New Updates

So as a few of you have noticed, I kind of "fell off the blogosphere."  Things got pretty crazy busy here.  Working in Bangladesh is definitely challenging, and it's probably the hardest thing I've ever done.  There's something hard every day, whether it's logistical, bureaucratic, a communication/language issue, or occasionally something related to the actual implementation of our project.

National level review

A lot has happened since the last time I wrote, so I'll try to recap.  First the work stuff.  As I may have mentioned, we are working on putting together a "toolkit" of communication resources for "frontline workers."  Basically what that means is that we collected and reviewed high quality communication resources, such as pamphlets, posters, TV spots, etc. that can facilitate communication and counseling between health providers and families.  These resources all focus on family planning, maternal and child health, and nutrition.

This lovely lady helps me with everything at DGFP

An example would be a poster or pamphlet which shows pictures representing the danger signs of pregnancy (e.g. hemorrhage, high fever, etc.) which would indicate a possible emergency complication, and the pregnant woman should be rushed to a health facility. 

Community Health Workers in the field reviewing a TV spot for contraceptive pills

We are packaging the best resources together in an electronic toolkit on small laptops that will be given to a few community health workers in two districts in Bangladesh.  After collecting over a hundred communication resources, we needed to review them to determine which ones are "best," so we conducted a two-phase review.  First, some of my colleagues at the national level government unit where I work reviewed the materials for accuracy and alignment with the national health strategies.

The whole team who helped in Dhamrai

Then we went to the field, and health workers who work directly with families both in the community and in facilities reviewed the rest of the materials for usefulness in their work.  Both phases were very challenging but rewarding when finished!

Now that we have all the best materials identified, we just have to get all the electronic versions and organize them into a toolkit.





We're also building eLearning courses and making a lot of progress and working with a local production company to make them into professional videos.  Although, it's been a lot of work, we have definitely come a long way in the last couple months.  Besides work, we've also had a lot of fun and travels, including trips to Thailand, the Sundarbans, and I even went home to the states for two weeks.  I'll write updates about the fun stuff soon.

I miss everyone at home so much, but I'm looking forward to being back soon.

Love,
Cassie

Exploring Nature in Downtown Dhaka

Peaceful spot at the zoo

This weekend, Kim and I decided to explore the Botanical Gardens and the Zoo in Dhaka.  Dhaka is a pretty crazy city with at-times overwhelming traffic, pollution, and overcrowding, so it's especially nice to find quiet, green, and beautiful spaces.  These kinds of attractions are also a lot less commercial than zoos and gardens at home.  Admission to the gardens cost about 6 cents, and admission to the zoo cost about 12 cents.  They are next door to one another.  I hope you enjoy the pictures!

Lily pad pond in Botanical Gardens

There were young couples canoodling in quiet corners of the botanical gardens and families having picnics on blankets in the zoo.  It's fun to see those customs that are present in almost every culture.  In the botanical gardens there were people fishing and young boys playing and showing off in a small lake. They were eager to demonstrate their swimming skills for us.

Children playing in a small lake in the Botanical Gardens

At the zoo, there was a surprisingly large variety of animals, and most seemed be treated relatively well.  The barriers between people and humans were totally different than what you would see in an American zoo (I actually watched a man hand a soda to a baboon through the wide set bars; to be fair, the baboon seemed to really enjoy it.); security in general here is just a completely different concept.  There was even a hippo munching on his food only a few inches from gate.  I could have reached through and petted him!  The picture below is not using any zoom at all on my camera.

Hippo at the zoo so close I could have touched his snout!

We even got to see a Bengal tiger napping in the shade.  When we go to the Sundarbans in the south of Bangladesh, we might even see them in the wild, but there are only a few hundred left in Bangladesh and only a few thousand in the world.  

I'll definitely be returning to the gardens.  It's such a peaceful and beautiful spot.

Napping Bengal Tiger

In other news, today and tomorrow are hartal days again, meaning we are not permitted to go anywhere by car or leave the neighborhood where we live.  The opposition party is stil missing one of their leaders, and there is definitely some political tension.  In my personal opinion, the hartals are damaging to the economy, the people, and the image of Bangladesh, so I hope they stop soon.  I don't think it will be anything to be concerned about as far as our safety; we're just watching the news and trying to be flexible!

Shuvo Naba Barsho!

Shuvo Naba Barsho!  Happy Bengali New Year!  Last weekend was the big New Year's Celebration.  Vanessa and I braved the crowds to get a look at what everything was about.  It's basically a big carnival (Bangladeshi style of course).  There was apparently also a parade, but we never made it that far through the crowds!  There were so many people it was pretty unbelievable.  The games and rides reminded me of festivals at home, but they definitely had their own local flavor.

Ring toss to win soap and cigarettes- the public health person in me was hoping everyone won soap, of course :-)

Throwing a ball to knock over 3 bottles of energy drink (you win the bottles if you knock them all over)

A semi-mobile concert in the middle of the street

Small wooden ferris wheel operated manually by a sweaty, shirtless man

Last week the preliminary data from the Bangladesh Demographic and Health Survey 2011 was released at a big event.  The data showed improvements in fertility and family planning, exclusive breastfeeding, and child health.  Nutrition and infant and young child feeding practices are still a major concern, and the percentage of children receiving Vitamin A supplements declined, but for the most part, the news was positive.  Bangladesh is one of not too many countries that is actually on track to meet some of it's Millennium Development Goals.  It's also positive for me and our team to be able to link health communication with the needs that still exist in Bangladesh.  Families who have access to coordinated and accurate health information can make better decisions with regards to family planning, nutrition, and delivery and child care, etc.  Our project is working to improve access to and use of health information by providing tools and resources to frontline health workers.  We'll be doing a pilot targeting a small number of health workers in distinct low-performing areas of the country.  Insha'Allah, our pilot will show that our approach is effective (at least in some ways) and we'll be able to scale it up to include more health workers in more parts of the country.

Today was a pretty slow day because unfortunately there was a nation-wide hartal, or strike, organized by the opposition party.  I won't go into the details, and I definitely don't understand all of them, but a government official with the opposition party was kidnapped, and his party has blamed the current government and is demanding his return.  Their primary tactic for getting attention seems to be calling a nation-wide strike in which they prevent transport of buses and private cars, so shops don't open and people can't travel.  The official was not found/released today, so the strike was also extended for tomorrow.  The strikes have very negatively affected an important workshop we had planned for today and tomorrow, but we're trying to make due by postponing and shortening it.  If you're interested, you can read more here: http://bdnews24.com/details.php?cid=3&id=222984&hb=top

It's been a while!

Hi everyone,

Sorry it's been so long since I've posted!  I've had a lot of distractions lately.  I met Darren in Barcelona for spring break the first week of April and am now catching back up with work.  Barcelona was simply amazing.  I have not traveled in Europe much, and it was Darren's first time, so it was a lot of fun exploring the city.  I took hundreds of pictures, but here are a few of my favorites.

Plaça de Catalunya

Beach!

Barcelona Cathedral

ICE BAR

Selection of Iberian Meats at Cerveceria Catalunya

At Nadal Vineyards in Vilafranca del Penedès

Park Güell

Park Güell 

Amazing Seafood Paella

Before I left for Barcelona, we went on a short field trip a couple hours outside of Dhaka to pretest a tool we developed.  There, we were able to talk directly with several health and family planning community workers and learn about the resources that are useful to them.

This week, I’ve been working on some activities to support journalists writing about public health issues in Bangladesh and focusing on eLearning courses for community health workers about family planning

This morning I ran an 8k charity run.  Teachers at the American International School of Dhaka organized a run the first Friday of every month, and each month the runners donate a few dollars to a charity.  This month, the run benefited the “Bangla-Dash,” an event in which two ex-pat teachers will run from Kolkata to Dhaka (291km) over 4 days to raise money for schools and education for poor Bangladesh children.  If you are interested in donating to this cause, I encourage you to do so on their website: http://www.bangla-dash.com/.

After the run, I was pretty tired and just had brunch and relaxed by the pool at the American club for most of the afternoon.  Tomorrow is the Bangla New Year, so I hope to share some pictures of art and festivities soon.

I hope all is well with you!  Talk to you soon!

Weekend in Old Dhaka

Vanessa and I went to Old Dhaka this weekend, which is, as its name suggests, the oldest part of the city.  It is crowded and chaotic with narrow streets that are only passable by rickshaw and bicycle, so our car and driver had to wait at the entrance to the market.  Old Dhaka is also where many of the city’s Hindus live.  We entered a small shop selling Shakha, which are white bracelets carved from conch shells.  Hindu women wear a pair of these bracelets, one on each wrist when they get married.  They symbolize the husband and wife.  The shopkeeper was the 5^th generation owner of his business.  He showed us the conch shells and how he carved the beautiful bracelets.  He was very sweet and asked us to share tea with him.  When we told him where we were headed next, he arranged a rickshaw to take us there.

Artist showing how he carves shakha from conch shells

Old Dhaka from a rickshaw

Next we went to the Armenian Church!  An Indian Hindu gave us a special tour even though the church was closed.  He showed us all over the church and its grounds, where several Armenians are buried.  Although there used to be more, there are only 9 Armenian families left in Bangladesh (that our guide new about, at least).  The church does not have regular services, but does have holiday services on Easter and Christmas.  The church was beautiful, and the grounds were like a peaceful oasis in the middle of busy Dhaka.  The groundskeeper introduced us to his wife and showed us pictures of his daughter who lives and works in Greece.  He insisted that we return soon to have dinner with him and his wife and his boss’s family.  Rumor has it, his wife makes an excellent mutton curry.

The gate to the Armenian Church

Armenian Church from inside the gate

From the second story inside the church

With our guide Shankar

Next we wanted to go to a famous mosque, but we had quite a hard time finding it or anyone who recognized its name, Sitara Mosque.  Finally while taking a break to drink some fresh coconut water straight from the coconut, we met a man who understood where we were trying to go and even escorted us to the mosque to ensure we would not get lost.  We couldn’t go in because the men were praying, but the mosque was beautiful, and now we know where to find it when we return.

Sitara Mosque

After working up quite an appetite, we went to a restaurant recommended by Lonely Planet.  They didn’t have menus because the only thing they served was chicken biryani, but it was excellent.  Two large plates of chicken biryani and a large water bottle cost us 250 bdt- just over $3.

We also saw some monkeys! Children were throwing them tomatoes.

After getting ridiculously lost on a rickshaw and asking half the town for directions, we finally found our way back to the market entrance where we had left our driver and headed home.  That night we met up with Kim at the American club for a beer in celebration of St. Patrick’s day.  For the first time since I’ve been here, it rained.  A torrential downpour soaked us in the short walk from the restaurant to the gate and transformed the roads home into small rivers.  It was just a glimpse into what the rainy season might look like.

Other highlights from the last week or two since I’ve posted include going to dinner at an excellent Korean restaurant with wonderful company, starting a Facebook page with the Government Unit I work with, and meeting several new people who are doing great work in health, nutrition, education, and research.  We are already starting to think about our next field visit as we start to plan more for our project.

Keep in touch!
Cassie

Field Trip to Gaibandha

Happy International Women’s Day!  Women’s health and women’s rights are so important to me, and I hope you enjoy reading about a couple programs that specifically focus on women.

Last weekend my colleagues and I went to rural Gaibandha in northern Bangladesh to observe two eHealth programs in action so that we could learn from their experiences and explore ways in which we can collaborate. 

The trip took about 8 hours on a long two-lane road in which our driver seemed to play “chicken” more times than I could count with oncoming buses and trucks so that we could pass any vehicle ahead of us.  It was a little nerve-wracking, but I am learning that that’s just how everyone drives here.  There were also some pretty interesting vehicles to watch that almost seemed to defy physics (also note that we are on the wrong side of the road here).

Gaibandha is absolutely beautiful.  There are rice fields as far as you can see on both sides of almost every road.  At this time of year, farmers have just planted and are now aggressively irrigating their fields.  Most fields actually have about an inch of water over the soil with vibrant green plants springing up.  

The vast majority of people in the area are farmers.  We saw a couple fields of wheat, corn, bananas, and hot chilies, but rice is the primary crop.  After the rice is harvested, it is heated over fire and then dried out on large tarps before being husked.  Planting, harvesting, and drying are done primarily by hand in Bangladesh, so the process is very labor intensive.

One program that we visited was the Mobile Alliance for Maternal Action (MAMA) initiative.  This program provides informational SMS and voice messages in Bangla to pregnant women and new moms, as well as their husbands, mothers-in-law and other decision makers in the family.  They receive one to two messages a week that are tailored to the week of pregnancy or the age of the child.  Messages remind moms and their families about what to expect during pregnancy, warning signs of complications, preparation for childbirth including where to go to deliver, healthy nutrition for mom and baby, breastfeeding, and other issues.  The program sends regular health information to families who may have limited access to clinics and providers.  Moms (like the one to the right) were able to recall messages they had heard and tell us about the resulting changes they made in their diet to improve nutrition.

The MAMA initiative is a great example of how mobile phones can help families stay healthy and be more prepared for pregnancy, childbirth, and caring for young children.  Below, a health worker registers an expecting couple for the MAMA messages. 

The other program that we visited was called Info Lady.  This program selects ambitious young women in their community and provides them with a laptop, Internet connection, speakers, a camera, some basic medical equipment, and a bicycle.  After a comprehensive training program, the women are prepared to go out into their community offering a variety of services.  They organize discussion groups with couples, mothers, adolescents, farmers, and other groups where the Info Ladies show relevant videos about health, agriculture, and other topics and then discuss and answer questions.  They can test for diabetes, monitor blood pressure and provide basic medical and emergency services. 

Info Ladies can also connect people in the community to physicians or other experts via webcam.  Info Ladies charge a fee for some of their services, so they are able to make a respectable salary, and the community is able to access useful information from the Info Lady herself and using her technology.

It was inspiring to meet several Info Ladies and observe their discussion groups in action.  One group was discussing and watching videos about safe motherhood and breastfeeding, and another was a group of young girls discussing adolescent health and HIV/AIDS. 

 

The benefits of this project are multifaceted.  The community is able to learn and discuss a variety of issues with a trained Info Lady, and they can also reach out beyond their community to learn from experts.  The Info Ladies themselves also benefit immensely.  They earn a good salary (the father of a young Info Lady confessed that his daughter made more money that he did), and they also gain invaluable skills in health, education, communication, and community mobilization, that will benefit their future careers.  All the Info Ladies we met were confident, empowered, and independent young women.  The program provides these impressive women with leadership experience and new opportunities, and they become great role models for other young women in their community.

Overall, it was a great trip.  Seeing programs in action and talking to the people who benefit from them reminds me why I’m here and why I have chosen this field.

First week and first accomplishments

Salaam alaikum!

This is my first full week in Bangladesh, and already it is very busy.

I really enjoy going to the DGFP IEM Unit to work.  I have a large office with lots of natural light, and the people are welcoming and hardworking.  I have learned in my short time there that ceremony is very important in the workplace.  Every morning when I arrive, I am expected put my belongings in my office and promptly visit the director of the unit in his office.  Most mornings he will instruct his assistant to bring tea and biscuits or sweets, and we will sit and chat as people are constantly flowing in an out of the office, having conversations in both Bangla and English.  Although these casual meetings sometimes feel like they take away from the work we need to do, I also know they are important for getting to know one another, building trust, and showing respect for the local customs.

On Saturday morning, the director and several officers were excited to show me pictures from their recent trip to India.  When I left Bangladesh after my previous visit, they had been frantically struggling to get visas to go for a conference, but it is very difficult for Bangladeshis to acquire Indian visas, due to a very high demand.  At the last minute, everyone was able to get visas and travel together.  It was clearly a very special opportunity for them.

According to our project, we are to provide “technical assistance” to the government of Bangladesh; I am learning that that assistance may be a bit broader than I previously thought.  One morning this week, the director brought in his brand new iPad and asked me to help him set up a wireless network from his laptop and USB modem and connect the iPad to the new network.  It was a fun and challenging task, even if it was a bit outside of my official job description, and, after a few Youtube videos and trials and errors, I got everything working.  I felt very technologically skilled.

My major task for this week was working with my unit to publish this month's eNewsletter.  There is a big effort to move towards a “Digital Bangladesh” and now that family planning officers around the country have access to email, we are able to publish an online newsletter to share the activities, accomplishments, and lessons learned from DGFP projects across the country.  With each edition of the newsletter, staff at DGFP take more responsibility and need less help from Kim and me.  

On Tuesday, I spent a couple hours working with two employees.  I taught them how to take the newsletter stories listed in a word document and copy and paste the text into an online template.  These employees had minimal experience with computers, so we started with how to highlight text and then copy and paste.  However, after only an hour or two, they were not only growing much more confident, but they also wanted to know more about how the newsletter template and client worked.  The editor has a series of buttons on top similar to Microsoft Office to format text, such as bullets, bold, italics, and even inserting pictures and text anchors.  They wanted to know what every single button did, even if they knew they wouldn't need to use it for the task at hand.  They seemed to really enjoy the lesson and said they wanted to learn and help more.  That was by far the highlight of my week.  By orienting these young employees to basic computer functions, I hope that I am genuinely building their capacity and increasing their potential and confidence.

I am very excited for this weekend because we are going on a field visit.  Although it seems I am already “in the field,” we will be leaving the capital city and going to Gaibandha District in northern Bangladesh.  We will see two projects operating in rural areas and spend some time with community health workers who work directly with families.  My next post will talk more about our field visit and hopefully include some more interesting photos.  

Currently I am in a very urban area.  This picture below shows the very commercial area of Gulshan-2 with huge buildings and copious advertisements.  That said, it is still not uncommon to see goats, sheep, and cows grazing on the side of large busy roads or in the middle of cricket fields between games.  Both pictures were taken within walking distance of my apartment.

I hope all is well with everyone at home.  Contact me via Skype at cassie.mickish.

First Days

It is my third day in Bangladesh, and I am finally sitting down to write a blog post. I have already been very busy, but today is the weekend, so I can relax a little bit. I arrived Wednesday morning at 4am, and Vanessa, a friend and colleague, picked me up at the Dhaka airport. I moved through customs with no problems since I had already gotten a visa, and waited nervously for my bags for about an hour, while swatting mosquitoes and chatting with a friendly Bangladeshi Canadian. Finally everything arrived, and we left for my new flat with our personal driver. Having your own driver is common and almost a necessity in Dhaka because the traffic is so crazy. It often takes almost an hour to go only a few kilometers, and the drivers are so aggressive. Rickshaws, auto-rickshaws (CNGs), motorcycles, and cars all battle for space amidst a sea of horns.

During my first two days at work, I went to several meetings and got to see several people whom I had met during my last visit in October. The people at the Information, Education and Motivation (IEM) Unit of the Directorate General of Family Planning, where I’ll be working most of the time, are particularly friendly and hard working people. In my experience so far, all Bangladeshis have been so caring and hospitable towards me and other foreign guests. They are always ready to help, whether recommending a place to buy forgotten necessities or giving you an all out tour of the city. Their hospitality definitely makes me think about the way we treat foreign visitors in the US.

We also met with a couple people working on a Hopkins research project in rural Bangladesh, one of whom was a former classmate of mine at JHSPH! They shared their research about the barriers to accessing medical care during obstetric emergencies with us and several members of government. It was very interesting to learn that in Bangladesh there is a belief that strong women are able to endure the pain of childbirth and deliver in their home with their relatives; seeking care at a hospital or from a trained nurse or doctor is seen as weak and shameful. Although the number of women delivering with a professionally trained birth attendant has increased over the past few years, about 85% of women still deliver at home in rural areas. It is important to consider that providing additional services and doctors may not be enough to encourage women and their families to go to a hospital for delivery; there also must be a change in the social and cultural norms.

I’ve been having a lot of fun here already. I’m living with Vanessa until we find another apartment, but it’s been great having someone to laugh and hang out with while I’m still adjusting. Since there was no work today, we decided to do some shopping and exploring. Vanessa introduced me to a store with beautiful clothing made with natural dyes and modern, unique decorations. I think I might be spending a lot of money there! These pictures are from the store:

We got groceries, passport photos, and a new hair dryer because I managed to simultaneously destroy a Bangladeshi outlet and an American hairdryer on my second day. We also stopped by the pearl shop I went to during my last trip, and the same jeweler remembered me. I think Nazrul and I will always be friends.


In the same area a young boy was selling parrots, rabbits, and puppies on a rickshaw cart. We saw an adorable puppy that Vanessa wanted to bring home. It looked like it needed a loving family.

  

After a delicious (and very spicy) lunch of daal and chicken tikka, we headed back home. Tonight, we’ll be meeting Kim for Thai food.  I am having a wonderful time so far.  I love the people and the food and the work that I’ll be doing. I’ll continue to take pictures and write more soon.