Last Char Visit

*August 16, 2011

The boat carried us through the smooth water, to our last char, Kharjani Char. The char is relatively new, only about two and a half years old. Because of this, a permanent FCM hasn’t been assigned to this char of approximately 85 houses and over 700 people above the age of 18.

However, we picked up an FCM from a nearby char to join our crew of health manager, paramedic, translator, and Sareeta Apa on the boat. The FCM would aid the paramedic and conduct the uthan boitak (health meeting) today.

The clinic, a small shack with a side of reed, was only half-full when we arrived. There was a baby on the ground in the front, playing with a piece of trash. A small boy ran past me, brushing past my legs. On his chest, there was a burn mark extending the length of his bottom rib, to match the red color of his shorts.

Later, as I sat with my checklist at the uthan boitak, watching the FCM show women family planning posters, I noticed an old woman about five feet in front of me. She had a kind face, but worn with years, unhappiness deeply planted in her eyes. Protruding from her orange sari, below her chin, was a lump, bigger than the size of my fist.

I leaned over to Sareeta Apa, and asked her if she was here to get it checked out. After the meeting, as patients waited in line to be seen, Sareeta Apa asked. The patient was at the satellite clinic to seek care for headaches, not for the tumor, as she had already been living with the condition for more than three years. Can you imagine? Three years without medical support.

I asked her, through my translator, if she had any pain or trouble swallowing. She had none.  But if it had grown to this size in 3 years, there was no telling when it would reach the point of obstructing her esophagus or larynx. The health manager intervened, telling the patient that we had a hospital where a simple surgery could fix her problem.

She was insistent, shaking her head from side to side. She also said she didn’t have the money to access the boat anyway. As she said this, the two or three young couples who had surrounded us to watch the situation unfold started laughing. I asked what was so funny, and the health manager answered, with a frown, that people were telling the patient she shouldn’t seek treatment because they’ll cut her open and she’ll die on the table. She’s old anyway, there’s no need to spend resources to fix her. Besides, it’s a curse from Allah. There’s nothing we can do to fix it.

I felt my cheeks get red. The discouragement from her fellow community members made her flee the scene as soon as she got her medicine for headaches. She had two sons who kept their distance, I was told. Additionally, I was informed that if she had daughters instead, they would be oppressed and ousted by the community, just like their mother.

Two things were at play here: 1) the fear and social taboo surrounding getting medical treatment in the form of an operation, and 2) cultural beliefs that the sickness was Allah’s will, and that’s it. Both are things that can be addressed with medical treatment coupled with educational outreach. It’s hard for communities to disprove the legitimacy of such operations and treatments once they see their neighbors healed. The hard part is getting those neighbors to get treated in the first place.

What a last visit. I don’t remember feeling this sad, disappointed, and hopeless in a long time. But one thing is for sure – this brought home for me the vitality of having services in communities in addition to our hospital boats. We can create all the hospitals we want – in planes, boats, buses – but if these health facilities are not used by those that they are geared to heal, then our work is wasted. Uthan boitak, our community health meetings, can be used for adding the roots needed to get these patients to view their health in an empowering way. The capacity is there, we just need to scale up, focus, and fortify.

I head home tomorrow morning. The bus will be a good time to process some of these thoughts and transform them into something positive – namely, a rant on the importance of community outreach in my internship report. I should have plenty of time, as bus strikes have gripped the nation by storm right before Eid.

Ownership

*August 15, 2011

Sareeta Apa and I had the first part of the day off. It was spent beautifully. We followed our old routine and took a rickshaw ride around Gaibandha. It was an adventure, at the surface, to shop for fruit, but our true unspoken motive was to take in the hidden parts of this bustling little town. We visited the train station, walked rock paths lined with old trees, next to quiet green ponds.

Beautiful scenery

We even visited a small Hindu village inside Gaibandha, which boasted architecture starkly different from the colonial-style buildings we kept spotting. In the center of the village, we entered a Hindu temple where a group of men, sitting on pillows, were debating in a circle. Sareeta Apa asked if it was okay if we could go in, and they smiled welcomingly. What a serene place – so much of what we saw was handmade. We hesitatingly exited the temple to finally head back to the field office for our meeting later in the afternoon.

Poking around in hidden Hindu temples

Back at the field office, the director of community-based programming started the meeting off with an overview of what monitoring would entail at the field level and the expected outcomes. As he talked, I noticed there was a lot of nodding (my translator was studying for exams today!) among the five field officers and paramedics, four of which had been at our first meeting in Gaibandha in July.

As we talked, some voiced concern that monitoring and focusing on quality might make Friendship compromise on the quantity, or vast access, of health services the organization offers. As in, giving more time to each patient might mean more patients turned away. This is a significant concern and one that cannot be dismissed without discussion, but if Friendship operates with the goal of improving community health, there are things we can do through monitoring to maximize our potential without having to compromise on the number of patients we see. The good part of the meeting is that it allowed us to lay down some additional concrete benefits of starting a monitoring culture within Friendship, per request of the meeting attendees.

i)  Creating a monitoring network within Friendship, where different tiers of field workers monitor and provide feedback to each other allows us to learn from each other, improve our services, and recognize/celebrate good performance.  One of the most eye-catching results from the situational analysis showed a lack of feedback loops, or unidirectional feedback. A network allows us to have “loops of feedback” that gives as much information back into the loop as it takes.

ii)  We can present these tools not only as accountability mechanisms for the quality of our services in addition to the quantity, but also to prove our liability to donors and interested parties alike. And honestly, no matter where you are, quality cost$ le$$ (don’t let the dollar signs fool you – costs include time, precious human capital, suffering, and losses to the organization when patients aren’t treated to the best of our capacity).

iii)  Monitoring and supervision allows us to create a paper-base, built-in documentation within our health system, which Friendship can use as a basis for future evaluations and impact assessments of our satellite clinic services.

What I particularly liked about the meeting was that we received a lot of questions and concerns from the field staff, which indicates that they’re actively thinking about all of this. A weakness of the meeting was that as we talked about our monitoring tools, the actual tools sat in the middle of the table, mostly untouched. I had envisioned a meeting where we would get feedback from the group for each of the tools, but alas, we spent most of the meeting actually convincing the field staff that monitoring is a good, worthwhile, and valuable thing. I would have liked to be a bit farther at this point, but at the same time, to have the director give the meeting, voicing some of the very points he had contested weeks ago, was a small victory for me. We attained ownership today, which I hope will be the foundation for Friendship to build upon the outcome of my internship and my time here.

Char Visits

**Retroactive posts because of low internet again, 2 more to come tomorrow!

*August 14, 2011

Today marked our first day of validation among the chars. We are very lucky that the director of community health services from the Head Office is accompanying us these next few days as well. He brings a wealth of experience and knowledge, about Friendship and about our health services on the field, that neither Sareeta Apa nor I possibly match. His ownership is a pivotal part of this project – without him, we don’t have leverage or the investment needed to finalize and distribute the tools, and advocate for monitoring and evaluation culture, in general.

We were also accompanied by my translator today, a kind-faced young fellow who ended up not only translating for me, but also eagerly took on the role of cultural ambassador, pointing to fish farms and different crops, to villages “where victims of river erosion live,” to bridges destroyed by floods and newly rebuilt. As we drove down to the riverside and hunkered down on the boat (it would take us 3.5 hours on the water each way today, excluding FCM pick-up time from different islands), he leaned over to tell me this was his first time on a boat like this. I smiled, asking: “Why? You live so close to water!” His answer, delivered with a nervous smile: “I’m so, so afraid of the water!” A part of me felt for him, especially when his mother called to ask if he was wearing a life jacket. In that instant, I realized a newfound appreciation for how far I’ve come with my own parents. They still worry, but I also think I’ve set the bar high enough that I can picture my dad being a bit disappointed if I didn’t take on some of the adventures that have come my way. My translator rose above, though, even coming with us to the roof of the boat from time to time.

A gray sky, with periodic bouts of rain, accompanied us on our long journey through the river. We visited two chars today, Mollarchar and Shonnashir Char, where satellite clinics were taking place. Both are stable chars that have had a lifetime of 15 to 20 years.

Because I had a translator, we were able to effectively delegate validation of the tools as the satellite clinic took place. The health meetings (uthan boitak) were delegated to me. On our first char, the FCM had just given birth, so instead the assistant health manager gave the meeting on fever and diarrhea. I pulled out the tool, made up of about fifteen benchmarks, and listened to my translator as he transliterated the lesson. I observed the audience, participation level, and the relationship between the manager and the attendees. One by one, I could see the components of the checklist coming to life! It was an amazing feeling and happy warmth rushed through my body.

The same happened on the second char, where this time the FCM gave the uthan boitak to some attendees. The tool also incorporates a check-in with one of the meeting attendees, a short interview to assess quality conducted on a private basis away from the satellite clinic. On both chars, my translator helped me to ask questions to women beneficiaries regarding the topics discussed, such as if the beneficiary is planning to, or has already used advice that she’s learned at the health meetings, and if she feels comfortable asking questions during the meeting. This went smoothly, as well, with one of the women even saying that because of the health meetings, she now knows how to make oral saline solution at home for her children whenever they have diarrhea. Perfect. That’s what we want!

I noticed some points of dissonance with the checklists, though – for example, the culture of taking attendance had disappeared somewhat from the meetings and needs to be brought back so we can track community involvement.

Once we were back in Gaibandha later on, a check-in with my supervisors revealed that there’d been frustrations about the distance traveled versus the actual amount of time spent at the clinics validating (about an hour each). I didn’t have any control over this and though I agreed, the selfish part of me enjoyed each of the seven hours I got to gaze at the gurgling water of the river, the numerous chars new and old, green and amber.

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.

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?

Why some call me Burcu Bhai

*July 9, 2011

On the mainland right outside of EFH each day, a sizable group of men gather to play football (that’s soccer for my American friends out there) right around sunset. Some of the players are from EFH and others come from around the char. In a weird way, I kind of envy them. More than merely just watching sports, I love participating, even though I may not be very good. I’ve thought about tossing the ball around with them several times, but each time, chose to stay away, reasoning it would be weird to socially insert myself this way. I continued watching and cheering from the dock of the boat.

However, today, I was watching the daily game on the grass with several workers from EFH and behind us, a scene started to unfold. A boat landed, several dozen men got out, and instead of the boat gliding away like usual, all of the men circled it and worked to lift it out of the water and onto the mainland. They chanted as they pushed, drawing attention from everyone surrounding them. I commented how I wish I had brought my camera. One of my colleagues, Hasib Bhai, had come ready – he flipped out his camera phone and started capturing the spirited event, jokingly stating that I had failed as a bideshi and that he wouldn’t share the footage.

I felt odd as a spectator when those I was watching were working so hard. I voiced this uneasiness, too, telling Hasib Bhai how I wish I could help the men. He said, half-teasingly, “Go. Do it. Go and help them.” I thought, a football game is one thing, but collective effort is another.

So I joined in and Hasib Bhai ended up sharing the footage with me. After the push, I got several big, appreciative smiles from some of the men, if not for my actual power, then just for my effort. I think my mom and dad will think it’s funny that my colleagues ended up calling me “Burcu Bhai” for several days after this.*

*Note: The footage is from a camera phone, so you may want to adjust the volume as you’re watching.

Just something fun! Here’s a recap…

• Minute 0:20: Heated debate about boat-sliding strategy.
• Minute 0:50: A bit of an awkward moment. All the men are probably thinking, “Umm, what?” or “Did that just happen?”
• Minute 1:09: Kind words from Hasib Bhai, warning me to be careful because the boat will be slippery.
• Minute 1:55: Subtle (or maybe not so subtle?) recruitment of men from one side of the boat, to mine.

*FYI- Although this might be a little late in the game, ‘Bhai’ is generally a term used to reference other men in a respective manner, while ‘Apa’ is used in the same way for women.

A Day Off

*July 6, 2011

The past several weeks have flown by with the same resolute wind that blew me to Bangladesh in the first place. But it’s amazing how different things look when you take a step back.

I had my first day off with Sareeta Apa today. We traveled to Chilmari and took a rickshaw to drive us around the village of Machabanda, a serene place surrounded by clusters of rice fields, divided by elevated dirt roads. Sareeta Apa wanted to walk, so two young girls offered to lead the way to a beautiful spot in between two fields, next to a small stream. It was there Sareeta Apa and I sat in silence, facing a vivid scene of goats and fishermen and water and trees, as bubbly monsoon clouds flirted with the sunset light in the distance. One of the most flooring things about being in the chars is just how tangible the silence is, especially after the bedlam of Dhaka.

Silence amidst beauty in the chars

We weren’t sitting in silence for long, as word spread like wildfire around the village that a bideshi (tourist) had arrived. At one point, I counted 18 children surrounding us. I also wasn’t doing my best at not attracting them, as I had started to practice some of my Bangla with the two girls that had led us to this spot. One of the girls that later joined us was 17 years of age. Her face was just ebullient, though it also revealed a maturity that I’m certain I didn’t have when I was 17. When I told her I was from Istanbul, she said one day she would come to my country and find me. She extended her hand, shook mine, and put her hand to her heart. A Bengali way to make a promise, I’m told. I’m a big fan.

The tone of the conversation makes it so easy for me to understand what they’re saying and asking, which makes it even funnier for Sareeta Apa when I don’t know how to respond. When Sareeta Apa asked why everyone was so intrigued by me, one of the girls answered that usually when bideshis come, they just sit the kids on their laps and give them money. She says no one has ever tried to speak to them before.

Proof that water is incorporated into all aspects of Bengali culture

During our visit, we also encountered a group of children racing toy boats – their hull made from banana leaves, their sails from thin plastic. No wonder I’ve seen the most beautiful boats I’ve ever seen in my life here – everyone starts training really young!

This boat, and others like it, presents the main method of transportation among the char-dwellers

We traveled back home on a lovely road called Dhormopul, sides lined with long, agile trees. Among rice fields that graced our view from the tuk tuk (one step up from a rickshaw, open and motorized), we also saw many brick guilds and fabric factories.

View from our tuk tuk

On the final boat home, I rode on the top like I have so many times before. I gazed out at the chars at night. It’s a scene devoid of any sort of electrical lights as far as the eyes can see, with only the stars to light up the view.

Allies on the Field

*July 5, 2011

I talk a lot about geographical barriers in the chars. My trip today to the Gaibandha field office is a perfect case in point of how arduous it can be to travel from Point A to Point B. Sareeta Apa and I left EFH early in the morning for a half-hour boat ride to the mainland. From there, another 20 minutes with a motorized rickshaw took us to the stop where we got on absolutely the most full public bus (a fun and funny experience all at the same time). We spent about an hour on the bus, and afterwards, took a motorcycle to the Gaibandha Field Office. Friendship was recently voted as the best-performing NGO in Gaibandha for 2011 (more information here).

We followed the same structure of the health meeting we had in Chilmari, with the main purpose of trying to identify the strengths and gaps in our current monitoring and supervision tools. Three paramedics, a health manager and the district supervisor attended the meeting – an impressive showing considering that today was the first day of a 48-hour hartal or national strike in Bangladesh. The strike is a result of recent political developments, namely a recent constitutional amendment which scrapped the provision for a pre-election caretaker government, making it so that elections will be held under an interim party government from now on.

Some of the best parts of these conversations is not only that we get valuable feedback from the level of the organization that deals directly with the community beneficiaries, but we also establish partnerships with the true program implementers. The significance of this cannot be understated. We leave these conversations with an overwhelming consensus that program monitoring and evaluation will help Friendship identify the problems in its programs and find ways to rectify them. The Friendship field staff are the most valuable allies we can have.

In addition to visiting the Gaibandha office, we also visited two NGOs to gain information about some of their own monitoring and progress-tracking tools. Namely, we visited GUK, which works in five districts in the North to strengthen coping capacity as climate change occurs. I was also impressed with the work of Akota, an NGO operating in Gaibandha that aims to establish sustainable livelihood with various interventions ranging from gender, justice and human rights to health, sanitation and environment.

Because of these various encounters and exchanges, I think a lot about the words that comprise my generally accepted epistome of development. It’s a constant tug-of-war in my head as I aim to answer my own questions of the macro vs. micro, quality vs. quality, collective vs. personal, what is actually possible with NGOs and what is not. I came to Bangladesh to seek clarity in some of these questions, but the obstacle of reconciling all of the parts of my experience will prove to be harder than I thought. One thing is for sure – for years, Friendship has prioritized the quantity over the quality to follow its philosophy of ensuring health access for all. My internship project is part of a strategic move on part of Friendship to review and fortify, to ensure quality access. This a daunting task given Friendship’s many arms and mere coverage, one that is made more onerous by some of the same barriers our beneficiaries face – geographic, economic, and even social obstacles that separate the Head Office from the field work.

On a simpler note, as we were leaving the mainland, we spotted a huge gathering of folks, singing in a narrow path next to a house. It’s impossible to observe anything here without attracting attention, so Sareeta Apa and I were ushered to the front to see a tradition that is a part of a Hindu wedding. It’s sights like this that make me feel like one of the luckiest people on Earth.

A truly far-flung life

*July 4, 2011

They have moved seventeen times. Seventeen. While he tells his story, his eyes make contact with mine, even though we can’t directly communicate. This man, I’ll call him “Tom” has four children, two daughters and two sons, all married. His wife, his eldest daughter and her grandmother-in-law, and a relative fill the room. We all sit on beds.

Tom tells me how all the lands he had previously owned had been “eaten by the river” and now he is completely landless because of river erosion. His family moved to the char we’re on about three years ago.

Some river erosion pointed out to me on a walk around one of the chars. It wasn’t there a few days before the walk.

He tells me he is a day laborer, even though he is approximately seventy. Even with his family’s investment in a profit-sharing cow, they make about 100 to 150 taka per day, which comes out to about 3,000 -4,500 taka monthly. To give you a picture of what that means, 1 USD equals about 74 taka.

I asked Tom when he married his wife. He answered, “Before 1974.” My heart sank. I had read the specific importance of this date. The measurement of time is different here. No one can tell you exactly when they were born or when they married. Instead, at least on the chars, events will be classified as either taking place before or after 1974 – the year that marked a most devastating famine in Bangladesh, killing more than a million. The famine resulted from the deathly mix of several factors: flooding along the Brahmaputra, government mismanagement of grains, legislation restricting movement of food from one place to another, among other failures in distribution.

We covered a plethora of topics during our conversation, from their healthcare-seeking decisions to their health care beliefs. For example, I learned that it’s widely believed that the cause of diarrhea is poison in the stomach and that barefooted-ness is a major part of maintaining health, because it maintains their connection with the earth. We also touched a bit on their fears of seeking healthcare from hospitals. The eldest daughter talked about the fear of “cutting her stomach” in a hospital to give birth to her baby. Socially, having a pregnancy that requires a hospital visit suggests that the baby is not normal or healthy. The maintenance of this normalcy is important in Bengali culture even as the baby becomes a child, as symbolized by a single rope or “tabis” tied around the stomach of the child, to prevent any sickness or disease. There are three healers or “daktars” that this char community has access to, who charge next to nothing for their services. All the women tell me they visit Friendship satellite clinics to get ANC care, but for the final birth, they utilize the “informal” community healers.

I found myself thinking about the importance of these beliefs for Friendship, because they give insight into the social embeddedness of the health-seeking actions of our beneficiaries. In a place where there are so many barriers lying between patients and services – social, economic, geographic, economic, and organizational – understanding and documenting this concurrently mixed method of seeking healthcare can only help Friendship operate more effectively in these communities.

After long, exhausting days visiting our chars (it’s exceedingly difficult to get people alone for interviews), we head back to EFH by boat at night, sometimes serenaded by the sweet voice of one of my older colleagues. Life at EFH is going very well. I’ve made some new friends!

Chars, Collection and Communication

*July 3, 2011

I sit on a bed, observing the satellite clinic. A paramedic, donning a worn white coat, sits at one of the longer sides of a rectangular table. One edge of the table is filled with medicine – various small tablets, pills, packages and boxes. The patient records, notebooks, lie in front of her. To her direct right, there is a chair for the community members to sit and tell her their grievances. Listening, she measures their blood pressure or temperature, or talks to them, and prescribes medicine.

The FCMs surround the table. One sits directly behind the patient, helping voice her precise health condition. The house itself is one of the FCMs’. I can’t help but notice an empty white bag, not far from where I am, hung on a bamboo support for the dwelling. “World Food Programme” is printed on its side with huge blue letters, followed by a picture of the Japanese flag. The family had received a ration of rice, as a “gift from the people of Japan.” What a striking situation, to get to see the receiving side.

This is my second day observing the chars and first day of official data collection on this island called Shirajbeg. Sareeta Apa and I will conduct interviews with the FCM, the paramedic, and the paramedic assistant on this char. We’ll also hold a focus group discussion with community members who attend the health meeting, lead and given by the FCM.

Shirajbeg is one of the closer chars to the mainland. It took us about half an hour to get here by boat.

The boat that we take to travel from char to char!

Yesterday, we visited Bozradiarkhata, where we tested some of our survey tools before starting to collect data. It was also on this char that I paid a visit to one of Friendship’s vocational training centers, where women learn how to weave and earn a living doing so, creating beautiful cloth.

Friendship's Weaving Center

Shirajbeg is younger than Bozradiarkhata. It’s sandier and the vegetation is shorter across the island.

Houses in the distance!

Char bank

The house we’re in has all the components of what you would envision would come with a makeshift settlement: hard-pressed dirt floors, a thatched roof and sides of reeds. The hut is small, and it’s clearly leaky during monsoon. Sides of the house are wet from the rain, with buckets strewn about to catch drips of water.

There is a growing line of waiting patients circling the house, all women, facing the heat to visit the satellite clinic (which costs 5 taka, or less than 0.07 cents). The scene is incredibly colorful. Each woman wears bright, catching colors in their saris. (I’ll really miss this about Bangladesh.) I also notice that all of the women come with at least one baby, which they casually carry at the hip. The babies are mostly undressed, except for a rope that they wear at the belly to ward off evil or malign influences. One by one, they sit in front of the paramedic, some to talk about contraception and others to get medicine for their babies. I can tell some of the children have watery eyes from fever, but almost all of the kids around me are incredibly underweight. They seem delicate; I’ve never seen bone on bone like this before.

I have also never been in a place where I am so constantly aware of different components of my identity – white, Turkish, woman, unmarried, Muslim. I have limited communication with the char communities, but they ascertain my status on some of these things pretty well nevertheless. And I’m proud to say I have mastered several key Bangla phrases, so why not use them as much as I can, no matter how ridiculous I may sound? In addition to the Bangla, I communicate in other ways, like yesterday, when a pre-teen girl and I winked back and forth for about three hours. Later today, I met the young daughter of a doctor on EFH. I drew for her a smile on a napkin, and she returned the gesture. What can I say? Like many overly naïve and idealistic travelers have uttered before me, the language of winks and smiles proves universal.

Smiles, smiles