Category Archives: Travel

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.

Leave a comment

Filed under EFH, FCMs, Field, Hospitals, Satellite clinic, Travel

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.

1 Comment

Filed under FCMs, Field, Satellite clinic, Supervision and Monitoring Tools, Travel

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.

Leave a comment

Filed under Dhaka, Travel

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.

Leave a comment

Filed under Field, Travel, Uncategorized

I’m on a boat (but no really!)

June 30th, 2011

As a result of a lucky scheduling coincidence, Sareeta Apa and I traveled to Chilmari by seaplane yesterday. The sprawl of Dhaka seemed endless even from a bird eye’s view; not contrary to my expectations – even from the ground, Dhaka seems in a state of perpetual construction, with bamboo supporting most new structures in lieu of metal rims.

Outskirts of Dhaka

My eyes absorbed a beautiful scene of water and green for the sweet flight duration of forty-five minutes. (I say sweet because the bus would have taken 10 hours). Bangladesh is truly more water than land, with the world’s largest delta system and the greatest flow of river water to the sea of any country on earth.

Towards the end of the flight, the thick white of the monsoon clouds engulfed the plane, before they cleared and we started spotting the char islands through our wide windows. Chars are newly emerged lands from the water as a result of accretion, with an unpredictable lifespan ranging anywhere from one to fifty years. In other words, from our plane, it looked as if some larger creature had taken his fingers and run them through the river, creating these unstable, transient islands.

Chars in the distance...

Anyone who visits the country sees that poverty is a pervasive problem in Bangladesh, but with limited land and other natural resources, added to the messy process of erosion and accretion in the river delta, impoverishment in these chars is truly extreme. Rapid erosion of Bangladeshi farmland renders many people landless (two-thirds of the rural population, to be exact), who then move to these newly emerging chars. These settlers lack secure title and can only occupy the chars with the consent of powerful “land grabbers” who illegally control this public land. Of course, without secure title, char-dwellers become discouraged and unwilling to invest in improving their land or houses.

Chars are usually unfavorable for farming due to salinity and flooding and are especially vulnerable to cyclones and storms. The living conditions are harsh, due to lack of clean fresh water and fuel. Moreover, there are very poor communications and minimal services from government and NGOs, because the chars are physically out of reach and well, in a country where even those in sight aren’t tended to properly, out of sight, out of mind takes on a new form. Climate change threatens to make the scenario even more precarious, exacerbating these vulnerabilities with greater probability of cyclones and storm surges, increased rainfall during monsoon, less precipitation in winter, high temperatures, and sea level rise. Char-dweller livelihood will indubitably worsen.

And then, we spotted it – like a beacon in the night, the hospital boat, EFH, docked along an older char. My home for the next 10 or so days.

Emirates Friendship Hospital (EFH) plus other ambulatory boats!

Friendship is one of the first NGOs to get involved in providing services to char-settlers, setting the bar high for NGO involvement here. On top of EFH that provides primary health care and specialized secondary health camps (surgeries, more involved procedures) at almost no cost to patients, Friendship holds satellite clinics twice a month in each of our chars. As an organization, Friendship has trained women from these communities to take on the role of community health workers (FCMs), and its these FCMs, along with trained paramedics from the mainland, that run the satellites to provide primary care, health counseling, behavior education, and family planning services to char communities. It’s these services I’ll be closely observing and then working on tools to help Friendship monitor its progress.

Meeting at the Chilmari field office

We held a meeting today at the Chilmari field office with 10 members of health staff, a conglomeration of the district supervisor, FCMs, paramedics and a paramedic assistant. Our goal was to gain insight on what kind of monitoring is happening on the field presently and note the current gaps and strengths of our community-based services. Like many NGOs meeting imminent needs, Friendship expanded rapidly during its inception in the late 1990s. Retaining many of the intended program components  – like constant monitoring and evaluation – through this scale-up became exceedingly difficult. Our current monitoring is scattered and sporadic at best, so I have my work cut out for me.

After the insights of the meeting, Sareeta Apa and I had a brief conversation about the universality of our field. We had both, once upon a time, cogitated a medical career and stumbled upon public health. After hearing many of the concerns of the FCMs and paramedics, we both agreed. Diagnosing patients, however valuable, seems unsustainable if the larger conditions that create their ailments remain undiagnosed.

2 Comments

Filed under EFH, Field, Hospitals, Travel

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.

3 Comments

Filed under Dhaka, Travel

Journey Woes and Lessons

It’s unbelievable to think that it’s only my first day in Bangladesh. I feel like years have passed since I left Cary.

Despite the fact that this is the longest journey I have made in my life, the flights here were all relatively easy-going until Istanbul.

As I was boarding the final plane east at Ataturk International Airport with the mid-journey stop in Karachi, I handed my passport to the Turkish airline official checking the gate passengers. She flipped over the green pages, and finally asked me if I had a visa. I told her I didn’t have one, that Turkish citizens can receive a 90-day visa on arrival. “I’ve never seen a Turkish citizen go without a visa,” she replied. She called over her colleagues to discuss and analyze, and informed me that the only thing the government would give me, maybe, would be a non-extendable “landing permit” for 15 days. At this point, the most incredible feeling of panic had surged into my body. I know I had read, “visa on arrival” on the Bangladeshi consulate website, which I had searched in-depth even before I knew I could come to Bangladesh. I showed the airline officials my invitation letter from Friendship, on the verge of tears, and one of the men said in Turkish, “I mean, I don’t know if they’ll take you, but I’ll sign off. She has a letter and everything.”

I joined the group that had already been checked, probably visibly shaken. A Pakistani woman I had met minutes before came over and asked me if I was okay. I sat, telling her and a surrounding group of people the saga of my Bengali visa, or the lack thereof. A man sitting across from me stated in a Bangla accent I have come to love, “Everything can be done with money. No problem.” One sitting behind me said, “Don’t worry. I know the Director of Foreign Affairs,” and scribbled his name and contact information on a sheet of torn paper. We lined up to board, and a Turkish man waiting behind me said he thought he remembered that they give visas on arrival. He asked me why I was going, I told him about my public health work, and he said, “Are you sure you want to go to Bangladesh? For that long? You know what you’re getting yourself into, right? I went for a week and I regretted it.”

With annoyance, I boarded the plane, to experience the slowest, most torturous eight-hour flight of my life. “What if I can’t get in?” became the only thought in my mind, echoing and strengthening with each passing minute. What would I do? I couldn’t contact anyone – no phone or Internet. I felt like a toad of some sort had lodged itself in the middle of my throat and any real capacity of my brain to think logically was impeded by “what-ifs” and scenario possibilities. I had been nervous before just about the airport pick-up; now, I knew that I would be the luckiest girl in the world if I could just get in.

The sweet Pakistani woman I’d met before sat next to me for six hours to keep me company, talking over possibilities and listening to me. She tried so hard to distract me from my own thoughts, directing my attention instead to the stars at dawn outside our window, or to my family, or to the US.  It is the most incredible act of kindness, to sit with a stranger during their tough time to help them through. We finally landed, and she told me I was welcome to visit her in Pakistan if Bangladesh didn’t let me in, leaving me her phone number and contact information.

Looking at the Pakistani landscape outside of my window during flight (and we weren’t allowed to leave the plane for security reasons when we landed), I noticed that the Karachi seemed extremely dusty and gray. Kind of like the movies, but I wish the same Americans watching those movies could have met some of the Pakistanis on this plane.  A well-educated, well-traveled and multi-lingual bunch, they would make any person think twice about stereotypes.

Life throws the most incredible people at you, right when you need them. I just don’t acknowledge it on a day-to-day basis.  During the wait, I also met a young woman sitting behind me, from the States, researching in rural Bangladesh on a Fulbright. Christy had learned Bangla, and was coming back from a short visit to the States.  She was the embodiment of what I wanted to be – she had an incredibly happy and easy-going spirit, and was extremely comforting to be around, both with the wealth of her wisdom and her down-to-earth mentality. We talked for a long time, and I felt more and more confident I would somehow find a way in. I told her my frustrations about people’s reactions to Bangladesh, how most people felt entitled to have a negative opinion on the country without ever having visited.  We talked about travel, about Dhaka, and she kindly offered to accompany me through immigration control when we landed, which we did, three hours of horrible baby-screaming, bumpy-flying later.

We walked out, and my body became more and more weak under the symptoms of anxiety. We approached the immigration desk, where two Bangla police were checking passports. My turn. My legs disappeared, my hands shook. He flipped the pages of my passport while Christy conversed with him in Bangla, I handed him my invitation letter and he directed me with a smile to the small room of a “visa office” behind us. My eyes had never seen anything so beautiful. Visa-on-arrival? Check. I was given a 30-day visa, not 90, that I can extend once in Dhaka. Even that, I owe to the fast-changing and ambiguous laws of Bengali immigration.

Happy as a clam, I walked with Christy to pick up my luggage, which arrived flawlessly. We walked out with our trolleys past the security cage where hundreds of families were separating or reuniting, taxi drivers were yelling, cars were honking. The monsoon rain had started since our landing, and a dynamic, colorful sight I’d never seen before met my eyes. Certainly, the rain brings life to Bangladesh, and it was the most beautiful sign of good fortune and of livelihood for me.

I got out of the airport just fine and made it to Gulshan-2, where I am staying. I’ve learned some very valuable lessons from this adventure:

  1. Airline officials are likely to know absolutely nothing, even though they boast walkie-talkies and Internet access. DON’T LISTEN TO THEM. If you read something on visa/travel regulations from a reliable and relevant source, print it out to show them. However, specific airlines do reserve the right to not let you board the plane if you do not have a visa, despite what the rules are in the country you’re traveling to. Call ahead and find out. I don’t think I would have been allowed to board in Istanbul if I hadn’t been Turkish and explained myself to them in that way.
  2. Worries are relative. Whereas before the idea of having to find my own way from the airport to my residence was daunting, that worry quickly seemed to disappear in the face of bigger worries.
  3. What goes around comes around. I have definitely accelerated the aging process for my parents by coming here, so it is only right that I also aged 40 years in the actual act of coming to Bangladesh.
  4. The same goes for good, positive acts. I will never forget the beautiful people – Munira, Christy, the Turkish businessmen, and THY hostesses – who provided a much-needed hand of help and encouraging words during a really trying time for me. I am still floored that I was the lucky recipient of such kind-heartedness, and I promise to pay it forward.

1 Comment

Filed under Travel