Day 1 - Sunday
Upon arriving at Zia International Airport, Dhaka, after a comfortable but long flight from London via Dubai, we are directed out of the airport and promptly walk into a wall of heat. My travel companions (Diana Thomas, competition finalist Sophie, and Guardian editor Sue George) and I eagerly give our bags to the driver (as lifting them into the car may cause a fatality), and seek sweet relief in the air-condioned car.
Our driver masterfully negotiates the chaotic mess of private cars, tuk-tuks, rickshaws and motorcycles that fill the 4 “lane” highway. Driving in Dhaka appears to be quite a skill and we are impressed by the mere fact that we get to our destination unscathed. Many journeys since have revealed something of a road hierarchy (everyone gives way to buses; pedestrians cross at their own risk) and I have come to recognize the simple (or complex?) hand signals that ensure a slow but steady flow of traffic. Although I do mean slow because despite Bangladesh’s dense population, it is not the streets that are overcrowded but the roads.
After quickly checking in and freshening up at the hotel, we are whisked off to meet our colleagues at Marie Stopes Clinic Society (MSCS). We meet with Dr Golam Rasul, Abdur Khan, Dr Reena Yasmin, and Shahid Hossain who give us an overview of their very impressive and successful program: 42 referral clinics, 42 mini clinics in slum areas, 46 upgraded clinics, 6 drop in centres and 6 premium (higher income) centres.
We learn about their outreach services, which include 32 adolescent programs, 96 satellite sessions per month to the homeless population over 12 locations, 53 NGO partnerships providing STI services, and activities to 121 factories via the ‘Health Care Card' scheme. Fortunately, we are scheduled to visit many of the centres over the course of the week where we’ll see first hand how MSCS provide reproductive and sexual health services and awareness to the poorest and most vulnerable communities in Dhaka.
Day 2 - Monday
Today we visit our first MS mini clinic, which is based in the slum area of Kallyanpur. Dr Masud joins us, and introduces us to the paramedic and the 3 volunteers who are recruited from the slums and trained by MSCS. Sophie interviews a newly married 19 year old woman who is visiting the clinic with her husband to pick up contraception - they have decided not to have children for 5 years until he has finished studying and they are able to afford better living conditions. Theirs is a romantic story as he disowned his very wealthy family who disapproved of his marriage to a poor girl, and as a consequence they now have struggle and support themselves. Despite this, they are a lovely young couple with eyes only for each other.
Next, we make a quick visit to a UPHCP satellite session before heading to Dustha Shasthya Kendra (DSK) where a very lovely Dr Lovely gives a presentation on primary healthcare and DSK health activities. DSK, an NGO with a strong development focus on primary health care, water, sanitation, skill development training and primary education, have established a revolving credit scheme which provides (for a small weekly fee) affordable health services to urban slum dwellers and squatters.
Our next visit is with Assistance for Slum Dwellers (ASD), a non-profit and non-political development organisation that attempts to provide basic facilities to slum dwellers in order and have undertaken programs in slum areas providing access to education, nutrition, health and income earning opportunities.
We move on swiftly to our final appointment for the day, a visit a slum-based MSCS Adolescent Program. Getting there involves an unexpected but highly entertaining cart ride over a flooded section of road. Arriving at the centre, we are greeted by the dozen adolescents who come 6 days a week to learn about health and social issues, and personal and physical development.
As Diana and Sophie interview individual teens, I spend an awkward half hour with the 10 that remain. Feeling much like a teenager myself, I’m paranoid I’m being talked about as they giggle and stare, and became terrified I’m about to break out in spots and bad clothes. My two words of Bengali are proving of little use (there are only so many times you can say hello and thank you) until one of the more courageous of the group breaks the long, awkward silence by showing me various arts and crafts they’ve made (they are taught skills such a making envelopes, candles, small handicrafts and incense).
My self-consciousness returns however when they ask me to sing – and it’s one of Michael Jackson's hits preferably. I figure if these kids know who he is then I can’t pretend I don't and I stammer my way through a couple of lines of 'Heal the World'. Clearly I'm more NGO than I thought. I’m rather offended however when all the kids suddenly jump up and run out the room, but as it turns out fast has broken and the kids are in the next room eagerly quaffing RC cola and handfuls of rice. Then it’s time to leave but not before we’re treated to a song by the entire group, followed by photos, kisses, and a sad goodbye.
Day 3 - Tuesday
A visit today to two slums, one in the city and one on the outskirts. We walk precariously on the bamboo planks that connect the houses, a makeshift floor raised 1/2m above the filthy, smelly sewerage water that lies beneath. We visit the communal cooking area and are invited into a number of homes which are surprisingly tidy and well decorated.
Women emerge from their houses carrying half-clothed children but when we start taking photos, the kids are ushered back inside before reappearing in their "best" clothes. The woman who is head of the slum invites us to gather with the other women in her house; a large and well kept room furnished with a television set and ceiling fan. The women know quite a bit about family planning, how and where to access it, and use a variety of methods between them.
As we listen to the women’s stories, it emerges that they are clearly dependant on the wages earnt by their husbands who work as either rickshaw pullers or day labourers. Often they can't eat or feed their children until their husbands return from work with their earnings. Others speak of husbands who spend their wages on drugs, and of the problems these addictions cause.
After next speaking to a group of men, we make a long journey across town to next slum. The conditions are much the same and we poke around the houses and speak to the men and women who live there. There are 3 health care facilities nearby (MSI clinic, government health complex and a pharmacy) and everyone here knows where they are located and what services they offer.
We speak to a woman with 5 children who has recently had TL (with her husband’s blessing), and others who say that they speak quite openly with their husbands about contraception. This is good news, even more so when they state their preference for the MSCS clinic for their FP needs. We are then led to a building which is used as the school and admire the pictures painted by the students that adorn the walls. Numerous photos are taken and discussions with accompanying MCSC volunteers from the nearby clinic follow before we bid everyone farewell.
Arriving back at the hotel in the late afternoon we venture out for dinner at a local restaurant. The streets are quiet and the restaurants empty as it is past 8pm and everyone has broken fast and eaten already. The restaurateur kindly sources a couple of beers for us, an evidently difficult task given the 20 minutes it takes for him to return. After a delicious meal for a very cheap £8 each, we head back to the hotel and straight to bed.
Day 4 - Wednesday
Day 4 of our visit to Bangladesh visit and we’re temporarily one man down. Sue has taken ill but we hope that she will be well enough to join us again tomorrow. Diana, Sophie and I start our day with a visit the referral clinic, which has a client breakdown is approximately 50% middle class, 40% factory workers and 10% high income earners.
We leave Diana to make her way to the maternity centre as Sophie and I travel to our next appointment with Mr Mostafa Quaium Khan, Executive Director for the Coalition for Urban Poor (CUP), an organisation working on the rights based issues of slum dwellers. Poverty assistance is a top priority of the BDG government, and although was initially a rural issue, there has been significant a growth in urban poverty since the 80s.
At present, largely due to migration from the rural to the urban areas in search of employment, there are 4.5million people living in poverty in Dhaka – 4million of who live in the slum areas and 500,000 “floating”. These numbers are increasing due to recent natural disasters in the rural areas and also for other socio-economic reasons.
There was no government policy for the urban poor in the 80s so in 1989 53 organisations (including Care & Action Aid) formed the Coalition for Urban Poor which today focuses on advocacy and lobbying for the rights of the urban poor.
The urban poor live with a high level of insecurity due to their lack of tenancy rights leading to regular evictions. There are also the problems of impoverished housing and sanitation condition, high rates of unemployment, spread of disease and unsafe water supplies. The CUP attempts to lessen these sufferings by undertaking appropriate programs addressing their basic needs. Mr Khan proves to be an engaging storyteller as we listen to the ongoing frustrations of the CUP with the coalition government following a slum eviction in 2007.
Our meeting runs just long enough to ensure that we are racing to our next - not literally of course – we’re simply sitting in traffic. Fortunately, the person we were visiting, Ms Fran McConville (Health Advisor DFID) is also stuck in traffic, although unfortunately this means we were only able to speak with her briefly. Only 5 weeks into her new role with DFID Bangladesh, Mrs McConville had already visited an MSCS clinic and was impressed with what she saw there. We leave the very fancy, but surprisingly security-tight DFID office and make our way back to the office.
Again we’re up early for an appointment with the DP Family Planning. I don't join Diana and Sophie for this meeting with Quamrun Nessa Khanam, largely because I am intimidated by a woman who insists on being called 'sir' and also because I have business to sort out with the hotel. My very few responsibilities on this trip include carrying computer equipment, taking photos and trying not to say stupid things. Nevertheless, this has seemingly proven too much for me, and today I have forgotten the camera batteries.
I’ve also endeared myself to my travel companions up to this point with the following intelligent remarks: “gosh, your hotel room is tiny”, and “I didn’t know slums even had electricity – his fridge is bigger than mine!”, and in a less focussed moment: “what’s this about a cyclone?” Ok, the last one isn’t true but I don’t think anyone would have been surprised to hear me say it. Needless to say there was no confusing which one of us was the journalist.
In an effort to redeem myself, I sort out the business with the hotel before making a quick solo journey down the market place, drawing the attention of a largely male audience. Not to get big headed about it however - I suspect the sight of a sweaty, disoriented foreigner feigning interest in what turned out to be an industrial goods market was more a source of amusement than anything else. Diana and Sophie's meeting is brief (cut short once Sophie announces herself as a journalist) and we are once again on our way..
Our next stop is Antanta Fashion Ltd, a denim producing factory who joined MSCS's Factory Health Insurance Scheme in 1993. The Factory Health Insurance Scheme aims to provide free, quality reproductive and general health services to workers on-site (who are mainly females of reproductive age), financed through monthly health insurance payments made by factory owners.
We meet with Abdul Malek, the Chief Engineer, who gives us an overview of the garment industry and its future in Bangladesh (strong, due to demand from China which now produces more sophisticated products, coupled with the abolition of the Quota System) and the services provided by MSCS.
Antanta Fashion were attracted to the scheme due to the high rate of illness amongst the poor, many of whom work in the factories. Joining the Scheme means that workers don’t lose earnings due to sickness (and also pay for private medical assistance), and therefore the factory doesn’t have to suffer the knock-on effects of reduced productivity and increased absenteeism.
Day 5 - Thursday
Again we’re up early for an appointment with the DP Family Planning. I don't join Diana and Sophie for this meeting with Quamrun Nessa Khanam, largely because I am intimidated by a woman who insists on being called 'sir' and also because I have business to sort out with the hotel.
My very few responsibilities on this trip include carrying computer equipment, taking photos and trying not to say stupid things. Nevertheless, this has seemingly proven too much for me, and today I have forgotten the camera batteries.
I’ve also endeared myself to my travel companions up to this point with the following intelligent remarks: “gosh, your hotel room is tiny”, and “I didn’t know slums even had electricity – his fridge is bigger than mine!”, and in a less focussed moment: “what’s this about a cyclone?” Ok, the last one isn’t true but I don’t think anyone would have been surprised to hear me say it.
Needless to say there was no confusing which one of us was the journalist. In an effort to redeem myself, I sort out the business with the hotel before making a quick solo journey down the market place, drawing the attention of a largely male audience. Not to get big headed about it however - I suspect the sight of a sweaty, disoriented foreigner feigning interest in what turned out to be an industrial goods market was more a source of amusement than anything else. Diana and Sophie's meeting is brief (cut short once Sophie announces herself as a journalist) and we are once again on our way.
Our next stop is Antanta Fashion Ltd, a denim producing factory who joined MSCS's Factory Health Insurance Scheme in 1993. The Factory Health Insurance Scheme aims to provide free, quality reproductive and general health services to workers on-site (who are mainly females of reproductive age), financed through monthly health insurance payments made by factory owners.
We meet with Abdul Malek, the Chief Engineer, who gives us an overview of the garment industry and its future in Bangladesh (strong, due to demand from China which now produces more sophisticated products, coupled with the abolition of the Quota System) and the services provided by MSCS. Antanta Fashion were attracted to the scheme due to the high rate of illness amongst the poor, many of whom work in the factories.
Joining the Scheme means that workers don’t lose earnings due to sickness (and also pay for private medical assistance), and therefore the factory doesn’t have to suffer the knock-on effects of reduced productivity and increased absenteeism.
As we made our way to the factory floor I cross my fingers for good working conditions and happy employees to counter the guilt I feel for being a purchaser of the garments they are producing (the factory is 100% export, with the main customers being H&M and GAP).
But my guilt is doubled when I discover that the 4,200 workers work 10hr days, 6 days a week, and for the measly sum of 60p per day. Nevertheless, we’re encouraged to continue buying these good because the garment industry is paramount in revolutionising women's economic empowerment, giving the women jobs and independence.
Once again running late for our next appointment, we finally arrive at the well-kept grounds of the local government offices where we meet with Md. Sirajul Haider, Deputy Project Director for the 2nd Urban Primary Health Care Project (UPCHP-II). The purpose of the UPHCP-II is to improve the health of the urban poor by providing greater access to services for those living in urban areas.
The main objective of the project is to strengthen primary health care infrastructure in an effort to reduce preventable mortality and morbidity, and also to change the role of Government in the provision of health care services.
As the days nears to a close, we return to office for a de-brief and to say our goodbyes to the wonderful staff at MSCS
Day 6 - Friday
Our last day in Bangladesh – Sophie and Diana fly out to India this afternoon and I’m going back to London. After a quick bout of sari-shopping, we say goodbye and head our separate ways. At 2am I’m wandering Dubai International Airport (en route to London), marvelling at the gross consumerism taking place around me (does anyone really need a 10kg Toblerone?), and thinking about my past week in Dhaka.
Thinking that despite the traffic jams, random power surges, oppressive heat, and harassment by the wretchedly poor and disabled, Dhaka is a vibrant, bustling city with a heart of gold. That the Bangladeshi people are hardworking and gracious, hospitable to a fault, and surprisingly opportunistic and optimistic. And realising that with so many people living in such difficult (and for me, previously unimaginable) conditions, it’s thanks to the relentless work by organisations such as MSCS, CUP, ASD and DSK that the poor people of Bangladesh are gradually gaining access to more and more essential services.
At the risk of sounding cheesy, having seen first hand the work of the impressive MSCS team and having heard personal accounts of how their services had improved the lives of so many people, I am proud to say that I work for such a dedicated international organisation. And I now see that the success of our program in Bangladesh is largely due to the fact that it is run by Bangladeshi people – intelligent, driven individuals whose passion to improve the lives of their fellow countrymen is fuelled by the suffering they see every day.
Nicole.