IDH stands for Infectious Diseases Hospital. It’s Government run, so the equivalent of an NHS Hospital in the UK, but take it from me…that’s where all similarity ends. I was only told where we were going crossing Dhaka city in a CNG. Some of the benefactors of my NGO, people living with HIV/AIDS, had been admitted, we were paying them a visit and meeting the Doctors who were treating them.
We arrived and entered the building but there wasn’t a soul in sight as we climbed the central staircase to the second floor. Two friendly nurses greeted us as we approached. They were sitting inside a little booth outside the doorway to the main ward itself completing piles of paperwork. I could see at a glance that this was a low tech environment, without even a phone on the desk and not a computer in sight. It’s notable to say that this isn’t just the first, but still the only ward in existance anywhere in Bangladesh put aside especially for HIV/AIDS patients. It was opened by the Government recently after four long years of advocacy from various HIV/AIDS NGO’s. Previously any HIV positive patients admitted who declared their status were immediately directed up to the seventh floor, right at the very top of the building. This particular floor is unique, being specially adapted to safely secure prisoners sent over from Dhaka goal requiring hospital treatment. When I was asked if I’d like a quick tour, needless to say I jumped at the chance.
We travelled up the remaining five floors in an ancient lift. Our escourting nurse hammered loudly with her fist on its metal doors to attract the attendants attention, seated inside on a rickety old wooden chair. His job was to operate the internal controls, as the external ones had long since ceased to work. Tuning in to the acoustics inside the lift shaft he estimated on what floor his passengers were likely to be waiting and made his way there to collect them. I did have a slight twinge of concern when we were all inside and underway…getting stuck in any lift is not desirable, but in this particular lift would be an absolute nightmare.
We arrived without event, left the lift and ascended a further flight of stairs to reach an enormous pair of metal gates. Our nurse-cum-tour-guide produced a large key fob and unlocked the rusty old padlock with an equally enormous key. She began to slowly unwind a long chain which was wound around and between the bars, eventually opening them wide for us to enter. We were able to walk around freely as there were currently no prisoners in residence. The atmosphere felt heavy, partly down to my vivid imagination, stirred up and driven into overdrive as I contemplated the background to this place. Caged in with metal bars preventing escape it was almost empty of furniture, no beds or even a spartan mattress on the floor. This was where HIV patients had been sent, locked up, and due to ignorance and fear, were virtually ignored by qualified hospital staff. As a consequence of this some had lost their lives. Even appeals from their family were ignored, they had been left to die here alone.
On one such occasion a family informed my NGO, appealing for help. They had waited several days for assistance which never arrived. Despite this added weight behind their appeals and even after alerting journalists of the unfolding situation, it was too late for the patient, who lost the fight during the course of that evening. Sad to say this in part strengthened the case for the necessity of opening a specialist HIV/AIDS ward. But even then, the government agreed only to provide bed frames, leaving my NGO responsible to procure everything else. This they did through approaching the Dutch Bangla Bank with an appeal for funds. This is a typical example of the government of the day pushing responsibility onto NGO’s, and failing to engage fully themselves. The next big challenge is to further include government departments, facilitating a transfer of responsibility for care and support. NGO’s have dedicated and experienced employees, but they are powerless to make change happen alone. With government support and funding an enormous amount can be done to improve the lives of those living with HIV/AIDS in Bangladesh.
I was relieved to leave. As interesting as I found it, this was not a place to linger. We returned to the second floor, back to the original purpose of our visit. Once there we initially spent a couple of minutes talking to the HIV nurses about the condition of our patients. As the conversation took place mostly in Bengali I used the time to study my surroundings. Furnishings circa 1950, old, rusty and badly worn. Several large ledgers on a cramped desk contained hospital records, carefully and very neatly written out in English. This was clearly an organised and efficient office with little or no facilities that we would expect to find in a modern 21st century hospital. The nurses uniforms consisted of large white, stiff card headress, white sari and white coats. Conversation over, we entered the ward itself. It was relatively empty, with more family members looking after patients than patients themselves. I was encouraged by this. True it appeared dingy and old, cracked paint on the walls and cracked glass in the windows, ancient bedside lockers used to house both clothing and food. There is no catering facility here, so relatives have to cook to feed their sick family members as well as themselves. But remember this is still a sanctuary, a legitimate ward. As old and basic as it appeared, it was still on the map, and that was a giant step forward.
I met one fairly young man who looked terribly unwell. He lay fully clothed on top of an old thin mattress, his mother and brother squatted at his bedside. He had been in hospital for a week and had been admitted with a very high temperature. The spike on the chart at the end of his bed when his fever had broken was clear for all to see. As a large number of HIV positive people in Bangladesh are disowned by their family, I found this another tremendous sign of achievement of my NGO. There has been a major project where ‘courtyard’ meetings take place involving immediate family and neighbours of our members to answer questions about HIV/AIDS, dispel fears and myths and encourage care at home. To give them credit my NGO had clearly made valuable headway in this area also.
We had an appointment to meet with one of the senior Doctors at the IDH, who has supported our endevours over the past year with energy, committment and leadership. He has pushed to improve available treatment and facilities here and continues to influence his fellow Doctors and every Government official he meets. When the ward was opened de-sensitization training was delivered to both nurses and Doctors at the IDH, and we have recently negotiated extra funding to follow up with a further two day refresher course. It’s intended to bed that learning in and reach any new staff members to ensure maximum coverage, sustain any gains achieved to date and build upon them moving forward. It was agreed that senior involvement was crucial to set the tone of importance this training commanded, and this message was to be pushed at the next medical monthly meeting that incorporates the Hospital Directors. It was clear that without this particular Doctors advocacy we would struggle. Networking and relationship building skills are key to opening doors and reaching those possessing power, even more so now that we have had a complete change of government.
We left that IDH and took a rickshaw to were CNG’s congregate, only a short ride away. Traveling through what was a bustling bazaar my colleague told me to take a good look around. She then explained that all this was hospital property but the land was being rented out, fairly lucratively as it would seem from the scene before me. Money was being made from land where new hospital facilities should stand. New government or not this type of practice will continue and further pockets will be lined, all at the expense of the general population who will continue to be denied access to good quality health care, an area that ranks pretty highly here in Bangladesh.