Here is a short report on my volunteer work as a doctor in Dhaka, Bangladesh:
In recent years, I have repeatedly spent six weeks on assignments with German Doctors (Nairobi, South Kenya, Calcutta, Philippines) as a general practitioner. Everywhere it was about primary health care for the poorest of the poor.
Here in Dhaka, our task was to reactivate an old project to provide basic medical care for people in the slums after a break of several years. Two Bangladeshi doctors had already been working for several months in various slum outpatient clinics for this patient group, some of which had high patient numbers.
We were welcomed and looked after in a very friendly manner and had a nice apartment on the seventh floor (with an elevator). The lower floors house training centers for simple vocational training and some school classes of the Manda School. One of the four Austrian Doctors outpatient clinics is located on the second floor. Aki, a very caring young woman with a perfect command of the Bangla/English app, cooked, cleaned and washed for us. So we had a clean oasis to live in with her.
The various outpatient clinics in the slums became increasingly cleaner over the course of our five-week stay, as the staff were very receptive to our explanations about sensible changes and gave us great support in implementing them. A good standard of hygiene was achieved.
We learned and had to take into account during our work that our patients are often illiterate and perceive personal responsibility very differently to what we are used to. They often live without work or as day laborers and are sometimes without accommodation. They are required to provide for their own and their loved ones’ basic survival. Regular medication, sensible dietary measures, adequate nutrition, a change of clothes, washing in clean water and applying cream are often not feasible or affordable. Occupational safety is almost non-existent. There are so many young people available on the labor market that the workers have to fit in and endure instead of being able to defend themselves or take their own needs seriously. It therefore seems very important to us to let the patients describe their life situation, then to ask them in an accepting and empathetic way about their options for improving their situation and dealing with the given illnesses and to let them develop these. Small suggestions were then gladly taken up, as was shown in follow-up appointments. It’s all about encouraging people to take responsibility for themselves and, if possible, offering communication on an equal footing, the keyword being “empowerment”. I learned so much from the patients and also from the staff. They show perseverance and strength, retain the will to live in the most difficult of circumstances and allow themselves to be confronted with new challenges if they feel that they are perceived as individuals. Even the Bangladeshi doctors, who were initially very reserved and reserved towards us older female doctors, increasingly opened up and became more open and relaxed when working together. As a result, we were able to laugh together despite our clearly different cultures, exchange examination techniques and discuss patient cases.
Themes that kept recurring:
- Diabetes nutrition with permanent hunger and partly unaffordability of >1 egg/week and rather cheap usual bad carbohydrates.
- Scabies therapy in cramped living and sleeping conditions, inaccessibility of therapy for everyone living in the household
- Tinea treatment for permanent sweating in synthetic clothing and necessary long-term continuous drug therapy
- Hypertension therapy for long-term stress
- Hanging out and eating are experienced as important relief strategies in everyday life
- Desire for painkillers and stomach medication for quick relief instead of a strenuous, mindful change in diet, exercise and lifestyle habits to the extent possible
- Excessive physical and psychological stress for many women and girls
- Lack of appreciation, lack of support, lack of relief for women/mothers
- Adaptation and tolerance of the given hierarchies
There are child marriages despite a legal ban, early school drop-outs and the acceptance of forbidden child labor, often born out of necessity. There are an incredible number of taboos in this patriarchal Muslim society. Often the husbands are employed abroad for years, then the women live alone with their children or in the husband’s family with the expected adaptation and disenfranchisement of the woman.
Basic medical aid is only possible in a holistic approach. Improving the education of the people in the slums is therefore extremely important. It is such a joy to experience the community of children in the Austrian Doctors schools with their teachers. The schools are a feel-good place full of opportunities and act as an oasis for both sexes in co-education. Some former pupils are now teachers there. The schools already have a coherent approach to social work.
From my western point of view, expanding the network with local health-promoting/social institutions would of course be very nice, but I suspect there are many, many stumbling blocks and other obstacles.
I really enjoyed working in Dhaka, even though the work demanded a lot from me. I learned a lot. As a focused, goal-oriented German, I wanted to experience, learn, sort and get a lot going; but it takes time, hopefully I was able to slow myself down enough.
Together with my dear pediatric colleague Gertrud, we were able to achieve a lot: We got equipment up and running, involved staff in the development of the project and learned to appreciate them, to love them. We created various information materials for training, launched medication lists and provided hygiene training.
I felt accepted by incredibly friendly people wherever I went and learned a lot from them in this very different culture. I end the assignment with a lot of humility and respect for the people who live here permanently and work on their future with a great deal of confidence.
Last but not least: Babul, the responsible coordinator and manager of the projects in Dhaka, was extremely supportive, helpful and caring at our side, also acting as host and travel agent/manager. Thank you very much!
All the best,
Ursula
