Heidi goes a roving
I have arrived in Dhaka to perform the Marie Stopes International (MSI) annual quality technical assistance (QTA) visit to our Bangladesh partner who as one of our longest serving partners has a large number of SRH service points, including 142 clinics throughout Bangladesh. Despite having lived in Asia for many years, including neighbouring Burma, this is my first visit and I am still a little surprised by the high levels of traffic; both mechanical and human. Every where you look there are cars, rickshaws, tuck tucks, buses, people on foot and street sellers passing car to car – many of them children as young as five years old – and this seems to be virtually 24/7. On the other hand there are many aspects of Bangladesh that are definitely more modern than expected, including a ride in my first gas powered car, and yes that is gas not the American slang for petrol.
Marie Stopes International Bangladesh (MSB) welcomes and briefs me on the countries vital statistics, with a population of 156 million people I am surprised to hear them call their country small, but relatively it is because it is half the physical size of the UK but has triple the population.
Bangladesh, with a total fertility rate (TFR) of 2.7, is a success story in Asia, however with a population of this size, taking your eye off the ball for just a minute; like a break in a family planning commodity, could result in a mini population explosion. This is where MSB comes in, working together with the Government of Bangladesh they are striving to increase the use and access of modern effective contraception methods and for those who have completed their families we are providing convenient long acting methods such as the intrauterine contraceptive device (IUCD) and permanent methods such as tubal ligation and vasectomy for both men and women.
As part of my assessment, I will travel to see MSB’s clinical activities in the field which includes roving teams, working in Ministry of Health sites and MSB clinics. My first journey takes me five hours north away from Dhaka to the town of Sylhet where we have 3 clinics, including a maternity centre for safe delivery. However tomorrow I will travel even further north to the foothills of India to Sunamganj district and Taherpur village. We set out early by car and visit the local Family Planning Deputy Director of services who tells us of the extreme lack of doctors and facilities in some of his districts and that the MSB team of a doctor and paramedic working with ministry of health teams in remote health centres are making a great contribution to access to long acting and permanent methods of family planning. After this meeting it’s a short hop to a small rented boat which takes us thirty minutes down stream past boat after boat decanting sand and stones that local men have gathered from the river and will be transported by boat down to Dhaka.
When I get back to dry land I am faced with a double dilemma! My next mode of transport – unbeknown to me – is a motor bike, not something I or MSI would be happy about me travelling on; and second do I sit side saddle like a lady from the seventeenth century (and the local custom) and fall off, or do I break protocol and go pillion? Well, I opt for safety over culture and hold on for dear life as we pass through village after village past the rice being gathered and dried on the road making an extra obstacle to join the children, animals and assorted bikes. Soon we reach a section of the “road” that even a motor bike can’t scramble through as the mud is so deep and the road unmade. I reluctantly plunge into the mud with my favourite green Birkenstocks and walk the mile past the local people hurriedly gathering the rice early as floods are predicted. Fellow travellers are shocked to see an English Lady plodding through the mire and I think of myself as the Jemima Khan of MSI wondering how far the women we will serve today have come and how they will have travelled, how far their journey would have been if MSB did not bring this service to them at village level?
The poverty I see is as driving as any I have witnessed in Burma, Sudan or Angola and the early harvesting of the rice is a worrying necessity as it may mean a poorer income to each household this year and possibly contribute to a reduced food intake for families with growing children. Two more boats on and several more tracks later I arrive at the health centre where the team have educated, counselled and consented clients wishing to have a tubal ligation and be free of worry of an unwanted pregnancy and frequent visits to health centres. The health centre is some what run down, but the procedure room that MSB has helped the ministry of health rehabilitate is pristine and the team are working together with the local nurses to perform the short and simple tubal ligation which will enable the women to be worry free of unplanned pregnancies and from which they will rest awhile then be able to travel straight back home.
I hope the women are happy with the service they have received today I am certainly happy to see that the medical standards of care are excellent and MSB are striving towards the MSI principle that with clinical care we have “one world, one standard”.