SHAPLA SHIP CLINIC
Patuakhali district, Bangladesh
Full transcript
MAHAMUDUL KABIR – Terre des Hommes
People… they are living in different islands and the ship has to go to doorsteps. Normally people has to go in other areas to got the treatment, but in this case we, with our team, we reach the spots so people can come and take the services.
Dr. REZAUL KARIM – Shapla Program Manager
Mainly inhabited by fishermen, they are extremely poor and needy people. During the Monsoon season, the floods erode the coasts and destroy their houses.
MAHAMUDUL KABIR – Terre des Hommes
Because whenever the smaller cyclon came, the off-shore islands are waste away, many people die, a lot of damage were there, so that’s why we thought it was so urgent and so important for us do something for the people in the islands.
SARA PIAZZANO – Terre des Hommes
In these areas, foreigners only manage to work during the state of emergency, unfortunately, once everything goes back to normality, all the projects are suspended, especially where more and more work is required, along the coasts and in remote areas, where the need is greater and the presence of non-governmental organizations is always in huge demand.
MOZIBOR RAHMAN – Health Educator
– How old are you? – 20.
– Are you pregnant? – No.
– What is your problem? – My chest aches.
Many patients come from far away, because here they find a good and cheap service, carried out by professionals.
Dr. SUZAUR RAHMAN – Clinic Team Leader
Few people starts just 4.30 am very early in the morning, and walk from maybe 10 to 12 km to reach our ship clinic.
MAHAMUDUL KABIR – Terre des Hommes
Many people when I spoke with them they haven’t seen a car before, for example, still now many people don’t know what kind of trasnsport is a motor-car for example.
PATIENT
I had already come here on the ship a year ago, you know, a year ago, at that time they gave me some medications and I felt better for six months. But now the pain is back again and that’s why I’m here.
ZAKIR HOSSAIN – X-ray Technician
– Hold your breath!
LITON CHANDRA MOLLICK – Medical Assistant
– Don’t worry, there’s no problem, can you see? This is the heart, it’s fine, but there’s a lung infection, that’s why it hurts, when you cough. Here, can you see this black spot? There’s a gastric problem.
You should drink plenty of water and eat a lot of vegetables.
– What about “giorda” can I chew it?
– No! No “pan”, no “giorda”, no tobacco, no smoke. Look after yourself! Ok?
MAHAMUDUL KABIR – Terre des Hommes
They also know which date the ship will be here, and people from the other part of the nearby area, they also know that the ship will be on Sunday, it will be in this spot, so trough the local transports, if the rivers is calm, then they can come and take the services actually.
LITON CHANDRA MOLLICK – Medical Assistant
In six working days, the ship reaches six spots: on Saturdays we go to Mohipur, on Sundays to Baliatoli, on Mondays we are in Chorcajol, this place here, on Tuesdays in Panpatti, on Wednesdays in Borobaisdia Tulatoli, on Thursdays in Rangabali Baherchor and on Fridays we take a day off.
MAHAMUDUL KABIR – Terre des Hommes
That’s the southern part of Bangladesh, its’a a very… cyclon and disaster… This is the most difficult area to operate, and that is why many NGOs didn’t go there; although for us it was difficult but at the end we were happy because we could serve the people those who really need help and there was no other help for these people in that particular area even for the government. Patuakhali district is at the end of Bangadesh actually: so that is called the forgotten district: out of sight out of mind.
SHUKLA ROY – Medical Assistant
– Did you have this before? – No.
– Since when have you had that? – Three years.
– Have you showed it to a doctor? – Yes.
– Have you got a prescription? – No.
– Has anyone else in your family had this? – No.... oh, yes, my brother, a little bit, but not the same as me!
– Have you got it? – No.
As soon as we saw the ad in the paper, we applied for it and soon we started working on the Shapla ship clinic. Now my husband and I are really happy to work here.
LITON CHANDRA MOLLICK – Medical Assistant
As soon as we saw the ad on the newspaper “Protom Alo”, Shukla and I applied immediately, because they were looking for a married couple.
MAHAMUDUL KABIR – Terre des Hommes
It’s very difficult in general Bangladesh to find many woman actually in professional areas, the more higher level you go it’s more difficult. Socially also they wont leave and work outside their own district or in such difficult areas, it’s very very difficult to get female staff.
Dr. REZAUL KARIM – Shapla Program Manager
When a woman is pregnant, the doctor has to feel her belly and here for cultural matters, only a woman can do it.
SHUKLA ROY – Medical Assistant
– Pull it down!
– Uncover yourself!
Dr. REZAUL KARIM – Shapla Program Manager
Therefore here we needed a female nurse, but as it is unconceivable for a woman to be the only one among many men on a ship, so we had to look for a couple.
LITON CHANDRA MOLLICK – Medical Assistant
Here on the ship, we need a female doctor, because people are all believers. My wife alone manages to look after all the female patients for their check-ups, during the period of gestation.
PATIENT and SHUKLA ROY – Medical Assistant
– My problem is that I haven’t had my period for two months. Right now I wouldn’t want another child, because my first one is only two. Now my chest aches!
– Did your husband use some precautions? – No!
– And did you take any tablets? – No.
– Look up! Put out your tongue! Look down!
Do this test and then come back to me. Go to room six.
– The toilet is over there!
ZAKIR HOSSAIN – X-ray Technician
– Sit there.
SHUKLA ROY – Medical Assistant
– If you didn’t want a child, why haven’t you taken any precautions? Children are not a joke, you must be sure you want them!
– Yes that’s right! The doctor I’ve seen before gave me some tablets and told me that they would have brought my period back.
Dr. SUZAUR RAHMAN – Clinic Team Leader
Her presence in the Ship signified that we are respecting the women’s perceptions and believe, thet this ship clinic at least …. A female medical assistant or doctor for conducting healty natal care, post natal care, during the delivery period or just after the delivery period, or having examination, so she is essential component of our team.
We can observe that most of our patients are female, but seems then that I heard that many husbands just deny their wife to visit here and deny to spend al lot of money for their tratements.
SHUKLA ROY – Medical Assistant
Here there’s a lot of poverty, 80% of people live on fishing. And there are days when they can’t even get a living, let alone spending 50 Taka, for example, to buy sanitary towels.
SARA PIAZZANO – Terre des Hommes
Period related talks are a taboo, girls don’t talk about it and mothers don’t explain anything. They are too embarrassed to buy sanitary towels and somewhere it’s also very difficult to find them, besides they are very expensive. Therefore you need money to buy them and permission to go out and get them.
SHUKLA ROY – Medical Assistant
Most of the times they don’t even know what they are.
SARA PIAZZANO – Terre des Hommes
They end up using old scraps of saris, therefore girls and women often get rather serious infections.
SHUKLA ROY – Medical Assistant
It’s pretty obvious that they won’t buy a package of sanitary towels if with the same amount of money they can buy five kg of rice so they keep getting infections!
ASHRAFUL ISLAM – Ship Master
– Mind the fishermen’s nets!
SHUKLA ROY – Medical Assistant
Even though my husband and I are Indu, we have no problems with the rest of the crew. Our colleagues and our supervisors are very nice with us.
PATIENT
– He’s one year and three months old. He’s been admitted into hospital for a month.
When I went for an ultrasound scan they saw that the twin brother had already died a week earlier, but this one was still alive, so they decided for an emergency caesarean, but I had high blood pressure and before they could intervene they had to lower it.
MOZIBOR RAHMAN – Health Educator
– How old is he? – He’s one year and three months old.
He’s got a cough and his temperature rises in the evening.
PATIENT and
SARA PIAZZANO – Terre des Hommes
– The child was born with his brain only partially developed. I’ve been told that he would benefit from physiotherapy a lot. He can neither stand nor sit down.
– Oh, yes, he definitely needs physiotherapy!
SARA PIAZZANO – Terre des Hommes
This woman here was carrying twins and she surely had a problem during the delivery, maybe the child has been deprived of oxygen and as a result one of the twins died and the other one developed major problems, either with the mobility or with learning difficulties.
PATIENT
– What are you doing my love?!
Dr. SUZAUR RAHMAN – Clinic Team Leader
Take a cloth, warm it up on the fire and apply it to the arm, then try to stretch it. It should improve in four or five months.
KABIR HOSSAIN BASHIR – Dispenser
– Would you like both medications on the prescription?
– I’m still in pain because of the caesarean, therefore I need them all!
– Those that are missing, have to be purchased elsewhere.
SARA PIAZZANO – Terre des Hommes
Also because Dhaka is where everything happens! If she really wants to be followed, if she wants to follow a specific physiotherapy program, which can really help her child, she would have to move to Dhaka, and the costs are enormous. Because one thing is being wealthy in this area and something totally different moving to Dhaka where the cost of living is ten times higher.
Dr. SUZAUR RAHMAN – Clinic Team Leader
Very least middle class you can see here, only those people very rich or very poor: the middle class is very neglected in proportion here. So for the rich there are sure no problem, but the 90% of poor people are fully dependent on village doctor which are not trained and efficient enough.
MAHAMUDUL KABIR – Terre des Hommes
In the rural areas they become the victims of the of the quacks, local doctors, those are not qualified: they sometimes arm the patients!
LITON CHANDRA MOLLICK – Medical Assistant
– Can you move your hand?
PATIENT
– My problem is that I climbed on a tree to pick some fruits for my grandson.
FRIEND
But suddenly he broked down to the bottom, about twenty feet he fall down.
LITON CHANDRA MOLLICK – Medical Assistant
He’s been cured already and has been given some stitches.
FRIEND
We found the local doctor, he came after half an hour and he bandaged his mouth, his forehead and his hand.
LITON CHANDRA MOLLICK – Medical Assistant
But they didn’t stitch him properly, if they only shaved his eyebrow first, it would have been a lot better.
LITON CHANDRA MOLLICK – Medical Assistant
– Umm… it’s a bit difficult here, some dirt has been left inside.
PATIENT
– After I fell off the tree, it has been hard to reach a place where I could be treated.
FRIEND
Shapla clinic is coming on Thursday but this already happened two or three days ago.
PASSERBY
– They say that we have to look where we walk and you end up falling off a tree!
MAHAMUDUL KABIR – Terre des Hommes
If they cannot get any services in the offshore islands they have to travel a lot, spend a lot, so they might as well suffer and struggling as they are not rich enough to come to the district to get the government support.
KABIR HOSSAIN BASHIR – Dispenser
We make them pay 80% of the cost of medications, for pregnant women three or four medications are free. Also for extremely needy patients the medicine is free, because some of them are really expensive.
– You have to take this three times a day before meals.
I try to make myself as clear as possible, but if they still don’t understand, I write my advice on a piece of paper and they can take it to someone who understands. I keep saying to them: “Go to someone who can read, before you take your medications!”
LITON CHANDRA MOLLICK – Medical Assistant
If we see that bad weather is on its way, we move away from the dangerous area.
ASHRAFUL ISLAM – Ship Master
When we get some bad news about the weather forecast, via text message or from the television, or there are problems with the tides or a cyclon is fast approaching, we shelter ourselves, get as close as possible to the shore and cast anchor, we fasten the ship to the mooring-pile and wait for the weather to improve.
SHUKLA ROY – Medical Assistant
Even if I’m the only woman who lives on the ship, I don’t have any problems with the men.
LITON CHANDRA MOLLICK – Medical Assistant
As we spend 24/7 on the boat, sometimes we can get off and have a break.
SHUKLA ROY – Medical Assistant
On Friday, on our day off in Colapara, my husband and I leave the ship and go to the local market to stock up for the whole week.
LITON CHANDRA MOLLICK – Medical Assistant
In our free time we have many options to enjoy ourselves, we play carambole, watch DVDs and TV and many other things.
Dr. REZAUL KARIM – Shapla Program Manager
Besides the option of watching television we have this terrace, where we gather and chat and play carambole. All in all we are like a family.
KABIR HOSSAIN BASHIR – Dispenser
It’s a friendship which is more special than the ones we have back at home, I really love this atmosphere.
MOZIBOR RAHMAN – Health Educator
I’m really proud of my job, because it’s a job that involves humanitarian tasks and I can visit many places. In seven days we visit six different locations and I like meeting new people.
ZAKIR HOSSAIN – X-ray Technician
Every day we go to new places and meet the locals, I like working this way, moving from one place to another so often, because it gives me the opportunity to meet new and different people.
LITON CHANDRA MOLLICK – Medical Assistant
I only perform an operation when I’m 100% sure that I can manage the case by myself, because I don’t want to damage ten years of good reputation of this ship, just because of my mistakes.
MOZIBOR RAHMAN – Health Educator
When I finish checking the patients in, if the doctors need any help, I go and give them a hand.
LITON CHANDRA MOLLICK – Medical Assistant (with sevaral patients)
– Move the light in this directions.
– Don’t move, don’t worry, with this injection, we are going to anaesthetize you, after that you won’t feel anything.
– Don’t give him another one!
– How did you hurt yourself?
– At home there is a small shanty, a shanty made of plate, for the animals, I climbed over the roof, to pick some fruits from a nearby tree, fell off and cut myself.
– Come back in seven days, we will remove the plastering, keep the arm upright!
– Has she been seen by another doctor? – No.
– Has she got a cough or temperature?
– He’s in Allah’s hands!
– Does it still hurt? – No.
– And, listen, have you had any problem since I stitched you? – No.
– Have you taken the medications? – Yes.
– In a week time you have to come back to remove the stitches, you can’t do it yourself, you’ve got to come back here. Ok?
MAHAMUDUL KABIR – Terre des Hommes
Our idea is not only to give a treatment to people, we have designed programme for the preventive healthcare.
MOZIBOR RAHMAN – Health Educator
The DVDs that we show are directed by Humayun Ahmed, a famous film director here in Bangladesh, and they are about personal hygiene. They teach, for example, how to keep one’s nails always trimmed and clean, not to eat food which has been cooked the previous day, to wear sandals, when one goes to the toilet and then to wash one’s hands with soap or ash.
MAHAMUDUL KABIR – Terre des Hommes
When we do more preventive healthcare it means that we have less disease, so although Shapla is giving them a very good service, still our ambition is ultimately to equip the people so they can take more health measures and get less diseases, and they have to come less to Shapla actually: that’s the idea.