Legacy:

Remembrance days: Diabetes Awareness Day, Sheba Dibosh & World Diabetes Day

28th February, the day the Diabetic Association of Bangladesh was founded, is celebrated annually as 'Diabetes Awareness Day'. The campaign draws attention to issues of paramount importance to the diabetes world and keeps diabetes firmly in the public spotlight. Meanwhile 6th September, the day Dr. Mohammad Ibrahim passed away, is commemorated as 'Sheba Dibosh' (Diabetes Service Day).

Internationally, in more than 160 countries and territories, 14th November is observed as World Diabetes Day. It was created in 1991 by the International Diabetes Federation (IDF) and the World Health Organization (WHO) to promote awareness of diabetes and to combat the global rise of the condition. World Diabetes Day became an official United Nations Day in 2007 with the passage of United Nation Resolution 61/225. Each year the IDF features a new theme to address issues facing the global diabetes community. While the themed campaigns last the whole year, the day itself is celebrated on 14th November, to mark the birthday of Frederick Banting who, along with Charles Best, first conceived the idea which led to the discovery of insulin in 1922.

Centenary birthday anniversary of Dr. Mohammad Ibrahim

On 31 December 2011 the 100th birth anniversary of Dr. Ibrahim was celebrated. All institutes and affiliated organisation of Bangladesh Diabetic Somiti celebrated the day. Special prayers was offered and Diabetes Screening Program were arranged and special diet for the admitted patients were served. A photo exhibition was also arranged reflecting the life and works of the Late National Professor. A new museum, "Ibrahim Memorial Museum", was inaugurated to preserve and protect memories of Prof. Ibrahim.

"Visionary and Missionary National Professor Dr. Mohammad Ibrahim" documentary

In 2010 Mahbubul Alam Taru directed a 56-minute documentary titled "Visionary and Missionary National Professor Dr. Mohammad Ibrahim'" which focused on the works and contribution of this great son of the soil. The premiere show of the documentary was held in the National Museum, Dhaka, where Chief Justice Mostafa Kamal and National Professor M. R. Khan were the main guests.

Since my childhood, I have seen him as a social activist. He was very religious.

Chief Justice Mostafa Kamal said the documentary will encourage others to follow the ideology of Dr. Ibrahim

It is Dr. Mohammad Ibrahim who inspired me to establish an organisation like the Institute of Child Health.

Prof. M. R. Khan, National Professor of Bangladesh

The documentary was later shown at all the diabetes centre in 56 districts of Bangladesh.

  • Mahbubul Alam Taru ()

What others say about him...

Those of us who know him personally, would not have met a man of his metor. Simple and humble but philanthropic and most indulgent to the care of underprivileged diabetics. Vocational rehabilitation of diabetes in rural Bangladesh was his exemplary contribution in the third world.

He persistently endeavoured to change the educational pattern and concept of medical practice from episodic to an anticipatory and comprehensive one, from clinical to preventive and promotive so as to meet the challenge of modern times with contemporary technology through example rather than precept.

We pray for a restful abode for him and his life to be a continuing inspiration for those who work for diabetics in the underprivileged social order.

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Dr. Ibrahim was a dynamic leader. He was very firm about what he wanted to achieve - and would go ahead and do it. He was firm, he might appear frightening but when you knew him well you would see he was at heart a very gentle man. I will always remember him for his contribution to women's development in Bangladesh. He took a very bold step in 1976 by appointing 13,000 women to work in village family planning programmes. Due to some bureaucratic procedures, the appointment could not take place for a long time. But Professor Ibrahim gave orders to complete the appointment by 31 March 1976. To do this in 1976, when only 6% of the women of Bangladesh were literate, was a miracle.

Mahnur Rahman, former Director of Training at the National Institute of Population Research and Training (NIPORT) in Bangladesh

National Professor Mohammad Ibrahim was a celebrated physician, a gifted teacher, a talented organiser and a great reformer. His contributions in the field of medicine in general and diabetes in particular have been nothing less than phenomenal.

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BIRDEM

The Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) is the central institute of Bangladesh Diabetic Somoti. it is a multi-sectoral health care centre, educational and research institute located at Shahbagh area in Dhaka. The hospital is housed in a 15-storied building established on a government plot and financed by the government.

It has the largest diabetic out-patient turnover in the world under one roof and it is one of the largest health-complexes in Bangladesh providing almost all types of clinical and diagnostic facilities that is expected of a modern hospital. The hospital has 674 beds - among these 30% beds are free. Poor diabetic patients and case of academic interests are entitled to these free beds where all investigations and treatment (including medications) are provided without any charge. The in-patient departments have taken the characteristics of almost a general hospital, although diabetic and other endocrine patients are always given priority.

BIRDEM maintains a separate research department staffed by full-time researchers. With large number of international collaborations the institute is now widely acclaimed as one of the most advanced diabetic research centre in the world. In recognition of its innovative, extensive and high quality services BIRDEM was designated in 1982 as a 'WHO-Collaborating Centre for Developing Community-oriented Programmes for Prevention and Control of Diabetes'. It is the first such centre in Asia and the first of its kind outside Europe.

The clinical services of BIRDEM provide comprehensive diabetic care free of charge to all the registered diabetic patients. The fund collected by 'Cross financing' system i.e through medical care and diagnostic service to other patients, is spent for imparting free medical service to the diabetic patients. The patients are entitled to get medical supervision, consultations, diabetic education (which includes basic knowledge on overall health), advice on nutrition, social support and rehabilitation, if necessary. Insulin, oral hypoglycemic agents, and medicines are supplied free or at subsidized cost.

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BIRDEM Academy

In 1986 the BIRDEM Academy was established with the objective of producing adequate qualified manpower for medical institutions in the country including BIRDEM. The Academy conducts diploma and degree courses like DEM, MPhil, MD and PhD in Endocrine Medicine. Besides, post graduation courses are also conducted on subjects like general surgery, ophthalmology, medicine, critical care medicine, etc, under the University of Dhaka and Bangabandhu Sheikh Mujib Medical University (BSMMU).

Training courses provided at BIRDEM Academy:

  • PhD.
  • MD in...Endocrinology & Metabolism, Radiology & Imaging, Gastroenterology, Internal Medicine, Neonatology, and Critical Care Medicine.
  • MS in...Obstetrics and Gynaecolgy, General Surgery, and Ophthalmology.
  • M. Phil in...Immunology, Biochemistry, and Radiology & Imaging.
  • Diploma in...Dermatology, Endocrinology & Metabolism (DEM), and Anesthesioslogy.

Other initiatives

BIRDEM is one of seven institutions currently working as part of the Bangladesh Diabetic Association to serve people.

Bangladesh Diabetic Somiti has 7 institutions which are:

  1. Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) = Website www.birdem-bd.org.
  2. Rehabilitation and Vocational Training Centre (RVTC) = Main objective is to train the poor Diabetics to help them to get employment after getting training in different trades like computer technology, beautification, dress making, printing, etc. The organisation helps them to be self supportive leading a meaningful, respectful life in society by generating their own means and resources and not become a burden on their family so as to lead a normal life. Website www.rvtcbd.org.
  3. National Health Care Network (NHN) = Established June 1996 to provide quality laboratory services all over the country. It has 13 out-patient centres throughout Dhaka city and 5 others throughout the country (at Ashulia, Gazipur, Comilla, Narayanganj and Patuakhali). Website www.nhn-dab.org.bd.
  4. Ibrahim Cardiac Hospital & Research Institute (ICHRI) = A non-profit and highly reputable organisation to prevent and treat cardiac patients, to create awarness and to develop skilled manpower. Website www.ichri.org.
  5. Ibrahim Medical College (IMC) = Established in 2002. The college offers 5-year MBBS Course as approved by Bangladesh Medical and Dental Council (BM & DC) leading to MBBS degree of the University of Dhaka. The goal and objectives of the college is to create leaders of medical profession, who are competent, committed, caring and willing to serve the community. The college provides excellent broad based education with a focus on professional development. Website www.imc-bd.org.
  6. Bangladesh Institute of Health Sciences (BIHS) = The objective of BIHS is to create a Model Educational Institute encompassing all disciplines of biomedical and health sciences. Website www.bihs.edu.bd.
  7. Kidney and Liver Transplant Unit (KALTU) = Formed in November 2004. Four kidney transplantation operations were performed on the same day. Regular kidney transplantation started on March 2005. In June 2010 the unit performed the first ever liver transplantation operation in Bangladesh and total two liver transplantations have been successfully done.

Dr. Ibrahim was very much aware about the quality of the service provided to the patients. He used to tell the patients: "We are grateful to you for giving us the opportunity to serve". His humility was legendary and most genuine. Deep empathy and compassion were characteristics of his dealing with his patients, especially those who were poor and in pain. He also motivated other doctors to serve the patients with empathy.

He included social welfare, health education, nutritional education and rehabilitation in the diabetes healthcare delivery system. He believed that an institution achieves its goal and excellence not by bricks and mortars; nor by machine or metals but by its human resources.

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Helping the aged

Dr. Mohammad Ibrahim was also involved in the care of the old and the aged. He was the chairman of the Bangladesh Association of Geriatrics during 1978-89 and helped to set up the Institute of Geriatric Medicine and Research. He was also Chairman of the Retired Government Employees Welfare Association from 1976-88. For his work on the old and the aged, he was elected a Member of the Executive Committee of the International Federation of the Aged, London.

Awards galore

In 1963, the Pakistan government honoured Dr. Mohammad Ibrahim with the Sitara-i-Khidmat (Star of Service) award for his special contributions to medical science.

In 1979 the Government of Bangladesh awarded Dr. Ibrahim the Swadhinata Purushkar (Independence Day Award), the highest civilian award in Bangladesh. This was followed by numerous Gold Medal from various reputable organisations throughout the country, such as Begum Zebunnesa and Kazi Mahbubullah Trust (1981), Mahbub Ali Khan Memorial Trust (1985), Comilla Foundation, Comilla (1986), Khan Bahadur Ahsanullah Memorial Trust, Ahsania Mission, Dhaka (1989), and Islamic Foundation Bangladesh (1989).

First physician to become National Professor of Bangladesh

In 1984, in recognition of his great contribution to medicine and to humanity, the Government of Bangladesh appointed Dr. Mohammad Ibrahim as the National Professor of Bangladesh. He was first physician to receive such high distinction. The following year he became a Fellow of Bangla Academy (1985) and the year later a Founder Fellow of Islamic Academy of Sciences, Amman, Jordan (1986)

Passing & burial

On 6 September 1989 Dr. Mohammad Ibrahim passed away in Dhaka. His death anniversary is observed as 'Sheba Dibosh' (Diabetic Service Day) to endorse and honour his great contribution to socio-medicare services.

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Father of diabetic care in Pakistan & Bangladesh

Diabetic Association of Pakistan

Back in 1956 the real extent of the problem of diabetes in the country was not evident. People thought that diabetes is a disease of the affluents and hardly anyone anticipated that diabetes would be an epidemic even in the developing countries - except Dr. Ibrahim. Foreseeing the problem, Dr. Ibrahim organised and led a team of social workers, philanthropists, physicians, and civil servants to establish the Diabetic Association of Pakistan on 28 February 1956 in a tin-shed building at Segun Bagicha area of Dhaka with only 23 patients. The association was a non-profit voluntary socio-medical service organisation. Primarily an adhoc committee was formed to run the organisation. Later, on 21 May 1956 the first Office Bearers of the Association has been formed with Dr. Ibrahim himself as the Vice President and the following members:

  • President: Major Dabiruddin ()
  • Vice President: Nurjahan Morshed ()
  • Secretary: A. M. Salimullah Fahami ()
  • Joint Secretary: Tahera Karim ()
  • Joint Secretary: Dr. M. A. Mannan ()
  • Treasurer: F. Dosani ()

The ground-breaking organisation was formed by Dr. Ibrahim to help the most needy. With this in mind, he gave free primary care to the diabetic patients irrespective of socio-economic, racial or religious status. Even rich patients were not allowed to buy the primary diabetic care, but could donate money to the association. The resources and fund was raised through motivation programs.

No diabetic patients should die untreated, unfed or unemployed even if she/he is poor.

The motto of Dr. Mohammad Ibrahim,

In 1957 the Association started an out-patient clinic in a small semi-permanent structure of about 380 sq feet (35.3 sq m) at Segun Bagicha.

Pursuing dream whilst juggling professional & academic career

Dr. Mohammad Ibrahim worked tirelessly to fulfill his vision of a healthy diabetes-free nation whilst simultaneously juggling his professional and academic responsibilities. In 1958 he served as the Governor at the Pakistan chapter of the American College of Chest Physicians. Four years later, in 1962, he received his FCPS (Fellowship of College of Physicians & Surgeons) degree - postgraduate training in specialties of Medicine - from Pakistan College of Physicians and Surgeons and served as the Professor of Medicine and Principal at Sir Salimullah Medical College and Hospital until 1964. During the same time, in 1963, the Government of Pakistan honoured Dr. Ibrahim with the Sitara-i-Khidmat state award for his special contributions to medical science.

In 1964, he was appointed Director and Professor at Jinnah Post Graduate Medical Center in Karachi, West Pakistan. While in the western wing, Dr. Ibrahim opened two new branch of the Diabetic Association of Pakistan in Karachi and Lahore respectively and became the Chairman at the Karachi branch.

Three years later, in 1967, he received his FRCP (Fellows of RCP) degree from the Royal College of Physicians (RCP) in London, UK. The following year he began the Applied Nutritional Research and Training Program. From 1969-70, Dr. Ibrahim served as Chairman at the Pakistan National Science Council in Islamabad, West Pakistan.

Renamed to 'Bangladesh Diabetic Somiti' (Diabetic Association of Bangladesh) after 1971 Muktijuddho

Following the creation of Bangladesh in 1971 after nine-months of genocide, Dr. Ibrahim returned to the country and retired from government duty, engaging wholeheartedly in his work as a physician, in his social work and in the diabetic health care program. He renamed the Diabetic Association of Pakistan to Bangladesh Diabetic Somiti (Diabetic Association of Bangladesh or DAB for short). The organisation is also known by 'Bangladesh Diabetic Association' or BADAS for short. Initially when the organisation was formed in 1956 there was no indoor facilities at Segun Bagicha. Patients in need of hospitalisation were sent to other hospitals. However, by the beginning of 1970s few short-stay beds were established to take care of the serious patients.

Dr. Ibrahim was aware of the quality of the service provided to the patients. He used to tell patients: "We are grateful to you for giving us the opportunity to serve". Deep empathy and compassion were characteristics of his dealing with patients, especially those who were poor and in pain. He also motivated other doctors to serve the patients with empathy. He included social welfare, health education, nutritional education and rehabilitation in the diabetes healthcare delivery system. He always believed that an institution achieves its goal and excellence neither by bricks and mortar, nor by machine or metal, but by its human resources. He spent all his life in developing talented human resources.

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Over the years, the clinic has turned into a diabetes care and research complex at Shahbag, Dhaka. After the death of Prof Ibrahim in 1989, the highrise building which houses BADAS was renamed as 'Ibrahim Memorial Diabetes Centre'.

One of the leading health complexes in Bangladesh

The Diabetic Association of Bangladesh is managed by a 32-member National Council comprising heads of universities, financial institutions, research organisations, donor agencies, community organisations as well as social leaders and government officers. Eighteen (18) members from the life member category and 6 members from the Affiliated Association category are directly elected by the representative life members and Affiliated Association members respectively in the Annual General Meeting (AGM).

BADAS' Diabetes Care and Research Complex, now converted into a large modern diabetic hospital, has both indoor and outdoor treatment facilities and it provides pathological and X-ray services. The hospital is World Health Organisation's regional collaborating centre for diabetes research in Southeast Asia. It serves about 300 outdoor patients daily and has about 461 paying and 80 non-paying beds and also 89 cabins. There are about 310 doctors, 171 paramedics and 523 nurses associated with BADAS. It employs 4,678 staff and has over 350 volunteers.

The organisation has about 102 health care facilities and 60 affiliated organisations throughout the country including in Bagerhat, Bhola, Cox's Bazar, Gaibandha, Jhendiah, Kishoreganj, Magura, Sunamganj and Tangail.

BADAS mission:

  • Provide total healthcare including rehabilitation for all diabetics irrespective of gender, economic and social status through different institutions of Diabetic Associations of Bangladesh.
  • Expand these services to provide affordable BADAS healthcare for all Bangladeshi through self-sustaining centres of excellences.
  • For human resources development create requisite specialized quality manpower (Physician, Technicians, Nurses and other related) of high ethical standards for manning these institutions and for the country.
  • Develop leadership in healthcare through dedicated and transparent management system.
  • Develop industries for diabetic and other health food and manufacturing medicines.

Following the guidance and philosophy of its founder, the Diabetic Association of Bangladesh has upheld its vision that no diabetic should die untreated, unemployed or unfed even if poor and all people shall be provided with affordable health care service.

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Growth

Starting with only 39 patients in 1956, BADAS, along with its affiliates, now serves the largest number of registered diabetic patients receiving regular and comprehensive health care under a single umbrella in the whole world. At the end of financial year 2012 (July 2011 - June 2012) the total number of registered patients was 2,110,146 of which 251,370 were registered as new patients.

In 1980 DAB established the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM) at Shahbag, Dhaka, to produce qualified manpower in diabetes, endocrine and metabolism. The out-patients centre of DAB was also shifted to BIRDEM. Through its Academy, BIRDEM conducts the largest number of postgraduate courses in the private sector. It conducts specialised postgraduate courses for diploma and degrees such as MPhil, MD, PhD, and MS in various medical and health science disciplines under the Postgraduate Faculty of Medicine of the University of Dhaka.

Along with its mother organisation BADAS, BIRDEM has 42 district level branches in the country.

Over the last five decades the Association has created the largest infrastructure and registered patients base in the world for the prevention and care of diabetes. In addition, next to the Government, it is now the largest comprehensive health care provider as well as the health manpower generating organisation in Bangladesh.

The type of projects which Bangladesh Diabetic Somiti carry out include:

  • Health Care Development Project (HCDP)
  • Pre-natal Care Project (PCP)
  • Preventative Foot Care Project (PFC)
  • Distance Learning Project (DLP)
  • Diabetes Prevention Project (DPP)
  • BADAS-ORBIS Eye Care Project
  • Diabetes Prevention Intervention Study (DPIS)
  • Extension of Diabetic Care Project (EDC)
  • Mother & Child Health (MCH)
  • Changing Diabetes in Children (CDIC)

Bringing awareness nationwide

In addition to traditional marketing techniques, the Bangladesh Diabetic Association employ innovative modern approach to bring awareness to the masses in this developing nation.

Mass awareness programs include:

  • Rally
  • Discussions
  • Question/answer session (doctors with patients)
  • Radio & tv programs
  • Distribution of awareness materials and diabetes/health magazine
  • Children art competition
  • Screening of diabetes in various centres and in the community of high risk people
  • Milad (special prayer)
  • Free heart camp
  • Free consultation on diabetes management and treatment at Hajj Camp & publication of book
  • Prevention and awareness for young and Type 1 diabetes
  • Video animation for the prevention and control of diabetes
  • Educational tools for the patients
  • Clay model of the food items

In 2012 a full length feature film called "Dui Beayier Kirti" had been released in cinema halls throughout Bangladesh to create diabetes awareness.

Member of International Diabetes Federation (IDF)

In 1959, three years after it was founded, the Diabetic Association of Bangladesh became a member of the world-renowned International Diabetic Federation (IDF). The IDF is an umbrella organisation of over 200 national diabetes associations in over 160 countries. It represents the interests of the growing number of people with diabetes and those at risk. The Federation has been leading the global diabetes community since 1950 and is a highly respected player in the field.

As a member of IDF, we express solidarity with the vision and mission of IDF in creating global awareness, fight NCD in general and diabetes in particular. We get more training opportunities and exposure, recent updates about diabetes and networking.

Dr. Ahmed Razee, President of Diabetic Association of Bangladesh (2013)

  • International Diabetes Federation (IDF) ()

Internationally, BADAS collaborates with leading health organisations in order to make sure the people of Bangladesh receive the best service. These organisations include: United Nations Population Fund (UNFPA), U.S. Agency for International Development (USAID), World Diabetes Foundation (WDF), University of Oslo, Women and Children First UK, ORBIS International, AUS AID and European Union (EU).

BADAS has gained international reputation for its diabetes health care model branded as 'Ibrahim Model'. It has also emerged as a major general health care provider all over Bangladesh. BADAS is contributing, to a large extent, in both undergraduate and postgraduate manpower development in Bangladesh through formal and informal educational and training programs.

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Working till his death

From 1972, until the day of his death, Dr. Ibrahim continued working diligently as chairman of the Bangladesh Diabetic Society. At the same time, from 1975 to 1977 Dr. Ibrahim served as Advisor to President Ziaur Rahman for the Health and Population Control, Labour and Human Resources and Social Welfare Ministries. He was involved with many philanthropist efforts, having established many such organizations and served in important capacities at many national institutions.

In 1978 Dr. Ibrahim received the FRCP degree from the Royal College of Physicians in Glasgow, Scotland, UK.

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Early life

Mohammad Ibrahim was born on 31 December 1911 in the village of Kharera in Bharatpur, Murshidabad, West Bengal, in British India. His father was a village postmaster in Murshidabad.

Education

Mohammad Ibrahim had to walk several miles to school. Encouraged by his father to seek a higher education, he earned one of the few scholarships given to Muslim boys at the time.

Mohammad Ibrahim passed his matriculation (or matric as it is popularly shortened to) exams from Salar Edward High School, Murshidabad, with marks in mathematics and his Intermediate (ISc) from Islamia College (now Maulana Azad College), Kolkata, the college attended later by Sheikh Mujibur Rahman. In 1938 he graduated in Medicine (MBBS) from Kolkata Medical College, after that he started to work as a doctor. He gained the opportunity to work as house physician at the ward under supervision of the Professor of Medicine at Calcutta Medical College. Afterwards, from 1938-1945, he worked in the same institution as the Emergency Medical Officer and Senior Demonstrator at the Practical Pharmacy Department. From 1945-47, he served as Resident Physician at the college.

After the partition of British India into India and newly formed Pakistan, Professor Ibrahim moved to the eastern wing of Pakistan (present-day Bangladesh) and began work as a Civil Surgeon in Chittagong. At the same time, he served as a Superintendent at the General Hospital and a teacher of Medicine at Chittagong Medical College and Hospital. In 1948, Professor Ibrahim travelled to London, UK, to study at the world-renowned Royal College of Physcians (RCP) where he became a MRCP (Member of RCP) the very next year. The year after that, he was awarded FRCP (Fellow of RCP) from the American College of Chest Physicians.

In 1950, Dr. Ibrahim returned to East Pakistan where the Bangla-Urdu language issue was intensifying. It was during this tumultuous period he joined Dhaka Medical College as Additional Physician. Eventually, he was appointed Professor of Clinical Medicine and Medicine. It was whilst working at the Dhaka Medical College that Dr. Ibrahim specialised in the area that he became synonymous with - diabetes.

He remained a man of simple tastes, spurning a lucrative practice in the pursuit of improving medical care for the disadvantaged.

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Family Planning Association of Bangladesh (FPAB)

Founded by Dr. Humaira Sayeed, a young female doctor

During the early days of Bangladesh, when it was the eastern wing of Pakistan, the socio-economic situation for the female was much worse than it is today. The female illiteracy was much higher and very few births were attended by health personnel. There were practically no sex education within the families and it was normal for young girls to be married before the age of 18 without knowing much about their bodies or about sexuality. It was also a time when the young nation was crippling from rapid population growth. And though family planning was never actually prevented, it was socially not accepted and frowned upon.

Worries about population growth began even when Bangladesh was part of British India. The belief, among the elites, was that densely populated lands would not benefit from rapid population growth and that such growth was the cause of periodic famine. This belief was further strengthened after the British left, partitioning the subcontinent into India and Pakistan.

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Role differentiation among our women is in the offing. It is markedly apparent among the middle class and the lower class. Generally they were confined to the kitchen and house keeping. Now with the increasing number of female graduates entering the job market they are increasingly going out to work while taking up the responsibility of accompanying their children to and from school with the added responsibility of taking care of utility bills and also shopping in kitchen market and the mall as well. All these activities used to be exclusively man's domain. The village girls until a decade ago or so were confined to their household chores including helping mothers with baby sitting. Now they are rushing out to the city to work in garment factories. Thus they have turned into bread earners from the reclusive home bound 'non-productive' life. Thus the role and functions of our women are changing and this change is taking place slowly but significantly.

Syed Waliullah, former Director General of National Institute of Population Research and Training (NIPORT) in Bangladesh

It was in this context that a young woman doctor, Humaira Sayeed, introduced family planning. Witnessing the tragic results of an increasing number of non-medical abortions and realising the serious threats upon development efforts of the country resulting from an increasing rate of population growth, Dr. Sayeed sought the co-operation of doctors, social workers, lawyers and lay person as co-founders of an organisation to tackle this important issue.

In fact, family planning as an innovative concept and service was introduced to the educated class of Pakistan, for that matter the sub-continent as a whole, by Abul Hasanat through his book "Jouna Bigyan" and "Jonmoniontron O Shu Sontan Lav" in 1952. As a professor of Dhaka Medical College, Dr. Humaira Sayeed was a pioneer in putting these theories into practice.

  • Humaira Sayeed (- 1957)
  • Abul Hasanat ()

In 1953 the East Pakistan Family Planning Association was established in Dhaka as a private initiative under the dynamic leader of Dr. Humaira Sayeed, who became the founding president of the Association. A clinic was set up in the Segun Bagicha area of Dhaka to advice women from low income families on family planning and distribute contraceptives among them. The prime objective of the Association was to improve quality of life of the under privileged section of the people by advocating family planning as a basic human right and motivating people towards the concept of small family.

In 1957, barely four years later, Dr. Sayeed died from complications of hepatitis. Among the friends she had brought into the association was Dr. Mohammad Ibrahim, then Professor of Medicine at Dhaka Medical College. As one of its co-founder, Dr. Ibrahim worked tirelessly for the Association.

Renamed after 1971 Swadhinata Juddho

The East Pakistan Family Planning Association operated as a non-governmental organisation (NGO) and led the family planning movement until the Pakistan government's official programmed was launched in the 1960s.

By 1960 Pakistan had begun public-sector programs, which Bangladesh continued after becoming a nation in 1971. The government, the donors and the multinationals picked up the urban-based programme for introducing the family planning service throughout the nation after the service was experimented in rural areas, as a project by Dr. Akhter Hameed Khan at the Pakistan Academy for Rural Development (now Bangladesh Academy for Rural Development, BARD) in Comilla, East Pakistan. Dr. Khan's rural project was known as the 'Comilla Model' and launched in 1959. It provided a solid foundation on which Muhammad Yunus established the microcredit concept for which he was awarded the Nobel Peace Prize in 2006.

  • Akhter Hameed Khan ()

In 1965 the East Pakistan Family Planning Association played an important role in formulating national family planning programme introduced by the then government of Pakistan led by military leader General Ayub Khan. As part of its public sector programs, family planning services were offered in government health clinics as part of regular health services. A system of using village aides to provide education was established but abandoned after only 18 months for a variety of reasons, including poor training of the aides, complaints that their services were directed only to family planning and not to other health problems, inadequate resources, and poor supervisions. It was followed by renewed efforts run by a new Family Planning Board independent of the Ministry of Health.

Their efforts in the late 1960s met with little success, primarily because of poor-quality services provided by a program that had been instituted on a large scale with little pilot testing and poor organisation. The program emphasised the IUD, which was met with resistance by many concerned about side effects and problems with its use. It did not help that the program was seen by many as having imposed on Bangladesh, then East Pakistan, by a government whose political support was declining.

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After the independence of Bangladesh in 1971 the East Pakistan Family Planning Association was renamed to Family Planning Association of Bangladesh (FPAB). In addition to Mohammad Ibrahim, national luminaries like Alamgir M. A. Kabir, Dr. (Captain) Abul Kashem, Dr. Syed A. K. M. Hafizur Rahman, M. Shamsul Islam, Shaheed Md. Maizuddin, Kazi Anisur Rahman and other eminent personalities have led FPAB since its inception.

  • Alamgir M. A. Kabir ()
  • Abul Kashem ()
  • Syed A. K. M. Hafizur Rahman ()
  • M. Shamsul Islam ()
  • Shaheed Md. Maizuddin ()
  • Kazi Anisur Rahman ()

In the aftermath of the War of Independence, although the health and social sectors of the government were particularly negatively affected, it was felt that family planning was urgently needed. A large and complex programs was established. A separate Population Wing was created within the Ministry of Health and Population to run this program. Thus, health and family planning services were separated. At the local level, the primary health care staffs were predominantly male, in a society where, because there can be little interaction between women and men who are not members of their families, male workers cannot provide maternal and child health services except immunisations. This staffing was a legacy of early programs to combat smallpox, tuberculosis, and malaria. It was ill-suited to the new focus. By contrast, local family planning workers were women, although their supervisors were men. They went directly to households and offered family planning counselling and free supplies. They spent same time on maternal and child health, although they were not well trained for this purpose.

The realisation that rapid population growth and persistent high fertility posed a serious threat to achieving a better quality of life and to development contributed to the establishment of the Family Planning Association in 1953. This initiative was launched by a group of social workers who met with staunch opposition in their efforts to make family planning services available to people. Initially family planning activities were carried out without any government support. This first phase was followed by a period during which limited support was provided, lasting until the government family planning programme was established in the Five-year Plan for 1960-65. A government-expanded programme was established during 1965-70 and a multi-sectoral and broad-based population control and family planning programme soon thereafter, in 1972. The First Five-year Plan after independence (1973-78) attached the same priority to population control as to food production. In June 1976, population was declared as the number one problem of the country and the government emphasised the family planning programme as an integral part of the development process.

The Second Five-year Plan (1980-85) aimed at raising the contraceptive prevalence rate from 14% to 38% by 1985 by expanding and strengthening Information, Education, and Communication (IEC) activities and family planning services.

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Dr. Ibrahim felt that anyone who came in contact with him was somewhat like his own child or relation. It was not friendship, it was something more than that. In our culture, someone who is a blood relation is more akin to you than anybody else. Whether people were related to him, whether he knew them or not. Dr. Ibrahim would make them feel that they were one of his own family. The basis of his treatment was always empathy. Not sympathy, empathy. There is a great difference between the two words. Nobody had talked about this difference before Dr. Ibrahim. I haven't heard this word uttered by any physician, social worker or scientist.

Dr. Ibrahim was concerned with the total person, that is why he was so interested in family planning.

...Staff training consisted of seminars, orientation courses. We talked about women's health, the issue of family economics - more children than you could afford, children's health. We also talked about the teachings of the Qur'an. In the Qur'an there are mentions of ajar, the withdrawal method. It is authorised by the Qur'an.

Initially we countered some opposition from the religious groups. To counter that we took on an education programme. I took a group of 20 ullamas (religious leaders) to Indonesia then to Malaysia, touring the two countries for a month. Visiting family planning clinics, they debated the pros and cons of family planning with Indonesian ullamas. When they came back to Bangladesh, although they did not come out and say these things, privately they told their students and disciples, "It is absolute necessary for us to take family planning".

In the rural areas, couples do not talk about intimate things like how many children they will have. It is extremely difficult for the wife to speak up in such a male dominated society. The woman must take on whatever the husband gives to her. All decisions are taken by the man. When I used to visit rural areas and to to houses I would ask women if they were using family planning. They would say "No, they don't know about it, nobody came to tell them about it". They couldn't tell their husband for fear that they may become angry.

'Small family, happy family' was the motto of the FPAB. We have a family planning unit here at BIRDEM.

I'm not a doctor. But Dr. Ibrahim took me from the Ministry of Information. I have been the managing director of the Film Development Corporation, in radio and in television. I have experience in almost all the facets of the media so he took me to the Ministry to start a programme with emphasis on Information, Education and Communication (IEC). We didn't say 'communication' we said 'motivation'. So I was the first IEC consultant in the ministry. The radio is still used for motivation programmes. We have the tremendous advantage of being homogenous, one language, one religion. These are very important advantages. It was much easier to work here. Unfortunately we have not achieved as much as some of the countries of South Asia which started their population programmes much later. There is no lack of services anywhere - but it is the follow up which is lacking.

Abul Hussein, former Executive Committee member of FPAB and close colleague of Dr. Ibrahim

Expansion

The family planning movement has evolved over time, starting with efforts to popularise the small family norm at the early stage of the programme to the more recent integrated health and population programme. Today, FPAB operates a robust and dynamic network of over 1,500 services points, including 37 permanent clinics, 58 mobile facilities and over 1,400 community-based distributors (CBDs) or community-based services (CBSs). The Association is governed by a National Executive Committee consisting of 21 Members and employs 800 dedicated staff and over 6,000 volunteers.

As an affiliate of International Planned Parenthood Federation (IPPF), FPAB is the oldest and largest family planning non-government organisation (NGO) in Bangladesh. Over the years, the program has continued to be revised and expanded, but throughout there has been high-level political support, strong financial support (especially funding from external donors), and extensive administrative support.

With the span of more than 50 years of its emergence, FPAB has made a significant achievement in creating awareness among the eligible couples about family planning and annually contributes 7% of the total national family planning performance. In conformity with the al and national needs, FPAB shifted its thrust from lone family planning interventions to the holistic approach of reproductive health in mid 90s of the last century. Instead of targeting fertile couples, interventions of FPAB now involve men and women of all ages with special focus on the disadvantaged segment of the population. Beneficiaries of FPAB have now exceeded ten million people.

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FPAB's work is diverse. It targets people right across the community, in all areas, but with a particular emphasis on work in under-served locations such as urban slums. In addition to health professionals, FPAB makes wide use of peer educators, community leaders and mass media to disseminate information on family planning, population and SRH issues.

...Allied to small loans projects, this training [workshop for women] enables women to realise a level of economic independence and financial input into households which empowers them to take greater control over decisions regarding their fertility.

A key focus for FPAB is ensuring that projects are sustainable and cost-effective, and the organisation has been highly effective in achieving this goal.

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To increase awareness, FPAB has emphasised provision of services, outreach activities at the village level, and mass communication through a variety of media. FPAB also organises seminars with representatives of religious groups and public authorities, trains health workers, and runs skills training workshops in order to strengthen women's personal and social position.

There are several qualities that made Dr. Ibrahim a very exceptional man. The first was his total commitment to whatever he did. This commitment meant of everything - his own health, wealth, his family - everything.

I have never yet to meet a man with such visions. If he were born in a developed society, I'm sure he would have been much more famous because what he could visualise what it took others 15-20 years, even 30 years, to think was important.

In his early career he understood that medical care is not purely a medical matter. This is accepted now, but that was not so in the early 1950s, especially in the developing countries where one thought that medical care was something to do only with doctors. He said, "That is not true, medical care is part of social care". He realised that for life-long diseases, like diabetes, in a developing country where there is no social security or assured medical care, there has to be something like the Diabetic Association which looks after people, irrespective of the financial, social or education status. He had vision about the question of family planning. He understood early on that the population question was going to become one of the top problems of Bangladesh. He was a deeply religious man, but he promoted planned parenthood very early. He was convinced about the need a long time back, before many other people here in this country.

Since I had the opportunity of being with him most of the time, I was the person who often quarreled, or argued, with him. For example he would say to staff at the hospital, "Get this, or buy that" and they didn't dare say, "But there is no money". So I would be the one to say, "We can't do it because we lack money". He would look at me and say, "Nothing has remained unaccomplished because of lack of finance".

It was quite unusual for a man like him, who was so religious, to discuss family planning openly with young children, talking about their puberty and all in decent language. He toured the entire country discussing family planning; it was part of his total commitment to everything he did.

Dr. Azad Khan, a consultant in gastro-enterology at BIRDEM and Dr. Ibrahim's son-in-law who lived with him in the family home in Dhaka

In 2004, in compliance with the changed global and national needs, FPAB developed its five year strategic plan for the period covering 2005-2009 with focus on five key areas: Advocacy, Adolescent, Abortion, HIV-AIDS and Access.

Mission of FPAB:

  • FPAB aims to improve the quality of lives of individuals, by campaigning for sexual health and reproductive rights through advocacy and services, especially for poor and vulnerable people.
  • We defend the right of all young people to enjoy their sexual lives free from ill-health, unwanted pregnancy, violence and discrimination.
  • We support a woman’s right to choose to terminate her pregnancy legally and safely.
  • We strive to eliminate Sexually Transmitted Infections and to eradicate HIV/AIDS.
  • We carry our work in partnership with organizations and donors to achieve our goals more efficiently and effectively.

In 2011, FPAB delivered:

  • 3.4 million contraceptive services
  • 6.2 million condoms
  • 1.1 million other sexual and reproductive health services
  • 2.3 million services to young people under 25 years

In the First Five-year Plan of Pakistan (1960-65) population control was the official policy of the government. In the 1960s, the government justified the need for family planning mostly as a race between food production and population growth. Since then, every successive regime in Bangladesh attached very high priority to containing the rate of population growth.

The First Five-year Plan of Bangladesh (1975-80) gave family planning equal emphasis to that given to food production. This marked the beginning of a multi-sectoral and broad-based family planning programme in the country. The base of the programme was broadened by integrating Maternal and Child Health (MCH). The Information, Education and Communication (IEC) activities received a good deal of attention. A number of multi-sectoral ministries were involved in population activities. In line with the government policy of ensuring community participation in family planning activities, NGOs and the private sector were gradually encouraged to undertake activities to supplement the government programme efforts.

Further emphasis has been given in all subsequent plans, and more particularly under the Fifth Five-year Plan (1997 - 2002). The main objective of the Fifth Five-year Plan is to ensure universal access to essential health care and services of acceptable quality and to further reduce population growth to replacement level by 2005.

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Applied Nutrition Project becomes BIRTAN

In 1968 Dr. Ibrahim founded 'Applied Nutrition Project' (ANP) in Jurain, near Dhaka, to solve the nutritional problems of the country. This organisation evolved and became a national organisation called "Bangladesh Institute of Research and Training on Applied Nutrition (BIRTAN)" at the 154th Council Meeting of Bangladesh Diabetic Society in 1979 with a view to spreading its activities over the whole country.

The primary goal of BIRTAN is to impart training and conduct field research on applied nutrition especially food based nutrition to make Bangladesh as a self-reliant, prosperous, poverty free and skilled human resourceful country.

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Dr. Ibrahim also introduced family planning as a component of his applied nutrition programme at BIRTAN and later set up a family planning section at BIRDEM.

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