Manikganj – health

Next stop was Kusitia –  a small village a fair distance off the main road, following a dirt track.  In between what looked like outhouses, was the village ‘square’, where a health education class was underway.  There was a group of about 6 women sitting on woven mats, an instructor and another lady with a box of some basic over the counter medications.  The topic for the class was hygiene – a reminder class for some and a new topic for others, including a newly pregnant mother.

For some background, here is how the health ‘system’ works under the BRAC program. The role of SS:  essentially a health worker – a volunteer women selected from the village, who is generally regarded as an influencer.  The neighbours trust and respect her, and she can translate any medical questions they may have in the comfort of their own home.  She undergoes 15 days training plus 1 day refresher training per month to assist her in identifying the most common of ailments – diarrhea, stomach upsets, common colds, headaches etc.  She treats these ailments with over the counter medications.

She also monitors pregnant women 4 times throughout their term and administers daily medication to patients who have TB and such like.  This ensures the medications are taken when they are supposed to be taken, and are not sold on the black market.

The SS is responsible for the general health of the 3 villages she is responsible for.  There are a total of 30 SS in a district. The role of the SK:  a semi-professional health worker who has completed her SSC (senior school certificate) plus received health professional training with BRAC.

The SK is responsible for the health of approx. 10 villages, and works closely with the three SS who work in those villages, overseeing their work and validating their diagnosis.  The SK will also review patients the SS is unsure about, and makes the decision of the patient should be referred to a hospital or not.  She runs three health care meetings per day, using simple methods of instruction such as pictures, diagrams and storytelling.  The SK will also keep an eye on trends of ailments, and report to the Program Organizer.

The role of the Program Organizer:  this is an oversight role with management of 3 SKs, approx. 30 SSs and 90 villages – phew, that’s a big district! Tthe PO manages the budget, does all the reporting to regional and head office, and works to manage communicable diseases.  TB is significant in the Manikganj district.  This is primarily because of poverty levels, lack of understanding on how not to infect others, and the local tobacco processing plants don’t help much either.

There are about 30 TB patients on this district’s list, all receiving daily medication in accordance with the DOTS method – directly observed treatment shortcourse.  I do not pretend to be a medical expert so check out this link for more info on DOTS.  The PO proudly tells me this treatment is effective in his district, with the SSs playing a key role in ensuring the patients take their medication consistently.  The instances of TB have decreased over the years, he’s been in this PO role for 10 years. Not being a medical person, I was just there as an observer, but learned a lot.  And became convinced of the huge importance of the role of the SS.  It was clear the women deferred to her if they did not understand something the SK had said.  It was also clear they had learned much about hygiene from the SK.

My presence gathered about a dozen kids to also come and watch the training session, and some of them learned too.  I mentioned it to the PO, that it would be a good idea to include the kids, who generally put pressure on their parents to change behaviour. He agreed, so the kids might be included the next time!

About Kate Coffey

After 30 or so years in the investment management industry, 2013 saw me turn my life up-side-down, making my way first to Nepal, then Bangladesh during that first ‘year away’. The year took me on a journey I did not expect, had me fall in love with Nepal and its people, and become inspired at the work of Spinal Injury Rehabilitation Centre (SIRC) located in Bhainsepati - 2 hours east of Kathmandu in the Saanga foothills. Since 2014, I have returned to SIRC numerous times, working closely with the folks there in the aftermath of the 2015 earthquakes. In Bangladesh I marvelled at the strength and resilience of marginalized women who have the courage and audacity to break the rules and make a better life for themselves and their children through microfinance programs with BRAC. 2016-2017 saw me embark on a totally new experience in Sri Lanka, a place I never would have chosen to end up in. It’s the 40C+ heat, big humidity and tropical snakes & animals that scared me! But I ended up love love loving! my time there, working with predominantly Tamil small business owners in remote villages in north and east of the country, trying their best to recover their businesses and the lives of their employees, after decades of a civil war. My time in Sri Lanka made me realize my hard-earned business skills and experience can really be put to good use! The work the BIZ+ team and I did there ended up earning me International Volunteer of the Year Award in December 2017, presented on Capitol Hill, Washington DC no less. I am currently home on Bowen Island, in the west coast of Canada, shoring up my finances before I head off to who knows where, for my next expert volunteer assignment. This blog initially started out as a travelogue of sorts to keep friends and family worldwide updated while I was off on my travels in 2013-2014. Since then it has morphed into a life story of the many places I have lived and worked and of the wonderful people I have met along the way. I hope you enjoy.
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