Purnota is finding new ways to translate medical research on Clinical Nutrition into tools that create more effective outcomes in government hospital settings as well as across the Indian health care system.
The New Idea
Purnota’s work is transforming the way one approaches medicine by bringing nutrition alongside medical care. Nutrition forms the backbone of treatment in diseases like diabetes and irregular blood pressure and supports pharmacotherapy. It is a sustainable solution for patients as they do not have to spend much on hospital expenses in the long run, accounting for many individuals’ lifetime savings. In recent years, researchers have built upon traditional ingredients and cooking for practical purposes in contrast to earlier eras where the Western hemisphere dominated early instances of nutritional healing.
Purnota focuses on fulfilling the individualized nutrition needs of child patients by placing trained nutritionists in cancer hospitals and serving nutrient-rich hot meals from hospital kitchens, along with nutritional supplements. Nutrition is complementary to medicine as it can increase the recovery rate and cause lesser complications. Purnota also engages their families and care providers who are immensely involved with the patients, often nutritionally uninformed themselves or already burdened by other responsibilities. Her intervention has shown that 82% of children have either improved or maintained their nutritional status despite cancer therapy, and 97% of the patients returned or continued treatment.
To address the growing demand for trained Clinical Nutritionists more generally, Purnota launched The Center for Clinical Nutrition which focuses on research and training Clinical Nutritionists through courses and cross-specialist interactions. An in-depth online course catalog is being developed, which significantly decreases the learning process and aids other organizations in their research. The online contents include podcasts, magazines, newsletters, articles, manuals, and Q&A forms to adapt to multiple learning capabilities and requirements. They create employment opportunities for nutritionists and cooks and as well as provide valuable input to cancer institutions. Over 180,000 children and their families have been counselled through in-person and online sessions. The program is present in 22 cities across 13 states in 37 hospitals (government and private hospitals) with 51 nutritionists.
Studies indicate that 40% percent of children entering government hospitals for cancer treatment in India are clinically malnourished. The same studies also show that 90% of children abandon treatment in lower to middle income countries (LMICs) due to financial constraints, alternative medicine, or the false belief that cancer is incurable. When children with existing malnourishment are exposed to repeated chemotherapy and medication, children’s bodies are pushed to the breaking point. The additional loss of weight and the lack of nutrition harms the child’s immunity to fight other diseases they are exposed to or causes life-threatening complications during treatment.
Children suffering from cancer are forced to move to cities and specialist centers that grant them treatment. The parents of these children are often not well equipped with the knowledge or resources to nutritionally provide for their children, as hospital fees are enough to leave a dent in the finances of parents and caregivers. At the beginning of the treatment, 80% of the caregivers were unaware of the nutritional requirements after a cancer diagnosis. Many have to stop treatment mid-way due to a lack of funds. Nutrition is ignored in this environment, and the thinly stretched and overworked medical professionals cannot take on the patients’ nutritional needs.
Apart from cancer, nutrition also plays an immense role in other diseases like malaria, which is heavily influenced by anemia i.e., iron deficiency. Diarrhea is the leading cause of death for children under five, affected by unhygienic food and water intake. Patients suffering from diabetes, cardiovascular diseases, liver, and intestinal issues are not aware of the nutrition they should be consuming, even though they are relatively common diseases and are increasingly affecting the younger generation.
The food provided by the hospitals or cancer treatment centers does not provide nutrient-rich food, which is vital for individuals to be able to maintain their weight. Such food does not consider the special needs and preferences of patients, which nudges children to consume food. The information and studies in the space for nutrition and childhood cancer are minimal in India, which further hinders progress. The space of nutrition has an untapped potential in India considering the widespread malnutrition caused by economic inequality or the areas in the country that require trained nutritionists to improve individuals’ health and the extended working force. Many children are needlessly dying due to a lack of nutrients vital for successful treatment and recovery.
While volunteering for the TATA Memorial Hospital in 2013, Purnota saw the plight of children with cancer and understood the connection between nutrition and cancer. She started out by researching the topic and asking doctors for guidance; she then built a problem-based solution through Cuddles.
The tried-and-tested six stages – access, evaluate, prescribe, provide, monitor, and support – approach the proceeding systematically. Nutritionists assess children on their individual requirements. A meal plan is made to support their needs through food and additional supplements to provide extra nutritional boosts. Hot meals are made in the hospital kitchens and provided to the children. The child's family are also provided with monthly rations for four to help them go through this tough time. The program has since supported over 15,000 children and their families through 180,000 counselling sessions and 11,500 ration bundles, with various stakeholders to deal with the issues holistically. Finally, the height and weight of the children are measured monthly, and sufficient changes are made if the results are not favorable. The nutritionist and the employees' morale are lifted by seeing the progress of their effort in helping out these children.
The nutritionists that come in are trained according to the organization's requirements to make the process as smooth as possible. These nutritionists not only receive quality education but also in-field skills through taking care of these children. The Cuddles Institute for Clinical Nutrition (CICN) focuses on research, training nutritionists through courses, and cross-specialist interactions. Furthermore, the Institute is carrying out specific research with practical objectives by collaborating with hospitals, specialists, and specialty cancer centers, with the aim to lead to systemic changes in the field of cancer medicine with a focus on nutrition in the treatment of pediatric cancer. An in-depth online course catalog has been developed, which significantly decreases the learning process and aids other organizations in their research. The online contents include podcasts, magazines, newsletters, articles, manuals, and Q&A forms to adapt to multiple learning capabilities and requirements. This online course is developed with a focus on pediatric oncology and is also being used to train students of nutrition and medicine, as well as training the Cuddles staff.
Families with cancer patients often must travel to big cities for treatment; they often lose their savings and are unable to provide nutritionally for their diagnosed child and other children back at home, leading them to abandon treatment midway. The resources provided by Cuddles encourages them to stay and follow through with the treatment. To date, the organization has provided 28,400 nutritional supplements, 11,500 ration bundles and distributed 14,400 hot meals. For children receiving nutritional support, there was a 16% improvement in average BMI with 8% increases in the category of average body weight, a 7% decrease in underweight patients and an 82% increase in nutritional status. The program measures its results through RTI consulting to get an unbiased external review of progress.
Cuddles has also helped reduce the burden of caregivers both financially and mentally. As a result of Purnota’s systemic intervention, families end up saving around 3,600 rupees per month. There is also a significant decline in the number of discontinuing patients, and 97% of new patients have returned for a second visit and continued treatment. The staff also educate the parents about hygiene and how to care better to prevent infections, which were very common. Parents have been thrilled with the positive impact they have seen on their children's health and happiness. Many of the children have regained their appetite and deal with less body pain. The program’s nutritionist makes the information very clear to the caregivers and are patient with their intellectual needs. Cuddles Foundation is advocating for new medical facilities to provide India's growing population with better health as well. They have spread their message through seminars, workshops, governmental schemes, and the recognition they get through receiving awards.
During the pandemic, Cuddles made an impact in the digital space through teleconsulting to reach existing patients and patients in remote locations. In 2021, Purnota developed the Food Heals App, which is used to team patients with nutritionists. The app is used by every nutritionist internally and ensures the eradication of any human error in the assessment of the grade of malnutrition and helps in preparing the nutrition plans for each patient. Through this app, Cuddles Foundation is beginning to measure their impact better and scale to more hospitals.
While Purnota’s plans for scaling her organization took a step back during the pandemic, she is back on track. One major goal of being present in every cancer facility in India is very close to reality. The non-profit wants to expand its presence along all age groups diagnosed with cancer. They are also looking towards other diseases through CICN that require nutritional support for recovery. Purnota aims to scale her organization to other countries facing the same issues in the Indian sub-continent and across Africa, either through Cuddles or collaboration with other institutions.
Growing up in Lucknow in the pre-liberalization period, Purnota’s grandfather was one of her biggest influences, with whom she spent a great deal of time working with his passion for trees and shrubs. From her younger days he always wished she would give back to society and create change. Her “awakening,” in her terms, began at college in Bombay when, at the age of 18, Indian Express recruited her as an intern to recruit a team to produce a children’s newspaper, a pilot project of Indian Express aimed initially at two dozen carefully chosen schools in the city, purposefully selected for their social and economic diversity. She was the newspaper’s editor, responsible for everything from ad revenue to getting the newspaper’s nine issues out on time, newsworthy for its audience and well-written.
After graduation, she spent a year at Indian School of Business in Hyderabad but wasn’t interested in the standard courses. Instead, she focused her interest on leadership and Indian mycology – study of fungi that are the connecting tissue between trees, responsible for the trees sharing of resources. She launched the Women’s Business Club at ISB, which continues to this day. She was recruited out of ISB to move to Punjab to launch Indian Express’s English language edition which she did successfully for five years, after which she moved to Shaadi.com (an Indian version of E-Harmony). At Shaadi she conceived of and launched Shaadi Prime. Seeing that Shaadi’s customers were primarily families searching for matches for their children, and not the children themselves, Purnota trained and recruited a new generation of online matchmakers to provide online matchmaking services to their customers. This business line managed to create three million people “paired” in its first full year of operation.
In 2006, Purnota decided to volunteer part of her time to work on the growing problem of cancer and got to know Dr. Brijesh Arora who was the Chief Medical Officer at Tata Medical Center as well as Dr. Elena Ladas who was doing related research focused on Africa at the Columbia School of Integrative Medicine. In 2010 she had a very difficult pregnancy, took a leave of absence from Shaadi, and began to spend more time volunteering at Tata Memorial Hospital and received mentorship in business start-ups with Unilimited India.
At that point she began to focus more closely on the issue of nutrition and cancer. Advances in chemotherapy treatment in the US for children were causing Indian doctors to want to adopt the treatment protocols but they faced a very different situation in terms of the profile of their patients. Purnota launched her first initiative, Cuddles Foundation, to address the nutrition needs of children being admitted for cancer treatment at Tata and realized that this wouldn’t work without including the parents in the treatment process. She saw the larger opportunity afforded to boost the field of Clinical Nutrition in India backed with the full support of leading Indian researchers in the field, and is building out that vision, step-by-step. As she does this, she remains in close contact with researchers at Columbia University focused on advancing the field of Clinical Nutrition in Africa and is exploring whether the Food Heals app could be used there.