Arrival - first impressions of this city
After completing my medical studies, it had been a great wish of mine for a long time to do voluntary work abroad. Austrian Doctors gave me the opportunity to gain an insight into their projects in Dhaka/Bangladesh.
After arriving, I was warmly welcomed at the airport by Babul, the local managing director of the project, and then spent three weeks at the project sites in Dhaka. The rhythm of the country generally seems a little different to Austria due to the warm temperatures. Although it is already after 11 p.m., the streets are still anything but deserted and there is still a lot of traffic. Babul offered me to sleep in her guest room for the first night, as the rest of the drive to the project site in Manda would be quite a distance from the airport. Although it is already very late in the evening, Babul invites me to his home for a very late dinner. I get to know his wife, mother, son-in-law and daughters and try traditional local dishes for the first time. The table is set with various curries, all kinds of vegetables and chapati – a type of flatbread.
The next day, the journey continues straight after breakfast. We take a tuck-tuck and make our way to Manda. Manda is a district of Dhaka in the east of the city. This means that we travel right across Dhaka from the airport. This first tuck-tuck ride already gives me a lot of impressions of life in the city. The journey takes us over partly asphalted roads, but mostly over those with only earth and huge puddles. There are sometimes people sitting at the side of the road or small stalls selling fruit and vegetables. The traffic is chaotic and we keep changing sides of the road. At the beginning in the city center on the better developed roads, there are many normal cars in addition to the rickshaws and tuck-tucks. The closer we got to Manda, the narrower the roads became and there were hardly any normal cars here. Apart from the few motorized rickshaws, the majority were still moved by bicycles. “A way for many people in this area to earn money,” Babul explains to me. There is a lot of plastic waste on the roadside and, given the overcrowded streets and poor soil quality, I can hardly imagine how this traffic can be managed in the rainy seasons. Overall, the cityscape looks very colorful – colorful houses in different colors, rickshaws and tuck-tucks in all kinds of colors, colorful umbrellas over the market tables. The houses are mostly multi-storey buildings, as is so often the case in larger cities, but most of them are unfinished or in dire need of renovation. I am surprised at how many trees and palm trees there are between the buildings, which I would not have expected in such a large city. The countless cables spinning along the streets between the houses above people’s heads seem particularly chaotic to me.
Manda - Life, city view and tailoring
After almost an hour’s drive, we reach our building in Manda. It is a six-storey building that houses the medical center and one of the schools as well as a training center. There is an apartment on the top floor of the building and I am allowed to live there for the duration of my stay.
The training center offers teenagers and young adults many different vocational training opportunities. In addition to the “beauty salon”, there are also computer rooms, a workshop and a few rooms for learning the craft of tailoring. During my stay, I had the opportunity to gain an insight into tailoring. One of the traditional garments worn by the local women is the so-called “three-piece”. It consists of wide trousers, over which a not particularly tight-fitting dress is worn, and a scarf that can be placed either over the chest and/or over the head – three pieces, so to speak. As is customary in this country, colorful fabrics and flowery embroidery patterns are used. The fabric is first cut and then precisely sewn in an elaborate process. The local seamstresses show me all the steps required to make these clothes. I am very impressed by the speed with which they carry out the sewing work with great precision.
The working week in Bangladesh begins on a Saturday and ends on a Thursday. Friday is a public holiday in Bangladesh. Conveniently, I arrive on a Thursday evening, so I move into the apartment on the day off and can use the day to settle in.
Living
When working in Dhaka, the volunteers are allowed to move into the top floor of the building in Manda. There is an apartment with an impressive view over the city. During my stay, I was also lucky enough to have Maya prepare local dishes for me according to my wishes, which I looked forward to every day at the end of my work. Maya is not only a very talented cook, but also a kind-hearted person. She also did my laundry during this time and when she noticed that the elastic waistband of one of my pants was broken, she surprised me with a repaired waistband in the afternoon, for example.
Medical projects - four locations across Dhaka
The project sites in Dhaka are located in the poorest districts of the city. Medical assistance is provided there six days a week in four different neighborhoods: Manda, Korail, Khilgaon and Gandaria. The majority of people in these regions cannot afford medical care.
The team consists of a pharmacist, a local doctor and a nurse, who performs all administrative tasks and takes the patients’ vital signs. There are currently two local doctors in total, who take turns looking after the various project locations.
Korail
So my work begins on a Saturday in Korail. Korail is one of the largest poor districts in Dhaka and is estimated to have grown rapidly in recent years. Even after intensive research, it proved very difficult for me to find up-to-date surveys on the number of residents in this district. The figures published by BRAC in 2017 report 50,000 residents, but the number of unreported cases is probably very high, as the dense population suggests. (BRAC. (2017). Korail Factsheet. Retrieved in September 2017)
In the morning, I meet the pharmacist Saiful and the nurse Pushpa. Together, we put the medication into boxes and load everything into the car. Then we drive towards the project site. On the way, one of the two doctors, Dr. Saed, gets in. The drive takes longer than I expected, but my three colleagues tell me that I was particularly lucky with the traffic today, because on some other days the journey takes much longer. Shortly before we reach the beginning of Korail, we drive through the banking district of Dhaka. There are high-rise buildings and glass fronts everywhere, with various well-known brand stores in the shop windows. The streetscape is almost disturbingly controversial compared to everything else I’ve seen of the city so far. Not much further, once around the corner and over a bridge, and everything seemed to be back to normal – chaotic, markets and lots of people on the street. Instead of high-rise buildings, I see small huts and houses selling snacks and convenience foods. You can imagine Korail as a kind of city within a city. We have to park the car a little way away, as the streets soon become so narrow and winding that you can only pass them by rickshaw, if at all. We come across men who have no clothes on their upper bodies or are only wrapped in a cloth. At the side of the road are small stores or cafes selling the local “Bangla tea”. I notice an oncoming boy carrying two buckets of water along the street. Again and again you see people sitting on the ground selling leaves, which are consumed as a kind of tobacco substitute. The majority of the small food stores sell fruit and vegetables or samosas and shingaras are fried in large pots of oil. In addition to all the people along the road, there is also a lot of plastic waste.
After walking for about 10 minutes and passing through a few crossroads, we reach the school where we also receive medical treatment. First, Babul gives me a tour of the building. The walls are all colorfully painted with animals and sayings. There is even a small courtyard at the back of the building, which has been set up as a small playground for the children.
Patients who come for treatment first have to register at the registration desk. This is done by Pushpa. She documents each individual patient in a large book and the patients also receive a “health card”. The health card is their health record, so to speak. The doctors treating the patients write down their diagnoses and treatment on it. This means that it is always possible to see what has already been done. The Health Card is brought along by the patient themselves for patients they already know and is reissued for those coming for treatment for the first time. Puspha also records all vital parameters, such as weight and blood pressure. These are also recorded in the Health Card. Regular weight checks are an important measure, especially for children.
The majority of patients come because of “all pain”, tiredness and exhaustion, malnutrition, infections or various skin problems. The treatment of infectious diseases in particular presents a challenge, as it is not always possible to implement adequate hygiene measures. Tropical diseases such as dengue fever are also part of the repertoire. Dr. Saed explains to me that the risk of infection is particularly high in the rainy season and has led to dramatic cases in this region, especially among children.
Manda
Medical assistance is offered at the project site in Manda on three days. Here, too, the system works in a similar way. Patients are first registered, their vital signs taken and then wait in the waiting area for their appointment. The medication therapy is also noted on the health cards. This allows patients to go directly to the pharmacist in the next room after the consultation, where they receive the necessary medication.
I remember a particularly dramatic situation with a patient who presented due to weakness and dizziness. The young lady comes into the surgery looking very pale and tells us that she gave birth to her fourth child a few days ago. Due to her young age of just 20, I ask her when she had her first child – at the age of 12. During the examination, she keeps getting dizzy and it is almost impossible for her to sit upright. Due to her condition, we decide to take her to the nearest hospital. Although she was repeatedly assured that she would not have to pay for this stay and that it was more than necessary in view of her poor general condition, she was absolutely unwilling to go. In the end, Pusphu manages to convince her and accompanies her to the hospital by car. First, however, they have to make a short stop on the way to drop off one of her four children, who was there for the examination that day, at her husband and mother-in-law’s home. The patient would not have come to the hospital without making sure that her child was with the family. However, the husband and mother-in-law would not allow the young lady to be treated in hospital and even all attempts at persuasion and arguments of urgency could not change the relatives’ decision. I still wonder today what happened to the patient.
Gandaria
Gandaria is located in the south of Dhaka and is visited by the medical team two days a week. The people there live along the railroad tracks, which have been increasingly expanded in recent years.
There are a few garages on the way to the entrance of the Gandaria school. Babul knows the people who work in these buildings. At one point I see a kind of mini-factory where car parts are processed and when we go into another building, I see a woman and a man making a kind of medal. The man is sitting on the floor and threading all the metal plates, which will later form the medal, onto a wire, while the woman at the desk next door is painting the almost finished pieces by hand. The motif shows a soccer player and when I ask, I am told that they will be sold to Europe.
While working in Manda and Gandaria, I get to know Dr. Mokhles, who has been looking after patients there for a long time and can tell me a lot about his patients.
Many people there come to consultations with type 2 diabetes. I was very surprised at first, because the selection of fruit and vegetables there is really impressive. However, most of the cheap ready-made products are high in sugar. I don’t find any high-quality bread in this region, but I do find some packaged types of cake preparations and dough that has been deep-fried in oil. The milk, which has to be bought in metal cans to be used for making tea, is also heavily sugared. In general, it seems to me that the people there are not really aware of the consequences of such intensive sugar consumption. However, there are probably no alternatives.
By far the largest group of patients were those who came to us because of itching. Almost all of them suffered from either a fungal infection, scabies or even both. Here too, implementing the necessary hygiene measures proved to be difficult in some cases, as the people live together in large family groups.
I realize that the distribution of the three project locations in three different places in Dhaka plays a particularly important role, as the majority of these patients could not afford the long journeys across the city.
Khilgaon
The treatment rooms in Khilgaon are located in a kind of inner courtyard along a rather local street. Compared to Korail and Gandaria, it almost seems as if there is a lot of infrastructure in Khilgaon. There are small stores along the road and again some local vegetable and fruit markets. However, the spectrum of diseases is similar to the other two regions.
School project in Manda - many smiling faces
I also spend some time at the school in Manda. I get to know the team of teachers and am given a tour of the building by Miss Rajna, a teacher at the school. The pupils are very busy as it is exam week. Nevertheless, they are happy to see me and wave to me from the classroom. Babul and Miss Rajna introduce me to all the classrooms and some of the students tell me about their subjects. Different age groups are taught there. As these children come from very poor backgrounds, many have never had a routine medical check-up. We decide to carry out a kind of school check-up for the children as a preventative measure. The children and especially the parents are very happy about this. As with the medical projects, we record the pupils’ examination results in the Health Cards. Once the examination has been completed, the children receive a banana as a reward. They are very happy. It is very moving for me to see how patiently and happily these children, some of whom are still very young (the youngest are around 6 years old), wait for the examination. They are highly motivated, after all they get a banana as a reward. This may sound very obvious to us, but such gestures were very much appreciated there.
I also had a great experience participating in the lunch break. The pupils receive a hot meal every day, which is served by the teachers. I hardly need to say anything about this, the smiling faces in the pictures probably speak for themselves.
The students make a very committed impression on me. It seems as if they are aware from a very young age that this is the only chance for a better future.
Leisure time, excursions and everyday life - between beautiful experiences and sad reality
On my days off, I use the time to explore the country a little. So I end up going on a trip with Babul south of Dhaka to Munshiganj and another time with a small team from the school for a school project in the suburbs of Comilla, about 110 km away from Dhaka.
Munshiganj
The day trip to Munshiganj begins with a train ride. It’s a highlight for me to see how public transport works in Bangladesh. As the trains are very crowded, I am glad that we are waiting at the station very early for our train connection. Getting on and off the train is extremely stressful – there is a lot of pushing and hardly any consideration for each other. Seats are very limited and nobody wants to have to wait for the next train. Once we arrive in Munshiganj, I visit the local market and take a drive through the town. Again, I get the opportunity to try various local foods. The way back to Dhaka was another highlight of this trip for me. Bangladesh is known as a country of many rivers – and rightly so, as a large part of the country’s surface area is water. Despite this, there is a recurring water shortage, especially during the dry periods, primarily due to a lack of drinkable water. This is mainly due to serious pollution. Added to this is climate change, which is having a devastating impact on Bangladesh in particular. During the monsoon season, the country is affected by massive flooding, which deprives many people of their livelihoods. Our boat is multi-storey and is used by the locals as a means of transportation. The distance covered by this boat seems to be longer, as many people are lying on the ground on blankets on the lowest floor. It seems as if they have been sleeping here for some time. Further up I find sleeping cabins, but for cost reasons these are not feasible for the majority of the locals. The water of the river in which we are traveling is brownish and heavily polluted. Again and again I see plastic bags and flip-flops floating by. The boats next to us are massively overloaded. At first, I’m amazed at their appearance – low and almost submerged in water. Later I realize that these actually huge ships have only sunk in so far because of the heavy cargo. The riverbank is built up on both sides with large companies from which clouds of black smoke rise. Between the huge cargo ships, you can also see small fishing boats on which one or two men are moving around with a paddle. As soon as one of the locals spots me on the neighboring boat, I am usually stared at in amazement. It seems as if they don’t meet visitors from other countries here all too often.
Chittagong
The region around Comilla is also one of the regions that suffers particularly badly from the consequences of flooding during the monsoon season. For this reason, two particularly committed pupils from the school in Manda volunteered to help in this region as part of a school project. I am allowed to accompany the two students and two teachers and get an impression of life outside Dhaka. Located right next to rivers, the water level in the settlements on the land rises dangerously during heavy rainfall. The people we visit show us their homes and tell us about the consequences of the floods they are constantly confronted with. The floods destroyed people’s homes and caused serious damage to agriculture. The fields became uncultivable, many of the farm animals drowned and the harvest was destroyed. The people in these regions do not have the financial means to compensate for such losses. Even after the floods have receded, heavily silted areas remain that can no longer be used. Often, the extreme pollution in combination with the animal carcasses that remain there create very unhygienic conditions, which subsequently lead to diseases. However, these people have little or no access to medical help. There is also hardly any infrastructure in this region. The people live in appalling conditions: in small huts, mostly made of corrugated earth, in a space that is far too small. The ground is muddy and there is garbage everywhere. The people’s clothes are broken and dirty, yet all the people meet us with a friendly smile and show us around their settlements. The children and young people are particularly enthusiastic about our visit. It is probably not very often that other people come to visit this region. They communicate with me using their hands and feet or I am lucky enough to have one of the two pupils translate for me in English. The children are excited about the opportunity to be photographed. I take some portrait photos with my cell phone and show them on the screen. Their excitement is huge. I very much hope to be able to print them out and bring them back one day.
Birthday
Coincidentally, my birthday also falls during my stay. I wasn’t actually expecting much from this day and went to one of the medical sites, just like any other day. At the end of our work, we drive to the school in Manda, as I want to take a few more photos of the area that day. When we enter the dining hall, I am speechless. Babul and the entire teaching team have organized a surprise party for me without me noticing. Everyone is singing for me, the room is decorated with balloons and there is a cake with candles and my name on the short side of the row of tables. I received presents from all my new friends and flowers. The seamstresses even made a local piece of clothing especially for me. I can safely say that I have never experienced such a big birthday surprise before. I will probably never forget this day. The solidarity between the people in this country overwhelms me.
Challenges
It is not always easy to find information and figures on the population in Bangladesh. The number of unreported cases seems to be high, just as local websites from Bangladesh are often blocked from Austria. This already led to difficulties with my visa application. Shortly before my arrival in Dhaka, there were major political changes in the country, which led to unrest and protests. This exacerbated the situation with the inaccessible online sites. During my stay, I tried to understand the views of the locals regarding their political situation. Personally, however, I never felt intimidated by related situations and felt the atmosphere was consistently peaceful, at least in the areas I saw. However, as it was my first time in this country, I have no comparison in this respect. I was often asked at home how communication worked. On the one hand, I tried to learn the language from day one and Babul also made a great effort to teach me more and more new words and repeated them with me almost every day. On the other hand, there was often the option of a translator. At school, for example, one of the teachers, Mr. Rouf, was kind enough to translate when I was working with the children. The rest of the time, especially after my work and when I was alone, I tried to communicate with the few words and sentences in combination with my hands and feet. Basically, however, I was pleasantly surprised at how well communication always worked, even without additional support. However, this was probably also due to the enormous patience and interest of the locals in me.
Summary - what remains at the end...
Back home in Austria, I have countless memories of all the people I met there and the many situations and experiences that moved me personally. This report only offers a small selection of these experiences and there is still a lot more to tell.
My stay in Dhaka changed my perspective on things and I can now appreciate many things at home even more. It is a luxury to have the opportunity to turn on the tap and drink clean drinking water, just as it is a luxury to be able to complain about small things.
There were many very moving and beautiful experiences, which were characterized by the outspoken hospitality and politeness of the people, the pride with which they tried to bring me closer to their traditions and the infinite appreciation and gratitude that all the locals showed me for my stay there. Above all, I was moved by their efforts to make me feel at home in their country. Despite the difficult living conditions, the people in Bangladesh are very humorous and regularly made me laugh.
However, some days and situations made me think and I felt disappointed, frustrated, sad or helpless from time to time – especially when you are confronted with things that you have to accept without being able to do anything about them.
I would be lying if I said that a stay in Bangladesh is a joy every day. The extreme humidity in combination with the heat, which was very tiring for us, made small things exhausting and I often felt unwell due to all the sweating. The heat also resulted in many sleepless nights and led to even more challenging days. Then there’s the garbage, the smell and the poverty of the people around you – not being able to move around freely at any time of the day or night as a young woman. But all these things that we take for granted in Austria/Europe are anything but commonplace in other parts of the world. And precisely these things, which I found to be an unusual challenge and restriction, are part of everyday life for thousands of people.
I am very grateful to have had this experience and very much hope that I will have the time and opportunity in my future medical career to return to Dhaka.
Kind regards,
Simone
