The Malice of Malnutrition

These days, it seems like most people are aware of the effects of malnutrition. Charities like World Vision and Medecins Sans Frontieres have done a great job in publicising the shocking visual impact of a malnourished child, and as a result many people consider feeding these children a key goal for the charity and medical fields.

Here in Bangladesh, conservative estimates put child malnourishment at around 65% – one of the highest counts in the world. Of that number, 60% are so severely malnourished that they are now stunted and will not recover a normal pattern of growth, even if they were now to undergo an aggressive feeding strategy.

Unfortunately, it’s not as simple a question as just making sure that families have enough food. That in itself is too simple an idea. As much as we would all love to ensure that all the villages have self-sustaining food sources, such as rice and potato crops, inclement weather and water contamination often prevent this.

These factors contribute to the malnutrition of entire families. According to data compiled by the US Library of Congress, 45% of rural families and 76% of urban families survive below the acceptable level of caloric intake. This means that malnourished women give birth to malnourished children – tragically setting their babies up for traumatic health experiences for life.

A stunning 40% of Bangladesh’s population is children. With such a high proportion experiencing malnutrition, education attainment is much lower than it is in other developing countries. This will continue to have significant economic impact – without education, employment opportunities are limited, in turn keeping people in the poverty that made them malnourished. It is indeed a vicious cycle, and without serious intervention will be difficult to break.

While we are doing everything we can to educate people on the importance of hygiene and to facilitate food access to the communities we work in, it’s an uphill battle. The total government expenditure on healthcare in Bangladesh is just 3% of the country’s GDP, and for every 10,000 people in the population, there are just 4 hospital beds. It’s simply not a priority in the power structures of this country.

We will continue to update you as regularly as we can on the work we are doing. Thank you for your ongoing support and messages of encouragement – they keep us going!

Microfinance and Medicine

It’s only been a few years since the term ‘micro finance’ was introduced into the world’s vernacular. It’s a curious idea – lending a tiny amount of money to someone on the other side of the world, interest-free, so they can get themselves on their feet.

Astounding, really. That an amount like $25USD can be enough for a family to pull themselves out of poverty, or finance a life-changing course of medication or treatment.

The World Bank recently released a report called ‘Voices of the Poor’, “gathered views from more than 60 000 poor people and reported that ill-health and inability to access medical care emerged as key factors inducing and resulting from poverty. In a subsequent publication, Dying for change, thousands of interviewees most frequently identified illness – even ahead of losing a job – from among 15 causes of a downward slide into poverty.”

We can certainly attest to this being the case. People living in rural areas, who are scraping by on a tiny income from extremely demanding physical work, often fall victim to ill-health – and their security instantly evaporates around them.

If you are sick or injured and can’t work, you are essentially ruined. For the hundreds of thousands of families who live hand to mouth in Bangladesh, sick leave is just not an option. It doesn’t exist, and there’s always someone ready and willing to take your place if you can’t keep up.

That’s why micro finance is such a godsend to these developing countries. It gives people a lifeline, a glimmer of hope. More than anything tangible, it buys them time. They can recover, regain their strength and return to the workforce, without calamity crashing down on them.
Already we are seeing changes in the communities we are operating in thanks to microfinance. Reproductive health and child nutrition have improved, diarrhoea and malaria are down, and we are confident that we will see reductions in the cycle of domestic violence and STDs as more women gain their freedom through microloans too.

Traditional Vs Modern Medicine in Bangladesh

Something we are constantly bumping up against here is the widespread belief in traditional medicine.

Bangladesh has an incredibly long history of traditional medicine. The country is home to a huge variety of medicinal plants, herbs and spices, and animal parts are often incorporated into ‘medicines’.

Ayurvedic medicine and Unani medicine are also widely practised and trusted in. Allopathic medicine, the modern practice used by all the members of Doctors in Bangladesh, is often seen as a last resort.

Most of the doctors working for our organisation have found that a large number of their patients will either:

  • Try traditional medicine before coming to them (often making the problem worse),
  • Disregard advice in favour of traditional treatment
  • Avoid seeing the doctors altogether!

Traditional treatments are usually a blend of ‘folk’ treatments with religious and spiritual procedures. A study by the Geneva Health Forum found that even when there are clinics or hospitals immediately available, at least 50% of the Bangladeshi population will still opt for traditional treatments.

This means we’ve really got our work cut out for us!

Not only do we need to make sure our facilities are open and appropriately staffed at all times, as well as being affordable, but we need to better communicate our value to our communities.

We need to show that even though you may experience side effects from allopathic medicine, it’s still more effective than traditional treatments that don’t provoke any response from the body.

We also need to continue to build trust, cultural understanding and respect with our communities. The better we do this, the more likely people will be to seek us out.

The Hygiene Issue

Any doctor working in a foreign territory will tell you that they face many challenges. These are social and cultural challenges, as well as environmental ones.

The biggest challenges my colleagues and I face here, though?

Convincing people of the importance of hygiene.

In the West, people are so hygienic that you might call them ‘germophobes’. Here in Bangladesh, most people don’t even think about germs!

On one hand, they can’t afford too. Thinking about all the germs you are being exposed to all the time will send you on a one-way trip to crazy town. But on the other hand, it’s important to strike a balance between that terror and absolute disregard.

This is what we are constantly trying to educate patients. We are working with local schools and workers guilds to make hygiene a standard part of the Bangladeshi day.

Teaching kids to wash their hands after going to the bathroom is a good start. Washing them again before eating is another step. Not sharing food if you’re sick, and not letting animals near your food is another big one.

According to the World Health Organization, hygiene education is one of the biggest factors in reducing preventable infections all over the world.

Often, friends and family back home express surprise (and sadly, disgust) when they hear that many Bangladeshi people don’t associate poor hygiene with disease.

This is a bit unfair. It’s not their fault that they haven’t had the education we have. There simply isn’t the cultural emphasis on cleanliness, because it’s not practical. Bangladesh is still struggling with the supply of dirty drinking water, let alone worrying about whether people are washing their hands before cooking a meal.

It’s up to us to educate our patients in a culturally sensitive way about how they can overcome the hygiene challenges their environment presents.

This is why we are trying to make it a standard part of the education and work systems. The more often people hear how important hygiene is, the more aware we hope they will become.

 

Don’t Go In The Water

Well, monsoon season (or ‘rainy season’ to the ever-unphased locals) is nearly upon us.

For Doctors in Bangladesh, this is the toughest time of year. We are inundated with people showing up dehydrated and grey from cholera, or covered in the rosy spots of typhoid.

According to the Pulitzer Center, we are operating in the most densely populated country in the world. Two thirds of the sewage here is left untreated, and often finds its way onto the streets and fields.

Come monsoon season, all this sewage gets mixed up with the storm water, carrying a double whammy of germs to people already extremely vulnerable to all kinds of diseases.

On top of this, the recent discovery of arsenic and manganese in the main water supply means that people are largely at the mercy of unscrupulous landlords and water vendors who will say they are providing clean drinking water – but are often lying to make a quick buck off a desperate populace.

It sounds bleak, and to be honest, it is.

We are trying to remain optimistic that the bright minds of the new generations will find a sustainable solution to these huge problems.

At this point, our best options continue to be purification stills, purification tablets and various other evaporation and ozonation technologies (as are commonly found in Thailand and other parts of Asia).

Currently, we must continue to rely on the support of readers and sponsors to help our patients and the communities we work in. Doctors of Bangladesh would like to extend our heartfelt gratitude for your generosity and we hope to do you proud in all our work.

 

The Flying Menace

Recently Bill Gates released a great image showing how deadly mosquitoes are – more deadly than any other creature in the world (by volume of infection, at least).

As you may know, Mr Gates and his wife are champions of reducing mosquito-borne diseases, especially malaria and dengue fever.

Here in Bangladesh, we are being ever-vigilant about mosquitoes. It is a very high priority for us to educate our clients and the local communities about avoiding mosquito bites as much as possible.

By doing this, and by distributing mosquito nets and repellants, we hope to control the incidence of malaria, dengue fever, and Japanese encephalitis.

Fortunately, the NHS in the UK has recommended that most of Bangladesh is now low-risk for malarial infection, with the exception of the south-eastern region of Chittagong, which is still high-risk.

Unfortunately, many parts of the country are still high-risk for Japanese encephalitis, and the CDC considers Bangladesh an endemic area for dengue fever.

In that the weather is so warm at the moment (36 degrees Celsius in Dhakar at the time of writing!), we really have our work cut out for us.

We are always encouraging the locals to cover up as much as possible, and to avoid being outdoors at dawn and dusk, as this seems to be when the mosquitoes are hungriest.

However, in agricultural areas, and even in industrial areas where the working days start early and finish late, this is not always practical. The best we can do is emphasise the use of mosquito nets, repellants and wearing thick materials to deflect any bites.

This is only going to get more important as the monsoon season arrives and mosquito breeding territories proliferate, so we will be sure to update you – hopefully with good news!

 

 

What We’ve Been Up To

Well, it’s been a long time since this site has been updated!

To be honest, we’ve been a bit overwhelmed. Last year there were violent protests in Dhaka, unseasonably cold weather, and we had a major building collapse which killed over a thousand people and injured many more.

Alarmingly, we have also seen an increase in the number of people contracting the deadly Nipah virus. We have been desperately trying to spread education on how to prevent contracting this virus, as the fatality rate so far is 100%.

Between all those things and the usual demands of treating our thousands of patients, there hasn’t been time for just about anything else.

The exception to this is the good fortune we have had in dealing with Massage World in the USA. They have been very generous in their sponsorship of our efforts.

With their contributions we have been able to extend our vaccination program and hygiene education programs into more rural areas.

We have also had an influx of contact from interested massage therapists who have heard about us on the Massage World site, offering to send their secondhand massage tables for use in our clinics. This is very generous and we are delighted at their kindness.

Massage World’s involvement now means that we will update this blog more regularly in an effort to be transparent with how we are utilising their sponsorship.

In the short term, summer is upon us. Due to the intense heat and humidity we will be focusing on helping our patients “disease-proof” themselves and their families.

As always in the very hot weather, and on into the monsoon season, the incidence of water-borne diseases like typhoid and cholera increases significantly, as do cases of vector-borne viruses such as dengue and rabies.