Tag Archives: monitoring tools

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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The Office Life

June 28th,2011**

**I was on the field from June 29th-July 8th and had little internet juice to upload information, but still (feebly) tried to capture my experiences by writing. I will post retroactive blog posts from my time in the field every day for the next 5 days. Enjoy 🙂 

My incorporation into Dhaka and office life has been going smoothly over the past week, mostly because of the warmth and liveliness of my colleagues. Lately, they’ve started inviting me to have snacks with them in a small snack shop downstairs, a sweet retreat in the stretch of morning work hours where they talk, poke fun, and fill me in on Bangla culture. During these sweet retreats, I’ve re-realized partially the reason I connect so well with the people here is because their warmth is one that is all in all very familiar. Though the vernacular is not the same, Turkish dialogue shares many identical tones and gestures of conversation. In fact, some things are so similar that at times I can replace the Bangla with my own native tongue, cross-check and find that I am right on par with my guess of what the conversation’s about.

Acclimation to Dhaka life has also been trouble-free. Just the other day, I made my first river crossing in a city, when the street in front of the language school completely flooded after an hour of heavy monsoon rain. I tried waiting with some friends, got tired of waiting, and waded in knee-high water to find a rickshaw to take me back across town. Welcome to Bangladesh!

As an intern, I’ve been lucky enough to participate and observe some strategic planning meetings for Friendship over the past few days, which has helped me to better understand the composition, values and direction of the organization. The last week has also been a period of refining my internship role and desired results, with joint meetings with my mentors, Sareeta, an MPH, and Dr. Naheed, who works with health services offered at EFH, the boat hospital in service currently in Chilmari (Made a Google map of my hang-out locations. Email me if you want to see it in detail!)

Chilmari towards the North, with Dhaka as the blue pin towards the South

As a result of the conversations, my mentors and I have decided that for the sake of sustainability and actual utilization of my work, I will be working on evaluation and data collection around our community-based health services. Additionally, I’ll help create community-level monitoring tools for our satellite clinics, rather than completing a research project on health-seeking behaviors, which may be needed but not immediately relevant for the organization. I’m extremely happy at this turn of events because it ensures that I will serve a meaningful purpose over the next few months and the output of my time here won’t just end up sitting as a file on an office computer. A lot of what I’ll be doing will still be research-based, but I will also be meeting with a myriad of stakeholders that make our community-based health services what they are – health program leaders at the head office, paramedics, FCMs (our version of Community Health Workers), paramedic assistants and regional supervisors – so that we create our tools with the feedback of relevant experts and the communities themselves.

I know I have so much to learn over the next few months, and indeed I think I’ll actually be learning a lot about how to learn. What’s great is that I think Friendship will be learning and capacity-building right along with me; it’s my humble goal to leave Friendship at least a smidgen better than I found it.

I also started to take Bangla classes at HEED Language Centre (link under “Bangladesh Info”), but chose to sit out for this month, as I’ll be in and out of Dhaka with trips to the field. I would recommend this center in Banani to anyone wanting to learn Bangla as my first few classes were great.

I will be leaving for the field for a while tomorrow! Wish me luck!

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