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Bangladesh - poor medical facilities for the majority

A riverine country

Bangladesh is a country with over 160 million people and most of them live in villages that are close to riverbanks. The land is criss-crossed with many rivers of different length and width, most eventually pouring into the Bay of Bengal in the country’s south. The rivers total almost 700, including the branching streams - and make up a 15,000 mile long water network, one of the largest in the world.

Medical facilities concentrated in urban areas away from majority population

Most of the hospitals and clinics in Bangladesh are located in towns and cities. The rural areas, where over 70% of the population lives, lack hospitals, clinics, health facilities and particularly qualified doctors. Thus for most people in Bangladesh going to a hospital is a lengthy, difficult and costly process. To be able to talk to a doctor is a unique privilege for the villager or the man in the street in a regular medical situation or emergency.

There are many reputable private hospitals and clinics. However, these are expensive and are only available for those fortunate few with money to fund their services. And while government-run hospitals offer low-cost medical care, they are often inaccessible, crowded, understaffed and lacking medicines.

Bangladesh suffers from both a shortage of and geographic mal-distribution of HRH (Human Resource for Health). There are an estimated 3.05 physicians per 10,000 population and 1.07 nurses per 10,000 population.

World Health Organization (WHO, 2011),

Combine this lack of resources and skillset with overpopulation, a weak (albeit improving) economy, and other difficulties characteristic of poor nations, it is no wonder Bangladesh has continuously struggled since its creation over four decades ago to provide adequate primary health care to the masses which breaks the cycle of poverty and poor health.

Major challenges include: an overly-centralised health system, weak governance structure and regulatory framework, weak management and institutional capacity in the Ministry of Health and Family Welfare (MoHFW), fragmented public service delivery, inefficient allocation of public resources, lack of regulation of the private sector – which employs 58% of all physicians, shortage of HRH (Human Resource for Health), high turnover and absenteeism of health workers, and poor maintenance of health facilities and medical equipment.

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The magnitude of disability in Bangladesh presents not only a major health problem, but it is also a prime cause of poverty and underdevelopment. Poverty, which first strikes the food security status at household level, creates havoc in the general health condition of the population. This is aggravated by a second factor resulting from the inadequate health service, especially in the rural areas of Bangladesh.

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"Floating hospitals"

To combat this grim scenario, Bangladesh has come up with an unique and innovative approach to supply many common medical treatment and services in large boats and ships and take these to people in remote areas within the country. These “floating hospitals” combine basic medical treatment with more advanced procedures to provide convenient and cost-effective service to the people who need it the most.

Hospital- and clinic-based services are definitely necessary at a certain level. But there are many health problems that could be solved at people’s doorsteps, which the paramedics can do, so time and resources can be saved.

Dr Manzur Kader, Programme Director at Gonoshasthya Kendra

"Jibon Tari" by IMPACT Foundation Bangladesh (IFB)

IMPACT branches worldwide

IMPACT as an international initiative to prevent and alleviate needless disability. It was formed in late 1982 via the collaboration of United Nations Development Programme (UNDP), World Health Organisation (WHO) and UNICEF following recommendation by blind British public health advocate Sir John Wilson. Sir John identified priorities and motivated like-minded people in a number of countries, including Bangladesh, to come together in the formation of national IMPACT organisations, each having shared aims, local trustees, is autonomous and registered in its own country.

In addition to Bangladesh, Impact Foundation works worldwide with branches in UK, Cambodia, India, Kenya, Nepal, Pakistan, Philippines, Sri Lanka, Tanzania, Thailand, and Zanzibar amongst others. It has restored sight, mobility and hearing, or repaired cleft lip for almost 800,000 people and prevented a lifetime of disability for many thousands more.

Collective targets for action for IMPACT branches include:

  • Early identification and treatment of disabling conditions
  • Affordable, accessible surgery
  • Safer motherhood and child survival
  • Ending "hidden hunger" caused by micronutrient malnutrition
  • Immunisation
  • Active ageing
  • Prevention of trauma (added later)

All of our projects are run by local people in touch with real need – they also contribute resources. This ensures that our work is cost-effective and appropriate.

Our aim is simple – that no one should become needlessly disabled by disease, lack of knowledge or shortage of medical services.

IMPACT

Launched in New Delhi, India

The global launch and inauguration of the first project took place in New Delhi, India on 2 October 1983. IMPACT India Foundation was established the next year, followed by the "Polio-free Madras Campaign", the "Bombay Fights Disability" programme and "Cure on Wheels" mobile clinic in 1985. The "Lifeline Express" hospital train began work in 1991 and has continued to take specialist care over the vast rail tracks to many parts of India.

IMPACT Foundation Bangladesh (IFB)

IMPACT Foundation Bangladesh (IFB) was registered in 1993 and immediately began an ambitious programme, initially focusing on the reduction of micronutrient malnutrition in Chuadanga District. This rapidly expanded to the establishment of a district-wide campaign to prevent and alleviate disability, radiating out from the Masudul Haque Memorial Community Health Centre, which has been in operation since 2002. Later, the Sir John Wilson Assistive Device Centre was added.

Impact Foundation has two primary service in Bangladesh: Inner Wheel and ‘Jibon Tari’ floating hospital.

'Inner Wheel'

Inner Wheel is an internationally reputed women’s voluntary organisation which is involved in philanthropic activities throughout the world. It is currently active in over 100 countries and geographic locations and has over 100,000 women Rotarian members.

Inner Wheel concentrates upon Friendship and Personal Service. It is not what is termed a money raising organization but each club has projects that build fellowship and raise money to support charities.

One of the greatest features of Inner Wheel is the opportunity given to members of the world over to get know one another, thus contributing to International Friendship and Understanding. Although there is a serious side to this organization, the emphasis is upon members enjoying the part they play in the world of Inner Wheel.

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In Bangladesh, Inner Wheel Clubs worked with IMPACT to implement the IMPACT Family Health Project which brought maternity care, clean water, sanitation, food security, immunisation and medical care to poor families living in a deprived rural area of Bangladesh. Together, both organisation help raise over £50,000 for 10 rural villages in Bangladesh. The money was put towards the prevention of ill-health and "needless disability which causes unnecessary suffering and keeps people in poverty by stopping them from working or going to school".

Having supported this wonderful charity for several years and seen its work in Bangladesh, I was keen to recommend this ‘IMPACT Family Health’ project in villages in western Bangladesh. Clean safe water provision, early recognition of ear and eye problems, maternity care improvement, immunisations and simple hygiene measures will hopefully make the lives of all the 25,000 inhabitants that much healthier.

Dr. Sheila Halliday-Pegg, Association Overseas Service Committee Chairman (July 2010)

How IMPACT is working to eradicate major health and social problems in Bangladesh:

  • In the poorest areas of Bangladesh, more than 1 in 8 children die before their 5th birthday. IMPACT provides clean water, sanitation and healthcare will help to protect them.
  • 80% of pregnant women give birth alone or without medical help. The IMPACT Family Health project trains and equip traditional birth attendants to keep women and babies safe from harm.
  • Lack of Vitamin A is a leading cause of child blindness yet only tiny amounts of this micronutrient are needed. IMPACT helps malnourished people grow vegetables to protect their children’s sight.
  • Only a third of men, women and children in rural areas have appropriate sanitation. Potentially fatal diseases such as diarrhoea and cholera spread rapidly in such conditions. IMPACT Family Health addresses issues such as these directly with cost-effective and simple strategies.

'Jibon Tari'

Unique creation

Building on the experience of the "Lifeline Express" hospital train in India, IMPACT launched the "Jibon Tari" (Soar of Life or Boat of Life) Floating Hospital on 10 April 1999 to take specialist care to riverside communities along 3,000 kilometres of waterway in Bangladesh. Taking its name from a poem written by Rabindranath Tagore, Jibon Tari is the first boat hospital in the world. It cost $1.5 million to build, with most of the money being raised in Britain. It began operating at the riverbank of Mawa in Munshiganj district with the aim of bringing surgical treatment to areas accessible only by river, where there are no hospitals and few medical facilities.

I feel very proud the Jibon Tari for the first time will be travelling to the south of Bangladesh where many people on off-shore islands have no access to modern medical facilities.

Monsur Ahmed Chowdhury, Director of IMPACT Foundation (Bangladesh)

The air conditioned vessel is 40 metres long and 10 metres breadth. It’s built on three decks equipped with a 12-bed ward, an operating theatre, post-operative room, out patient department, pathology and radiology department, physiotherapy unit, assistive device unit, 24 hours electricity support, ambulance and speed boats. It also has a training centre and even its own water purification plant.

It moors at each site for about 12 weeks and offers surgical and medical care, training and health education. The average cost of each life-transforming operation on board the Jibon Tari is £40 GBP.

Treatment

Treatment is provided by volunteer doctors assisted by a small permanent staff. By 2012 a total of 37 staffs including 4 full time doctors and 5 nurses were working in the hospital, with the chronic and complicated patients being attended by specialist doctors from Dhaka.

Within the boat IMPACT have the resources to carry out cataract, clubfeet and cleft operation and help people with hearing, mobility and other disabling conditions. The hospital can also treat orthopaedic and ear, nose, throat (ENT) patients and provide pathology and radiology services, physiotherapy, treatment and supply of associative devices against a token fee of Tk. 20 but in case of complicated surgeries the fee ranges from Tk. 1,500 to 2,500 inclusive of food and bed.

By 2012 Jibon Tari had treated 380,318 patients including 25,661 surgeries. The hospital has also completed 41 projects in 28 locations along the major rivers of Bangladesh.

The Jibon Tari's fame has spread quickly and crowds of people greet it at each site in the hope of treatment. In a country as impoverished as Bangladesh, the need for a service like this is almost limitless.

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IMPACT’s solution is to ‘take the hospital to the people’ in innovative ways tailored to local conditions or to establish static facilities to provide quality medical services in remote areas.

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Monsur Ahmed Chowdhury is the Director and a Trustee of Impact Foundation (Bangladesh). Monsur, who is blind, is also co-founder of the National Forum of Organizations Working with the Disabled (NFOWD) which is instrumental in guaranteeing the rights of disabled people through national legislation.

Jibon Tari, is successfully fulfilling its prime mandate: preventing and curing disability. The boat carries a tent capable of accommodating up to 150 outpatients in places where appropriate accommodation facilities are not available. To move it from place to place, a tugboat is used. The vessel is capable of being anchored or moored at a riverside with a permanent mooring facility. The hull and the superstructure of the vessel have been constructed with steel in accordance with the rules and regulations of the Inland Shipping Ordinance of Bangladesh and the Lloyds Register of Shipping Inland Rules and Regulations.

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In March 2008 I had the great fortune to participate in a surgical expedition in collaboration with the Impact Foundation. This is a charity whose objective is to reduce disability around the world by advocacy, education and intervention. Their West Sussex office is experienced in arranging for UK-based surgeons to go to centres in Asia and treat patients in the fields of orthopaedics, ENT and ophthalmology.

I travelled with my good friend and colleague, Mr Ali Mearza FRCOphth, to 2 locations: Ashuganj, capital of Brahmanbaria province to the East of Dacca, and Chuadanga in the West. At Ashuganj, we stayed on Impact’s floating hospital. This houses accommodation, clinics, a laboratory, a ward, a surgical suite with 2 operating tables, and a seminar room on the top deck. At Chuadanga we found a dedicated hospital building in the conventional sense, set in the grounds of a local nobleman’s house that had been donated to Impact some time previously.

In both settings, the staff were utterly dedicated to serving the population and the patients passed smoothly and effectively through the system from registration to post-operative examination and discharge.

Dr. Mohammed Muhtaseb, Consultant eye surgeon

We believe that it can, over the years, change the whole pattern of disability amongst these people in the waterways.

Sir John Wilson, President of Impact, believed the floating hospital had all the capability of a really big city hospital