Q&A with Dr. Archana Sarada on her initiative Udaan
On a bright Thursday morning, after days of heavy downpour in Mumbai, I stepped out of my house to reach the other end of the city. On my agenda was to speak to Dr. Archana Sarda, the founder of “Udaan”. Is Udaan an initiative; or is it a campaign? Perhaps it’s a foundation; but when I spoke to Dr. Sarda, I realized that Udaan is pure passion!
Little I knew then, that the next 45 minutes would be a wholesome experience; I took on a journey that started from the grounds, reached a height where the world starts looking beautiful, and explored arenas that aim to reach the galaxy.
Meet Dr. Archana Sarda, the lady who founded Udaan that relentlessly works for the welfare of children with Type 1 Diabetes. Metabolic Health Digest is elated and honored to present insights from Dr. Sarda’s selfless contribution…
Dr. Archana, when you first founded Udaan, was it something that you planned in a structured manner?
While Udaan seems like an achievement today, ironically it is not an initiative that was pre-planned. It is something that eventually took birth with circumstances and arising needs.
With that being said, I am now curious to learn how did it all start?
Well… While I was in Chennai, I had already worked with children with type 1 diabetes; and then later I gained more experience with my tenure at Bombay Hospital. But, the actual story begins in the year 2000: I was in Aurangabad, a small town in Marathwada. That’s the time I had just started my practice as a diabetes physician and to my surprise, I did not come across a single kid with type 1 diabetes. When I tried to inquire about them, I was asked that why am I interested in such children? They are not important, they have so many complications, so they don’t survive. I was astonished to see such reactions.
After about one month of my practice, a man visited me with a 13-year-old girl with type 1 diabetes; he placed the little one on my table and said, “We have tried our best, but her condition has drained all our resources and energy. We can’t look after her anymore. We’ve been socially outcasted by the family as people believe that the girl is suffering from an infectious disease. You take care of her and even if she dies, we have no regrets.”
I was still internalizing the fact that the father had left it on me to do my best. I looked at the girl; she was emaciated, tired, and was facing breathing difficulty as she was in DKA. There was nothing available in the vicinity and I only had a nutritionist and a receptionist to call it a “team”. I was shaken, but I carried the girl in my arms and rushed her to the nearest hospital, which was 100kms away. The hospital doctor said, “I will admit her only if you personally take charge. Because we don’t know who will pay her bills? Who will check glucose every hour, and who will monitor her ketones?”. I stayed back with that child for a week as a doctor, mother, caretaker, and everything else.
This episode served as a reality check, it was not just the lack of insulin but also the lack of knowledge, money, access to care, and a supportive environment. That’s when I felt the need to make an effort to bring a change.
That was surely a harsh reality, how did this journey then proceed from the seed of thought, and when did Udaan actually come into existence?
Initially, I could only provide them (kids with type 1 diabetes) free consultation and education but soon I realized that it wasn’t enough. We then started to arrange insulin, but then storing insulin in a place where the temperature is very high was a challenge. Every child in summer had high glucose levels and needed insulin. My son was studying physics, so he helped us develop validated earthen pots that can be used to store insulin in hot climatic conditions. These earthen pots even got featured in ISPAD guidelines 2014 for ambulatory care. By the time we tackled one problem, we had another awaiting us. We did not have adequate funds but we somehow managed the situation; time passed by, and soon we had about 50 children with type 1 diabetes. So, in 2005, with these 50 kids, Udaan was formally launched. And today, we are a family of 900; I also have 100 grandchildren (laugh, with a sense of fulfillment)…
They are all so lucky to have you; do you also have other clinicians, diabetes educators working along with you?
Unfortunately, no. Even today I’m the only doctor at Udaan. There were a few pediatricians who joined us in past, but as we work exclusively for the community, there is no scope for expected financial returns, which could be one the reasons for people discontinuing their service. But out here, I would like to mention that my entire family and several friends contribute to Udaan in terms of their time, and expertise; they also extend financial support as and when needed.
Isn’t it difficult to manage everything by yourself? We wonder if you possess some superpower….
(laugh) Definitely, it has been challenging to manage all of this. In the beginning, we were working to provide education, monitoring, and resources only. Soon I realized a need for social change; but we don’t have any diabetes educator, or properly trained nutritionist to help us. To overcome this, we created a structured training program named “MyT1Mom: a DMom to D coach program” with an aim to train mothers of type 1 to become coaches. Today along with experience and training, these coaches help doctors manage type 1 diabetes patients in villages. So this is how we made our approach structured and well manageable.
You have set a structured training program in a place where there was so much negativity surrounding type 1 diabetes, this is really commendable, Doctor. Since you’re working in a village set up, has language been a barrier?
Language was the biggest barrier, and when someone had a low literacy level or difficulty in understanding concepts, it becomes more challenging. Hence, we developed educational tools, visual carb counting, board games, seed games, street plays, drama in their regional language i.e Marathi. They felt more connected that way.
To cheer them up and to overcome the sadness around them, we created clubs. Udaan now has a drama club, a dance club; we also go on treks. In short, we at Udaan make children believe that they can do every other thing a normal child does.
This journey is not only inspiring but also a journey that has positively touched many lives; did you receive any financial support for this work, doctor?
We had no support for a very long time and even today resources are an issue. One of the biggest support that Udaan received in the past years is that from the CDIC – when they provided insulin to 300 children, and these children are still receiving insulin for free. We are in discussion with the State Government currently; we are advocating for insulin availability and improved quality of treatment. It is very important that we do not cut corners or compromise on the treatment, as children could then end up with complications later.
With a valid rationale, what could have been the reason for the delay in securing financial support?
Actually, that’s a limitation on my part because, with limited human resources, my priority has been to provide adequate treatment and to save lives. We usually spend a period of six to twelve months in counseling parents to let their children live, because the thought of letting children die was common here. I even have to bribe parents with saree, bags, sandals in exchange for taking care of their children. Hence, I have not been able to concentrate on arranging financial resources. Secondly, while I have all the data of each and every child with me, I haven’t yet presented my work to any authority. That may help Udaan securing financial support; we are actively working on this now. Another reason for the lack of resources is that I don’t want people to come and set up a donation camp for my kids. There are many who can come, donate, click pictures; but I don’t want that. Children at Udaan hold their heads high and they come here with authority; they don’t even realize that something is being donated to them and I never want someone to make them feel like recipients. Kids out here (at Udaan) clean, grow trees, and we even asked them to donate 200 rupee for the cause. That’s how they think they are contributing back.
We are confident that Udaan will soon receive the financially aid it deserves. On another note, doctor – we all know that the pandemic has influenced each one’s lives, how has it affected Udaan?
Yes, there was a financial crisis that we experienced, but overall the lockdown has positively contributed in the working of Udaan. Prior to the lockdown, we never got a chance to reach out to different villages except for Marathwada. We only had people reaching us, which meant that some or many were missed because they might choose to not reach us. So in lockdown, we have taken out ambulance with permission to reach villages and conducted our clinic under trees, in the farms, amidst cows and buffalos. We’ve ensured that insulin reached every house where there was a child with type 1 diabetes. While it was a unique experience, it made us believe that there is a way to reach out, and then we made changes in our usual plans. Also, we wrote a 52-page book in Marathi during the lockdown. This book contains pictorial representations that are effective to train anyone with basic knowledge of type 1 diabetes.
So we can say that Udaan had a makeover with the lockdown and took one step further ahead! Doctor, while you’ve worked for this cause for so long, what do you feel is still left to work on?
Like I said at the beginning – Udaan took birth eventually, and it was not something that I had planned for initially. The only thing that I consciously worked towards was to realize my dream of reaching and helping each child in every taluka of Marathwada. This dream is still incomplete, I wish that each taluka should have at least one center where children with type 1 diabetes can reach out to for help. Actually, this is my mid-night dream (laughs), at dawn, I would like to see that every child with type 1 diabetes is taken well care of in India. At the moment, Udaan runs 24×7 helplines; our remote education and care facility has substantially decreased the need for hospitalization in kids. I am proud to place on records that Udaan does not compromise on global standards of individualized care of insulin/ monitoring/ education and investigations. The journey has been long, but it is full of life!