Maybe you have never thought about Bangladesh and do not know Dhaka from Dakar, but I do. I think about Bangladesh every day. I have lived in South Asia long enough to wrap my own sari and to think that purple and orange go together well at least some of the time.
Before Bangladesh, I lived and worked in Baluchistan (the border province between Pakistan and Afghanistan), and Nepal (among other places), as a trailing spouse. Along the way I managed to produce three sons in rapid succession and acquire a cat, a dog and a PhD.
Now I work at ICDDR,B which used to stand for the International Centre for Diarrheal Diseases, Bangladesh, but we aren’t just about diarrhea anymore. My small and not-too-glamorous research programme focuses on health and family planning systems. Some of my time is spent figuring out better ways of getting shots into the arms of babies in the remote hilly areas and swamps, or new ways to deliver health care for the urban homeless. Other times, there is more analytical work like meta-analysis of health systems issues or evaluating maternal financing schemes.
Lately, I have fallen into coordinating a chronic disease research programme—something new, bold and necessary for developing countries like Bangladesh. Now that there has been success with meeting the needs of under-five children, women of reproductive age, and those with a major infectious disease what do can be done for everyone else?
How should a health system be reconfigured or adapted to meet the needs of adults? The public health sector is beginning to gear up to provide the services, but this does not mean that there are not other trained and untrained providers giving advice for diabetes and hypertension.
In the park where my husband and I exercise before dawn every morning there is a man with limited training who has set up an awning with a table and two chairs—one for him, one for his client. For a small price he can check your weight, check blood pressure, give a finger stick or sell you a soda or a bottle of water.
Most of the older men and women also walking seem to have the resources that would take them to a qualified doctor with an office rather than the open air stall. I wonder how this vendor stays in business. It must be the soda and water or perhaps a less affluent clientele circles the lake after the sunrise.
Although male park walkers wear Western clothes, the older women tend to dress head to toe in black burkhas or wrap up like brightly colored burritos in saris so that only their faces show. I admire their willingness to work out in such restrictive garb in the ultra-humid weather with temperatures often as high as 40 degrees even at 5.30am. They do not make very good time in their laps as the sari is designed for slow movement, but at least they are out exercising. The biggest change in the park lately is the daily exercise class for men is now taught by a woman in workout pants and a tee shirt.
I hope that this blog might serve as a forum for communication not just one way but both ways. My goal is to provide you insight into the lives of people serving on the front lines in the war against poverty and disease and the amazing events that take place here. Perhaps the response will be amusement, guidance or, I hope, the generation of a community in which learning can be shared.
Tracey Koehlmoos is programme head, health and family planning systems programme, and adjunct professor, James P Grant School of Public Health, BRAC University.