Working with an NGO like MCC, I have had the opportunity to learn a lot about development and working with the poor in Bangladesh. Although MCC doesn’t directly implement primary health care projects, I am becoming familiar with the health care system here, and this has helped me better understand how Bangladeshis engage with this whole system when they fall ill. For this post I will be sharing and reflecting on some of the things that I have learned thus far.
| ONE |
The first thing I have learned is that there is poor access to quality primary health care practitioners in Bangladesh. The Bangladeshi government strives to provide universal health care, but due to the lack of resources and trained professionals, it is unable to provide appropriate and quality health care to those in need, especially to those in urban slums and rural parts of the country. Consequently, many Bangladeshis have compensated by seeking medical help from informal providers that often give quick advice that is less expensive then trained health care professionals in private hospitals and clinics. Studies have noted that around 75% of Bangladeshis utilize informal health care providers (which include traditional healers and homeopaths). (Context Analysis: Closes-to-Community Heath Care Service Providers in Bangladesh, 2014).
I recently read an article that contextually analyzed community health care service providers in Bangladesh. One perspective voiced in this article was of a married Bangladeshi woman living in the Dhaka area on her concerns regarding the government hospitals:
The government hospital charges 200–300 taka but does not give good medicine, and they take less money from the poor and from the rich people they take more. They do not give good medicine, so that patient visits them repeatedly.
(Context Analysis: Closes-to-Community Heath Care Service Providers in Bangladesh, 2014).
It is these types of situations that force people to seek out informal providers despite their lack of training and medical knowledge.
Another symptom of the weak health care system and lack of appropriate insurance programs is that the poor become vulnerable to additional burdens. For those barely able to meet the basic needs of their families, financial planning for health crises is extremely difficult. Therefore during a health crisis, the poor pay large out of pocket fees, wearing away their income and accumulating debt:
[A]ccording to one estimate, about 4-5 million people in Bangladesh are driven into poverty annually by catastrophic health expenditure (expenditure on health exceeding 10% of total household expenditure or ≥25% of non-food expenditure)
(Syed Masud Ahmed, Bangladesh Health Scenario: A Centre of Excellence for Universal Health Coverage, 2014)
| TWO |
Secondly I have learned that access to almost all drugs can be attained without a prescription from a physician, therefore many Bangladeshis go straight to a local drug stores when they are sick to self-medicate.
In Bangladesh, a 2007 national survey revealed that 95% of healthcare providers are unregulated, informal and often lack qualifications in their field.
(ICDDR,B Health and Science Bulletin, Vol 12-1, March 2014)
In many countries like Bangladesh, drug sellers play an important role in the health care system, providing advice and medicine. However, drug store owners often have minimal training if any at all, so their advice is based on experience. Many times they don’t even assess the person with the illness as family members are sent on behalf of the sick person to get the medicine. Pressure to treat the illness quickly in these circumstances often results in the careless distribution of drugs like antibiotics without proper testing and assessment.
Drug retail shops are often the first and only source of health care outside the home for a majority of poor patients in developing countries, and Bangladesh is no exception. According to an estimate, there are about 80 000 unlicensed drug stores in the country…As revealed in this study, irrational use of antibiotics and poly pharmacy are the most common problems found with drugstore salespeople.
(Ahmed etal. Human Resources for Health, The health workforce crisis in Banglaesh: shortage, inappropriate skill0mix and inequitable distribution, 2011)
| THREE |
The third thing that I have learned is that there are health care professionals who are trying to addresses the shortcomings in this health care system. One such initiative is a three year capacity building program run by the Asian Pacific Hospice Palliative Care Network (APHN) and the Lien Collaborative for Palliative Care.
This collaboration aims to enhance capacity for palliative care service provision in several Asian countries with little or no palliative care development, by building up a core interdisciplinary group of clinicians who will be capable of training others and to act as champions for palliative care within those countries.
(Asia Pacific Hospic Palliative Care Network, A Project to Enhance Palliative Care Leadership and Capacity in Developing Countries).
In August I attended a week-long training with foreign faculty who taught approximately 25 physicians, nurses and pharmacists on a range of topics focusing on palliative care. Here I observed the training program at two hospitals, the National Institute of Cancer Research Hospital and the Bangabandhu Sheikh Mujib Medical University, in the Dhaka area. Unfortunately in Bangladesh, many people with cancer and life-limiting illness are diagnosed at advanced stages, therefore curative therapy is forgone with little additional support given. Through educational training and ongoing support from the APHN and Lien Collaborative, the hope is for better supportive symptomatic care and pain management in the Bangladesh health care system.
During the week-long training program, I witnessed the eagerness of the participants as they learned more about palliative care from faculty with extensive clinical experience. I was also encouraged to see each participant work through case examples and apply the information that they learned to provide better, more appropriate care for their patients.
As I reflect on the things that I have learned, I feel more equipped in the health care work that I am doing with MCC as I have the opportunity to work with women that are employed through different projects that MCC runs in the Mymensingh area. This has challenged me to holistically think about the health advice that I give and I am thankful for this time of learning, reading and engaging in many different avenues to create an increased awareness and understanding of life and health care here.
PLEASE BE PRAYING THAT:
1. We continue to learn new things about Bangladesh and that I specifically maintain a positive attitude with regards to engaging in a health care system that is growing and changing
2. We are able to work well within our office and with our colleagues at the tasks set before us as both
3. We will receive our new 1 year visa that was recently applied for
Erin (and Nishant)
Check out the full album at: August 2014
The Monsoon season might be officially over now, but we still got a heavy downpour that flooded our street. Here is a brief glimpse from our office window. (To get a better appreciation of the rain, turn the volume up to the max).