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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The Value of Experience, Acknowledging Failure and Knowledge-Sharing

“My experiences are mine alone.” I hear this phrase often. I use it a lot as well, peppering it in toward the end of a long-winded explanation of what happened, what I saw and where. Most times, it’s a way of reminding both parties, “There’s space, open room. Your experience could be completely different than mine.” For me, it’s an attempt to let my listener know that my experience contains its unique limitations, most inherent of which is my perspective, shaped by my background and tools that have facilitated my learning and evolution: my education, reading and well, other experiences.

I have been pondering this phrase lately though, and I have reached the conclusion that despite well intentions in its use, the statement is not completely right. The truth is if I want my generation to tackle and actually solve the unnerving, deleterious societal problems of our world today, my experiences shouldn’t be mine alone. They simply can’t be. The phrase dismisses the accountability that comes with unloading experiences unto others who are very much impacted by the information we share. What’s worse is I think the expression waters down the value of the experience shared, at times even thwarting the sharing process altogether.

It makes sense, too. Perhaps my most under-appreciated “tool of learning and evolution” has been what I hear and learn from others and their experiences. I’m not talking about listening to professors reading from their lecterns, I’m talking about debates that take place over coffee or drinks with friends, late night chats with my roommate, long emails and blog updates from buddies doing good work. These are genuine exchanges of lessons learned and stories of failures, but access to this type of useful information is then essentially limited to my social circle. Newcomers, observers, mere strangers are left making the same mistakes that could have been avoided if say, I, had talked to them.

This happens on the macro-scale, too. Development organizations and NGOs are generally very positive in the public presentation of their work. In the small number of conferences I have been to, I’ve never heard an organization analyze and share its faults. With quiet and private learning and progress, organizations doing the same type of work face the danger of making the same mistakes over and over, with limited educational benefit.

But things are looking up. I’ve recently read of a few leaders working to bring these conversations to the public sphere. Engineers Without Borders launched the website admittingfailure.com, with this persuasive argument as to why it’s important to organizations, and Saundra Schimmelpfennig explains how it can help educate donors, too.

The failure blog for Peace Dividend Trust, for example, is an impressive example. The information is specific; it’s clear they’re not messing around – i.e., not “we are working to strengthen our internal memory structure,” but “we have almost no Knowledge Management system.” They even go so far as to admit that it’s really hard to get a precise sense of the impact that their programs have created. Measuring impact is an immense task, so I appreciate this type of honesty – to mirror the words of a Global Health Corps member who also wrote about these failure blogs, “we do each other and the world no good by pretending that we’re solving simple problems.”

Since I love this idea so much and I am a bit more than halfway done with my internship (hard to believe I have less than four weeks remaining in Bangladesh), I thought I should also partake. My failure blog is personal, not about the organization I’m working for. I will follow Peace Dividend Trust’s model, and include ways I think I can work better.

I don’t use my work plan. After I came back from the field, I made a week-by-week work plan to finish the key deliverables of my internship. The work plan has a plethora of different items on it, including meetings to be had, sites to visit, and benchmarks for my deliverables. I’ve been very scattered in terms of my approach to research and tool development thus far, doing Week 3 items before Week 1. This also means I am not prioritizing. To address this, I’m putting aside fifteen minutes at the start of each workday to review my work plan and make a prioritized list of tasks for the day and fifteen minutes at the end to note my progress. I will work on each task until it’s done or handed off before moving to the next.

I need more buy-in. I did a good job after returning from the field of letting everyone know what it is I was doing and my progress. In the past several weeks, I’ve had my head so deeply in open-source capacity-building documents that I’ve forgotten to check in with key stakeholders to let them know where I am. Making time for meetings ahead of time will help me to space myself – aka every 2 days, I need to check in with person X while I’m working on the tool that’s relevant to person X. Actually following my work plan will help alleviate this problem as well.

I respond too quickly to things. Those who know me know it doesn’t take much to get me enthusiastic quickly. In meetings, when someone suggests an idea or recommends a new direction for the project, I instantly form an opinion about it. The fact that I quickly attach myself to an opinion inhibits me from remaining open to new ideas and prevents me from fully listening to that person who is pitching the idea. I used to be worse at this but I need to improve still. In meetings, as a person is talking, I will make sure I am actively listening and conscious about my habit of forming an opinion instantly. In fact, when I catch myself not listening to the person at hand because I’ve already dismissed an idea, I will be sure to ask that person to repeat what they’ve said. In a country where my patience has already strengthened so much, there’s no reason I shouldn’t be able to do this.

I have neglected the rest of my life. I’ve done a really bad job of meeting personal goals – learning Bangla, visiting Buddhist temples and Dhaka sites, reading for pleasure. I also haven’t exercised for several weeks. Last week, at least I made up a little for my complete failure in keeping in touch with friends back home. This isn’t really the kind of person I want to be and it makes me feel unbalanced and bland. I also really paid for it this week, I think, and hit a pretty deep mid-internship “slump.” I made a daily checklist of what I want to make sure to get done for me and am involving friends and flat-mates, for both accountability and participation of some of the activities! In terms of keeping in touch, I want to Skype with at least one friend a week (let me know if you’d like to be included!)

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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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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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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.


Filed under EFH, Field, Hospitals

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.

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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.

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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!

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