Matlab-Going into the villages!

We woke up bright and early in order to actually go with the healthcare worker to a village. 

These health care workers each visit a village every two months, where they do their population surveillance and checkup on the village community worker. We first visited the house of the community worker. 

The community worker’s are all local women who are already married and can read and write. They are all trained by icddr,b to give appropriate vaccination to the children and birth control counseling to the women.

 As we enter, we see there is a crowd of about 10 women with their babies waiting to be seen. 

We observe as each woman comes forward with their babies and their vaccination records and get the appropriate shot. But instead of simply giving the shot, the community worker teaches the women what this shot is for and what it will prevent in her child.  

As she tells us, this is a very important part of her job. In a country that is grossly overpopulated and in families too poor to care for their kids, she says if women have the knowledge they will be able to change the future of the families. When icddr,b started this counseling, the birth rate was quite high with 7+ babies per household. Now she tells me 2 is the average number of kids in each household.

After we left her house, we went and followed another community health worker who goes to each and every house in his/her area which contains about 200 houses and takes a surveillance. This entails, asking about new births, deaths, immigration, emigration, and etc from each household. 

They also go around and note what method of contraception is used by the women and whether they are using it properly-for e.g they will ask to look at the birth control pill box, and match the number of days that has passed since their last visit and the number left in the box.

It is because of this, that icddr,b also proudly has the longest running longitudinal surveillance in a developing country setting and therefore provides a perfect model to test out public health schemes.

In fact, the effectiveness of zinc in treating acute diarrhea was tested right here in Matlab!

After this exhausting but inspirational day out in the village, we return to our guest house to enjoy the peace and quite of rural Bangladesh.

Matlab-Simple ideas saving lives.

I was blown away with the work the Matlab crew does. From the doctors who performs deliveries, to the healthcare workers in each subcenter who ensures proper vaccination of the children, proper use of birth control among the women and proper resources being available to the expectant mother.  One example of this is that each woman who is expecting a baby is given a birthing kit, in case they either prefer to deliver at home or of an emergency delivery where they can’t get to the hospital or the subcenters fast enough.
These kits contain sterile gloves, gauge and other supplies and a birthing mat (designed by icddr,b) which has a color changing border. This border will change its’ color and indicate that too much bleeding has occurred, and that medical assistance is required. This kit is a genius idea, because not only is it low cost, it is simple to use and can be distributed widely.

Another one of icddr,b innovation has been to implement Kangaroo Mother Care (KMC).  

As we all know premature babies cannot maintain their body temperature and this has been the cause of many pre-term deaths. The goal of KMC is to battle this. The concept is quite simple. Since hospital around Bangladesh, and icddr,b cannot afford expensive incubator, they decided their own mothers can act as their natural incubator. The mothers simply strap babies to their chest, so that their body heat can transfer to the babies. They also continue to breast feed of course. The KMC ward is in one word adorable. We walked in to see mothers with their tiny babies on their chest. But as  the on-call nurse tells us it can be hard, because there mother are told that they only should unstrap the babies when they are taking a shower or going to the washroom. So for months at a time, these mothers are stuck in the KMC ward. However, as every mother there will tell you “anything for my baby.”

Matlab-Caring for the rural woman

On Wednesday, June 18^th, 4 other foreign interns and I set off to the village of Matlab-in a what was supposed to be a 4 hour drive. But as my fellow interns quickly learn, and I re-learn, that nothing in Bangladesh is what is “supposed” to be. You should just learn to improvise and “go with the flow” as every local will tell you time and again.

As such, after getting lost and ending up at the wrong iccdr,b subcentre, we finally arrived in iccdr,b’s main Matlab hospital- about 4 hours later than we were expected.

After wolfing down anything and everything in front of us, we set off on a tour of this amazing place.

To understand why Matlab is so unique, you need to know a little bit of background of rural life in Bangladesh. There are still many places in Bangladesh that has no access to electricity, clean water or healthcare. In a situation like this Matlab hospital opened its’ doors and contributed significantly to the development of this little town. Now the hospital treats diarrheal patients from all over the region and it takes care of the pre-natal, delivery and post-natal care of all the women and children in the population of 225,000 that is under their jurisdiction. Matlab can boast that since they started maternal care they have increased the number of deliveries in a hospital setting from an insignificant amount to a startling 90+%.  The maternal mortality rate in Bangladesh is unacceptably high, and one of the reasons is that many poor, rural women give birth at homes without any medical supervision. In a place, where most don’t have any motor vehicles available, they cannot be transported in time to receive life saving care. Matlab hospital has changed all of that and provided an example for all of Bangladesh to follow. In fact, it is because of the great work of icddr,b that the small town of Matlab is now known country wide.

First week in Dhaka

Although half the people I meet in North America do not know where or what Bangladesh is, my decision to come here was an easy one. You see, I am a Bangladeshi by birth. I was born and raised right here in Dhaka, until one day, more than 8 years ago, my parents decided to immigrate to Toronto. And so when I was debating where I can spend the "last summer of my life" I was naturally pulled to Dhaka, Bangladesh. 
Today is Thursday, and I just completed my first week at icddr,b. icddr,b (or International Centre for Diarrhoeal Disease Research, Bangladesh) is a hospital that opened its doors in 1962 and ever since then has provided lifesaving care at no cost to the patients. Bangladesh, if you didn't know already, is a developing country and is riddled with all the problems that comes with that title. It is, thus, not surprising that cholera is still an ongoing problem. Indeed, there is a cholera epidemic going on right now (the pre-monsoon epidemic). The locals here know icddr,b as the cholera hospital and so if they are experiencing diarrhoeal symptoms they know where to go for free care. My first day here, the ER saw 547 new patients alone and I was told that last week they saw around 1000 new patients everyday. The policy here is no patient will be turned down and so there are huge tents set up outside the hospital building to accommodate these huge number of patients.

Now for a quick overview of what happens at icddr,b. Patients if they are able to walk and talk, that is they are not severely dehydrated, are triaged. They first get registered, then see a nurse, and then they see the doctor who will decide where they should go. Now, the surprising thing is, that all of this happens within 10 minutes because all three off these stations are in one room (the ER). The doctor might send them to the OPD (Outpatient Department) where there is a nurse and healthcare worker who oversees mothers feeding their babies ORS (Oral Rehydration Saline). The OPD is mainly for infants (who have no signs of dehydration) and their mothers. The mothers are encouraged and taught how to feed their babies ORS and bread/banana (for Potassium) properly. For patients, who have signs of dehydration (mild to moderate) or any other complications, they are sent into the hospital SSU (Short Stay Unit), and there they are either given IV fluids or ORS if they are not vomiting. For patients who have other problems, such as respiratory problems, malnutrition, other GI problems (such as diarrhea that has been ongoing for several weeks/months), they are sent to the LSU (Long Stay Unit). If the child is in critical conditions, they are sent to the ICU. Finally there are patients who come in on a stretcher or wheelchair (severely dehydrated), and they are directly given a bed in the ER and IV fluids are started immediately. 
I spent my first week getting a handle of all these departments and how they function. Next week, I am going to start focusing on individual departments and joining each of their teams. 
After a very busy week at the hospital, I am going to enjoy my weekend (the weekends here are Friday and Saturday) spending time with my relatives and friends. So far, it has been an amazing and eye opening experience and I can't wait to go back to the hospital 8:30 am Sunday!