Building bridges

The last full day in Bangladesh and on some level the most nerve wracking. We ran a workshop for a group comprising front-line healthcare workers, Professors, NGO project directors. A real diverse group, who proved to be such a powerful force. From the first warm-up to the last input of the day the group engaged and contributed freely their ideas and energy to make it a day full of laughter, fun and brilliant insights and ideas. Our translator Suley coolly translated back and forth, I have much admiration for him. Alex and GO nailed both their sessions – the broad smiles on their faces gave away just how much they enjoyed it.

Perhaps the most wonderful part of the day was to see people from different NGOs exchanging business cards… bridges were being built before our eyes. According to Steve Davis, CEO of PATH, www.xconomy.com/seattle/2012/06/04/building-bridges-in-a-new-global-health-landscape/ building bridges is critically important in the coming decade for global health. Today we witnessed that at first-hand.  If only these partners could work together as effectively in the field as they did in the workshop the future would be brighter. What a great high note to end the work of our visit to Bangladesh.

Ivory towers, business cards and air conditioning

Our travels today would take us beyond our hotel’s armed guardsto meetings with academics and executives.  Quite a departure from the end of the socio-economic spectrum experienced over the proceeding days. Remiders in the form of street kids were still around.

Our discussions ranged across topics focused on country-wide development goals and challenges in Bangladesh and new solutions.  Coming from an academic background I enjoy the view from the Ivory Tower, now on this trip the connection of that view with the practical reality on the ground is blurred at best. 

The goals we covered, especially, the new education policy to increase the number and quality of secondary teachers is ambitious, and if successful would be an incredible step forward.  Having heard about the challenge of persuading teachers and healthcare professionals to work in the remote communities, and moreover, have them stay there for any meaningful length of time, I have doubts how effective the new policy will be away from the attractions of Dhaka. 

Interesting social business models were discussed, and it is through these that there are new ways of catalysing development.  Perhaps not appropriate for all problems, the social business approach does appear appropriate in certain circumstances, and can offer quite creative solutions to recurrent problems.  As can taping in to the work ethic and resourcefullness of the locals.

This day of air conditioned offices and business cards was a stark contrast to the mud-floored village huts and warm greeting smiles we’d grown used to.  Thankfully, the wamr smiles were still present.  Being able to straddle these two worlds is surely a large part of the key to successfully designing, funding and delivering new interventions to improve the lot of people and communities in extreme poverty.                 

The road back to Dhaka

Early start to visit Mahasthangarha www.wikipedia.org/wiki/Mahasthangarh an enourmous historic site that is thought to be the oldest known settlement in Bangladesh.  The area we first visited was overrun with locals who had moved in and were using the historic brick and stone work for their houses.  Eventually we found the museum, only to be ushered away by a security guard concerned that we were there to rob the place!

First on the day’s work agenda were interviews with a variety of beneficiaries of UNICEF funded health and education projects within Bogra city.  Even within a city, awareness of these projects was variable, and this led on to who was accessing the services on offer.  As with projects in rural areas, awareness was largely spread by word-of-mouth, and to a lesser extent through fliers.  With such tight knit communities and family units it is no surprise that word-of-mouth is so effective but it is not reaching all people. 

Outside the temperature and humidity were rising – it was roasting.  Our final interview was in a lady’s house made from corrugated iron sheets that made the perfect conditions for an oven.  The temperature inside must have been well above 40°C and could have been touching 50°C.  The conditions were on a par with our first interview in Brahambaria right at the beginning of our trip.  Sweat just poured of us all, I think even my eye balls were sweating it was so hot.  Only the lady we were interviewing seemed comfortable with the conditions, after all it was her house. 

Of her own fruition she had taken on responsibility for raising awareness of community projects within her neighbours, and would even give up her own time to accompany those who were unsure to the clinics. How long she will continue to do this act of good for was unclear as she was receiving no appreciation from the project officials for bringing them new ‘customers’. She wasn’t looking for money, just a simple ‘thank you’.  It is a salient lesson on the value of appreciation when motivating people.        

On route to our last stop in Bogra we saw the police administer some street justice to a poor rickshaw driver who made the mistake of bumping his front tyre into the back of the police pick-up truck.  A nasty and unnecessary attack on a man who was just trying to earn a living. 

What came next couldn’t have been further away from the bullying behaviour of the police. At a wonderful UNICEF funded school we met the most charismatic and excellent Head teacher.  He was a true innovator, using creative ways to bring younger children in to school and to bring lessons to life.  He clearly knew that creativity and enjoyment was the best way to attract, engage and inspire his pupils.  He even demonstrated how he had converted a Bengali poem into song: he had such a fab voice! 

What a great example he was of the importance of leadership and ingenuity that is required to solve the myriad of problems in this country and to propel it forward.  In many ways he reminded me of my first science teacher, Mr Mitchell, who when I was 12 lit the spark that got me in to science.  I could have stayed talking with the Head for so much longer than our itinerary allowed for. 

True to form the school kids crowed around us, posing for pictures and wanting to know who we were, where we were from and why we were there.  Great inquirers and bundles of energy.  As with all the schools we visited, I wished that we’d more time to give something back, to more fully answer their questions, and maybe even to play a quick game of cricket. Perhaps next time.

Final rural destination  was village we had to walk from the nearest road, across the paddyfields, to reach.  Such beautiful ‘countryside’.  We met with a father and his young son who has suffering from lymphatic filariasis http://en.wikipedia.org/wiki/Filariasis

In respect to this amazing little boy I will not show any photos, but it was really shocking to hear their story.  Over a ~10 year period they had been repeatedly let down by healthcare professionals who had mis-diagnosed and wrongly treated him.  As a consequence his father had pretty much conceded defeat.  The boy outwardly seemed ok, but I think the obvious difference between him and the other children crowded around us must have been having some sort of impact on his life, and if not now, then would do in future if the filariasis was left untreated. 

It was only three days before in the Chars that government officials were preventing filarisis by giving the local children, albendazole for free, as part of a global elimination programme.  Now we had a boy, who if given the correct medicine, would likely make a good recovery.  We left the father with information on the medicines his son needed – I need to find a way to check whether the father followed through the advice.       

Another early evening storm decended, but this time no fallen trees delayed the long drive (~5hours) back to Dhaka. 

Once again driving at night added a new dimension of terror.  More near misses than I can count.  I used to worry most about the trucks, now it was the buses that set a new level of craziness.  As GO put it ‘they think they are F1 drivers’!  This was the main highway between Bogra and Dhaka – at one point had we to literally stop our mini-bus to avoid a head-on collision with a bus overtaking another bus on our side of the road.  Oddly it was becoming fun, something akin to a 6 hours adrenaline rush.

Our time away from Dhaka was over, and the rest of our time in this wonderfully, crazy, beautiful, country was to be spent in Dhaka.

Mothers, babies, and mango trees

After saying goodbye to our hosts on the Friendship ship, a speed boat ferried us to the mainland some 45 minutes away.  The river we followed was incredibly wide and in the rainy season would become a torrent some 30 miles across – an inland English Channel.  No wonder the existence of Chars is so labile and their inhabitants so isolated from the mainland and its essential services.

Next stop a mother and baby nutrition and education programme funded by CARE www.careinternational.org.uk

As a dad to three beautiful children I go easily gaga over babies, so our meeting with 8 mums and their little ones was no exception.  One baby, who I guess was about 4 months old, really stole the show!  These mums said just how much their babies’ nutrition and development had benefitted from the programme.  The mums seemed full of the joys and hopes of motherhood, all wanting a better life for their children – I think that with their determination and resourcefulness it will come. Am beginning to realise that the future destiny of the majority of the people in this country is poorly supported by a government that, in the main, is AWOL.  Sure their resourcefulness, resilience, warmth, and pride will see them through. 

Back to the mini-bus driven by someone who looked no older than 12 and drove not much better!  Long bumpy, crazy, nerve jangling trip to Bogra where we checked in to the hotel, grabbed a quick bite to eat before heading out to visit a CARE and Danone supported education programme.  They knew we were coming and put on a show involving flowers, tree planting, and plaques.  Sorry to say that this pomp and ceremony gave a false impression and clouded a decent project.  Still, I notched up two more firsts of receiving flowers and planting a tree all in a day’s work.  And I thought you had to be a Major or related to royalty to get to plant trees as acknowledgement of your status.  Wish they’d just spent the money on the school kids. 

 As the final handfuls of soil were being dutifully pressed in to place around the newly planted mango trees the skies darkened and the wind picked up – a storm was heading straight for us.  Our local guides urged us to QUICKLY head back to our transport to get us back to Bogra.  One wrong turn, torrents of rain and force 10 winds later we were now stranded by a fallen tree blocking the road home.  This transpired to be the first of many trees brought down by the storm.  I now got to witness the police way of working at first hand. 

While waiting for the storm to subside a truck-load of police arrived at the scene of the fallen tree, to which I assumed they’d coordinate the removal of the tree so that traffic could flow again.  How wrong I was.  They firmly stayed inside the truck and all the locals stood round staring longingly at the tree but without moving a single leaf.  What was going on?! Found out that the government owns the trees alongside the roads and to stop locals chopping them down for fire wood there is a law that forbids locals from cutting the government trees. 

The police were now waiting for an unsuspecting local to set an axe or saw upon the fallen tree so that they could exert their ‘tax’!  Only the intervention of the local NGO Director who put in a call to his relative, a government official, convinced the police to let the locals move the tree.  Given the go-ahead the locals made short work of the tree.  All along the drive home I saw people carrying away fallen branches for fire wood and cutting up whole trees (while the police weren’t checking!) to be sold to wood merchants. Living under such grinding poverty the gift of free wood was not to be missed. 

All of a sudden our transport ground to a halt.  The cause was quickly traced to a broken water pump.  With no AA to call, we waited an hour for replacement transport. I was grateful to make it back to the hotel, my bed and sleep to the all too familiar honk of car horns.

Not everything that can be counted counts and not everything that counts can be counted

Back in Dhaka and now able to catch-up on the last few days ….. 

With GO’s arrival following a short unscheduled hold-up in Dhaka Immigration, our team was now at full strength.  And after three days in the field with our local colleague, Rumana, and the agency staff, Lucky, Shuley and Adnan our team had grown in numbers and ability and was now unstoppable.

Being asked how much I weigh is not something I’ve experienced when booking a flight.  Our flight today was not normal… Saturday morning and we were to take the Mission Aviation Fellowship www.mafbangladesh.org/ 08:30 flight from Dhaka domestic to an expanse of water in northern Bangladesh in an 8 seat sea-plane.  So now I understood why weight mattered so much! 

Having eaten a few too many pies in my time, it transpired that flying with our luggage would have tipped us over the weight limit so our luggage went ahead by mini-bus while we flew. Apart from the lack of an in-flight movie, the flight, particularly landing on water, was an amazing experience. Curiously, there was no announcement that in the event of (crash) landing on water that the escape slides are to be used as a life-rafts.    

First stop the Emirates Friendship Hospital run by Friendship www.friendship-bd.org/

Runa Khan, CEO and Founder of Friendship accompanied our visit, and it was a great pleasure to see the interaction between her, the staff and the people they serve - the amount of respect flowing between them was enourmous.  It was a total privilege to spend this time with her, hearing of Friendship’s work and her personal journey.  It left me with the impression that I’d be in the presence of a truly inspirational and great person. 

Our visit took in the hospital ship that provides an impressive array of clinical services to the remotest of communities who don’t even have a fixed shop let alone a fully equipped hospital. 

We talked with many of the patients who had received life-changing treatment, for free. For these extremely poor and remote people, such treatments are just not available, nor affordable. Harrowingly, three were young girls who had extensive burns to their legs due to their sari catching light from the open fires that are used for cooking. A simple modification to enclose the fires was being tested, and if successful should reduce the incidence of needless burn victims.   

Next by ambulance boat to nearby Chars http://www.banglapedia.org/httpdocs/HT/C_0135.HTM to visit nutrition, health and education programmes. 

Without needing to count and just by looking around me and listening to the people I got a great impression of the effectiveness of these integrated programmes.

The school children were fab, so full of the zest of life and so curious to know about me. 

And for the first time ever I was sung to (three times!) while at work.  This trip has already notched up many firsts for me. 

Spent the night in a house-boat moored next to the hospital ship. Mother nature put on a wonderful show of lightning, thunder and heavy rain.  After getting drenched stood out in the rain it was time for bed, with sleep quickly induced by the gentle rocking of the boat.  The lack of car horns honking was a total treat. 

Rural development

Yesterday we headed outside of Dhaka to visit two villages in Brahmanbaria district to speak with people who have been part of a Save the Children project targeting personal hygiene and sanitation standards (http://multimedia.savethechildren.org/corporate/glaxosmithkline-to-improve-childrens-health.html) and Grameen Bank micro-financing for women (http://www.grameen-info.org/).  

Our driver, kept alert by chewing betel nut, expertly (and manically) negotiated numerous near-miss head-on collisions with people, animals, rickshaws, CDGs, cars, buses and most frightening of all trucks.  Sat in the passenger seat it was one hell of a white knuckle ride!  Still, it seems to be the way of the road here, and our driver was a master of ‘on the edge of your seat’ driving style.  Have so far declined his offer to have a go at driving the minibus!

 

On route we made an unplanned visit to a rice processing factory where we saw ghost like women workers in the most dusty and noisy of conditions. Somewhat reminiscent of scenes from the industrial revolution.

Once the road ran out, the rest of our journey by boat was more relaxed. 

Our boat pictured above was a little less crowded and a bit more stable than others we saw…

Alex and I prepared best we could for the interviews ahead, but soon realised we’d just have to go with the flow, and the questions thought up back in the comfort of the office were soon discarded.       

The local villages are built on raised areas to minimise the risk of flooding during the rainy season, when each village becomes an island, a “safe haven” from the waters that now surround and isolate each village from the mainland.   

All the villagers we spoke with feared the inevitable rainy season and the hardship it brings for 3-4 months every year. Even accessing the most basic of healthcare is extremely challenging during this period when many people, inparticular children, become ill.   

Interestingly, we only got to speak with women during our time in the villages, despite the fact there were plenty of men in the crowd around us.  It seems this is due to the gender difference that views personal hygiene and sanitation issues as women’s issues. All the women were amazingly proud and open with us. 

It was quite a challenge to work in the heat of the day.  I’d never appreciated the effect the heat has on ability to concentrate and take notes for long periods.  Between Alex, our interpreter and me we captured an amazing amount of rich information. 

Everywhere we went we quickly attracted crowds of curious people - we were the day’s entertainment!  

Our final group of 8 women who had taken out micro-finance loans to start their own business ventures were quite inspirational.  For some the loan allowed them to generate enough income to now provide two meals a day for their families and sometimes have a little left to spend on their children. Yet for others, and inparticular those that depended on a good harvest from their agricultural business, the loan hadn’t improved their economic position. In some cases the women had to take additional loans to pay off existing loans.  For the majority the ability to access money at a relatively cheap rate was positive, yet this was not unanimous. 

From these women and others we spoke with there was as a sense of empowerment and willingness to master their own destiny, but this was not true all.  Am none the wiser on the role that local men have or want to play in the future development of these communities. 

Back to Dhaka after an even more death defying night-time drive on roads filled with all manner of vehicles without lights.  Thankfully our driver was well awake and seemingly eager to get home as evidenced by how quickly he drove.

Today, Friday is a day of rest in Bangladesh. Time to take stock and recharge before our team mate GO, arrives from London tonight. We have a lot to catch-up on before leaving Dhaka tomorrow morning to travel to the far north of Bangladesh by seaplane.  

Now it really begins

So I fell asleep to the sound of car horns blaring and woke to the very same sound this morning.  Dhaka city is an incredible assault on the senses - full of life, bewildering sights, cacophony of sounds and unusual smells, all baked in oven-like temperatures.

And death defying way to paint the outside of your building!

Some of the stuff around  is familiar, but so much is alien that it defines a culture shock.  And this is only the beginning.  But still what an experience today was. 

Our day began in the Local Operating Company about 1km from the hotel, that took nearly half an hour to drive - yes I know we should have walked!  For the locals, talking about the state of the traffic is the same as a Brit talking about the weather, so true to local form I will intersperse this blog with regular traffic reports. 

We were greeted by Rumana, our super-efficient and well connected local host, who as with everyone else was most welcoming.  After a short introductory meeting and impromptu brain-storming session, lunch was served, after which we headed to our first meeting with the beneficiaries of a charitable hospital called Gonoshasthaya (www.gkbd.org).  We saw two groups, first the women and then the men.  All were very open with their healthcare needs, concerns and hopes.  All said that their and their families’ health was better due to the services available at the hospital, and for less money than it would cost elsewhere.  Not very scientific or quantifiable but these ‘measures’ of success are real to them. 

Next stop Gonoshasthayahospital itself. 

I’m not a fan of visiting hospitals in the UK as generally it means a trip to A&E for one of my sons who got injured “play” wrestling his brother!  In many ways this hospital was familiar, from reception, to people waiting inline for treatment, to wards and to recognisable ’departments’.  Our host was so incredibly proud of the work they do providing healthcare to the poorest people in Dhaka, irrespective of ability to pay.  We were shown a great example of innovation in the form of a project of mobile clinics designed to carry the hospital to the people.  What they lacked for in modern equipment they more than made up for in their overriding focus on the people they serve.

Once more back into the now even slower moving and more hectic traffic to make it back to our hotel.  Head is spinning with what I have experienced today and trying to make sense of what it means for our project.  So much to think about. 

Tomorrow is an early start for a trip outside Dhaka.  Bed now to the familiar sound of car horns.                   

On our way

Due to Alex’s organisational prowess and with able support from GO, we, the SocROI team (minus GO who travels later this week) are finally on our way to Bangladesh.  I write this, my first blog-effort (so excuse any faux pas), from Dubai airport while waiting for the flight to Dhaka.  It seems very much as if all the planning is done and our trip is now in the hands of the plan and what ever will come our way during the next 10 days. 

Having been on many business trips before, this one feels so very different.  For once I have no powerpoint presentation to give or conference to attend and no familiar haunts to visit. This time it is all about getting to know the frontline - tasting, smelling and feeling the country, and for as far as is possible ‘being with them’. 

One thing in common with previous business trips is that I miss my loving family. Good news is that the thought of them keeps me going.  William, Daniel and Phoebe for their curiosity of all things, constant challenge and the heaps of fun, laughter and love they bring to my life.  Melanie for her lust for life, for keeping our family on track, and as with our children, the heaps of fun, laughter and love she brings to my life. I am indeed a lucky man.     

I feel an overwhelming sense of responsibility to take something from this trip, other than Bangladesh belly, that will be a vital ingredient in our project and its legacy.  Even without having yet witnessed first-hand the enormous amount of good that my company can do in a country like Bangladesh, I know that this project is too important to fail. For me there surely will be sights and sounds that will change me and my outlook on life - for the better I’m sure.

Just time to down some more caffeine to keep the lack of sleep at bay, before the flight to Dhaka.