Tracey Koehlmoos: Non-communicable diseases and bringing the fishbowl to Bangladesh

Tracey KoehlmoosI am not going to lie. I love planning conferences and meetings although as a serious scientist, I do not think I am supposed to think and feel this way, but I do. Why? As my Hirsch score indicates, I spend a lot of time writing papers that no one reads except for the editors and peer reviewers, but if I bring hundreds of people together to exchange ideas, I know that I am making an impact. Thus, when planning for the recent 13th Annual Scientific Conference (ASCON XIII) on Science to Accelerate Universal Health Coverage, I was actively seeking to highlight the need for non communicable diseases (NCDs) as a health systems issue to be included in any future plans for universal coverage in Bangladesh.  

We were offered two sessions. The first one covered “universal coverage in low and middle income countries for non communicable diseases” and the second looked at: “implementation of non communicable disease programmes in low resource settings.”  The normal approach would have been to invite four speakers per session, have each person talk for fifteen minutes and then field questions from the audience for five to ten minutes. People often nap during this type of session, particularly if held after lunch. I wanted to do something memorable and less conducive to snoring, something edgy that would generate ideas.

I decided to bring the fishbowl to Bangladesh. If you’ve not attended such a session before I will explain that it consists of a panel of subject matter experts, and that the panel may or may not make presentations; however, the fishbowl part of it comes after the introductory activity. The experts are seated in an area, preferably a circle, which includes extra, empty seats. Rather than being limited to asking questions of speakers, the audience is given the ability to “swim” into the fishbowl and join the discussion as an expert.

Our designated day for the two sessions was March 16th and recognising that the most important person in any fishbowl session is the moderator, we covered our bases by inviting the BMJ’s former editor, Richard Smith, to chair the two sessions in his role as Director of United Health Group’s chronic disease initiative. Richard brought life to the sessions and, in a way that is nothing short of a miracle, managed to keep everything running on time without offending participants.

We also invited local experts like Andrea Krigge from GTZ, who spoke about an innovative employment based health insurance programme in the shipping industry in Bangladesh, and the grande dame of diabetes in Bangladesh, Hazera Mahtab from BIRDEM. Our international panel members in the two sessions included David Dror chairman and managing director, Micro Insurance Academy, New Delhi, who had not previously evaluated his extensive data from an NCD prospective; Naomi (Dinky) Levitt, of the chronic diseases initiative in Africa, and division of diabetic medicine and endocrinology, University of Cape Town; and Adolfo Rubinstein, from the Institute for Clinical Effectiveness and Health Policy, Argentina. It was an amazing set of experts.

After the panelists shared the results of their studies, we assembled them into the fishbowl. Because this was a new seminar style in Bangladesh, Richard Smith explained the rules—anyone could enter the fishbowl but his or her role in the conversation would be limited to two minutes.  It really could have gone either way with this new technique falling flat on the audience and descending into a standard question and answer session—and considering that each session hosted more than 100 attendees, doom seemed close at hand.

However, it was a great success. Participants were hopping in and out of the fish bowl’s seats, which were always full. People were alternately asking questions and providing answers and new ideas on NCDs and priority areas were circulated and shared. The participation extended to all levels so that students, fellows, senior scientists, and even policy makers were taking turns in the discussion. Most delightfully, and perhaps, in the true spirit of a “fish” bowl—some of the participants with great comfort and humour would literally “swim” in and out of the central discussion. The energy was fantastic as well as the ideas, and to some extent it was a unifying event that we are still talking about today.

Tracey Koehlmoos is programme head for health and family planning systems at ICDDR,B and adjunct professor at the James P. Grant School of Public Health, BRAC University, Dhaka, Bangladesh.