Category Archives: Office Life

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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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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My First Wedding

*July 15, 2011

As I am ushered to the table where my co-workers and I will eat dinner, I am told that a wedding of less than five hundred people is considered small. I am also doing my best to keep my sari from falling apart. It’s a lively red and yellow and I tried to put it on myself this time around, for the first time. I succeeded only a little – the beautiful folds that Sabrina Apa had recreated only two nights ago with another sari were barely recognizable.

A dear colleague who I met just three weeks ago was so kind to invite me to her wedding, at the end of my very first week in Bangladesh. Snigdha Apa works with Administration at Friendship and has played a pivotal role in my integration into the Friendship family over the past three weeks.

So two nights ago, I attended her gaye holud, an event that takes place a few days prior to the religious and legal Bengali wedding celebration. In this instance, it was a separate event for both the bride’s family and the groom’s family. This means that only a mere fraction of the overall wedding guest list attended – people close to the bride.

In a gaye holud, the groom’s family comes, but without the groom, and brings dessert, food, holud, or red paste, among other things to the bride. Then, after the guests piece by piece feed it all to the bride, the guests enjoy a feast together. Sabrina Apa and I attended jointly, and she helped me put on the blue sari we found for the occasion. I feel so lucky to have stumbled upon such kindness!

In mid-laughter

As you can see from the picture, Snigdha Apa (in the middle) was decorated and adorned from head to toe. Even her hands were decorated with elaborate and beautiful designs.

The wedding itself was extraordinary. I don’t think I’ve ever seen the color palette taken advantage of like that, with so many textures and contrasts. Snigdha Apa and her new husband sat on a stage and everyone took turns taking pictures with them. Then, with hundreds of other guests, I enjoyed a meal with a table surrounded by my colleagues to celebrate the new union.

We're a lively bunch!

Doesn’t Snigdha Apa look beautiful? And who knew that I’d attend my first wedding in life 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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