Tag Archives: chars

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

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Filed under FCMs, Field, Satellite clinic

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.

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Filed under EFH, Field, Hospitals, Travel