Interviews

For the past ten days, Arshadul and I conducted interviews of the traditional birth attendants throughout the region. Each day we visited a different village, interviewing three birth attendants, for a total of thirty-six interviews. The interviews were guided by a series of questions I had worked with the Berkeley team to develop and were conducted as casual conversations. They were recorded and will be transcribed and then translated into English later at ICDDR,B.

The birth attendants are, of course, remarkable women. They spoke passionately and confidently about their work. They range in age from twenty to seventy, and the older ones have commonly had eight or ten children themselves. They told stories of every order: new and old, funny and sad, relevant and not. We learned a tremendous amount about their understandings of their work, the misoprostol administration training and the misoprostol itself. I will spend the next week compiling our early impressions from the interviews and preparing the data for the more thorough analysis that will take place over the coming academic year.

Language

The official language of Bangladesh is Bangla, which is spoken throughout the entire country. There is tremendous pride in the Bangla language, tied to a mid-20th centry struggle with the former West Pakistan over what would be the national language. After obtaining independence, to commemorate the struggle for language and to honor Bangali culture, the government created the holiday Bangla Language Day, which is celebrated in a similar manner to how we celebrate our Fourth of July. I can communicate numbers up to one hundred, exchange fifteen or twenty pleasantries and order any food I want–but that is largely the extent.

English is the second most common language, spoken by well-educated adults and children and teenagers who have attended good school and learned English as a foreign language. While English is fairly common in Dhaka, it is quite rare in and around Lalmonirhat. My colleagues at ICDDR,B speak English as a requirement, and RDRS professionals do so to varying extents. The children all love to ask me “how are you?” They generally follow confidently and grinning with “I am fine” before I have a chance to ask.

Surveys

The main component of my research involves surveys administered to 450 birth attendants immediately before and immediately after receiving two days of training from ICDDR,B. That training addressed general best practices for the birth attendants, but focused on the proper administration of misoprostol. The pre-training survey characterized the background of each birth attendant, recording her age, marital status, reason for becoming a birth attendant, explanation for why she became a birth attendant and other demographic information. It then characterized her knowledge and practices–how often does she refer patients to a health facility, for what reasons does she refer patients to a health facility, does she know the signs of infection, what does she do when a patient is bleeding after birth? The post-training survey reassessed her knowledge and understanding of best practices and it also evaluated her understanding of the administration of misoprostol.

The surveys were waiting for me when I arrived. My job has been to sort out the different versions of the survey that were administered, create a data-entry template, enter the data, analyze the data and compile a summary report. At this point, I have finished entry and done a rudimentary analysis. I will expand my analysis and compile and submit a report to the team at Berkeley by the end of August.

Market

Arshadul took me to one of Lalmonirhat’s better markets today. We had gone to buy fish for dinner. The produce and its presentation were some of the most beautiful I have ever seen. And the variety was also impressive. Chickens can be purchased dead or alive, cleaned or not. Fish is very fresh (there is no refrigeration) and cleaned on the spot by vendors moving it over large, stationary knives. The delicious meal that Arshadul would proceed to cook for me consisted of rice, vegetables, a salmon-like fish and potatoes, was flavored with turmeric and cumin, and was accompanied by hot milk.

Daily Star

Each day I read Arshadul’s “Daily Star,” one of the major English newspapers from Dhaka. The press is very free, almost painfully presenting both sides of every issue. Centered around Dhaka, as is the whole country, it has a metro section, a domestic section and an international section. One hot topic has been India’s decision to move ahead with building a dam on one of Bangladesh’s major rivers upstream of Bangladesh. The damn would greatly reduce the availability of water used for irrigation in a large portion of the country. The international section, generally taken from international news sources rather than direct correspondence, does a very nice job of summarizing the world’s events in a few simple pages. As I can only imagine is the case in all newspapers, there has been much writing about Iran during the past week, and Michael Jackson made the front page.

Arshadul

I have become close friends with a Senior Health Trainer from RDRS. Arshadul Islam is about 30 years old, is married and has an infant daughter. He earned a master’s degree in social work (not his first choice, but the government testing and assignment system assigned him to that) and for the six years since graduating has been working for RDRS. He educates local health workers about best practices and ethics, coordinates RDRS TB, HIV and maternal health programs, and trains RDRS health staff for their work in the field. I eat dinner with him on many evenings, and he has shown me all around Lalmonirhat. He will likely assist me during the coming weeks in translation and logistics as I conduct interviews of birth attendants throughout the region.

Breakfast

Each morning it seems the omelet I have for breakfast is the best I have ever had. Hot off the wood-fire, it is cramed with onion, green chili and garlic and served with three pieces of fresh naan (flat bread) and a bowl of dhal (spicy soup).

The people who own and work this restaurant seem to be there all day—from six in the morning until midnight—every day. I am learning my numbers with them as I pay, and the meal is a pleasant opening to each day. It ends with a piping hot cup of delicious chai.

Rice fields

The main crop of Bangladesh is rice, although this is followed closely by jute and tea. Water management in the rice fields appears to be a very important task. The fields are all flooded by six inches or a foot of water, and the farmers go to great lengths to divide the flooded sections up by 3-foot walls of dirt in order to resist the flow of water and to have some control over it’s level. As the country is built on the silt deposited by the great rivers that flow through it, the farmland is incredibly fertile and every patch of it is a glowing green. Despite this, Bangladesh is still a net importer of food—even land this fertile, but only the size of Wisconsin, is not enough to meet the needs of 160 million.

Dr. Azmi

Dr. Azmi is my wonderful colleague with whom I share the ICDDR,B office at RDRS. She has a bachelor of medicine and a master of public health, and carries the designation Medical Officer at ICDDR,B. She reports directly to the Principal Investigator for the project, and she oversees the work of the six Field Research Supervisors in the region that maintain our relationships with the 600 birth attendants and 66 community health workers of RDRS. Dr. Azmi lives near me with her 8-year-old son Abid, but her husband, a physician specializing in neurology, lives in Dhaka. In six months she will return to Dhaka in order to begin work towards a PhD.

Monsoon season

When I first arrived, the temperature was an unceasing 90-100 degrees. Since then, the rains have begun, and most days are now cloudy and relatively cool. Although not yet as severe as I am told it will become, it rains about one third of the time. And when it rains, it rains very hard, with lots of thunder and lightening. The streeds are flooded deep. Interestingly, most Bangladeshis do not wear raincoats. Some carry umbrellas, but most either stay inside or stand under the metal awnings for as long as possible, and when they must, they just get wet.