INDEPENDENT UNIVERSITY, BANGLADESH (IUB)

LFE REPORT

COURSE NAME: LIVE IN A FIELD EXPERIENCE

COURSE ID: LFE 201

Venue: PROSHIKA HRDC, MANIKGANJ

REPORT TOPIC: HEALTH AND MEDICAL SERVICES

SUBMITTED BY:

NAME: MAHTAB MURSHED

ID NO: 0920615

SUMMER 2012

Group No-09

Acknowledgement

First of all I want to say, we are very delightful to have a special

program (Live in a Live in Field Experience) in our university, which is a

very enjoying, thoughtful and unique course in Independent University,

Bangladesh (IUB). We are very grateful to IUB for giving as such a practical

experience of the rural life of Bangladesh through the LFE. I really

appreciate the host organization Proshika HRDC, Manikganj for giving us

such an opportunity to explore the area and for helping and guiding us

throughout the course and to for the support of accommodation, food

facilities, and security. My special regard goes to Mr. Latiful khabir and Mr.

AFM Mainul Ahsan who have supported us and helped us all the way

through and took care of all the problems faced by us during the program

.Special thanks go to the LFE monitors Rakibul Hasan (Technichal), Shahin

Pramanik (Technical), Mahira (Regular) and Moinul Karim (Regular) they

were also very cooperative and helpful. All of them have guided us

throughout the course session to achieve our success in collecting the data.

Table of Contents

Section Contents Page No

1.0

Introduction 3

1.1 Objectives 3

1.2 Limitations 4

1.3 Procedure and Methodology

4

2.0 Working Area

5

2.1 The district Manikganj 5

2.2 Proshika HRDC

6

3.0 Health and Medical Services

8

3.1 Introduction 8

3.2 Findings 8

3.3 Resources 9

3.4 Diseases and Health Care Services

12

4.0 Village Doctor

13

4.1 Profile of village doctor 13

4.2 Interview review 13

5.0 Upazilla Health Complex, Manikganj

15

5.1 Condition and Services

References

16

16

6.0 Conclusion

17

References 19

APPENDIX 20

1.0 Introduction

The terms Health and Medical services are interrelated to each other and increasingly

central to our lives. Bangladesh is a land of hard working souls and the major population of

this nation dwells in the rural areas. LFE has been designed to provide a brief knowledge

over the living structure and social and economic and also the health condition of the rural

areas of Bangladesh. The awareness about health and Medical services are increasing day by

day. Like other countries, Bangladesh has a strong commitment to address the health and

Medical services issues. Attempts have been made here in this chapter to figure out the

population, health and medical service conditions of Purba Para, Golora, Manikganj. A major

aim of this report is to formulate the policy-response for achieving development for the

village in our point of concerns – “the health and Medical services”. In the past years, the

health and Medical service problems were treated separately. But this Trend has changed in

the recent years. In most cases, population is seen as an aggregate of Consuming units and

putting stress increasingly on the natural resources leads to Environmental degradation. This

is why there had been many attempts to explore the interrelationship between population,

health and medical services at all conceptual and organization Levels. In reality the inter-

relationship between population, health and medical services is more Complex and multi-

dimensional. Human beings are not always consumers, they are also Producers and some

time they are conservators of nature and environment. The quality and Quantity of the

population of a country have inevitable interaction with its natural resources And

environment. Considering a field study on a certain village I was required to acquire a rough

knowledge about the condition of the people living in the rural areas all over Bangladesh

since the assumption is that the villages of Bangladesh are almost alike. Out of around 93000

villages we studied only one village in Manikganj district. The economy of Bangladesh is

mostly dependent on the contribution of these villagers and though the air of technology and

advancement is blowing over the whole nation we cannot think Bangladesh without villages.

Golora, This village is almost like the other villages all around Bangladesh and learning

about the village to project a scenario of the major population of Bangladesh was my main

objective.

1.1 Objectives

To reflect the state of health, immunization and medical facilities available in the

village.

To visualize the different types of health problems according the villagers.

The name of the common diseases in the area.

To capture the differences of villagers in their health conditions and concept.

The types of health facilities the villagers are getting.

The NGOs operation in the village regarding development of the villager’s health care

facilities.

To get the real picture of the present environmental condition of the village, like

source of water supply toilet facilities and kind of fuel they used.

To learn the overall condition of the village and its people.

To explore the socio economic condition and lifestyle and the way of managing the

resources.

To unearth the distance and psychological factors of the villagers that drive them to

lead a different life from the urban dwellers.

To explore the health issues of the certain residents.

To find the medical support they are having in their village.

To find the financial condition of them for their medical support.

1.2 Limitations

The LFE is a very short term research based course where we need to find various valuable

information’s about the society we are researching. So the validity of the information

provided remains susceptible to errors. Lack of human resource and shortage of time does not

permit full disclosure of the information’s extracted and lack of proper guideline and

condensed questionnaire may lead to wrong information collected as verification of the

collected data is quite impossible within this time. Our survey time was in the morning. At

that time most of the males were out of their house for work and the females were not being

able to provide information properly due to lack of knowledge and were reluctant to speak

with us about their problems.

1.3 Methodology and Procedure

This research work had been done on our internet based cell phone. This survey was

conducted by Real time data. We took data from household members then straight away we

sent our data in the server via Cell phone. We used unique House hold Id for every single

family. To gather all the information I also used some people as tools and self-observation

and estimates of different demographic tools and also interviewed the related persons. Simple

random sampling was the main focus. Qualitative & quantitative data were well thought-out

to analyze this study. To assemble information on community resources, literacy, and

community development programs, health worker, village doctor, Upozilla Health complex

information we did straight way interview. Moreover dispensary and the service of a village

doctor have been done through different observational techniques and open end questions.

Sample notes and on spot handouts have been used to collect information all through the

coursework.

PROCEDURE:

By collecting identity of households.

Collecting data by using questionnaire survey from household members.

Giving collected data as input in IUB internet based mobile website (man.iub.org)

Finding the inside of health condition of the villagers.

By checking the available health care center.

Summarizing the data.

2.0 Working area

A total of twenty five groups of two persons took place in the LFE summer 2012 program

held at Proshika, Manikganj. I worked at the middle of the Golora village which is known

and golora moddho para and Golora purba Para. The Area we surveyed was consisting of

approximately 2 square kilometers east and middle of the land. I also went to the Koitta

bazaar which is the nearest bazaar of Golora to take further information about the village

doctor and other related topics. Not only this I also deployed my best effort to collect the

necessary information from the residents of Golora. I have also communicated with the

visitors to this place. I aslo went to the Manikganj Upazilla Health complex and had an

interview with the medical officer in charge of the health complex.

2.1 Manikganj Overview

Manikganj District (DHAKA division) with an area of 1378.99 sq km, is bounded by TANGAIL

district on the north, DHAKA district on the east, FARIDPUR and Dhaka districts on the south,

the PADMA, JAMUNA and the districts of PABNA and RAJBARI on the west. Annual temperature:

maximum 36°C and minimum 12.7°C; annual rainfall 2376 mm. Main rivers are the Padma,

Jamuna, Dhaleshwari, Ichamati and Kaliganga. An extensive area of the district especially

riverine area of the upazilas of Harirampur, Shivalaya and Daulatpur become victims of

riverbank erosion every year. Manikganj (Town) consists of 9 wards and 49 mahallas. The

area of the town is 20.59 sq km. It has a population of 53161; male 51.16% and female

48.84%; density of population is 2582. Literacy rate among the town people is 49.9%.

Administration of Manikganj subdivision was established in 1845 and was turned into a

district in 1984. It consists of 1 municipality, 7 upazilas, 65 union parishads, 1357 mouzas, 9

wards, 49 mahallas and 1647 villages. The upazilas are MANIKGANJ SADAR, SINGAIR,

SHIVALAYA, SATURIA, HARIRAMPUR, GHIOR and DAULATPUR. Main occupations Agriculture

37.96%, fishing 1.87%, agricultural laborer 22.25%, wage labourer 3.92%, industry 1.15%,

and commerce 11.97%, construction 1.03%, service 8.43%. Transport 1.76% and others

9.66%. Source : Internet

2.2 Proshika HRDC

The name „Proshika‟ is a Bengali acronym made of initials of three words: Proshikhan

(training), Shiksa (development education) and Kaj (action). Since its inception as a

Bangladesh non-government development organization in 1976, Proshika’s aim has been to

create a self-reliant development process among the rural poor by extending support for

getting themselves

organized, becoming critically conscious of their situation and making united and collective

efforts to improve their socioeconomic condition. The promotional organization of the rural

poor

is recognized as the core activity of Proshika "Before you profess, practice yourself". With

this principle PROSHIKA began the Research and Demonstration Project at its Human

Resource Development Centre (HRDC) at Koitta, Manikganj, to develop more sustainable

and productive technologies, management practices and production methods that it asks

others to follow. The objective thus has been to measure the possibility of success and the

risk involved in technologies before they are handed over to the poor group members so that

they do not face any financial debacle later. Besides, the group members‟ theoretical

knowledge acquired from various training programmes needs to be complemented with

practical skills. Otherwise, expected results cannot be achieved.

Currently, the RDP at Golora has the following components:

(a) Ecological Agriculture.

(b) Livestock (Dairy Farm; Poultry Parent Farm and Poultry Hatchery.

(c) Fisheries Farm.

(d) Shrimp Hatchery.

(e) Pest and Natural Enemy Interaction in Low Input Rice Cropping System.

(f) Sericulture (Silkworm Stock Rearing, Silk Reeling, Silk Weaving).

(g) Plant Tissue Culture.

(h) Iron Removal Plant.

(i) Bio-gas Project.

3.0 Health and Health Service

3.1 Introduction

The objective of the study was to find out the health condition of the village and take a fair

idea.

The health position of different age groups and medical services available was the main focus

of my study. Moreover I tried to find out the impact of industrialization on the environment

and whether it has any adverse effect or not. What is the villagers‟ attitude towards their

surroundings and their initiative to preserve the natural beauty was also part of our study.

3.2 Findings

Area masque Golora Modhaya para

Present health condition of Golora village is comparatively quite good. People are much more

aware than before and they are self-driven to remain healthy by consuming good and keeping

their surroundings neat and clean. The roles of NGO‟s have been a major factor in creating

this awareness. People are also very aware of the environmental issues and are trying to keep

their surroundings clean to avoid the dispersion of various diseases. But the village is lacking

the fruit trees it used to have and the plantation of Eucalyptus has been a dominating culture

now a days which is the only flaw found about the environmental condition of this village.

But one most interesting fact was that most of the household people surveyed were in very

sound health position however those who were ill were suffering severely and helpless in

getting any type of support. The survey questionnaires will serve better to understand the

overall health condition and environment of the village.

3.3 Resources

Water resources and their utilities:

Water no doubt one of the most essential elements of environment and also important for life

and living. Bangladesh is an over-populated country with its demand for its basic

requirements increasing in an unconditional way. As the population is increasing, the demand

for water is also increasing for various activities. Water is a crucial feature for civilization.

Water is used for domestic purpose like drinking, bathing, cooking, washing etc.

Tabular Analysis:

Table: Type of Water resource and their utilities

Source: LFE Field Survey, summer 2012

Analysis:

It’s good news to know that the household members of Golora Purba and Madhya para are

properly awarded of safe drinking water. They know that tube well water is safe from every

kind of pollution. They also use tube well water for their other house hold purposes like

washing, cooking and bathing. Although they are little bit anxious about arsenic because

arsenic test is not done in this village.

The sanitation facilities:

Sanitation is one of the most important aspects of the environment. The awareness for better

and cleaner sanitation facilities required for better living is absent in the mind of the people

living in the rural parts of the country in proper format to be executed by all. In other words

we can say that, we can find a moderate awareness of sanitation among village people. Thus

the villagers awareness is the consequence of the efforts from the Government and as well as

NGOs and the health workers. The improved sanitation system has contributed well in

avoiding the sickness and maintaining the environmental and personal Hygiene.

Tabular Analysis:

Types No of house Percentage

Ring slab 09 75%

Hanging latrine 01 8.3%

Septic tank 01 8.3%

Pit latrine 01 8.3%

Table: Types of toilets uses by villager’s

Source: LFE Field Survey, summer 2012

Use of tube well

water

No. of Household Percentage

Drinking 12 100%

Bathing 12 100%

Washing 12 100%

Cooking 12 100%

Analysis:

In our fact finding about toilet facility used by villagers we found that, eight percent of

families are using pit latrine that is not a good hygienic system. Seventy-five percent of

families are using Ring slab. Only few of them are using septic tank. After analyzing all the

data I find that urbanization reached to the village. The villagers should avoid open toilets

and welcome septic tank base toilets instead of pit and hanging toilet. Otherwise germs of

disease will get vote to spread.

Waste disposal:

Waste disposal may create a major impact in the environment, health and medical services.

The wastes those are disposed right outside the household may pollute the near atmosphere

and may result in contagious diseases around the area. Although disposal of waste is harmful

to the atmosphere, it may be also be disposed in a certain place, which rather helps the

society as a whole.

Tabular Analysis:

Way of dumping No of household percentage

In a whole beside

the house

09 75%

In the nearby ditch 01 8%

In a specific place 02 17%

No specific place - -

Table: Places of dumping

Source: LFE Field Survey, summer 2012

Analysis:

We got a good figure of disposal of waste in our survey households. We got actually twelve

families responses and among nine of them use fixed hole method which is In a whole beside

the house and the rest dump wastages at In the nearby ditch. All should use fixed place to

dispose their daily wastes. It saves the environment from further pollution. This rotten waste

mixed soil can be used as fertilizer for plants. When the household disposals are thrown in

the cultivable lands, it rather helps the land by increasing its productivity. On the other hand,

the best way to get rid of the disposals is to bury it under the surface. The proper disposition

of leftovers helps us for our better living, this concept in the minds of all is very important

because everybody should be well aware of their cleaner environment.

Types of fuel use for cooking:

To survive people need to eat, to eat people need food, to get food people need to cook and to

cook people need fuel. This fuel can be of many forms as they are used in different parts of

the world according to facility and availability they’ve got.

Tabular Analysis:

Types of fuel No of families Percentage

Kerosene - -

Fire wood 12 100%

Leaves and twig - -

Gas - -

Cow dung - -

Straw - -

Table: Types of fuel use for cooking

Source: LFE Field Survey, summer 2012

Analysis:

In a developing country like Bangladesh, more than 80% of the total population still lives in

the rural areas where there are scarcity of resources and overall people are constrained of

using the proper fuel that are friendlier to the world’s environment for mainly two reasons,

either it is that they are unaware of the fact or else they don’t have the capital. The main fuels

for cooking purposes used by the people in the country are cow dung, leaves, twigs and

straws. In our study village it was observed that the person uses a variety of fuel types for

their cooking purposes. It is seen that, the major portion of the households relies more on

Leaves and twig. Some of them are also using cow dung and straw for fuel purposes. Smoke

has been created by using this type of fuel resources for cooking. Thus the environmental

atmosphere harm by burning fuel gases. That also affects human, children and trees. Because

of fuel crisis in village sometimes the villagers chopped down trees which create a great harm

to our nature and overall atmosphere.

3.4 Diseases and Health Care Services

Major diseases are seldom in this area but people who are facing stomach disease, asthma,

fever, sometimes chronic fever or other serious diseases are due to their bad habits like

smoking or other bad habits. Normal cold and seasonal flu are prevailing among both

children and adults. But certainly this negligible cold and flu causes serious problems when it

comes to overlooking them. And in this village since people do not consult to a doctor

properly for various reasons, they suffer from various diseases as they grow older. The health

care facility in this village is also very poor. As the private clinics are too expensive to afford

for this low income group, they find their way cure in the local pharmacies. The village is

quite free of superstitions and unlike other village it is free from the dominance of local

priests in curing diseases. Response of the villagers towards the public health care service in

the village Golora there is no registered doctor, so the people have to go to “Koitta Bazaar”

bus stand to see the village doctor which is 2 km away from the village or Manikganj sadar

hospital. The main problem found is the lack of transportation facilities. The direct route to

the sadar hospital from the village is almost 10-12 km. But there is an alternative way which

is almost inaccessible for a patient to follow. The villagers are very happy with their village

doctor Shorol Chandra Sharkar. This doctor is very dedicated person and tries his best to give

the service .So they are very happy with the doctor. There is a big problem that there is

lacking of medicine. If any patient prescribes by another doctor with a high antibiotic then the

patient will not be able to get the medicine from the local pharmacy. The costs of the

medicines are slightly higher than Dhaka. I asked to the doctor that why they are taking the

excess money from the villagers, he said me the place is far from Dhaka. The suppliers are

charging little bit high for the transportation cost. So they need to sell this in slight high price.

4.0 VILLAGE DOCTOR

4.1 Profile of the village doctor

This is the interview session with the village doctor by me and my group partner on 28

th April

2012 summary:

Interviewer: Mahtab Murshed & Tanzim Lopa (Group#09)

Interviewee: Mr. Shorol Chandra Sharkar

Designation: Village Doctor (short medicine and paramedic course)

Location : Shorol Pharmacy, Koitta Bazaar, Koitta, Manikganj

Interview session of Mr. Shorol Chandra Sharkar

Shorol Chandra Sharkar is a village doctor and he is 35 years old. He is giving medical

service to the villagers for about last 10 years. He passed his SSC and HSC from a

government school and college. He is from the science group. After passing is HSC he took

some training on village medical studies from Dhaka and Manikganj Sadar hospital. He took

RMP and LLMP course from the hospital. He can give primary medical treatment. But he

cannot give the treatment for chronic and severe diseases. He can only give the medicine

which is not very dangerous.

Shorol Chandra Sharkar has a dispensary of his own. After finishing the course from Dhaka

and Manikganj he started to serve the people through his dispensary at Koitta Bazaar, Koitta

Manikganj. He is always available there. Shorol Chandra Sharkar can prescribe medicine. He

can inject the saline, provide first aid, and also can stitch the cuts. He is well reputed as a

doctor according to the villagers. He is serving the people of Golora village, Burundi village,

Dhankora union and some other place. In his dispensary he invites MBBS Doctors to see

patients. He charges the patients a very negligible amount. He tries to sell the medicine in a

very cheap rate. Shorol Chandra Sharkar is very happy with his service. From his child hood

he wanted to help the people. He thought that there are many ways to help people but to give

the health service is the easiest way to come to the people and help them. Providing the health

service is the best practice to help mankind. Shorol Chandra Sharkar also said that he tries his

best to give the best treatment to the patient. He doesn’t charge any visiting fee from the

patient; he takes only the medicine price. Moreover when he visits the people outside on his

personal bike he does not charge for his fuel cost. He said that he want to give them a good

service .He is feeling very happy whenever the patient is getting cured. He said he never

gives doubtful treatment to his patient. If he cannot give the treatment or if he does not know

then he refers the patient to the hospital. He also gives time to consult with them if they want

to go in the hospital or in Dhaka to see any specialist for the particular problem. He helps

them to select the best doctor. Shorol Chandra Sharkar wants to give the very best service to

the village people. But he said he needs More important courses to develop his expertise. He

also said that if he can get more courses then he will be swifter on his work. By the higher

course he will also be able to know about the antibiotic medicinal function. He also suggests

that if the government also starts some free training for the village doctors that will be more

fruitful for them. By these courses they will be able to give better services to the people of the

village and people would not have to go to the hospitals in Dhaka, additionally they can get

service in very cheap rate and the patients will no more be harassed. As his future planning he

wants to take more courses on rural medical treatment. He wants to learn about the

orthopedic working because in his area lots of people get injured working in the field.

Sometimes they are get injured by falling from the trees. So if he can get the training that

how to make plaster then it will be quite easy to make plaster to the injured people. So that’s

why e wants at least 1-2 years course on the relative fields. He wants to expand his

dispensary. He wants to take some emergency medicine to his dispensary for example, in that

area there is only 3 pharmacies but none of them keep inhalers for the patient who are

suffering for asthma. There is also no nebulizer for the baby who is suffering from

pneumonia. If he can get more training on the village medical works then he can expand his

dispensary and provide better service. In the long run he wants to establish a hospital for the

poor people in his village.

5.0 Upazilla Health Complex, Manikganj

The Sadar Upazilla Hospital of Manikganj was established with 100 bed. Now it contains 150

bed. Each and every day the hospital gets more than 300 patients. Its located at Manikganj

sadar. For more information we interviewed the civil surgeon of the hospital and also we

interviewed the pathologist of the hospital.

5.1 Condition and Services

Picture:Mr. Shiddheshar Mazumdar (civil surgeon, Manikganj sadar hospital)

Acording to the interview of Mr. Shiddheshar Mazumdar, the hospital gets paiteints from all

over the Manikganj, which covers our research area Golora of Saturiya. Mr. Shiddheshar

Mazumdar discussed a lot of things about the present situation of the hospital. This hospital

has not enough resource, Doctors, Instruments, and Beds for the patients. To cover the

situation they use the time shift theorem and peoples are using the hospital floor as their bed.

Which is not healthy and against the hospital rule, as the people need service them cannot

deny it.

Recommendations

As per my observation in Golora village, Manikganj I noticed a lot of diversity among the

people. I spoke very responsibly with the villagers as well as the chairman. I discussed with

them about the facilities provided by the village doctor and the health worker. Especially the

village doctor comes at the first call of a patient. He always tries to give his best effort to cure

the patient. But I want to give some recommendation for the village doctor:

village medical course

for the village doctors

en try to test any treatment without the proper knowledge

For the villagers:

ers have to be respectful to their village doctor

nt to take to the doctor

For Upazilla hospital:

They should extend their beds (Seats).

They should appoint more doctors.

They should be more careful about patient’s condition.

For the local authority:

rainy season it is getting more muddy and slippery.

e village because there is no community clinic

s to develop the village doctors

6.0 Conclusion

The topic of my report was health and medical services. Medical services has now been

accepted as the key issue for the rural and country progress and development. Survival of the

world and as well as the human race, directly depending upon environment and the natures

existence. Future of Bangladesh also lies in environmental and rural development efforts

specially on the health condition of dwellers. Health and medical services concerns all and an

effective solution of related problems can never be worked out unless everybody is involved

in such a task. As the ultimate aim of all human activities is to improve the quality of life and

ensure a safe and sustainable future for mankind, it is imperative that all sources and

resources are harnessed towards these ends. This will be possible only when everybody is

aware of the depth and dimension of the problem and spontaneously participates in the

process of health and medical services, conservation and rural development. The country

inherited a system of health care with preference for curative services over preventive

activities since last couple of decade and more stress has been given to recognize the health

service to provide comprehensive primary health care to the people of villages which are yet

to be achieved. Despite sound infrastructure the health care service remain out of reach of the

majority people. The primary reasons, believe experts, was the governments lack of

commitment. Allocation for the health care service sector has never been a priority.

But it is hopeful to know that the government has made tremendous strides in the area of

health care & family planning in the last two decades. The endeavor have reduced mortality

rate to a significant proportion & have attained success in the family planning sector. But still

it has a long way to go towards proving health care to every individual and to ensure it for the

people of the remotest parts of the country. Only then it will emerge as a healthy nation and

many of its problems relating to the improvements of the economic structure will be

dispelled. The agricultural & industrial production will boost & the country will proceed

towards attaining financial emancipation breaking all chains, which previously cursed the

lives of our ancestors.

Reference & sources

Shorol Chandra Sharkar

Village Doctor, Koitta Bazaar (Referred to Golora village)

Asma Begum

Student, Golora

mia

Shopkeeper, Koitta, Bazaar.

Villager, Golora Village

Health worker

Gonoshsatho

Fruit Seller

Nayadingi Bazaar ,Manikganj

Carpenter, Golora

Ashar Alo kindergarten school (Students and Teachers)

Golora, Manikganj

Manikganj

APPENDIX

House Holds details covered by (Group#09)

Done by: Mahtab Murshed

ID: 0920615

Sl. No. House hold head Name House hold ID

0001 12001

Md. Owaz uddin Abdul Hashem

0005 12005

MD. YOUSUF MD. SOBHAN MOLLAH

0010 12010

MOJIBUL MOLLAH LATE SIRAJ MOLLAH

0015 12015

MD. BAIZID CHUNNU MIA

0020 12020

ALI HOSSAIN DORBESH ALI

0023 12023

MOJJAFOR MD. DORBESH ALI

0030 12030

SONA MIA SHEIKH GOPAL

0035 12035

MD. ALI AFTAB UDDIN

0040 12040

ABDUL SALAM MD. OWAJED

0043 12043

ALI HOSSAIN KAJI HOSSAIN

0053 12053

ABDUL MANNAN LATE AMIR UDDIN

0056 12056

KALO MIA LATE NUAB ALI FAKIR