Why this project?

The working area of partner organizations Aloshikha and BVDO is located is the lowest-lying area of Bangladesh, in the delta of its two largest rivers. Until 1997, no medical facility was available in this rural area, which is flooded for about three to four months a year. At the time, the government's nearest health clinic was an hour and a half by riksha (trishaw), or a three hours' walk. Additionally, the clinic faced major operational problems: understaffing, inadequate supply, and poor hygienic conditions. Care was not guaranteed: at arrival, it was uncertain whether the doctor would be present, whether the operating room was usable, whether the necessary medication was available, and whether there was room for an extra patient. As a consequence, most people preferred to visit the local traditional doctors and midwives. Only in extreme cases of emergency did they undertake the trip to the government’s health clinic. In many cases, just to be turned away, or to be referred to a larger government hospital, even further away. At that time, this meant a boat journey to cross two more rivers, and quite often, the patient did not survive this trip.

 

To mediate the lack of access to health care, partner organization Aloshikha established a clinic in 1997, the 'Maria Mother and Child Health Care Clinic'. The clinic is comparable to the practice of a General Practitioner, expanded with a small-scale hospital facility where first aid operations can be performed. A qualified doctor holds daily consultation hours. Twenty-four hours a day the doctor can be called for emergencies. There is a small laboratory, an X-ray machine, and a small but well-maintained operating room. Treatment is available to combat bacterial infections and common diseases, simple bone fractures and other injuries, but also a cecum surgery and caesarean sections can be done. Before the establishment of the clinic, it was not uncommon that people died from these health problems that require just simple but adequate treatment. Funding is available for the poorest of the poor to compensate for necessary costs. In addition, there is close contact with the health facilities of the government for referral in case the treatment of health issues requires complex treatment, and the clinic provides accommodation and logistical support to the national vaccination program in the work area.

 

SAKO Foundation supports the community health program that was set up at the same time as the clinic. This program is carried out by two partner organizations, Aloshikha and BVDO, each organization is responsible for a different but complementary geographical part of the delta. Aloshikha has 12 community health workers who work in the area around the clinic. The team consists mainly of female health workers. Through existing structures, they offer an integrated program of health education, care, timely detection of health complications, and referral. The team of health professionals from partner organization BVDO visits around 25 villages in the adjacent area, reaching about 800 families.

 

The tasks and responsibilities of the community health workers

Community care in Bangladesh differs from district nursing in the Netherlands. Daily care tasks for the sick are performed by the family. Therefore, the focus of community health workers is directed to supporting family members in their care tasks by sharing knowledge, practical information, and by deploying existing networks. Hence, the range of tasks performed by community health workers is very diverse.

 

Mother and Child Care

The community health workers carry responsibility for their own allocated area, consisting of about five to ten villages (depending on distance and accessibility). The health workers hold monthly consultations in the villages within their area. Pregnant women and new-born babies receive preventive check-ups, and receive free medication if necessary, such as iron tablets and vitamins. Additionally, the health workers facilitate the implementation of the national vaccination program of children aged 0 - 6 months. When health workers detect any complications during a pregnancy, women are referred for medical support. Sometimes it is necessary for health workers to make a home visit to convince the family around the woman of the necessity of referral, and to mediate in case of any money problems. In consultation with the family, an emergency plan is made for each pregnant woman, as to what to undertake in case of emergency. Most women want to give birth at home. However, it is important to plan ahead in case complications occur and medical assistance is required. That means thinking about transportation, its costs, who accompanies the woman during travel, etc. Experiences have shown that a predetermined plan ensures that more women timely receive professional help, significantly reducing the mortality rate of both mothers and new-borns. After delivery, a health file is created for the new-born baby. Growth is being monitored, vaccinations and possible health problems are reported.

Additionally, the monthly consultation hours of the community health workers are also used by people for general medical advice in case of general illness or injuries. When necessary, the community health worker refers the patient to a doctor and assists the family in arranging the necessary transport.

 

Health assistance to women groups

Health motivators disseminate health messages through the existing structure of women micro-credit groups, in particular for discussing gender-sensitive topics. Teenage pregnancies, birth control, planning more time between two pregnancies, domestic violence, and teenage pregnancies. It offers women a platform to discuss sensitive issues together, and to develop strategies to strengthen their own position in the community.

 

School Health Program

Twice a year, the health worker visits the pre-schools in her work area. In the working area of partner organization Aloshikha, the health worker is accompanied by the doctor of the clinic on these visits. All children are examined preventively examined; weight, vision, and hearing are reported. Early detection of disease or injury is also part of the check-up. When necessary, medicines are provided for easily remedied disorders, for example a worm treatment, vitamin preparations or iron tablets. In case a referral for further medical support is necessary, the health workers contacts with the family to organize such referral.

 

Clean water, sanitation, and hygiene

In their working area, Aloshikha and BVDO strive to ensure that all people have access to clean water and sanitation. The construction of deep tube wells and toilet facilities are financed separately by other donors. However, it is the health workers' job to assist this project by providing the necessary health education.

 

Healthy food campaign

Every month a Nutrition Camp is organized in one of the villages. These events take place in the open air and target all members of the community. Everyone is welcome: men, women, and children. The health workers organize these events, and provide information about the importance of healthy food, why pregnant women and children need extra nutrition, the importance of growing fruit and vegetables, and how nutritional deficiencies can be detected and addressed. At the Nutrition Camps of partner organization Aloshikha the clinic doctor is sometimes present as well. At the end of the informative part of the event, a healthy meal is prepared for all participants.

 

Promotion of the health workers’ expertise

The health workers meet with the clinic doctor and/or certified nurse to discuss problems and case studies among each other. These meetings aim to increase the expertise of the community health workers on a structural basis and recurrent basis. Case studies and practical examples are the starting point to arrive at a joint and comprehensive approach to health problems. In addition, Aloshikha and BVDO seek contact with traditional healers and midwives to promote cooperation. This link is essential, because especially the poorest people are accustomed to using this traditional network of healers and midwives. The clinic doctor of partner organization Aloshikha organizes regular meetings, aiming to increase the basic medical knowledge of these traditional healers, the detection of serious health issues that need further medical care, and to encourage referral when necessary.