hens at home. She gives regular worm treatment
to her children and they are maintaining a book at Kondavil Divisional Hospital for worm
treatment.

11.4 Environmental problems

11.4.1 No safety water supply and improper water drainage system.

There is no well in their compound. They get water supply from a common well in front of
their house which is not closed. From there water is pumped in to a plastic tank and they use
the water from it. Their rope and bucket is put on floor. Their drainage canals are not
properly maintained and there were small water collections.
Recommended solution
We advised them to contact area PHI to chlorinate the well in future and explained about the
amount of chlorine needed to that well and about the right method of chlorination. We
advised to cover the well. In addition to contamination there is a chance to their small
children to fall accidentally in to the well. We also advised to keep rope and bucket by
hanging in a stick. We asked them to clean the tank frequently and made proper water
drainage system from the place which they bathe.

11.4.2 No sanitary toilet

They defecate in open pit which is not cemented, only covered by a cemented floor.

Recommended solution
We discussed this problem with PHI. We tried to construct a latrine with the help of NGO’s.
But it failed, because their land was not registered in their own name. Then we advised them
to reconstruct it as much as possible.

11.4.3 House with over crowding

Light and ventilation are inadequate with dirty surrounding.

Recommended solution
We discussed this problem with our family members and asked them to extend their house.
But they were unable to reconstruct their home because of their poverty. They cleaned their
home and environment with our help. But they don’t maintain it clean all the time.

11.4.4 Improper method of refuse disposal

They put their refuses in front of their house and burn after some days. There are some old
bicycle rims in their compound.

Recommended solution
We advised to put their solid wastes (such as plastics, metal materials into the place which
was constructed by PHI) We asked to bury the green leaves to plants such as coconut tree,
banana tree. They are not sincere enough to follow these methods. But they kept the cycle
rims in a proper way without allowing mosquito breeding sites.
11.5 Social problems

11.5.1 Poor intra and inter familial relationship

Grand mother is a psychiatric patient. So she frequently quarrels with her daughter and her
daughter in law. At one a moment her daughter decided to go to separate home to live.

Recommended solution
We talked with both of them regarding this problem and explained about mother’s problem
and disease to her. And we asked the daughter and daughter in low to avoid making problems
as much as possible. We took grand mother to psychiatric clinic and ensured her clinic follow
up. We also freely talk with her and give advises.

11.6 Economical problems

11.6.1 Unstable and inadequate income

Mr.Layaaharan’s income is unstable and inadequate to meet all their basic needs. They don’t
have additional income and their relatives also not supporting them financially. They don’t
have the habit of saving money at bank.

Recommended solution
We discussed the alternative methods to improve family income, such as poultry farming,
and home gardening. But it failed, because there is lack of land space. And we advised them
to open an account at a bank and to deposit small amount of money and to increase.
Table 2 - Health problems

Problems Condition after our Achievements / non

intervention achievements
1 Pregnant mother with mild Improvement Completely achieved
anaemia
2 Mother was not on any Improvement Now she is on IUCD
permanent contraceptives
3 Drop in growth chart of 2nd child Catch up of growth in Partially achieved
growth curve
4 Under weight of 1st child Little improvement in body Partially achieved
weight
5 Psychiatric problem of grand Following up psychiatric Completely achieved
mother clinic & good outcome
6 Poor hygienic practices Little improvement Partially achieved
7 Poor nutritional states Little improvement Partially achieved
8 No worm treatment Continue worm treatment Successfully achieved

Table 3 - Environmental problems

Problems Condition after our Achievements / non

1 No safety water supply from
protected well with out covering
and proper method
chlorination
2 No sanitary toilet
3 House with over crowding and
poor ventilation and light and
dirty surroundings with
mosquito breeding sites
4 Improper and irregular refuse
disposal
intervention achievements
Contacted with PHI for
chlorination. Still the well is
Partially achieved
of not closed properly.
No solution recommended Not achieved
Environment was cleaned
Mosquito breeding sites are
Partially achieved
reduced
Burning frequently and
burying leaves to plants
Partially achieved
some times.
Table 4 - Social problems

Problems Condition after our Achievements / non

intervention achievements
1 Poor intra familial relationship Registered on psychiatric Successfully achieved
with grand mother clinic & regular follow up

Table 5 - Economical problems

Problems Condition after our Achievements / non

intervention achievements
1 No stable and adequate income Poor co-operation and no Not achieved
own land

12. DIARY OF VISITS

14.01.2008 PHM introduced us to the family. We explained about our family

attachment programme to them.
22.01.2008 We identified the family members, their date of birth, their
education, occupation and made good rapport with them.
02.02.2008 We observed the house, environment, water supply, and latrine and
got to know about the ownership and had a talk with mother about
pregnancy care.
10.02.2008 We discussed about their economic status, expenditure pattern,
nutritional pattern, observed her pregnancy card, children’s CHDRs
and gave nutritional advise to mother.
26.02.2008 Discussed with PHM about our pregnant mother and explained her
about the preparation of delivery.
04.03.2008 Visited to their home to monitor her.
05.03.2008 Visited to hospital to see the mother who was admitted for delivery.
06.03.2008 Visited to hospital.
10.03.2008 Monitored the mother and child at home. Discussed with mother
regarding breast feeding and infant care.
22.03.2008 We explained about the importance of clean environment and good
personal hygiene.
30.03.2008 We asked about their debts, savings, inter and intra family
relationships.
31.03.2008 Visited to grandma who was admitted to hospital at that time.
10.04.2008 We got to about the availability and utilization of services.
Discussed with mother about family planning. We got to know
about grandma’s worries.
17.04.2008 Discussed with PHI and PHM about their latrine and water supply.
29.04.2008 We explained the mother about immunization, weighing post and
their importance.
20.05.2008 We measured the height and weight of the family members.
26.06.2008 Grandma accepted to consult Psychiatrist. We observed the
children’s weight and height in CHDR.
03.07.2008 Discussed with Dr (Miss).Mullai about grandma’s depressive
illness.
09.07.2008 Took grandma to psychiatric clinic.
25.07.2008 We made sure about the visit of mother to CWC.
15.08.2008 Discussed with mother about weaning.
02.09.2008 Monitored about weaning practices, CHDRs and grandma’s clinic
follow up.
24.09.2008 Gave advises regarding their last child’s health.
12.10.2008 Mother discussed with us about elder daughter’s education.
29.10.2008 We took photographs with our family members.
31.10.2008 We thanked our family for their co-operation
 13. ACKNOWLEDGEMENTS

Now, we are in the stage of thanking people who have given their advices, support and guide
to complete our family attachment programme successfully.

First our sincere thanks to Dr.N.Sivarajah Visiting Professor, Department of Community

Medicine who has organized this programme.

In addition, we sincerely thank Mrs.Malayarasi Sivarajah, for giving valuable advices and
helps for improving our family health.

Our grateful thanks to Dr (Miss).Mullai for giving psychiatric consultation with our family
grandmother and continuing her follow up.
We also thank to our PHI Mr.Premkumar for his affords to make latrine facilities, and giving
valuable ideas regarding to safe water supply, refuse disposal, and proper water drainage
system.

We also thank to our PHM Mrs.Sharmila in giving advices regarding maternal, child care and
contraceptive methods.

Finally let us our sincere thanks to our family who have given their co-operation as much as
possible to carry out family health attachment programme successfully.