Category Archives: Dhaka

Women and BRAC

Last week, a friend and I braved the Eid traffic to visit a colleague’s wife who works in the Gender Specialty unit in BRAC. We got lost, of course, which made getting to the final destination that much better.

It was interesting to hear what BRAC is doing on the issue of women’s rights and equality in Bangladesh. This visit is also uniquely timed; news of women committing suicide over harassment has been dominating the news over the last several weeks. It was only earlier this month that Bangladesh adopted the National Women Development Policy with a provision for equal share to property, employment and business for women.

Bangladesh has made some strides in women’s equality, but there is still so much more to be done.

Another anecdote about BRAC is that from its top floors, you can see Dhaka spread out before you. Covering an entire side of the landscape visible from the high windows is Korail Slum (one of ~7 big slums in Dhaka). If you can’t tell from the picture, the houses are actually built on water, held up by stakes, with tin roofs and walls.

The views from the top floor of BRAC, the largest NGO in the world, overlooking Korail Slum

My friend and I were so taken aback by the sheer size of it. How could we have missed something so big? The affluent districts and water almost circle it completely. In fact, the divide couldn’t have been clearer.

Korail Slum and the beginnings of affluent Benani across the water

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Visiting Family Health International

It’s amazing how much public health has helped me make connections in Bangladesh. Two days ago, I decided last-minute that I wanted to try to visit Family Health International (FHI) in Gulshan-1. I left work right around 4 PM, with the full expectation than when I arrived at their office, they would be closed. I was right. The office was empty. I went up to the counter where a man was sitting and introduced myself as a public health student from UNC- Chapel Hill, right down the road from the international headquarters for FHI. The man, with a kind smile told me everybody had already left work early because of Eid. Understandable. I asked if I could just take a look around, and the man nodded.

Like the obvious nerd that I am, I took out a pen and paper and started to take notes on some of the published material they had on their shelves. What can I say? Their work especially in HIV/AIDS monitoring and evaluation mesmerized me. I have always been a huge fan of FHI, but it was just entirely different seeing the models at work (well, kind of) that I had heard so many of my guest speakers talk about. After fifteen to twenty minutes of this, the man at the counter then called someone and talked to them on the phone. A few moments later, another gentleman came downstairs and introduced himself as the Director of FHI. He had stayed behind to work a little longer, and they’d phoned him upstairs to tell him about a student that was just really interested.

He took me upstairs to his office. As we walked, I noticed that beautiful facial portraits of some FHI beneficiaries covered the walls, labeled with their “name,” age, occupation (many sex worker or IDU), and one or two lines of their story. What a way to arouse inspiration in the workplace.

The director and I ended up talking for almost 2 hours about their current services and programs regarding STI, STD, and HIV in specific populations. It was absolutely phenomenal! I love their program structures, which are very multifaceted in nature. As I was leaving, I mentioned Friendship’s own findings of increasing incidences of STI and syphilis on the chars, and if there was any chance of information exchange or collaboration between Friendship and FHI. He gave me his card, smiling, telling me that they “would love to help with capacity-building.” YES.

Check out this success story of Pahari, a hijra or transgender sex worker who greatly benefited from FHI’s Shustha Jibon (Healthy Life) Program.

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On brain drain and innovation

Several weeks ago, a colleague and I were sharing a rickshaw ride home. We conversed on the complexities of development in Bangladesh, of Friendship and of what we had seen and experienced since our arrival. Following the flow of the conversation, I asked: “Well, what is next for Bangladesh? What are their choices, what should they do?”

We started talking about how the Bangladeshi government might plan to shape policy around benefiting and preparing for out-migration. We agreed that this idea is realistic only to a certain degree, but also reflected on how out-migration is almost always associated with brain drain (assuming that those who are higher on the socioeconomic spectrum are usually the ones who have the opportunities to move and live abroad). This association is often one of the first points raised in migration debates, and one that is not really backed by any micro-evidence of what it is these migrants might actually be doing. As in, to what extent does “brain circulation” actually happen, if at all? At what levels do remittances occur? Are migrants actively engaged in knowledge transfer about study and work opportunities abroad?

Perhaps the most interesting part of this is that those countries which keep their best and brightest inside their borders do not necessarily show impressive rates of growth and innovation (North Korea, for example).

Which brings me to my next point – my colleague said that she believes the reason that Bangladesh is and will remain resource-poor is because “there is no innovation here.” My initial visceral reaction to this was pretty intense, to say the least, but I wanted to write just so I could organize my thoughts on why I disagree with this statement.

i) We need to stop defining innovation from our Western point of view. Bangladesh is its own country (and one that is just 40 years old) and will undoubtedly create and shape its own story. We cannot expect our own European and American models for growth to apply to all other countries.

ii) Bangladesh is often referred to as the Silicon Valley of Social Innovation. Think about it – revolutionary organizations like BRAC and Grameen Bank came into the world from this country. The loudest critiques of Grameen’s micro-finance techniques, and thus strongest alternatives, also come from this country. Again leads me to beg the question, by whose terms are we defining innovation? From a public health standpoint, Bangladesh has achieved in just 20 years with its population growth rate what the US and Europe barely achieved in 200 years. This is a result of health marketing campaigns, BCC, IEC, which all requires a certain amount of innovation.

iii) If anything, Bangladesh just doesn’t have the infrastructure necessary to support the mass scale-up of innovations we might envision happening elsewhere. There’s a certain amount of time and energy lost in cultivating the innovation that’s already there, because the fundamentals of statistics, monitoring and reporting are missing. This doesn’t mean say anything about the Bangladeshi people’s ability to innovate, just that the country is in the middle of the taxing and continuous process of building a system to make innovations operational.

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On the field again

*August 13, 2011

Our bus from Dhaka to Gaibandha lasted about eight hours today. We tumbled north through the narrow, moldering highways that connect this part of the world to the rest of Bangladesh. As a fourth-timer on such buses, the constant honking and fierce rocking from side to side no longer bother me. As we wobble and sway past rice paddies, quaint villages and verdant countryside, I pretend it’s all some sort of sweet lullaby and this chimera eases me to and from sleep.

From the onset, I can already tell Gaibandha is better off than Chilmari, the region of my first field stay. In the city center of Chilmari, dirt-floored convenience stores, metal roofed cook shacks, one-story makeshift shops and kiosks with crumbling foundations and paint line the streets, whereas in Gaibandha, we strolled past numerous fabric shops, handicraft shops, and shops that even sold TVs and motorbikes, that look better-maintained, more diverse. Gaibandha just seems livelier, too. After iftar at the Friendship Gaibandha office, we joined all kinds of hawkers and pedestrians on the streets, joining a throng of locals going for their evening tea. Actually much of what I know of Gaibandha comes from constant news reports of extreme flooding in this area over the past several weeks.

The purpose of our field visit, scheduled to last for five days, is to validate the monitoring tools completed so far – more precisely, our service checklists for the FCM’s one-on-one family planning counseling, for the uthan boitak or the community health meetings that the FCMs conduct, the checklist for the physical set-up of the satellite clinics and finally, our antenatal and postnatal care counseling. Tomorrow, we’ll visit a couple of chars to validate the tools on-site, and assess whether we are indeed where we need to be (in the ball park). In two days, we have a scheduled meeting with the health program managers and paramedics to go through the tools. Then, we’ll return to the chars for another round of validating and feedback from the on-site health workers and paramedics.

As our group walked around the city center after evening tea, I couldn’t help but ponder how fast time has flown. I’m proud of what we’ve done with this project, despite its ups and downs. Hopefully, our conversations with the field staff will make the tools that much better, that much more relevant. At the same time, on a more personal note, the fact that this might be my last time in the field and among the chars is a heart-breaking kind of realization, and one that resonated within me unstoppably tonight. It certainly makes my final departure from Bangladesh in three weeks that much real-er.

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Celebrating Janmashtami and some reading

Today marks the birth of Lord Krishna, which means it is a holiday for us at work! It gave me a good opportunity to sit back and do some background reading on traditional healers in Bangladesh. Like I’ve said before in this blog, it seems that it’s pretty widely recognized that these informal health providers have no formal training or education. Mostly, they get their knowledge of medicine through their families – the knowledge trickles down from one generation to the next. These healers don’t usually receive any fees for their treatment, just the price of medicine. If a patient does not have the ability to pay the cost of the medicine, they are exempted, which is another reason for the healers’ popularity in their communities.

Bangladesh has a severely limited public healthcare budget, so the public provision of subsidized healthcare is also limited. Furthermore, in Bangladesh (similar to many other countries in the Global South), there is a persistent shortage of skilled healthcare professionals who are not distributed optimally in rural and semi-urban areas.

Thus, village doctors and healers fulfill a very obvious need. At Friendship, I am wondering how we can better use the existing workforce at the primary healthcare level in these char communities? How do we engage village healers and form a connection between them and Friendship, or them and the formal system? And lastly, how can we creatively link and connect the informal and formal sectors (referral processes, capacity-building) to provide huge returns of healthcare to the rural masses in Bangladesh?

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How to Handle Environmental Refugees?

It’s no big secret that Bangladesh is on the frontline of countries to experience mass migrations as a result of global warming and rising sea levels. This means higher tides in the Bay of Bengal. The result: trillions more liters of water sloshing over a country where three river deltas meet, depositing and taking away billions of tons more of its usual sediment. I’ve heard so many of my colleagues and friends say that each year it seems that the floods caused by monsoon worsens. This year is not an exception. My friends also say that weather patterns these past 20 years especially have regularly produced floods that should otherwise occur just once every 50 or 100 years.

The fear caused by such things has inspired an approach that has rapidly infiltrated into the NGO climate in Bangladesh, with many organizations adding “increasing disaster management and coping capacity” and “disaster risk reduction and planning” to their core goals.

Bengali char-dwellers will be one of the most affected group of people on Earth as the dangerous symptoms of climate change take hold. I have been thinking a lot about next steps – how can NGOs effectively address the char-dwellers’ landlessness in the face of diminishing and changing land? Where will these people go? Dhaka is growing exponentially, they say, because a lot of day laborers in the chars and affected rural lands come to search for jobs and  move their families to the city. Migration out of the country will likely increase as a result of deteriorating farming and environmental conditions all over Bangladesh. A compelling take by the IOM during a recent Climate Change and Migration Policy Dialogue:

“Environmental migration is often portrayed as a failure of adaptation and a worst case scenario. However, while migration can be a manifestation of acute vulnerability, it can also represent a logical and legitimate livelihood diversification and adaptation strategy that has been used for millennia and is likely to be of growing importance in the future. Migration can help reduce risk to lives, livelihoods and ecosystems, contribute to income diversification and enhance overall capacity of households and communities to cope with the adverse effects of environmental and climate change.”

With that in mind, the Indian government’s decision to build a USD $1.2 billion barrier across 2,500 miles of the India-Bangladeshi border (said to rival the Great Wall of China) is understood here to be a preventative measure, linked to the fear of an influx of Bengali environmental migrants. The Border Security Force (BSF), India’s version of Border Patrol, is currently assigned to patrol the barrier. Alarming, since reports in 2009 surfaced that hundreds of Indians and Bangladeshis alike are killed by the BSF indiscriminately along the wall. In fact, read this recent report by Human Rights Watch on new killings along the border just this year.

It’s clear that if these reports are true, treatment of Bengalis and others at the border is a breach of human dignity and a violation of their human rights, whether they are environmental refugees or not. And it also seems to me that more than finding palliative solutions, serious discourse on an international scale should be instigated to shape our migration policies to help those afflicted by environmental changes – obviously, we should share the “coping.” Right? How do we encourage governments to be accountable for the treatment of environmental refugees now and in the future?

Anyway, just some quick thoughts as I continue to learn more and more about the country that seems to be facing a very trying future. To the field for tool testing for about a week (EEK!), so more updates to come then!

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It’s Communication, Stupid!

The last week has been filled with much research, compilation, writing and tool development in Dhaka. I visited ICDDR,B, an internationally-renown research institution in Bangladesh, to check out their newer and grand Monitoring and Evaluation department. Sareeta Apa and I plan to schedule meetings with experts in the department in the weeks ahead to seek their input on strengthening monitoring culture in Friendship. On my own, I also paid a surprise visit to BCCP, a non-profit communication NGO started in 1996 as the successor to the Johns Hopkins Bloomberg School of Public Health Center for Communication Programs. By surprise, I mean I literally walked into the center and asked to speak to someone because I was a public health student. The term “public health” was very welcome indeed and the director himself came down to speak with me.

I had passed the center many times during my first week in Bangladesh because of its proximity to my house, but when I visited it, it had been closed on holiday. Later on in the field, I noticed the Center’s logo in the right-hand corner of almost all of the posters and visual aids that Friendship’s community health workers used during uthan boitak or community health meetings. I had promised myself to follow up.

The visit was very insightful and I got a personal tour of its facilities. BCCP is committed to providing high quality services to audiences in rural and urban settings, helping them adopt positive behavior towards various social issues, such as education, anti-trafficking, agriculture, democracy and local government, terrorism, and social development. Thus, BCCP helps develop communication strategies, but also implements, monitors and evaluates them, along with designing materials and developing community-based, mass media, BCC (Behavioral Change Communication) and Inter-Personal Communication (IPC) interventions. The Center seems to be very involved in capacity-building as well, training key personnel of relevant institutions in strategic communication, message development and development of Entertainment-Education programs.

The Center’s work verifies what I have been learning in this internship thus far, as well as at Gillings and my own dabbling: the process of communication is intrinsically linked to the success (or failure) of public health interventions. It seems to be a repeating pattern in my public health education.

Social marketing oriented towards public health began decades ago, but it wasn’t until the mid to early 1990s that HIV prevention and family planning media campaigns started getting major press for playing a pivotal role in encouraging use of contraception and safer sexual behavior around the world. (Check out this 2003 paper by our own Carolina Population Center based in Chapel Hill, showing that higher exposure to BCC messages in mass media was associated with higher contraceptive intentions and use in Uganda). Collaborations between schools of public health in the United Sates and abroad increasingly involve media campaigns (check out this one in Vietnam!).

Everything from the impact of celebrity involvement in the AIDS pandemic to managing uncertainty and fear in the face of swine flu, the impact of communication spans the entire spectrum of our activities in public health. And that’s not even the end of it. The Center for Communication Programs at Johns Hopkins, the Population Media Center, programs like PRACHAR in India show the extent and vast coverage of this phenomenon.

Which begs me to ask: we communicate, but do we do our best listening? I know Social Change isn’t linear, but true change seems difficult to attain if these interventions aren’t at least bilateral or participatory, even at the macro scale.

As a dynamic process that unfolds over time, communication geared towards public health should involve networks to harness the insight and knowledge of the message “recipients” to aid in its own evolution. Ideally, the “recipients” should somehow be directly involved in the actual creation of the communication material. I’m reminded of Dr. Bonnie Duran’s speech at the Minority Health Conference this year, not-so-softly warning that evidence-based interventions may be a form of forced acculturation. For global public health experts to strike a fine balance between taking full advantage of communication and mass media, while at the same time remaining true and close to the recipient communities seems a tremendous task, but one well worth the attention.

I’m almost imagining real-time feedback that includes more than just message recipient or beneficiary numbers, but provides a platform for interpersonal communication amongst the beneficiaries and to the message disseminator. Then, the question becomes how to develop, implement and sustain such a network in low-resource settings?

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In Honor of Harry Potter: Top Ten List Why Bangladesh is Like a Page out of HP

*July 16, 2011

I know I usually try to write a bit more seriously, but everyone and anyone who knows me can attest to the fact that I am an avid Harry Potter fan. And seeing as how I missed the premiere yesterday, aka the end of a very notable era in my life, I thought I’d write a blog post in honor of this special occasion.

  1. Just like you need an entry letter of admission to Hogwarts, you need an entry letter in order to be admitted into Bangladesh.
  2. I felt just like Harry did when he got his first set of robes, when I picked up my first set of salwar kameez.
  3. The weather is as temperamental as the stairs of Hogwarts castle.
  4. “Of course it’s happening in your head, Harry. But why on earth would that mean it’s not real?” I hear car-honking all the time (I mean all the time), to the point where I think now it’s just happening in my head. But it’s still real!
  5. Remember the Knight Bus, the triple-decker, purple bus that quite literally squeezes itself through traffic? This actually happens in real life, right here in Dhaka. You think your bus can’t fit through those three cars in front of you? Think again.
  6. I swear someone is carrying a Deluminator around here. Why else does the electricity go out five times a day? And no, lumos does not help.
  7. You don’t choose the rickshaw, the rickshaw chooses you.
  8. Can’t find Platform 9¾? Welcome to my life of trying to find most places in Bangladesh. You’ll see Road Two, Road Three, Road Four, and then suddenly Road Eight. Where are Roads Five through Seven? Except walking through a wall to reach my destination doesn’t work so well for me here.
  9. I sometimes wish I could take a sip of some Polyjuice Potion, so I wouldn’t stick out so much.
  10. Everyone I’ve met here emits the incredible hospitality and warmth of Molly Weasley.

Just a list of things to show my appreciation for all of the small idiosyncrasies and magic happening right here in Bangladesh.

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The Office Life

June 28th,2011**

**I was on the field from June 29th-July 8th and had little internet juice to upload information, but still (feebly) tried to capture my experiences by writing. I will post retroactive blog posts from my time in the field every day for the next 5 days. Enjoy 🙂 

My incorporation into Dhaka and office life has been going smoothly over the past week, mostly because of the warmth and liveliness of my colleagues. Lately, they’ve started inviting me to have snacks with them in a small snack shop downstairs, a sweet retreat in the stretch of morning work hours where they talk, poke fun, and fill me in on Bangla culture. During these sweet retreats, I’ve re-realized partially the reason I connect so well with the people here is because their warmth is one that is all in all very familiar. Though the vernacular is not the same, Turkish dialogue shares many identical tones and gestures of conversation. In fact, some things are so similar that at times I can replace the Bangla with my own native tongue, cross-check and find that I am right on par with my guess of what the conversation’s about.

Acclimation to Dhaka life has also been trouble-free. Just the other day, I made my first river crossing in a city, when the street in front of the language school completely flooded after an hour of heavy monsoon rain. I tried waiting with some friends, got tired of waiting, and waded in knee-high water to find a rickshaw to take me back across town. Welcome to Bangladesh!

As an intern, I’ve been lucky enough to participate and observe some strategic planning meetings for Friendship over the past few days, which has helped me to better understand the composition, values and direction of the organization. The last week has also been a period of refining my internship role and desired results, with joint meetings with my mentors, Sareeta, an MPH, and Dr. Naheed, who works with health services offered at EFH, the boat hospital in service currently in Chilmari (Made a Google map of my hang-out locations. Email me if you want to see it in detail!)

Chilmari towards the North, with Dhaka as the blue pin towards the South

As a result of the conversations, my mentors and I have decided that for the sake of sustainability and actual utilization of my work, I will be working on evaluation and data collection around our community-based health services. Additionally, I’ll help create community-level monitoring tools for our satellite clinics, rather than completing a research project on health-seeking behaviors, which may be needed but not immediately relevant for the organization. I’m extremely happy at this turn of events because it ensures that I will serve a meaningful purpose over the next few months and the output of my time here won’t just end up sitting as a file on an office computer. A lot of what I’ll be doing will still be research-based, but I will also be meeting with a myriad of stakeholders that make our community-based health services what they are – health program leaders at the head office, paramedics, FCMs (our version of Community Health Workers), paramedic assistants and regional supervisors – so that we create our tools with the feedback of relevant experts and the communities themselves.

I know I have so much to learn over the next few months, and indeed I think I’ll actually be learning a lot about how to learn. What’s great is that I think Friendship will be learning and capacity-building right along with me; it’s my humble goal to leave Friendship at least a smidgen better than I found it.

I also started to take Bangla classes at HEED Language Centre (link under “Bangladesh Info”), but chose to sit out for this month, as I’ll be in and out of Dhaka with trips to the field. I would recommend this center in Banani to anyone wanting to learn Bangla as my first few classes were great.

I will be leaving for the field for a while tomorrow! Wish me luck!

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Dhaka jabo

Close your eyes. Imagine a booming city, busting at the seams, so full of life and vigor, that its warmth encapsulates you in its arms. There’s nowhere else in the world where all of your sensory buttons can be pressed this simultaneously. The sight of colorful rickshaws carrying up to four passengers, buses, and people on the street is the first thing to strike you. You’ve never fit so many people per frame of sight. And sounds match the life of the streets – there is never a quiet moment here. Cars honk constantly, more in a way to say “hello” than to say, “get out of the way,” (sometimes very long hellos), and the call to prayer adds graceful beauty. The cool, fresh wind preceding the daily rains of the monsoon brings relief to your skin. Honestly, parts of Dhaka don’t smell very good, a mix of trash and exhaust, but step inside any house and Bengali food spices greet you. The taste of these spices, of dal, of fresh mango juice, is just exquisite.

View from my room window near Friendship

Mughal rulers made Dhaka the new capital of Bengal in 1608, and it stayed so until 1717 when the capital was relocated to West Bengal. Dhaka was almost reclaimed by jungles until the British took control of Bengal in the 18th century. In an effort to make political ties with the Muslims in East Bengal to counterbalance the growing power of Hindu elite in the West, the British designated Dhaka as the capital of East Bengal after the Bengali partition of 1905. The separatist Muslim politics that plagued Indian politics for several decades afterwards began here. The British rule finally came to an end in 1947, and Dhaka was proclaimed capital of East Pakistan for 24 years, though it was the center of agitation against Western Pakistani rule during that time. After nine months of the Liberation War, Bangladesh was born in 1971. So came Dhaka, finally the capital of its own country.

Today, Dhaka is a city of unparalleled dynamism, and home to the most genuine smiles I have ever seen. My first day was full of introductions at the Friendship Head Office, a magical place with glass separating different departments from one another. It seems such an open and welcoming place to work, with fish-tank meeting rooms. I am so looking forward to spending time here.

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