To the jungle and fields

Asia » Bangladesh » Dhaka » Dhaka
June 12th 2008

Published: June 12th 2008

Edit Blog Post

steff53

Matlab B Block

This is one of the sidewalks within the B Block health center in Matlab. It was a pretty garden to walk through.

I finally left Dhaka. I suppose it was about time since there is an entire country and continent that is left to see outside this metropolis. I planned to spend two nights in Matlab, though I ended up shortening it to one night for various reasons. The trip started early at 7:00AM when a car came to my apartment to pick me up. From that I switched to a van, which jostled and honked its way out of Dhaka’s morning commute. After about an hour and a half, we stopped in this little town. A few boys around nine years old rushed to the van to carry the passengers’ belongings but I insisted on carrying my own. This country has been a confusing twist of needing to be very independent and yet let others do menial tasks for you. I’ll never get used to it. I was told we’d take a speedboat the rest of the way because one of the bridges to Matlab was under construction. So I climbed into the tiny speedboat, which consisted of two benches that could fit three people each, including the driver. The boys pushed us out into the slow-moving, wide Magna River and off

B Block center

Another picture of inside the B Block health center

we were. The boat ride was an hour of flat countryside and skinny fishing boats with tapered ends. There was not a great distinction as to where the river’s edge turned into land. The land in Bangladesh’s lower delta is so flat that the water appears to spread out, lazily coerced into a river by slight banks of land. I would periodically wish that I wasn’t stuck in my salwar kameez and could instead put on a swimsuit and some water-skis—with rivers as wide and peaceful as these, I’m thinking you could probably stay up on skis until after the boat ran out of fuel.
For how many people there are in Bangladesh, most of the land remains agricultural. As a river nation, fishing is an obvious industry as are rice paddies. They also grow potatoes, various tropical fruits (especially mangoes), various vegetables, and jute—the material used to make old-fashioned rope and the bottom of rugs. We passed numerous fishing boats and ferries, transporting fish and people from town to town. We were the only speedboat that I saw. Later, when I would leave Matlab in the company of some doctors, a crowd of men and boys would gather

B Block

Looking out of the entrance to the health center, you see some idle rickshaws.

to see us off—as usual, blank-face staring out of curiosity. As we would slowly traverse the narrow, windy river that leads out of Matlab’s main center, we would pass numerous small houseboats, from which little children would come running and waving and giggling in excitement. The ratio of children to elderly people in Bangladesh is much higher than in the U.S. yet despite their omnipresence, they remain intrinsically and helplessly adorable.
My purpose in coming to Matlab was to better understand the data I am working on. ICDDR,B—the organization I work for—established a field surveillance site in Matlab forty years ago, making it the oldest and largest population surveillance project in the world. Included in the surveillance/intervention site are four main blocks composed of dozens of villages, including about 100,000 people. Due to its unique features and organized methods, the Matlab field site has been a popular place for population health studies to be conducted and there are always several going on at one time. It was here that the study I’ve worked on at Cornell and in Dhaka was actually conducted. Thus it was an exciting opportunity to see where the data and numbers I stare at daily

Ambulane

This is the rickshaw ambulance used in B Block. Rudimentary, yes, but it's used mostly to transport women in labor who need medical attention. After the monsoons really hit, a boat is used instead.

came from.
The health system in Matlab is very well-defined. At the lowest level are the community health workers who work out of their small homes throughout the area. These people, mostly women, are trained in providing basic health services. Of the two I visited, the patients they saw were men coming to get condoms, women coming to get birth control injections and pills, and mothers bringing their babies to be assessed and vaccinated against such diseases as polio, typhoid, and pneumonia. As one doctor told me, the community health workers are the nucleus of the system—without them, nothing would be possible. The collect important data about their patients in highly organized logbooks, which they report back to the doctors and researchers at meetings. It is also their responsibility to know when to refer patients on and to where.
The next highest level is the block health center. There is one health center in each block. It is here that women are encouraged to give birth with the help of highly trained midwives. It’s also here where I was fortunate enough to be with doctors and nurses actually collecting data from my study—MINIMat’s mothers and babies. MINIMat started

Health worker

This is one of the community health workers at the block health center

when the mothers became pregnant and now the children are almost five years old. Almost 3000 women remain in the study group and they continue to bring their children to the health centers for measurements and assessments. While I was there, the children that came in were weighed and their height measured. Their body fat composition was assessed in multiple ways and their head and arm circumferences measured. After this, the children’s blood was taken and their hemoglobin and fasting glucose levels were measured. The rest of the blood samples will be sent to Sweden to have their full micronutrient profile assessed. Then the children were given a vaccine and sent on their way. They return one month later to have an ultrasound performed to assess the health of their liver, kidneys, and spleen, as well as more blood work and a tuberculosis test. It’s easy to tell the children that are on their second visit because they begin to scream as soon as the iodine swab touches the hollow of their elbows. Their mothers hold them and whisper in their ears and the nurses feed them potato chips and cookies after. I tell them that’s all pretty similar to

Rice paddies

A view outside the dining room window of the guesthouse where I stayed.

the U.S. I don’t think children anywhere deal well with needles and certainly do not easily forget the first traumatic experience.
All of the children look healthy—plump and energetic, except for one with a boil on his foot. They are Muslim and Hindu and their mothers are young and old. Some mothers dress in salwar kameezes or saris, others wear more conservative full black clothing that covers their faces. There are more women who dress in the full covering in Bangladesh than I initially had thought. They are not the majority but there are a good number of them. In typical Bengali style, they seem unable to totally embrace the concept and I’ll often see a woman in full covering but instead of black it will be all neon green—it’s hysterical actually. Or more often, they will wear the full covering but will wear a shawl over themselves that is both loud in color and pattern. And in the company of women and male nurses and doctors, such as at the clinic, they will flip up their face covering to reveal a smile that the eyes showed anyway. They still joke with us and cuddle their children to their

Coca Cola

The coke I had at lunch. That's coca cola in Bengali on the wrapping, which I thought was funny.

chests. They don’t seem to judge me for wearing my clothes so I try not to judge them for wearing theirs. That being said, I do not agree in any way that women should be forced to cover their bodies like that, especially when men walk around in lungis with no shirts. I think it’s silly I have to wear a salwar kameez as if the scarf around my neck actually covers my breasts or makes people forget I am a woman that inherently has breasts. I think it’s silly that married women traditionally need to wear saris, which though pretty, are the completely impractical. And saris actually expose quite a lot of a woman’s back and side of her waist, which is for some reason okay. It’s interesting the strange lines we all draw for right and wrong when it comes to propriety. Our own line is more liberal, but no less haphazardly drawn.
And so women and men walk about in the summer heat, chatting away in Bengali, looking at me curiously until I fulfill their curiosity by telling them who I am and where I’m from. It puts them at ease and they like I can

Lebu ar longka

Citrus slices and chili peppers are the customary condiments served with Bangladeshi meals. Thought it might be worth including. One of the chili peppers reduced me to forced painful tears after wiping my eyes after deseeding one.

at least talk a little to them. One woman asks if I’m married after I tell her I am 20. I answer, No no, I am too young! She smiles, That is old here. In a country with a lifespan much shorter than our own, I don’t know if I can blame people for getting married at 17, though much younger I still find discomforting, though it certainly happens. And then babies result, in a seasonal pattern. As most weddings happen in the good weather of winter, so due the births about a year later. To its credit, Bangladesh has had a remarkably successful family planning campaign, especially given its location, poverty, and Islamic character. Posters line health clinics encouraging family planning and explaining different options. People choose methods from vasectomies and tube-tying to traditional condoms and pills. Abortions are also legal (though they are known as something like “menstrual control”) up until about the end of the second trimester when Muslims believe the fetus develops a soul. I suppose the biggest difference between American family planning and Bangladeshi family planning is that Bangladeshis usually want children right away, mostly to help with the family. Thus they now have about

Palm tree

Things grow everything in Bangladesh. You throw seeds and they'll grow. Palm trees are everywhere.

two or three children and then begin birth control. This is a much lower number of births than in Bangladesh’s past and shows the impressive results of good education and availability of family planning options. One woman, however, told us she already has three daughters but will try again for another child hoping for a boy. Not that she doesn’t love her daughters, but she worries about her husband not having help in the fields to support her and her daughters. In such a setting, it’s a legitimate concern.
And so I left the block health center to return to ICDDRB’s main Matlab hospital, which is the next highest level in health care in the area. It is here where more serious cases of diarrhea, largely from cholera and roliovirus, are treated with antibiotics and rehydration therapies. Also mothers and children with birthing complications are cared for here. One baby I saw had jaundice and was thus receiving light therapy. Another woman had given birth to twins. The second twin was larger than the first and also in a transverse lie—a death sentence for a mother and child without proper healthcare. In her case, she was taken to the

Matlab

Near the guesthouse

nearest hospital (the next highest level of health care) where she received a Caesarean section. Though the babies were tiny, they looked healthy. The mother looked about my age and was lying next to her own mother. Both women had the babies strapped to their chests, a method used here to help preterm babies grow. In the background, a cricket game played on the television. Behind that through the window you could see the palm trees and rice paddies receiving a bout of monsoon rain. It’s a different setting here, but the problems are not always so different from our own.
Now I am back in Dhaka and strangely glad to be back even though the weather is oppressive and I’ve completely lost electricity in my bedroom. I’ve grown more used to this strange city and the characters that play parts in my life here. This afternoon I will be going to a cricket match of India versus Bangladesh. I’m told the game will only go from 3 to about 10. Based on the heat and my disinterest in television cricket, I give myself 2 hours before I hop in a CNG and head home to watch Nip/Tuck and