Celebrate! The 100th International Women’s Day – 8th March 2010

On the 8th March, spanning across the globe, many countries celebrate the economic, political and social achievements of women. Whatever your perspective, despite undeniable and vast progress, many women and girls still face gender-based issues each and every day. We must remember and recognise that there is much more which has to change to ensure an equal, bright and safe future for young girls of today.

The unfortunate fact is that women are still not paid equally to that of their male counterparts, women still are not present in equal numbers in business or politics, and globally women’s education, health and the violence against them is worse than that of men.

For many years the United Nations has held an annual IWD conference to coordinate international efforts for women’s rights and participation in social, political and economic processes. In Bandarban town both women AND men marched together through the streets in celebration, ranging from school children, NGO employees to local dignitaries.

The face of women here in the Chittagong Hill Tracts is represented through many and varying forms. Some wear nijab and others bhurka, with indigenous women bathing at dusk in the local pond, swimming, splashing and laughing with delight.

Most however work hard while facing restrictions and prejudice of some kind, just the same as their sisters in other parts of the world. Even so, I do see great strength, passion and talent in the women here, which I feel sure will continue to move things forward, shaping a more empowered life for those generations yet to come.

While walking back to the office from the march today I stopped to speak with some local marma women, one of whom asked me to take her photograph. I find her strong and dignified image fairly representative of the indiginous women living here in Bandarban.

One year on…and what have I learnt?

It’s now just over one year since I stepped off a plane from Heathrow airport and onto Bengali territory, where I’ve made myself a temporary home. So much has happened during that time, but reflecting back there are a few things in particular which stand out in my mind as being key learning from this amazing and crazy experience.

Top of my list would have to be that in Bangladesh power is such a strong drug. Everybody wants it; from the very top, right the way down, with everyone fearing who currently holds it. As an ‘outsider’ this wastes so much valuable time, creating huge confusion, causing my head to reel and on occasion making me want to jump off the merry-go-round that is life out here. The worse thing to stomach however is the injustice it creates and the fact that it clogs everything up by shifting focus and energy from where it’s really needed.

I personally have first-hand experienced of what it feels like to become a pawn in the power game. As a foreigner my cooperation represents a desirable association. But for me, calculating the impact that association might have through the ripple effects which will travel through the community is crucial. Any negative impact depletes my ability to work successfully, it’s like running to stand still. Calculating with any accuracy is virtually impossible, so what to do? The sad thing is that we all inevitably end up playing the game, trying to work our way out of this maze. I felt like I was slap in the middle of a mine field.

While there appears to be a general acceptance of ‘the power game’, hope for the future, pride in Bangladesh and a wicked sense of humour abounds. Polite and welcoming people reach out to assist at a moments notice. I’ve even been invited into a Mosque by a couple of women to join them in prayer: an amazing honour and treasured experience.

Personal learning is also high up there. Working through enormous stress and difficulty alone is a major challenge. To cope without normal outlets for frustration, which will inevitably build, is an acquired skill, and one for which there is no short-cut. You simply must face the experience to establish new coping strategies. I can say it has been a fascinating journey however, to be able to reflect so clearly on my own particular personal response, which has now become familiar. But what cost this growth!

While music always has played a big role in my life my iPod has become a lifesaver, helping me to connect with, express and work through the emotions of the moment.

Deciding who to trust in such a transient community has also extracted a measure of pain. The common mistake is to view all foreigners working under the same conditions as being part of a tight and reliable group. Unfortunately not the case, as was demonstrated fairly early on. That said, I have met some pretty inspiring people here, making a small number of very close and treasured friends in the process. Important people in my life who I will continue to hold dear when we all move on to pastures new.

To round it off, the most important thing I’ve learnt is that there is never an easy way out, and so, I stand my ground.

NGO Exposure Visit to Calcutta

My NGO received a small grant from the Elton John Aids Foundation via VSOB last year to set up and run an HIV/AIDS Helpline, currently the only one in operation in Bangladesh. An exposure visit to West Bengal formed part of the obligation to accepting that grant.  It should have taken place last year but fell through, due to the Mumbai terror attack, which triggered the closure of the Indian border on the eve of departure. So it fell to me to reorganise this visit to ensure we fulfilled the conditions of the grant. The key objective was to meet with similar Indian HIV/AIDS NGO’s based in Calcutta, also running a Helpline, with the purpose of learning ways of consolidating and expanding, but also efficient operation and service delivery.

The first thing that struck me was how responsive the Indian organisations were, how keen to meet with us.  They confirmed, filling up our four day timetable in no time.  In fact we could have easily stayed a further four days as there were many more who we simply couldn’t accommodate and incorporate into our schedule. So with our visit planned and our objectives set, it only remained for us to travel to Zia International airport to catch our flight to Calcutta,

Such heavy precautions in place to manage the swine flu epidemic surprised me on arrival at Chandra Bose Airport.  Not simply form filling, asking all the obvious questions, ticking all the usual boxes, but men in white coats and face masks taking the passenger’s pulse. Scary! We muddled our way through the white tape and hired one of the bright yellow taxi cabs, gaining our first glimpse of India as we drove through the city streets in search of our hotel in the heart of Calcutta.

We launched our programme early the following morning, spending an entire day with the Calcutta Samaritans, at their Aurnoday Midway Home, which operates a Pavement Club, a Primary Health Care unit, an HIV/AIDS programme, a Home for children at risk and support for the city’s Rickshaw Pullers. With such a well established NGO we planned to spend the morning meeting with their HIV/AIDS Programme Manager and Helpline Counsellors, the afternoon visiting their Home for orphan slum children and their HIV/AIDS Drop in Centre, and the evening on a field trip to spend time with some of the city’s sex worker population.   

Learning from our friends at the Drop In Centre

Learning from our friends at the Drop In Centre

After a full day in consultation with an assortment of fascinating and highly capable individuals, we made our way as darkness fell, to the park opposite the Victoria Memorial, a beautiful, white monumental building.  Victoria Park itself covers a vast wide open space, where groups of young people, families, food hawkers all mingle…and collide with the sex industry, who’s workers operate spread out all over this busy area.  The Samaritans have allocated a central focal point where one appointed sex worker spends a minimum of two hours a day on behalf of the programme.  Handing out free condoms, both male and female, she offers advice to all who enquire, related to sexual health in general and HIV/AIDS in particular.    

We sat with her, cross legged on the grass, and within moments I could see them starting to trail over, converging on us from every direction, curious to see who had come to visit their ‘patch’. They greeted us on arrival, sitting or squatting until we had formed a large circle.  Some were shy, but others came up to greet me personally.  One, with startlingly good English, held me in fascinating conversation for many minutes, talking of her difficult and unhappy home life, dominated by her mother-in-law.  Unusually tall, she stood erect and proud, her hair loose and flowing, and despite several missing teeth and advancing age, she still struck me as a fairly magnificent woman. 

From time to time one of them would simply drift away, returning to sit back with us again ten minutes or so later.  I never could work out how they knew their clients were waiting, but somehow they did. Overall I found the exchange fascinating, and came away really appreciating how flying, or mobile sex-workers operate, their key areas of risk, and the many challenges present in their daily lives.  

Support vehicles

UN International Drugs Support Vehicle

The following afternoon our second field trip was scheduled, an appointment to visit a short term shelter home in North Calcutta to meet ‘The Dancing Boys’, adolescent and young gender variant males, with a feminine demeanor.  A high risk underground group, this vulnerable population, some identified as young as 12 years, can be hard to reach, and regularly fall into prostitution from an early age.

As a marginalised group they are typically victims of social stigma and gross human rights violations, and as a result face serious barriers to joining mainstream occupations.  As an alternative they join the troop as a ‘Luanda Dancer’, and migrate to Bihar and Uttar Pradesh to dance in the marriage rituals.  Their livelihood as Hijra or folk entertainers put them at grave risk of sexual harassment, abuse, assault and trafficking, which on occasions has resulted in death.  

The lauder naach is an integral part of the marriage ceremony, and an age-old popular tradition in northern India, where a wedding is an elaborate affair comprising of music, food, drink and dancing, but here effeminate boys dance in the marriage procession and ceremonies dressed in women’s clothing. This custom evolved from poor families, who could not afford the more expensive women dancers, but gradually the practice  became not only popular but an intrinsic part of the ceremony itself.

Usually from lower middle class poor families, the dancers, typically between 15 to 25 years old, travel from West Bengal, Nepal, and Bangladesh for the peak marriage season, April to June in the summer and December to February in the winter. The groom’s family normally hires the dancers, who, along with the baraat (groom’s entourage) journey to the bride’s family home, where the laggan (marriage) ceremony takes place, usually commencing late in the evening. Once the dancing begins, it continues, in most cases non-stop through to dawn and as the celebration progresses, their vulnerability to both physical and sexual assault increases.

The attraction of Launda dancing is mainly the income, a performer could earn Rs.6000/ to Rs.12OOO on a three month contract, usually with the addition of free food and lodging, but the dancers can also be paid in cash at the end of each session.  However they often get less than their contractual agreement, and sometimes nothing at all.  But it is the freedom to express their womanly instincts away from the jibes of relatives and neighbors that provides the main source of satisfaction.  So in spite of the risks involved, very few actually want to quit this seasonal profession, and they have a serious lack of alternative options.

This relatively small network impressed me greatly.  They were so active, protecting their rights and attempting to gain control over their lives. I admired their photographs and short mobile-phone video clips that they openly shared with me.  As I watched the dancing ceremony, peering closely at them on the tiny screens, it was clear they were immensely proud.

Throughout this exposure visit we met with and learnt from enthusiastic, dedicated and informed NGO staff, doing amazing work under, in most cases incredibly difficult circumstances. They are true professionals with many great achievements, which have changed the lives of an immense number of marginalised and stigmatised groups within Indian society for the better. Without them an awfully large number of people would be in a much more precarious position. I thank them one and all…long may they and their valuable work continue.

Corporate Social Responsibility

A percentage of my time in Bangladesh will be spent working with the VSO Programme Office, and a couple of weeks ago the Country Director invited me to become involved formulating a project to engage with the corporate sector, as this was the background of my former career. 

After establishing contact with HSBC Bank, both the Country Director and myself, accompanied by the Programme Manager in charge of  Livelihoods, one of the three strategic programme areas operating withing VSO Bangladesh, visited to fact find and ascertain what relevant links we could establish. We left the meeting with the plan of producing a concept paper to submit at their July Board Meeting with the proposal of partnering with them. It was the production of the paper itself that first offered me a glimpse into the specific challenges of life in the Chittagong Hill Tracts, a region in south-eastern Bangladesh close to the Burmese border. 

In 1984 the CHT was divided into three separate districts:  Khagrachhari, Rangamati and Bandarban, which constitutes 10% of the total land area of Bangladesh.  The population is roughly 2 million, of which approximately half are tribal and the remainder from different communities.  The indigenous peoples are mainly followers of Theravada Buddhism, and collectively known as the Jumma, which include the Chakma, Marma, Tripura, Tenchungya, Chak, Mru, Murung, Bawm, Lushai, Khyang and Khumi. Following years of unrest, an agreement was formed between the Government of Bangladesh and the tribal leaders which granted a limited level of autonomy to the elected council of the three hill districts, but there remains a heavy military presence to this day.

The modern conflict in the Chittagong Hill Tracts began when the political representatives of the native peoples protested against the government policy of recognising only the Bengali culture and language and designating all citizens of Bangladesh as Bengalis. In talks with a Hill Tracts delegation led by the Chakma politician Manabendra Narayan Larma, the country’s founding leader Sheikh Mujubur Rahmnan insisted that the ethnic groups of the Hill Tracts adopt the Bengali identity, and is reported to have threatened to settle Bengalis in the Hill Tracts to reduce the native peoples into a minority.

In the CHT, the indigenous peoples are commonly known as Jummas for their common practice of swidden cultivation (crop rotation agriculture) locally known as jhum. An environmental study has recommended changing this practice, and as controversial as that sounds the pressure is on.  Support is urgently required to skill some community leaders with the basic financial know how to enable funding to be managed to support and facilitate some complimentary agricultural practice and transitioning livelihoods. This we intend to facilitate through sharing the skills of the talented employees of HSBC through carefully selected short term volunteering interventions.   

I have my fingers crossed that this proposal will be considered a worthy one when all applicants are reviewed at the HSBC Board meeting. From our side we don’t require money, simply the release of some of their human resource.  So much talent is already contained within Bangladesh.  Sharing skills and changing lives is the VSO strapline, but that doesn’t always have to constitute International exchange.

The Chittigong Hills

The Chittagong Hills

Meanwhile…back at the Indian High Commission…

…things were moving on…very slowly.  I knew the routine by now, and even a few of the faces, this being my third visit.  My first was to ensure I was fully aware of all the required paperwork necessary to submit my visa application,  which was closely followed by the second, when I was told I did not in fact have all the required paperwork to submit my visa application, dispite being informed some 24 hours previously what was necessary. So, third time lucky. 

It sounded as if I might need some luck as I sat listening to the raised voices of the Indian consular staff in the adjoining room, processing foreign visa applications. Overall the whole experience felt pretty surreal, the passionate shouting, the bright blue plastic chairs, the lime green walls, and in amongst it the most beautifully carved wooden door I had set eyes on for ages.  Somehow it began to resemble pupils waiting to be called into the Head Master’s study for some minor playground misdemeanor. Tension was tangible on the faces of those waiting, eyes widening as voices raised another decibel or two. 

Personally I couldn’t help but find it amusing. Not that this was going to help me in any way when my number was called.  Thirteen?  Yes, that unfortunately was me. I couldn’t believe it when, as required, I had scribbled my name and passport number on the security guard’s list on arrival. In I ventured, the smile almost wiped off my lips, but perhaps lingering slightly as I witnessed the fraught but comical interrogation of a poor man attempting to travel to Madras for medical purposes.  They were having none of it.  He was sent packing to produce yet another letter he knew nothing about from his surgeon, before they would even consider looking at his application papers.

They went easy on me. I had, after all produced everything previously demanded. My passport and three thousand taka, the equivalent of approximately thirty pounds, were handed over, and I am destined to return in four days time to collect the permission required to fly to Calcutta.  

Myself and three of my colleagues are traveling there on an exposure visit. Our HIV Helpline has been in operation for a year now and we have arranged to meet with a number of similar Indian NGOs, to learn how we can better integrate this service and further develop its capacity, cranking up our efficiency to our end user, as well as improving donor value for money. With such an eclectic mix of cooperating organisations, I believe I’ll also appreciate much more about the lives and challenges of those people living with, and at high risk from HIV/AIDS in the Indian sub-continent today.

FOUR DAYS LATER:-  Yippee…have my visa in my hand, in and out this time in under 20 minutes!  Calcutta here I come…watch this space!

International AIDS Candlelight Memorial

There are 33 million people living with HIV across the world today. 

The International AIDS Candlelight Memorial, organised by the Global Health Council, is one of the oldest and largest grassroots mobilization campaignes for HIV/AIDS, with the aim of raising awareness of the lives of HIV positive people.  Initiated in 1983, the Candlelight Memorial is led by a coalition of around 1,200 community organisations in 115 countries, hosting local memorials that honor the lost and raise social consciousness about the disease. It continues to serve as an important intervention for global solidarity, breaking down barriers, and giving hope to new generations, as many coordinating organisations use the Candlelight Memorial as an opportunity to promote local AIDS services, encourage education and community dialogue, and advocate for the advancement of public policy. National coordinators are appointed to lead activities in their retrospective countries, and my NGO headed up a group of relevant organisations to deliver the programme of events in Dhaka city, representing Bangladesh as a whole. 

The voice of people living, either directly or inderectly with HIV/AIDS forms the backdrop to this event, with the focus particularly on the commemoration of those who have passed away during the previous year. My NGO had commissioned Chanel I, a National Television studio to make a documentary, featuring some of the stories of our HIV positive benefactors and their families to highlight the current situation here in Bangladesh. One hundred and fifty guests were invited to view this documentary, including the Country Director of Family Health International, the Director of the South Asia HIV/AIDS Programme for Save the Children, and many of my HIV positive colleagues and benefactors.

The audience sat rivited while heartbreaking story after story was told, first from the perspective of a husband, then a wife, next a daughter, son…and so on, highlighting the heavy price paid by individuals but also by the community in general.  The media attended in force, creating maximum opportunity to raise awareness of this problem in a country which has so many other issues competing for attention. But whatever way you look at it, stopping the silent and deadly spread of this disease around most countries in the globe has to factor up there amongst the most important challenges we face every day in the 21st century.      

Lighting candles in memorial

Lighting candles in memorial

 http://www.aids.org/info/FAQs.html

Dr Nilufar’s Clinic

I spent some time with Dr Nilufar today, who I really like and respect. She was holding a clinic at the Service Centre operated by my NGO where ARV was prescribed and dispensed. This was made possible as throughout the previous month each and every one of our 600 odd HIV positive members from all over Bangladesh visited an Army hospital in Dhaka for a CD4 test.  A pretty monumental event in itself, this activity had come out of a UNICEF initiative announced during a meeting I attended only six weeks ago, so it was really heartening to see action taking place so soon.

CD4 testing hasn’t been readily available in Bangladesh, partly due to lack of suitable facilities, a shortage of qualified lab technicians and partly cost related. Most CD4 referrals were as a consequence of clinical diagnosis and therefore too far down the line to be anywhere as effective as they could and should be.  This is certainly not helpful when trying to sustain what can be the fairly fragile health standards of some of our HIV positive members. To add context, the vast majority of the population of Bangladesh don’t enjoy particularly good health, being vulnerable to all sorts of problems ranging from chronic diarrhoeal diseases to TB.

Starting ARV is both a big decision and a major commitment.  Once treatment is underway it continues for the rest of your life, not only that but maintaining consistency is paramount as effectiveness is seriously impaired if taken erratically. This is what creates problems for HIV positive drug users.  Typically people in Bangladesh receive ARV after presenting with clinical degeneration,not ideal or typical in most other parts of the world. By this time the individual is already weak and with a low white blood cell count is vulnerable to opportunistic infection. Things become compounded when illness further reduces a typically low wage, and with little money they become reliant on family members for support. The sad truth unfortunately however is, that due to stigma, fear and discrimination most find themselves disowned and homeless.

Dr Nilufa explained that everyone had to be tested in batches over the past month.  She gave me an example of how important CD4 testing can be through the story of a ten year old positive child who’s result whose result led to prescribing ARV. Within fourteen days his health greatly improved and he has even put on a little weight. Without this test his count could simply have continued to drop, possibly resulting in future complications. Not knowing the white blood cell count Dr Nilufa is restricted in her ability to prescribe ARV as not only clinically but financially criteria need first to be met. The drug itself is currently funded by the World Health Organisation but there are oly two options available to her: a double or triple combination. The double combination is used for those who contract TB, which is the biggest killer of people living with HIV/AIDS in Bangladesh, as one of the triple combination drugs reacts badly with those used to treat TB. Normally a six month recovery period is doubled for a HIV positive patient, if in fact they make it through at all.

Things weren’t going smoothly and the stifling heat didn’t help. We left Dr Nilufar’s office and walked together to the patient’s reception area where our members waited. Although the clinic had finished and all had prescriptions ready, the ARV hadn’t arrived causing all proceedings to grind to a halt. Having been in Dhaka city for two days everyone was keen to return to their villages and worried that they would miss their transport home.  Most had journeys of nine and ten hours in battered, old and dangerous vehicles that frankly wasn’t fit to be on the road. Being Bengali New Year only added to the pressure with roads crammed fuller than usual. Vehicles pass slowly by with many people squashed inside, more sit up on the roof and others even stand on the back mudguards holding on tightly.

Amongst the members I spotted a man lying on a gurney.  He looked shockingly thin and very weak. I asked Dr Nilufa, who told me he was a TB patient sent over from the hospital during the afternoon for a HIV test. Fearing exposure of infection to TB, I must admit my first thoughts were for myself. But I quickly realised he posed no threat, surrounded as he was by people, most of whom were HIV positive. It appears he spent the last five months in Dhaka’s TB hospital without showing any signes of improvement and had been referred to my NGO is it was suspected that he was HIV positive. Sadly this proved to be correct as his status had just been confirmed. Dr Nilufa immediately prescribed ARV, but even with this benefit still expects his recover to many months. With all other treatment on hold to allow him to gain a little strength and weight I’ll keep a lookout and monitor his progress in future clinics.

A further hour passed and levels of restlessness increased. Apparently it used to be like this every month when ARV was dispensed making everyone tense each time they attended a clinic. Things have stabilised somewhat since then and over the last six months the supply has improved greatly, so this delay took everyone by surprise and wasn’t at all expected. I decided to walk back to our head office which is only a couple of minutes away to find out what was happening and see if things could be moved along a little from there. One of the nurses accompanied me. On arrival it became clear that the delay was caused by some kind of documentation inconsistency which had failed to meet strict regulated standards, (Bangladeshis are meticulous about paperwork), and so letters of authenticity were being hurriedly written to try to bridge the gap and enable the drugs to be released.

Eventually the drugs were produced and both the nurse and I took a large bag each and hopped into a rickshaw for the short journey back to the service centre as the heat and dust had worn us out. We arrived there the very moment the electricity cut, so knew we’d be sweltering for at least an hour before it was back on again and the ceiling fan would cool us down. I sat with our two nurses in the dispensary as I wanted to see how the process was managed. In the main things moved fairly smoothly and some people, especially the women tried to communicate with me asking questions: Do I have a husband? Where was I from? Some addressed me directly but other questions were put to me through the nurses and I was amused to hear one of them saying I came from New York!

Everyone presented Dr Nilufa’s neatly written prescriptions with an official looking stamp in the top right hand corner. Then they signed for their drugs in a huge red ledger…even the smallest newest member, a four year old boy who wrote his name in wobbly letters guided by his mother. I applauded when he finished…and although he was delighted his shyness overcame him and he hid his face in his mother’s long black robe.

It wasn’t until the very end of the process when the last two women presented their prescriptions that things blew up, and by this time I was so hot and exhausted I was nearly falling over. I don’t know what the problem was, perhaps their paperwork wasn’t correct, but one thing was for sure, they wouldn’t have been left without drugs, my NGO would never turn anyone away. But some kind of problem had occurred and almost immediately voices were raised…and I mean raised. Even in normal everyday conversations you hear Bengalis talk loudly and quite forcefully over each other.  It always sounds fairly aggressive and quite argumentative when actually it often isn’t at all. Myself, I love the passion behind it, but this time, well it was all pretty full on, and didn’t look as if it was going to settle down anytime soon! As a passive observer with little grasp of the language at the best of times, let alone at this speed things seemed to be going around in circles and at one stage I felt as though I ought to put an stop to it and try to guide them to some sort of conclusion.  I was at the point of intervening but not really appreciating what it was all about and as the nurses seemed to be holding their own I felt perhaps it wasn’t right for me to do so, at least not quite yet.

Then one of the nurses turned to me and asked me to visit the Infectious Diseases Hospital…right out of the blue. I informed her that I had done so, but for an awful moment I thought she wanted me to hop in a CNG and whizz over there right away and I nearly collapsed with relief when I realised that this was not the case! I would have done of course had it been necessary but it would have been a real trial in those conditions. Perhaps there are some issues over there that she thought as a bidesi I might be able to sort out? Anyway she plunged right back into the fray and I sat back passively on the sidelines again sweating buckets.

Once again she turned to ask me if I could read out loud some of the items on the prescription, and for a moment everyone settled down remaining quiet while I did so.  I slowly and clearly read out the names of all the drugs indicated and when I was finished everyone also attempted to pronounce them.  And then…we were off again for a further ten minutes.During this time the kitchen maid appeared carrying a tray with a cup of sweet black tea and a glass of water for me. I was really grateful for her kindness as I was seriously in need of some liquid by now having drunk all of my own. And at last, as suddenly as it had started everything seemed to calm back down. I was so relieved, but that’s one of the main problems with having such a lack of language skills, you can’t always sense where you are with things. I intend to get to the bottom or it though by asking my colleague Bishwajit to act as my translator and to have a conversation about it with the nurses as I believe it’s really important for me to understand exactly what the issues were.

As interesting as it had all been I can’t pretend it wasn’t a relief to lock up the Service Centre at the end of what had been a blisteringly hot and gruelling day.Then the four of us, two nurses, the kitchen maid and myself walked slowly back up the dusty road together to our head office on Auangajeb Road.

At the clinic

At the clinic

 

Infectious Diseases Hospital

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.