Tag Archives: healthcare-seeking behavior

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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