Health Care in Bangladesh

-The care provided at the clinic is free. They get free consultation and free medicines, which is uncommon. Most other clinics provided cheap services but not free. The downside of this is that people come and receive free drugs to sell it elsewhere. Kids even learn from their parents what they’re supposed to say to get certain drugs.
-Patients come and call the doctor “uncle,” but refers to the pharmacy worker as “doctor.” This frustrates that doctor because the people at the pharmacy are simply trying to sell drugs, regardless of what will be best for the patient, yet they get more respect. On the other hand, the doctor needs a separate helper just to give out the medicines to make clear that his jobs isn’t just to write prescriptions and give medication indiscriminately, since patients sometimes come in without symptoms but just asking for free drugs.
-Patients get upset when the doctor just gives them paracetamol (like Tylenol) for pain or fever because they’re used to getting antibiotics at the pharmacy and feel like they’re not getting enough care. But in actuality they usually get antibiotics unnecessarily and only need the basic pain killer/fever reducers.
-Scabies and rashes are among the most common illnesses seen, primarily because of the living conditions in the slums.
-There are no facilities in the clinic to do blood tests, rectal screenings (which would be helpful for diarrhea/dysentery cases), etc. There are just the bare minimum tools and the doctor doesn’t have enough time to give all of the patients physical exams. Most times he just listens to their complaints and provides medicines, especially since they don’t have the capacity to do full screenings.

Also, I have never heard not to use soap from an American doctor, but the doctor here insists that soap is unnecessary. He explained to me that soap just removed the body’s protective layer faster than it normally sheds which makes us more susceptible to infection. He says we should only just water to bathe, but should use shampoo daily. I still have to look into this further, but I was surprised to hear it. I wonder if its just because of the kind of soap they used in BD?

The most memorable patient who came in while I was working was one who complained of pain in his body after having an accident of some sort. The way he remedied his pain when he wanted to sleep was by rubbing kerosene on his body. He acted like this was a common remedy that was used for pain and insisted that he couldn’t sleep unless he did it. The doctor was extremely shocked (as was I) about this and provided the man with normal medication for pain instead.

Although my time in Bangladesh is almost over, I was not able to blog until now for a number of reasons which will be explained through the next few posts re-capping my trip.

When I first arrived in Bangladesh I was greeted by some hosts from my organization along with sweltering heat and mosquitoes. The following day I met with the country coordinator of the NGO that I’m working with (Distressed Children and Infants International [DCI]), and we decided that I would spend a few weeks working in their urban health clinic and surveying the slums, followed by time to volunteer with various other groups.

The organization I work with has a number of centers in Dhaka (the capital) as well as in various villages. They’re biggest program is the Sun Child Sponsorship (SCS) program, through which they motivate families to continue their children’s education. They know that education would take away an income source from the family, so they explain the importance of education to the families, and provide school supplies and some moneys for food and necessities. They are funded by donor families from the U.S. and give most of the money (I forget the exact amount) directly to the families and only use a small portion for administrative costs. They also provide health care and health education, as well as skills training and income generating opportunities.

The SCS program is mostly implemented in rural areas, and in the city they are trying to start something similar. For now, they have an Urban Health Care Center, which is where I worked. The clinic provides free doctor’s consult and medication, and only asks for a one-time 10 Taka fee for the patient registration card. This center is one of a kind, as I haven’t heard of any other places providing free care. Their patient population is the slum-dwellers who live near the clinic, as well as some middle class families. Apparently, even though they are middle class, they are still barely making ends-meet, so they aren’t truly abusing this resource. DCI is also trying to figure out a way to maybe charge a lower fee for those who can afford it.

My first day at the clinic was a bit frustrating because on DCI’s website they described a number of activities volunteers could partake in—such as, taking blood pressure and temperature, and dispensing medicine—but in reality these tasks were being performed by someone else. The doctor described to me what he understood volunteer to mean as someone who comes to observe the situation and then fundraises in their own country. Basically I was just shadowing him, which wasn’t my purpose in coming. After the first day I found ways I could help him. I started to help him fill out cards that the patient takes home that has their registration number on it, and soon afterwards I began a survey. The survey had basic demographic questions about the patients income and number of household members, as well as questions about their water sources for drinking and cleaning clothes and dishes. I carried out this survey both in the actual slum and sitting in the clinic with the doctor.

In the afternoons I would go to the office and organize the doctor’s ledger information into an Excel file that separated the patients by age and gender. This helps the doctor so he can know what age range he primarily serves so he can better target his care. It took some time to adjust to the system and be able to speak up and suggest projects that I could do, but once I did it got better.

Angelina Gomes ‘09 will be blogging about her experiences working in the health sector in Bangladesh.