A Sight to See

It’s only been two weeks and I already can’t remember the date I arrived… I actually had to look at the calendar just now. May 22nd. I arrived on May 22nd. It is quite possible that I am losing my mind, but more likely (hopefully) that I have just been so busy that it feels like I have been here for at least a month.

Last week I was just getting my bearings and adjusting my sight to the new environment and surroundings; much like stepping into the glaring sun on a hot day, feeling a bit disoriented at first, needing to steady myself while my vision comes to and thinking, ‘well that was strange, let’s get on with things’.

It seems that traveling has made me at least somewhat adaptable as I jumped right into work on Sunday morning and haven’t stopped since (well, aside from a few lazy mornings sitting by the pool). After learning that my project was de-funded by 90%, I jumped into three new projects simultaneously. I haven’t drowned yet, but let’s see.

The first is a mapping project of all nutrition interventions countrywide. Luckily my role in this project is overseeing the staff entering data and answering questions they may have. I reorganized their database so that each project is easily transferable into mapping software. Hopefully they will be done at the end of the week and we can start developing the maps.

As I have indicated to some already, going back to the mindset of being an intern can be challenging at moments, but at the same time I have a good deal of autonomy and ability to provide input into the projects we are working on. And on days when work seems like no fun or I am feeling frustrated, having the chai-wallah come to my desk at 3pm always makes me smile. Who doesn’t love a personalized (milk and one spoon of sugar, please) cup of chai? As a side note, for some reason I can’t get out of my mind that I feel the term ‘chai-wallah’ is demeaning. To get over my fear of being insensitive, I may now refer to myself as a ‘health-wallah’ (even though, according to wikipedia, ‘punka-wallah’ sounds much cooler- the servant who keeps the fan going on hot nights- something to work on for next year).

The second project I am working on is a randomized control trial for diabetic retinopathy. We are randomizing patients to one of two types of health education tracks to determine if intensive case management improves adherence to attending follow-up appointments. I am currently writing from my hotel room in Chittagong Province where we work with a large eye infirmary, the location of our randomized control trial. I won’t go into the details but there are some barriers to starting the trial; hopefully we can start data collection early next week. Luckily, I was finally able to start taking some photographs.

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Our data collectors interview patients using an electronic questionnaire.

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Our health educator counseling a patient on dietary and exercise habits to reduce the likelihood of diabetes related complications.

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Eye examinations

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To make my travel to the field more diverse, I requested that we do a community visit this afternoon with a patient from the hospital.  These are from a slum in the surrounding area of Chittagong City.

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Her papers say 48, but our guess is that she is in her sixties. Diabetes and a bad case of gangrene that rendered her disabled have taken their toll either way. I learned that it is common in Bangladesh (as it was in Cambodia) for women to tel people they are younger than they really are.

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Hard at work studying.

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There were lots of children and adults milling around both inside and out of the house during our visit. As I understand it, in Bangladesh homes are organized into Baris. One Bari is occupied by an extended family under one sort of ‘master of the house’. Once a woman gets married, she goes to live with her husband’s family (for which a dowry is paid, as the bride is ‘gaining’ the man; therefore her family must provide money/cows/gifts to the grooms family for basically taking their burden/daughter), and they start their own family. For the work I do we look to effect behavior change not only among these women/mothers, but the husbands and mothers-in-law as well. The husband and mother-in-law are the primary decision makers in the household, especially when it comes to the health and nutrition of young mothers and their children. When these practices are detrimental to health, everyone suffers, so working with all members of the family is key.

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Young girl carrying baby. While this girl is still too young to be married or to bear children, early marriage is all too common in Bangladesh. The legal age of marriage has been set to 18, but this is virtually impossible to enforce. Another reason why maternal and infant health remains such an issue in this country.

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The third and ultimately most exciting project I am working on is still in it’s stages of development, but we have a household food security program within which we are pilot testing a gender awareness curriculum. I will be conducting some qualitative research in a few weeks to determine preliminary effectiveness of this curriculum and to determine if it will be feasible to include some more maternal and child health related outcomes to our randomized control trial and end-line evaluation. This project is now what I am hoping will ultimately become my thesis.

Overall the heat, pollution, and chaotic streets can be overwhelming, but I truly am enjoying my time here. I am especially looking forward to the opportunity to travel outside of urban areas to see the countryside a bit- I imagine the rural areas to be a lovely, cool place with fresh air and serene nights. Until then I’ll remain constantly amazing at the sheer volume of activity going on around me!

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One response

  1. Ayaz

    Punkah means ‘fan’ in urdu too!

    Everything you talk about is pretty much the same way in Pakistan too. Glad you are enjoying your stay in Dhaka.

    June 6, 2013 at 11:27 pm

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