So, I find myself with a bunch of twenty something medical students from the big smoke for four weeks in Bangladesh! Hmm. Well it’s interesting and I have to remind myself that I have nearly 25 years on most of them and maybe I was like them too but it’d be nice to think they’ll develop a little more resiliency and maturity before they hit the world as doctors… Thank goodness for the ‘Prof’ and my wonderful sister-in-law Deb who are here to be an old fuddy-duddy with and stay sane. 
Having said that they were generally lovely people and some were very lovely, it was good to meet them even if some of them did drive us ‘oldies’ a little crazy… might say more about us?
The trip was a real mix. We had days in Dhaka which is the crazy capital of Bangladesh. More people than you can imagine squeezed into a tiny space all jostling together for survival. Rickshaws, trucks, cars,autorickshaws, vans, double decker buses, CNG’s, bikes, pedestrians, hand drawn and horse drawn carts, cattle and even elephants (yes!) all vying for space 5-6 abreast on two lane roads. And if there’s more room on the other side – wellwhy not just drive down the wrong side of the road for a while too! There’s a reason that all the vehicles are covered in dints and scrapes – even our van didn’t escape getting scraped between two buses. 
Dhaka mostly consisted of visits to hospitals. It has been nearly six years since I first visited Bangladesh as a master’s Public health student. Now I am back helping my former professor as he takes a bunch of medical students on this journey, hoping that not only can they learn but also that they/we can contribute in some small way to the work of the amazing NGO’s that work here like MCC and our hosts Symbiosis (www.symbiosis-int.org)to alleviate poverty and suffering.
Before heading out to do our medical survey work, we have visited some hospitals again. Visiting a second time it has been heartening to see some major improvements in health status of children in this country. They have made some of the biggest leaps in the world in meeting the Millennium Development Goals – but they had a low base to start with!
The severe acute malnutrition with swelling and skin falling apart is now less common. The reduction in vaccine preventable diseases is remarkable. When I was here last some vaccines were being introduced for the first time and government vaccination programs were ramping up. Before we saw wards full of children with measles, horrifying cases of tetanus and other entirely preventable illnesses but we have ‘struggled’ to find these cases this time.
Similarly, other problems seem to be in decline due to government public health programs – for example blindness due to Vitamin A deficiency thanks to programs where children receive vitamin A capsules and reduction in iodine deficiency due to iodine fortified salt.
This has been encouraging to see. Sadly, much preventable suffering remains and there is still work to be done. Wards and villages were full of babies and children with irreversible brain damage and cerebral palsy due to difficulties in labour and birth and no skilled personnel at the birth to resuscitate babies in distress. NGO’s such as Symbiosis are working on training the Traditional Birth attendants that attend the majority of births in Bangladesh, but the task is huge and resources are few. 
But the other improvements show that public health programs CAN make a difference.
Coming to Bangladesh is an especially unique experience for Australians. As Bangladeshis frequently say to us “Bangladesh small country,big population: Australia big country, small population”. Nowhere is this more apparent than in its capital, Dhaka which is literally heaving with people, rickshaws,cars and trucks. Where traffic can mean a 2-hour drive for something you could probably walk in 20 minutes. In a place like this personal space is a luxury and is something an Aussie really needs to be prepared for when coming here – having people stand around you two inches from your face to stare at you (‘white’ foreigners are still an oddity here)can be quite disconcerting. But generally,people have been friendly and welcoming and our colleagues in the hospitals have been generous with their time and sharing their experiences. I wonder in amazement at how they cope with the constant flow of overwhelming misery, fully aware of their lack of resources to do the work they want to do yet they do some amazing work. There really are some amazing wonderful doctors here in Bangladesh. But like in so many countries, the more rural and remote one is the harder it is to access healthcare. And if you are poor and remote (which is much of Bangladesh) – forget it – getting to healthcare in a big town is mostly an unachievable dream. Improving access is important but more achievable in the short term is more concerted efforts towards prevention so that people have less need of health services. Both are important though.
It was so exciting to see this inspiring Paediatricprofessor (Dr Whitehall) and the neonatal nurses introducing the CPAP machine that saves lives to the professors at the leading children’s hospitals in Bangladesh.So what is special about these? We use them in Australia but ours are beyond the reach of most Bangladesh hospitals, are expensive and require expensive oxygen. These can be made with a Chinese fish tank aerator pump and some tubing that all up costs $32 AUD (vs thousands for the commercial ones) and doesn’trequire oxygen! I got goose bumps to see it being accepted. I was involved in developing the first iterations of this machine with the Prof back in 2013 and it has been used in the smaller rural hospitals we left it in back then but exciting to see the acceptance by the bigger hospitals. Respiratory disease is one of the biggest killers of children in Bangladesh. Having the nurses with the expertise to train local staff in their use has been fantastic and hopefully we can put together some online resources for local staff to use atno cost to them in the near future.
Then there was Mymensingh. A step down from Dhaka, still a little crazy but subdued compared to Dhaka. We were being hosted by Symbiosis(www.symbiosis-int.org)which is an inspirational NGO that does amazing grassroots community development work with the poorest of the poor in Bangladesh with an emphasis on empowerment of women and self-sufficiency of families. Their accommodation in Mymensingh was an oasis in a sea of chaos. Whilst there we visited a number a hospitals and whilst there were the amazing improvements mentioned earlier it was still confronting to see the level of need and the low level of resources. Whilst the cases were now hard to find we still saw a baby that died of tetanus at 10 days old because the mother was not immunised. We also visited inspirational institutions like the Damien Foundation Leprosy and TB hospital providing wonderful caring service and research led by a feisty battler of a woman who rules the place with love, compassion and advocacy.
Other great visits were had to equally inspirational NGO’s like Larche which providesa home and income generation for intellectually disabled young people including some they had found abandoned on the street or in orphanages. 
Then there was Basha,a project of MCC (Mennonite Central Committee) that rehabilitates streetworkers who have often been sold into prostitution or were escaping violent relationships and teaches them how to make beautiful kantha blankets out of recycled saris that are then marketed all over the world. 
Some of the workers go on to be trained in business and help run the business side too or leave to setup their own businesses. It was encouraging to see the beautiful blankets for sale in an upmarket café in Dhaka and of course we bought some from the lovely ladies themselves.
The Professor and I then divided into two teams with the medical students. My amazing sister-in-law Deb with her public health and community development skills has been shared between the two teams. Each team has been through 12 villages each. The villages varied in remoteness with many being within throwing distance of the Bangladesh/Indian border and several only being accessible by foot. 
We carried the gear in except for the ultrasound that wenton the back of the NGO worker’s scooter. Some villages were Garo tribal villages (Christian) and some were Bengali (Muslim) and others were a mix.
The people were lovely and friendly, welcoming us into theirvillages. In many cases people were opening their homes for us to use as a clinic . The differences in issues and health behaviours and cultures was interesting. One observation made by some locals was that Garo culture/religion dictates that food is shared equally and pregnant women get more food – whereas often Bengali women get less food and no extra when pregnant. This is reflected in the higher rates of malnutrition and poor health in the Bengali babies.Health education and changing perceptions of women in cultures is also important for health outcomes too.
One thing I found very concerning is that whilst the western world may be bringing advancements and benefits such as vaccination, we also seem to be sharing our problems and bad habits at a rate of knots too. It seemed that junk food snacks and sweets and soft drinks were on the rise as incomes very slowly rise and in the bigger towns and as conditions improve – diabetes and the lifestyle diseases are looming in their future. The tragedy is that people who were malnourished as children and then adopt a ‘western diet’ are more at risk.
When the teams split the Prof was at Joyramkura hospital – a wonderful institution established by the Baptist mission that includes a nursing training school and is run by the seemingly unstoppable Garo doctor couple Dr Tapos and Dr Lucy. They are truly inspiring, and we’ve been supporting them through Symbiosis since my visit in 2012. 
The other site where I was based was the Bhalokupara mission near Ghoshgoan – right near the Indian border. Another inspirational place – an old catholic convent over 100 years old still run by nuns. These sisters were just such loving, hardworking, giving women. 
There were four of them and they ran a boarding school for very poor village children, looked after visiting groups like us, ran a church, ran a clinic ( just one of them who was a nurse!)with very few resources that covered a large area of villages with no access to health care AND produced ALL their own food including rice fields they had to harvest and process. The last one we were aware of as it was rice harvest time and everyone, including the boarding kids was working super hard and piles of rice and rice stalks were everywhere. End of year exams were also on so the sisters were busy with that for the boarding kids and despite all this busyness they waited on us hand and foot and cooked us three beautiful meals a day of fresh homegrown food. And one of the sisters was 75 years old and kept working all day. The best part was they never stopped smiling! 
During our child health surveys, we were doing two things.One was collecting data on the children and the mothers which would be used for research that would help inform the local NGO’s about specific needs and help them in advocating for funding for particular programs. It will be worthwhile but the hours of data entry each evening was not something any of us enjoyed after a big day! We ended up surveying and doing checks on 3000 children and 1700 mothers. The other thing that happened was we were able to identify cases, mostly by ultrasound, of conditions like congenital heart disease that would eventually cause death without treatment. The tragic thing was some of the mothers knew something was wrong but couldn’teven afford the transport to a doctor to find out. Work is now ongoing to organise transport for these children to Dhaka and organise vital heart surgery. If you’d like to help with this please visit https://chuffed.org/project/ultrasound-machine-for-international-child-health-projects
Bangladesh is not on the ‘tourist trail’. Pretty much everyone assumes you are here for some other reason because tourism barely exists. The nice part about that is it’s somewhere you can travel without being hassled by touts. Yes people are in your face everywhere- but it’s because they are genuinely fascinated by you and just want to check you out not sell you stuff. Mostly people are really friendly and the stares are not rude just pure curiosity. A terror attack on a café in Dhaka many years ago put it on a no-go list for many which is a shame as I felt very safe whilst there and think my risk would have been far greater in the streets of Paris or London.
I have only been here for study and volunteer work and it’s not known as a tourist destination but I’ve heard there are some interesting destinations here like the tea plantations of Sylhet and the Sundarbans the world’s largest mangrove forest full of swamp tigers. The more remote areas we visited were more peaceful and beautiful and there are some wonderful NGO’s worth visiting in places like Mymensingh that I mentioned earlier. Certainly, it’s super cheap to travel around here. The food is delicious,but you have to be pretty selective about where you eat as hygiene knowledge and disease prevention still has a way to go and typhoid fever for example is still very common. 
But if you want to see a country yet unspoiled by tourism where you can meet people who genuinely love to meet you and are as fascinated by you as you are by them then maybe it’s worth a visit if you’re in the area!
