Ignorance Is Not Actually Bliss

Barely an adult, Maya Rani Mandal of the Kalmegha village in Shathkhira (a district situated in Southwestern Bangladesh) was met with a proposition for marriage at the early age of 18. In a desperate attempt to escape from the pressures that came with being a woman of marriageable age in her society, she yielded to her parents’ wishes and accepted Panchan Mandal, a day labourer in the local fishery, as her husband. Ignorant as they were about any form of family planning, being from an uneducated, rural background, Maya was pregnant within the first few months of their marriage. And before even a year had passed since her first pregnancy, she was with child for the second time, and these two consecutive pregnancies in the span of two years took a toll on Maya, both physically and mentally.

Luckily, it was around this time she made the acquaintance of Pratibha Rani Mandal, a woman who was not only her neighbour, but also the Friendship Community Medicaide (FCM) in charge of the region Maya lived in. In addition to providing primary healthcare services to the residents, as FCM, it was Pratibha’s job to facilitate and educate the locals on the importance of family planning, nutrition, maternal and child healthcare, pregnancy and safe delivery among other things. When she began a survey of the locals regarding their awareness of the importance and availability of these services, Pratibha realized Maya was completely in the dark when it came to maternal and newborn healthcare needs and, as such, took no measures to ensure her or her child’s well-being during the pregnancy. Upon Pratibha’s insistence, Maya decided she would visit the satellite clinic for her first checkup.

“Thanks to FCM Prathiba’s timely intervention and the medical treatment that Friendship makes available and accessible for all, I am now in good health, and more importantly, so are my two babies. Imagine if I had never found out; I would be living in ignorance, and would have put my children in danger.” — Maya Rani Mandal

At the satellite clinic, through Paramedic Tamima, Maya was suprised to discover that one must undergo at least four checkups during pregnancy and after the delivery as well. Having spent almost the entirety of two pregnancies without any medical help, she hadn’t realized how her negligence had put her and her child’s life in jeopardy. In an attempt to undo the possibility of any long-term damage, Paramedic Tamima prescribed Maya a myriad of supplements in addition to her dietary plan to ensure the baby’s proper development. Despite any deficiencies in Maya’s body during the pregnancy and the delivery, Maya and her two children are healthy and happy as ever today.

Family Above All

It is a hot, humid summer’s day in July when Musammat Nazma Khatun sits down in front of the camera. Notun Khiruar Char, in Chilmari, Kurigram is far from any built-up roads, power lines, gas or modern infrastructure of any kind, save for a scant, wavering, single bar of cell phone reception. That is where Nazma lives, however, and so that is where we collected her story.

As she settles into her plastic chair, she fiddles with her shawl and clip on mic, shy about speaking on camera. She takes a breath and starts her story. By the end, she is the one to smile and say, “it’s okay — come meet my kids. I’ll go fetch them”, as we are at a loss for words.

She has 3 healthy, happy daughters; a pre-schooler and two preteens; and a tall, moustached, husband, all of whom share a home. As we take their picture before our next assignment, we cannot help but think hers is a story to remember.

The literal picture of domestic bliss that was now contained in our camera leaves no hint of the trauma that she once suffered years prior. 6 months into her first pregnancy, she suffered from debilitating pain in her belly. Cramps that lasted for days and were so blindingly painful that she had no choice but seek medical attention. That however, was nowhere to be found. Notun Khirua was outside of Friendship’s range back then, and she and her husband had to scrounge up whatever money they could, and loan the rest, to make their way to the nearest town, Kurigram. The doctors there were unequipped to diagnose her and had to refer her to a bigger clinic in Rangpur. Barely clinging on through the pain, she finally made it to the clinic to learn what was causing it. Her unborn child had died in her womb, more than a month prior.

“They evacuated the remains,” she says, matter-of-factly, as if the revelation was not disturbing, “the bits came out all rotten. It had decomposed, that’s what was causing the cramps”.

A stunned silence fills the air, but she sits up and proclaims, “well I have 3 kids now, though so it’s okay. The next time I got pregnant, I just went to Friendship and they took really good care of me. So much so, I had 2 more. They’re all girls though, so my husband and I are trying for a boy. Let’s see” she says, smiling.

“I heard about Friendship from the Friendship Community Medic-aides that had come around. Thank God they did, otherwise I don’t know if my second child would have survived. But here we are. I’m putting them in school, which Friendship is also helping out with.”

We can barely stutter out an apology for what she’s been through, but she smiles and says, “it’s okay — come meet my kids. I’ll go fetch them”. Quickly gathering our equipment, we jog after her as she maternally yells at her kids to come up. Her bewildered husband is confused as to what’s going on, and tries to duck away from the camera before she reels him back into the frame.

 We snap a picture as she explains that her eldest had gone to visit her aunt, and we bid our goodbyes. She waves at us as we leave, and her grumpy youngest finally smirks. The little girl clearly likes her privacy.

Restoring Vision for 400

Souwara Khatun, an elderly woman breaks down in front of the camera while recounting her experiences. “I was too scared to get the surgery last time. I came here with some clothes and bedding and then lost my nerve and went back” she narrates, her unbandaged eye welling up with tears. “I steeled myself and went through with it finally, and I am hoping to get my eyesight back.”

Souwara is one of 400 cataract surgery patients of Friendship’s Vision for Coastal Communities project, in partnership with Standard Chartered Bank (SCB). The bank’s biggest CSR activity worldwide is their Seeing is Believing campaign, which seeks to prevent and cure reversible blindness, specifically targeting poor and marginalized people. Present in over 30 countries, it started in 2003 in Bangladesh and SCB has partnered with Friendship to mark its 15th anniversary by providing 400 cataract surgeries using Friendship’s facilities in the southern coastal regions, particularly the Rongdhonu Friendship Hospital (RFH). Other organizations partnered with the bank include Sight Savers International, Hellen Keller International, Orbis et al.

Bitopi Das Chowdhury, Head of Corporate Affairs of Standard Chartered Bank Bangladesh, states “This is the first time we are working with Friendship. In areas like Kutubdia, where there is a great need for healthcare and people cannot get to the mainland hospitals, Friendship is the one that is providing the service to their doorsteps through their hospitals and integrated 3-tier healthcare system. RFH will be providing diagnosis, medication, eyeglasses and when necessary corrective cataract surgeries. I hope we can continue this for many more people for a very long time.”

Speaking of the impact, she says “The cataract surgeries are something that only takes 5 minutes to do, and 3 days of recovery. However, 79% of the coastal people don’t even know what the procedure might be, how long it might take etc. That’s because it is one of the most neglected ailments. If someone has a headache or a stomach ache, it has a sense of urgency that compels them to seek immediate attention. However, with the slowly creeping blindness, it gets neglected for far too long. That is why I cannot stress the impact of this program enough — that a person’s life can change from such a little surgery, it cannot be overstated. That is in fact why we chose to work on reversible blindness when we started here in 2003. We felt like this was the area that it made the biggest difference, which is why we even call it “seeing is believing”, because it seems unbelievable without seeing for yourself how much it can affect someone’s life.”

Kazi Golam Rasul, Director and Head of Health, Friendship concurs, “there’s no pain or discomfort, so they ignore it, thinking that it would cost a lot of be too painful. They have no idea that they can, as we are doing here, get that surgery for free. Someone who cannot see becomes a burden for the rest of the family; but right after this surgery, they can return their former productive lives.”

Rasul offers some of the statistics collected during the camp from surveys, which also shed light on the situation. 80% of the respondents, he states, said that if it were not for Friendship, they would have had no options, and nowhere to go. The other 20% said that they would have had to make the trip to one of the larger towns but could not guess how much the surgery would’ve cost them, with estimates between 2,000–12,000 taka. The mean average age of the patients is 59, 50% male, 50% female, and have been suffering from blindness for 4 years. By the time the ships cycle back around between Chalna, Mongla, Kuakata, Hatiya and Kutubdia it takes 8–9 months, and there are always new patients when the ship returns. Almost every single patient heard of floating hospitals from the Friendship Community Medicaides (FCMs) who are part of the Friendship’s proprietary, innovative and unique multi-tiered healthcare system.

Dark clouds hover over survivors in camps

Having slipped and stumbled up the worn-out steps carved into the slope of the hill, the view from atop makes it very difficult to be optimistic. Ominous rain clouds hang over hill after hill of bare brown mud, crammed with makeshift tarpaulin and bamboo structures.

Last year, these slopes were densely forested, with a few makeshift settlements for Rohingya people escaping persecution in adjacent Myanmar. In August 2017 the Myanmar military launched a scorched earth operation, which sent thousands of terrified refugees fleeing across the border each day. Within two months the hills had transformed into the largest refugee camp in the world.

It took an unprecedented humanitarian effort by Bangladesh to accommodate more than 700,000 desperate new arrivals. Government and non-government agencies rushed to install basic infrastructure. A thousand acres of forest was razed with astonishing speed to make way for homes.

Rohingya Camp

Much of the infrastructure built to provide essential services to the new population became potential threats to their safety. For example, in the first weeks since August 2017, NGOs dug as many latrines as they could wherever they could find space, to try and preserve the dignity and health of the traumatized newcomers. But within weeks, the same latrines, dug to an inadequate depth, and used far beyond capacity, were quickly filled up and overflowing. A light shower of rain sent rivulets of putrid waste running through the camp.

Now that monsoons and the threat of cyclones is nigh, the vulnerability of the camp inhabitants is starkly obvious. Already this month an eight-year-old girl was killed in a landslide. According to the Emergency Preparedness and Response Report by Inter Sector Coordination Group (ISCG) as of 22 May, around 200,000 individuals are at risk of landslide and flood in camps, of which 25,000 are at very high risk. Some 18,408 people have been relocated from high risk locations or were otherwise part of risk mitigation efforts.

Moreover, the density of the population here means that even a small occurrence disaster could take many lives. UN’s recommends having at least 35 square meters of space per person in any habitation. In the camps there is less thanfive square meters to each person. Further relocations are on-going to reduce the density and risk.

“When we constructed our latrines, we took these dangers into consideration,” says Farid Ahmed Sagar, senior manager of Climate Change Adaptation and Disaster Management at Friendship, one of 79 majorNGOs working at the Rohingya camps. “They are enclosed spaces with bathing rooms and separate latrines for men and women. They were constructed on raised cement platforms, in areas that we deemed least likely to flood.”

Friendship dug its latrine pits to a minimum depth of six feet. Yet, knowing that eventually even these will fill up, they have constructed two desludging plants to empty and treat the waste from surrounding latrines. Sagar points out that each detail represents a struggle. Even finding a space in the crowded camp, where a project does not inconvenience or disturb residents in any way, is a difficult task.

Despite the precautions, it’s impossible to guarantee the safety of the latrines, says Friendship director Kazi Amdadul Hoque. “Because we have never worked in this landscape before, we do not know it well. We have done all our work during the dry season. We can only identify possible threats and arrange alternatives.”

The site management at the camp, which is a partnership involving all the organizations working at each camp block, have been surveying to identify at-risk facilities and getting the organisations responsible to dismantle or move these projects. However, their assessments are mere approximations, given that the landscape has not been tested by severe flooding or rain.

All it takes is one flooded latrine to contaminate all the water sources in an area, destroy the environment, and put the population of the camp at risk of cholera outbreak. Heavy rain poses other risks. Latrines on slopes are at risk of collapsing during mudslides.

Bangladesh has done a herculean job of accommodating the largest fleeing population of our times. But the entire job was done without regard for future problems.

Looking at the landscape from atop the hill, one wonders what might happen if a bad cyclone were to sweep over the area. How long would it be before the flimsy bamboo and plastic sheeting would give way? What might the scale of destruction be in such a densely populated and vulnerable area? Are there shelters and hospitals equipped to even begin to deal with such a contingency?

With the risk of cyclones, rain, and floods around the corner, the upcoming season will be a trying one in Cox’s Bazar.Now that the immediate catastrophe of a fleeing population has been negotiated, attention to long-term disaster preparedness is the next most urgent need.