from Womb to Tomb

on my second visit to a healthcare organisation in dhaka, my boss at FPAB sent me to another NGO organisation called Bangladesh Women's Health Coalition.

in the morning, i took the ritual of a CNG taxi to mohammedpur, the west part of central dhaka, the journey itself in the morning is pleasant. the road takes one past the parliament building which i have yet to snap and also the impressive structure of bangladesh's astronomy centre. regarding the stars, bangladesh spent a whopping 120M USD on building this? its strange why education like this takes prioty when that money could have been utilised in an appropiate channel eg the poor people!! or rurual education!!! lions led by donkeys...

so i reached the head office of BWHC a little early and i met the good friend of my boss, Dr Julia Ahmed. the striking thing about her is that she is relatively young to be head of an NGO. i would say she is early forties and is in good health. i was in her office for about half an hour discussing my reason for being in bangladesh and my reason why i have chosen in essence reproductive health when i could have chosen any speciality and any destination in the world.

i told her honestly that the idea of seeing the world is a desire of mine, and i would love to be where chewee/tony are or even where raj is but this opportunity to return to the homeland and to not be a tourist but someone who has a more grounded understanding and dare i say it, maturity is a chance that i couldnt pass. i admit frankly now, that dhaka is not the best place in the world especially for a social life or having fun, but i have london for that and i have my friends and also a certain special someone in manor park that i can have fun with.

anyways, Dr ahmed, explained what BWHC was about and the moto they have is, healthcare from the womb to the tomb. today, i was in for a treat, i would be sent by the company car (luxury or what) to see all the clinics they have in their urban programmes, they do rural programmes, but me being the city boy i am is finding it difficult being in the countryside. i think i get nightmares about the rural clinics of health care because i hate bangladesh countryside, for some, its natural beauty, for me it is a symbol of boredom. (no offence to the lovers of bdesh countryside)

the first clinic i was sent to was about 3miles away from the supreme court. the supreme court is this strikingly whilte building in the heart of the city and it is where all the legal things are fought about, i dont know whether or not the place is an honest place to be involved in as a lawyer but one thing which i know about bangladesh, is that, never trust the government, even if they are involved in a massive crackdown at the moment. this is a country with people with hidden agendas and a lust for money and social status.

so i arrived at the first clinc. there was a loss in the translation, i thought i was going to spend the whole day there but this was purely a visit. this centre was a maternity centre, it was a building situated right in the heart of one of dhaka's most poorest populations, and it served the people not just as a maternity centre but also as a health care clinic. the building was four floors. the ground floor was the reception and pharmacy, the second was the GP clinic, the third was the obs/gynae section and the top was the office. the lady who recieved me here was dr rebekah. she was a wonderful women, explaing what the centre does and who it serves and all the history and any answered any of my curiousities. people have been treating me with very warmly here, i wish people could be a bit more like this in england, especially at the hospitals.

so, i was then handed over to the anaesthist who deals with c-section pts, his name is dr rashid, very nice guy, young tall and a bit overweight. he then gave me the grand tour of the centre, introducing me to all the staff as 'Dr Mirza' (still feels weird knowing that im not gonna be Mr anymore) explaining to them all that i am from the UK and here to have a look at health care here. the staff were very friendly and really nice, asking me if i want a cup of tea every 5s, but it was touching. after the ground tour, i was then shifted over to the driver who brought me here to go to another urban clinic. i was sad to leave this centre, cause i really liked it and wouldnt have minded spending the day and doing some medicine in their GP section of the building.

i now went to another clinic in an area which was more poor than the centre i was at. the clinic was small and here, they have a doctor, a counsellor and no pharmacy. the doctor that works here was a young doctor, probably 25 and her name was dr khan. the striking thing about her was that she was really pretty, (hubba hubba!!!) but she was cool, she gave me the brief guided tour of the place and explained who her patients are and etc. after 20mins, and another 5 offers of a cup of tea, i then sadly departed, not being able to use my charm on her to go to the second to last clinic i was going to visit.

the place was called gandaria, and it was situated a mile north of the big river buriganga. this place was right in the heart of 'old' dhaka. the area was made of a meshwork of slums where most of the patients live. as you can imagine, the patients here are commonly ill with TB being the most common disease. dr shilpi, a young doctor was the lady in charge here. her job here was similar to that of a gp, patients come in, their notes are provided and then bang, same as a GP surgery in england. the difference here compared to the other places where i had visited, was that, i was now playing an active part in patient diagnosis and management. dr shilpi, gave me the privaledge of taking the history and and prescribing the medication. i saw a crazy number of patients in the space of 3 hours, all these patients are sadly very poor and dont have very good education. its just hard to comprehend this exists especially in the comfort of england. but i tried to do as much as possible to help, for example, with one patient, i taught him how he should be using his asthma inhaler. dr shilpi, had her faults, she didnt give a damn how he was using it, but, i told her simple things like education is imperative!! i was afraid i may have been patronising her, especially since i am still a student... but at the end of the day, she was really nice to me and said i am welcome to have dinner with her and her husband at their house. after we finished the clinic at 4pm, it was time to move on to the last place to visit for the day.

this place, if my parents knew i went to would be upset but i am the today and they are the yday. this clinic was not a clinic as such but a place with counsellours providing healthcare and advice. no doctor chooses to work here because they fear they may not be employed elsewhere. it sad that a mentality like that exists here but i will explain to you why.

the final clinic i visited was the drop in centre where commercial sex workers visit to receive healthcare and advice. it also serves as a nursery for their children so they can receive education whilst the mums are at work. poverty is so desparate in bangladesh that there is an estimated number of prostitutes that exceeds the population of some small countries. islam and a conservative social culture mean nothing when it comes to helping the poor in the land of bangladesh. so if you are curious why i went to visit this place, its beacause i care about these people whilst others do not.

i was received here very warm. the lady who works here is called anodha, and she was a former sex worker and now a trained health care advocate. teachin about condom use and recognition of STIs. she was really nice and i was touched when she called me brother. i told her, please dont call me brother, call me shuwaib. she went to show me her humble clinic, and the achievements they have made displayed by photos taken by BWHC. she was a very proud woman. i got to meet some patients that were here and spoke to them about what they were concerened about and i once again answered the questions about why i am in bangladesh. but i didnt mind, i am just satisfying their curiousity like i am doing with mine. at the end of the half hr i was there, i had a crowd of 6 patients, and i demonstrated to them how to put on a condom. if no other doctor will show them, i really should. the 6 of them knew exactly how to put one on, they didnt use my willy to demonstrate but i bought some bananas for the demonstration.

i then popped my head into the nursery to see what the kids were learning. so innocent and yet forgotten by their people. i said my goodbyes and i promised anodha i will return and teach the kids the english alphabet before i head back to england.

it is sad that an NGO takes resposibilty for them and not a GO. on the bright side of it though, and slightly contrary, BWHC is funded partly by the bangladesh government. however, it is a shame the government can not just come out and be frank about the internal problems of the country but does the easy option and just pay someone else to do the work for them.

i got home that evening for 9pm. i stopped off at Kozmo lounge, the best place for coffee in this city. its a nice coffee shop. i will take pictures of it, but i go there to just wind down.

anyways, im off, gonna chill for the rest of the day.

shuw

private medical care, u gotta love it

On Monday, I spent the most part of the working day in a private medical college in gulshan. I was looking forward to this very much because it would be an interesting stark contrast to what I am used to after learning in the clinical settings of the NHS. My previous exposure to private healthcare was at the south Wellington whilst I was doing my SSM late last year and also at a harley street clinic. I, however, have been trying very hard to be open minded in what I will expect in when I go to these places. I cant be biased and the british upbringing I have shouldn’t cloud my expectations of what exists.

Healthcare in Bangladesh is very important. It is expensive here and there is a massive shortage of facilities in the public sector. However, in the private sector, the patients here are the ones that can afford to pay for their consultations and medicines and the rent required for the hospital bed. Knowing all this, one should also bear in mind that this is a country where the average wage is under the golden British pound.

I arrived at the college and I was greeted by the principle of the college; he is a good friend of my boss at FPAB and therefore, this is how I got the contact and the arrangements for my visit. The principle, himself was a character that really put the fear within me. He has very few facial expressions and he appears at times to be obnoxious to my curiosities of his college. I actually felt quite intimidated by this man, thinking that the next time I open my mouth will be something that offends him. We both had tea together and I told him my schooling history and family history and he then told me his history and how he had been to London to get a PhD from the london school of tropical medicine. For some benign reason, when I tell anyone the name of my medical school, they appear clueless which leads me to believe, is it a shit uni??

The prof then called one of his staff, a young doctor who lectures in pharmacology at the college to give me a guided tour of all the departments at the college itself. They take a lot of pride here, and the facilities they have; one thing that struck me was the amount of science these students do. I swear the stuff the 1st years were being taught was the stuff I learnt in high school, I swear by it.

Then I looked around the anatomy labs and histopathology and microbiology depts, I was feeling thick because at Bart’s we don’t do half the stuff these kids get taught. We have learning landscape but that is nothing to what they have. The big contrast is that the kids in Bangladesh learn, or should I quote, memorise text, pictures and things. They don’t use their minds to work things out or how to apply their knowledge, but they learn things in text books like the way I used to learn my lines whenever I used to be in a school play.

After I had been given a tour of the college, it was now time to be given a tour of the hospital. The hospital is very clean. If you are going to be in a private hospital, cleanliness is the thing that makes one feel that their money is well spent. At the hospital, it can hold a maximum of 300 patients. And unlike an NHS hospital, there were, believe it or not, only 20 patients. On questioning why there are only so few, the answer is, ‘it’s a new hospital and many people think it is too expensive.’ This excuse is exhausted and I felt extremely insulted seeing a hospital not being utilised for its maximum potential. There are people dying at the entrance of government hospitals and this place does nothing to help. It really is sad. The other thing that really pissed me off was the fact there are so many doctors, just lounging around, reading a paper, drinking tea and literally being paid to do nothing. These doctors go abroad to get fancy letters like FRCS, MRCS so they can go back to Bangladesh just so they can be paid 1 lakh per month to sit on their arses. It really is a disgusting sight.

My guide then donated me to another doctor who works in the ITU, there were three registrars for ONE patient!! The patient had a stroke and the registrar was going through the history of the patient and discussing the management plan. I looked at the notes and the drug history for him, and I was shocked. This patient was being treated for symptoms of the stroke. But nobody has even bothered to treat him in preventing a second stroke. Even his drug history was awfully managed. His doctor who was looking after him for his diabetes and high blood pressure was not even applying the modern guidelines in his drug regimen. I then told the registrar it was no surprise he had a stroke. The registrar then defended my accusation of negligence by saying the community doctor must be some crappy village doctor. The truth is, the community doctor is probably some city doctor, making big bucks but not properly looking after his patient. This was disgusting and if this were England, we would have a legitimate legal case here.

I understand when it comes to medicine I am not the sharpest knife in the drawer, but I know my basics and I am now a lot more confident and I feel competent in knowing when a patient is being fucked over by his doctor. Anyhow, needless to say, the registrar and I fell out. The irony was when the ITU consultant came down and I then told him what should be done. I am not even a doctor yet, I have another 4 months left. I was feeling extremely angry. Thank god in the UK we have NICE guidelines.

Afterwards, I was then taken to see the outpatient clinics; here I met an Indian couple. They were the typical Bangalore IT workers employed by a Bangladeshi company. Sad, that Bangladesh doesn’t have people to do their jobs but India does. Anyways, the couple were in because the wife was having her 1st antenatal check. They were very nice people, very chuffed to have a ‘Dr’ from the UK come sit in with them in their consultation. The reason of concern for the lady was that she was anaemic and as they were vegis, they needed to put more iron in their diet. The advice the obstetric consultant was giving was simply ‘take iron tablets’. I then intervened and asked, are you not going to advise anything else? So, I then gave them dietary advice, what to eat, what to avoid, what to do to stay fit and how to recognise the signs of anything bad that hopefully wont happen. I think the consultant was quite offended, because I was doing her job, the only difference I was that I wasn’t expecting a fee. After the consultation, I went along to see the ultrasound being done. I swear in England, ultrasound is not done by doctors. It is a nurse’s job, however, here they employ a doctor to do ultrasound all day!! What a waste of resource. She doesn’t even report the findings, all she does is applies the jelly and gets the image. That’s it!! 5 years of med school so she can take pictures! This was ridiculous, next thing I was expecting to find was a doctor mopping the floor. I mean no disrespect to people who do these jobs, but doctors treat people.

I learnt after this day that the place was really inefficient, and only god know how the hospital survives and is able to afford to pay doctors their wages whilst they have so few patients. I learnt today how an MBBS is wasted and when I think of it, it makes me sick.

i didnt take many pictures, i dont think the places deserved it

lost in the bay of bengal

On Friday morning, after all the AGM had finished, I woke at 6am so me and 30 other people could go to bangladesh’s most southern point and one of the world’s unspoilt treasures. The place, is an island called St Martins.

The bus ride from cox’s bazaar to the smuggling port of teknaf was an arse aching 3 hours. We even got given breakfast on the bus, but eating that whilst dancing on the seat was a mission impossible. I didn’t sleep much that night, hasan and zaki kept me up in their banter, we spent an hr debating which bolly actress was the hottest. I said priyanka cause her body is fantastic. Curves in all the right places.

The majority of the bus ride was spent sleeping. People kept waking me up every 2mins trying to explain to me that the Bangladesh scenery is beautiful and I should be awake, but I kept snoring fak off to them. So we reached teknaf, the place was saturated with buses from tour companies because st martin is a massive tourist destination in Bangladesh. I was really chuffed, because I have heard so much about the place and now that I was going there, it felt surreal. We boarded the boat. It had three floors representing 3 classes.

The downstairs was plastic chairs, middle was comfier, and upstairs spacious. It was an ok ride, I managed to get some more shut eye in between taking pictures, so I was happy. The weather like usual, was warm and pleasant. Its not like the june, july months where it hits 40 deg Celsius. We reached st martins finally, seeing the island on the horizon of the bay of Bengal reminded me of what the island in Lost looks like. It really is a beautiful sight. The place is tiny, two fat people would make it look like a box room. But the beach was a beautiful colour. The population is small, 7000 and the main industry is fishing. Boats litter the shore and fishermen can be seen casting their nets.

There are a few hotels on the island. The place has potential for being a massive tourist site, because it also has a coral beach. I did see 2 white people there, enjoying the tranquillity and peace that this beach offers. In Bangladesh, beach culture is much more reserved, so sadly, u don’t see bikini babes wet and bathing in the sun, but I have a dvd in london for that so I aint too bothered.

So we walked around the beach, I took some pics, drank water from 4 coconuts, they were really good and took some more pictures. I bought rahima her shell, I was going to buy coral but I was afraid that it might be illegal so I declined. We found this standard Bengali restaurant a little inland. Sadly I didn’t get to eat fresh fish. The people I was with were pretty boring in that sense. after lunch, we headed back to go back to mainland Bangladesh. We did not stay for long at st martins, because we were heading back to Dhaka that night. But, the 2 hours I was there for was good. The only sad thing about st martins that I will remember, is that, u still see poverty here. It doesn’t matter where in Bangladesh you are, you still see poverty. It disgusts me that nothing has changed. But I alone can not do something. Change must come from the central government, and it needs to be soon.

To go back to mainland again, it was another 2 hr boat journey. I made a friend on that journey, nadia is a 10 year old studying at an English medium school. She is really cute and she wants to be a doctor in the future. Why? Because I am going to be a doctor.. little copy cat!!!
We reached our waiting bus and the sun was now beginning to set. Again I didn’t get to see a bay of Bengal sunset. I am not too upset, but it is something I will regret I am sure. The bus journey was a nice experience. Like in bollywood films, everybody started singing bangla songs and reciting famous bangla poetry. It was a really nice united feeling. I am beginning to understand how important language is and culture is. The more I am learning and the more interaction and exposure I get, the more I feel proud about the men and women that fought to preserve the Bengali language. Maybe I am not proud of what Bangladesh is now, but the spirit that exists amongst the people, rich or poor is something that is reaping a patriot emotion within me.

Cox's Bazaar Day 2 & 3

Tuesday morning and the conference started at 9am. At 9am I was still in bed sleeping and enjoying my life of pure bliss. This period of my life will never repeat so I shall make the most of everything I have and just chiiiiiiil. I finally awoke from the giant sleep at 11am and I then strolled the 5 minute walk to the conference walking along the road that is parallel to the shore and telling every rickshaw driver I do not need to use them. At 11.45, I slipped into the conference room right in the middle of when my boss was giving a speech. I don’t think she recognised it was me because like me, she is short sighted so I was in luck.

Anyways, the day was not that fantastic, it was the same stuff as Tuesday but however, the twist was that in the evening the FPAB team at cox’s bazaar had organised a cultural evening. Cultural you ask… well, this meant, some traditional Burmese dancing and the bangla singers lightning up the room and people dancing. I myself also bopped on the dance floor, but instead of 50cent, it was some bangla song. It was really cool. There were about 30 people, all above the age of 30 except myself dancing. I have never seen Bangladeshis dancing, as it is frowned upon and regarded as haram. However, as I learn more and more about the culture, I can see the reasons why over here in Bangladesh nobody is bothered at the hesitancies the Bangladesh community in the UK have. People have to remember, that many of this people were in the country when they shed blood to save the language. God was not available that night when all the scholars at Dhaka University were murdered. The culture therefore now celebrates music, and singing and poetry, and seeing all these people come together that night, I felt proud as a Bengali, and being grabbed hold of by the people to dance with them made me feel even more proud because I am now beginning to feel I am a member of this race.

After all the serious conference speeches, we were treated to Burmese dancing. There were four really adorable doll like girls who have grown up in Chittagong brought to entertain us. This was the first time I had ever seen anything like this and I have to admit, I really enjoyed the show. The music, the dancing with candles and umbrellas was really cool. Next time I am in Chittagong I am going to have to see a show like this again. After the girls had done their dance, I chased after them, not because I have yellow fever but because I wanted that exclusive photo. The weird thing was that they were so fluent in bangla, but the other weird thing about this is the stark contrast in physical features between Bangladeshis and the Burmese in such a short distance on both sides of the borders. People either look Bengali or Burmese, no in between. If you know what I mean.

After the Burmese dance, was the Bengali band. There were three singers, 2 girls and one bloke whose picture I didn’t want to take. But in between the dance and music from the band, the people of FPAB wanted an encore, so guess who took the mic and started to sing, my boss!!! She is so brave, such a cool brave, such a cool modern Bengali woman. I wish many more Bengali women would be like her. She is 50 years old but she won’t let anything stop her in her ambition whether it is educating about sexual reproductive health or wanting to sing for a crowd. She did two numbers, and I have recorded one of them on my camera, but until I can figure out how to upload them to this site, they will just remain on my hardrive. The band then arrived in typical Bangladesh timing fashion, but they did sing for 2 hours, it was good. Like I said earlier, people got up and danced.

After the dancing, the night was over and everybody went home. I was starving and I did the easy thing which was order room service. The milkshake at coral reef aint bad.

On the third day, which was now Thursday, my typical day pattern did not follow. I woke up at 10 this time, but instead of heading off to the conference immediately, I went to this most delightful and charming café/snack bar which is built on stilts and sits on the beach. When it is high tide, I am told the place is one of the best places to be in Bangladesh and maybe in the world. The name angel drop is quite fitting, and I hope this place remains forever and that the effect of globalisation doesn’t destroy it.

For my breakkie, I had a cup of tea, typically loaded full of sugar and a biscuit, I didn’t order much partly for the reason they don’t really have much on the menu. But it was good never the less. One striking thing about Cox’s bazaar is the noise the Bay of Bengal produces. The waves crash with such volume that they are a formidable opponent for the central line.

Today was the last day of the annual project review (AGM) so I should really have been there much earlier and stay all day. I did the latter which was ok. It was the same old stuff again. speeches, but this time the critiscm and reviews were handed out to people and the different districts were told where they were going wrong and how to improve.

The day finished early, around 3pm. But in the afternoon, there was a debating competition, 10 regional finalists came to cox’s bazaar to battle out who is the best. The subject was sexual reproductive health, gender based violence and all the trimmings that went along with it. The competition was interesting, the one thing I had learnt from Bangladeshis when it came to debating is that it is all about voice projection and copying what the politicians do. People don’t use wit here, they shout, and bang fists and this is what the crowd like. It gives a buzz and to see teenagers doing is quite remarkable. In the UK everyone is a bit more relaxed, the content of what they say uses humour and intelligence, but it was interesting to see the contrast.

After the debate, and the prizes handed out, FPAB then staged a little natok. The drama is typical of what the volunteers do for FPAB. Educating is more effective in staging the message rather than handing out leaflets so it was nice to get an insight into this. The story was, a pregnant wife beaten by the husband and then given shit by the mother in law. FPAB then comes to the rescue to teach the family why they should not be doing what they are doing and so on.

The sad thing about Bengali culture in the village is that pregnant women have it hard. This needs to change, obvious statement I know, but this culture is centuries old, so the task is hard.

After the day ended, I treated the guys I made friends with to the cheapest meal ever. 4 peeps ate for less than 70 pence. Hail the strength of the pound and my time in cox’s bazaar.

I went to bed early because the day after, I was headed off to St Martins!! Woo hoo!!!!