Tag Archives: Chilmari

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.

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Filed under Dhaka, FCMs, Field, Supervision and Monitoring Tools

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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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.

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Filed under EFH, Field, Hospitals, Travel