When HVU facilitator Afrin weighed Rajin at a courtyard session in Sardertari village, Lalmonirhat district, Bangladesh, he was eleven months old and weighed just 5.2 kg. His mother Fensy Akhtar, 20, had noticed he was small and that feeding was difficult because of his cleft lip. She had not known the situation was critical.

“I thought he was just small,” Fensy recalls, “until the HVU team explained to me how serious it was.”

Fensy’s household depends on her husband’s earnings as a farm labourer and her father-in-law’s work as a van driver, bringing in approximately 14,500 taka (approximately €102) per month. Before the Healthy Village Urban (HVU) programme began working in her community, no one had reached the family with information about nutrition support or the possibility that Rajin’s cleft lip could be treated. In many communities in Lalmonirhat, congenital conditions like a cleft lip carry stigma and are often accepted as fate — the belief that treatment is impossible or unaffordable keeps families from seeking help even when they sense something is wrong.

Fensy began attending courtyard sessions in October 2023. These sessions brought caregivers together for practical learning on nutrition, hygiene, and child health, and used home visits and personal invitations to reach families who had not previously engaged with health services. When Afrin measured Rajin and found him in the red zone — severe acute malnutrition — she followed up at home and found his condition worsening. He had a fever and diarrhoea. She referred the family to a clinic the same day. Rajin then received specialised nutritional care at the hospital’s dedicated unit for children with acute malnutrition.

At home, the family built a hygienic latrine, cemented their tubewell platform, installed a motor pump for safe water, and set up a handwashing station. Fensy began washing hands before every feed and preparing nutritious meals for Rajin, including khichuri, a traditional Bangladeshi rice and lentil dish commonly recommended as complementary food for young children.

Rajin’s growth chart tells the story month by month. At eleven months: 5.2 kg, severe acute malnutrition. At fifteen months: 6.6 kg, moderate malnutrition. At twenty-one months: 7.8 kg, on a healthy growth curve. The progress came from surgical treatment, nutrition support, and improved hygiene practices working together — not any single intervention on its own.

The costs throughout were a real strain. Medical fees and WASH improvements stretched a tight household budget. And stigma had meant the family did not reach out earlier, even as Rajin’s condition worsened. These barriers — fatalism around congenital conditions, financial pressure, limited access to information — are not unusual in Lalmonirhat, and they are what the programme’s community outreach and dialogue work is designed to address.

Fensy now co-facilitates courtyard sessions in her community and encourages neighbouring mothers to set up handwashing stations at home. Rajin continues to be monitored through the programme’s growth tracking system.