Sharing precious memories of MPH course of JPGSPH, Brac University.

Sharing precious memories of MPH course of JPGSPH, Brac University.

Experience from the Field, 3rd Batch JPGSPH, BRAC University

We started our journey to pursue MPH degree on the 22nd day of January 2007. We Bangladeshi students went to BRAC centre first and from there started towards Savar.  After reaching there we were watching the beauty of the ground. It was so floral and so much of green trees that we were fortunate to be there. But the next story was quite different. We could not even enjoy the beauty at all, because of the tremendous pressure of the course. Some of us had enjoyed through out the year but they were few.  We were 26 students, 13 of them were Bangladeshi nationals and 13 international students were in the course. Among them 8 male students and 5 female Bangladeshi was there. Among International students 7 were male and 6 female.  

Our first exposure was observing the field at Korail/ Shattola urban slum, Mohakhali, Dhaka. Not with any particular agenda but had to look at in a way to experience some Public health problem. For example, sanitation, condition of safe drinking water, Maternal Nutrition and Child Health (MNCH) care centre ran by BRAC. On the way to Savar we were scheduled for ICDDR,b to observe how the research center was running and how they were managing the problem of Diarrhea. It was in January 2007.

After coming to TARC from Dhaka we visited several time to Kakabo village, Nager agey, Shamaier at Savar. In the introductory course with Richard Cash & Alayne we observed Kakabo village and we found that the ORS packet was widely used by the village households and we have seen the tore packet on the streets. Richard cash was very happy to see all these and he had a presentation in the Thailand where he used that tore packet digital picture on his presentation. Our group had been asked to comment on his presentation. We commented and he put up with our comments for further improvements. It was a nice experience we had come across.

It was an overwhelming experience; we all went through the qualitative research with Skaak van der Geest and Dr. Shahaduz Zaman . Apart from the field visit we all went to the campus to see the qualitative life of the staff members of the BRAC, TARC at Savar from the security guard of the gates to the cook of the kitchen and made a qualitative report and presentation on anthropological approaches and qualitative research module. One very early morning we all visited Kakabo village with view to carefully watch the village without asking any question to anyone, we wondered how we got so much to learn from a careful watch even had been possible with out asking a single question.

 We were astonished by the stunning performance of Diana in quantitative method module. She taught us how to develop research questions. She helped all of us a lot. She showed us how to determine a sample size from different villages. We used Kakabo village again for collecting the information / data of different diseases of the child to the old keeping in our mind the issue of ethical consideration. Remarkable experience.

So far, I can remember all the courses were greatly focused on field visits, except Biostatistics & Epidemiology. Which had been given us very hard time!

We had a memorable skillful experience with the guidance of Dr. Anwar Islam in the Health System Management course. We in a group visited to see the facility in a specific organization among government, NGO and private agency.  Our group visited Bangladesh Rehabilitation and Assistance Centre for Addicts (BARACA), Birulia, Savar established in 1988 with the help of Caritas. Caritas a development organizarion works for all people irrespective of caste, creed and social denomination, building a peaceful communion of communities.

It was particularly one of the very important and memorable experiences through out my MPH course. We admire the goal of the organization which is to put itself out of business through eliminating all unfortunate drug addicts from the society. When we asked BARAKA’s mission statement, assistant project director Ruben Dias mentioned that they look for a future where there will not be any client of BARACA. BARACA has a capacity to accommodate 60 clients at a time. It is a 2 years program including 4 months residential course at BARACA. It is a drug rehabilitation facility for men. BARACA accepts motivated clients only. Estimated relapse rate was amazingly “at least 30%.”

BARACA has all kind of clients from poor class as well as those from the middle and upper classes. Regardless of classes all clients are treated equally. All the clients are scheduled for their routine activities from the 6am to 11pm. Every minute is scheduled within a program. Every body is scheduled to perform anything and everything is needed to run the organization. Such as taking the class in a scheduled time, gardening, cleaning, cooking, cutting vegetable, fish & meat etc. even when we were their few clients were busy to make tea and serving the tea for us. Most of them were graduate students. They share everything with other clients and they get the guidance for not telling lie. So it reduces the burden of loneliness and all the clients are happy to be there who came with a hope of a future without drugs. Every body wants to live a normal life and BARACA  is working for that. BARACA has successfully helped 1800 drugs addicts since 1988. 

We had another visit at BARACA in the course of Health Economics & Health Care Financing by Kent  Ranson & Damian Walker.  We also observed the same mentioned earlier including the financial involvement to run the program and that is why it had taken a deep impact on my mind. I have come across some drug addicts and I suggested them to visit BARACA. BARAKA with it‘s work has motivated me a lot. They are trying hard to present Bangladesh a drug free society. 

Apart from the visit at BARACA in Health System Management course we also visited Gazipur to observe the DOTs program implemented by BRAC and went to see the facilities at External Quality Assurance Laboratory, UHC Laboratory at District Hospital, Gazipur. Also we visited BRAC Health centre (Shushatha) to see the facilities. Susashthya or Good Health clinics were established to provide better health care to the public at reasonable charges. These clinics are run on self support basis. A monthly detailed report about the services offered and income generated is submitted to the health division in BRAC headquarters. Shasthyo shebikas know about the 10 kinds of common illness to treat; when they find complications they refer them to Shushatha clinic. If the doctors find the patient with complications beyond their scope of practice, they refer them to the hospital.

DOT mainly maintained by Shasthyo Shebika. Patients come in the morning to take the dosage. She, the Shebika, usually searches for the patients. Patients can be identified and sent to the smearing centre to give the sputum and send to microscopy centre for further verification. Mostly we found both male and female who were working in the garments from the visited area under the program of DOT. 

In July 2007 for the first time we visited Matlab, ICDDR, B research center guided by Bilquis Amin Hoque, had both enjoyable and frustrating experience as well. Enjoyable in a sense that we visited the solid waste and clinical waste management system of a research centre and we visited the household to see the sanitation and hygiene improvements, services of water supply and met with the person those who were arsenic patients. Most of the time it was raining. Staying with Bilquis Amin in the field was a good experience.

The frustrating part occurred for Bangladeshi male students. We will never forget that one night at Matlab. How our Bangladeshi students (males) survived. It could be a different story to write. It was totally the lack of the vision of managing a trip. Mosquitoes & bugs were not able to fall down our students Zillur, Mesbah, Tanvir, Rose, Asish, Mahbub, Zubair  & Tarique in a hotel at Chandpur. However it was a shocking experience. We have learnt a lot from that experience also.

Our group again visited Matlab in August 2007 in the Epidemiology of Infectious Diseases course conducted by Richard Cash to see the hygiene behaviors of the caretakers of children and risks associated with Diarrhea. We were fortunate to use the research study design which helped us for our own independent study. We learned here to develop questionnaire and pretest before going to the field for data collection. We had to select a study design and based on our study we chosen Case Control study and we tried our best not to get biased and went to several places to find out the right person according to the definition of “Case “ and “Control”. We went through by Boat. It was post flood visit. The area was flooded. After collecting the data we used SPSS for the data entry, coding and recoding etc. This visit has helped a lot undoubtly. 

Now the desired course had come for me and I enjoyed the most at the Public Health Nutrition coordinated by Dr. Tahmeed Ahmed & Dr. Ziauddin Hayder. We all put our best effort here. We had so many things, field visit, and video-conference with Meera Shekar (World Bank, Delhi) from World Bank Dhaka office, and the poster presentation which helped again in the final. We had a field in outside Dhaka but because of Curfew in Bangladesh the management had to cancel the field visit and put another field visit within Dhaka and nearby area. We had no break at lunch. We used to start at 8:45 and it ended at 5pm. Very rigorous course. Being a public health professional and being a lady ( non Doctor) for the first time I observed a delivery, though I am mother of two daughters with normal delivery, I was surprised to see the delivery.  We visited MANOSHI (Korail and Shahtola, Mohakhali, Dhaka ) a pilot maternal, neonatal and child health initiative in the urban slums. We visited 2 days the slum area and  mostly observed the situation  and also varify few issues regarding delivery at Birthin Hut.

As I mentioned earler that we have been through a delivery process at Birthing hut. It showed quite a simple process but for me I found it very difficult. I am surprised to see that how a delivery happend with minimum resources and every body was happy. There were not enough clean  cloth to hold the baby . The birth attended diliverd the baby without gloves. There was lot of blood in her hand and She was trying her best to handle the situation. Nomal drum water  has been used for cleaning the  mother breast during brest feeding to the baby. We checked with the deliverd mother after 2 hours of delivery and she was with full satisfaction of the services she has received from the pregnancy identification to the delivery.

Aging & Health by Zarina Nahar Kabir  was a wonderful eye opeing course and we experienced few issues which have been ingnored traditionaly. The love care & support we usually get from family, friends, relatives, neighbors & community people is considered here. It includes the provision of health care and special care. Elderly population in a society like Bangladesh is asset to those families where they are looking after the grand children. In this way they are getting some mental support and happiness and the grand children also learn values and get care from grand parents. The relationship between grand children and grand parents is a blessing for both. 

On the other hand when people turn old and they become unproductive and they also become disabled mentally and physically, right that moment it is very tough for a family to support the older members of the family. Every body has there own family life and involved in the family affair. To survive every body is struggling in this society. Often one can not make time to look after their parents those who are old.  Some times it is even frustrating situation when parents are financially dependent on their children  but the children has no time to look after their needs or to take care of the parents. It is not because the child has no love or no respect for the parents but they themselves are struggling with their own limitations. Another issue is migration. Many children are settling outside the country and they are not able to be physically present with their parents. Though they are talking over phone and keeping relationship from a long-distance but it is always a painful situation for the parents not to see their children. 

We visited Matlab again and our group in the course of Reproductive of Health & communication and went to see the Home-Based Life Saving Skills (HBLSS), which overall goal is to build skills at the home level that are acceptable until reaching a referral facility, to inrease access to basic life-saving care, decrease delays, and support birth preparedness and encouraging involvement of family decision makers to make timely decisions. Our team’s objective was 

  • To observe a training meeting of HBLSS on “How to prevent problems during birth”
  • To see the quality of care/counseling
  • To interact with the community health research workers, pregnant women and support persons
  • To assess the level of satisfaction of pregnant women and their supporters.

The course was conducted by Sabina Faiz Rashid, Marge Koblinsky (ICDDR.B) & Malabika Sarkar.

In the course of Principle of Health Communication (field visits were within Dhaka cities) we went to see that how health communication through multi sector initiative reaches the mass population in the country. Mass media activities are necessary in both developed and developing countries.  We visited ‘Bangladesh Centre for Communication Programs’ (BCCP). We observed how they developed communication strategies to reach the mass people as service provider perspectives and it was presented to us. The mass people (poor and uneducated) usually don’t understand the facilities which are offered to them at a minimum cost. It needs huge campaign to make them understand about the services they can get. Now the world is heavily dependant on communication. All we need is to communicate with each other to solve a problem. Discussion and communication is the best strategy to fight against any problem. No wonder it will be solved.

End

Written by Lubna Yeasmin