Bangladesh

By Markus Leenen

Friday, April 11th, 2008

On Monday, a huge bulldozer close to our office in Dhaka attracted my attention. My first association was that probably a big road-building project starts somewhere around here. In the neighbourhood, there is a small slum, where people live in adverse circumstances. In this part of the world, it is nothing special – you barely notice it. However, when I wanted to catch some food, it stroke my eye – suddenly the huts were just gone. The government ordered the bulldozer I marvelled at the day before. It recultivated new building land out of the living space of about ten thousand people. When our staff member Belal told me that our cleaner, who comes once a week, lived there, a lot became clear to me. Before, I tried to communicate with her (each of us persistent in our own language). She just wanted to tell me about her current fate, while I thought it was about our dusty office. When I talked to our staff member Shabbir about the happenings, he told me that none of it was reported in the local newspapers or newscasts. Is it this common here or does the government cover it up? During the following days, diverse police and military units observed the persons, who freed their last belongings from the ruins.

Monday, April 12th, 2008

Today, we submitted all necessary documents to the authorities in order to gain a four-year project permission, the permission to bring foreign currencies into the country, and a work permit for a doctor and me. In total, we wrote about 40 pages in English, of which we had to submit nine copies. Bureaucracy at its best.

On April 14th, I had to return to Germany, because my tourist visa expired. The applications would be in the authorities’ pipeline for another while before my work visa could be issued. Five weeks later, on May 22nd, I was allowed to go back to Bangladesh. This time, I entered together with the doctor Prospero Tolete, a retired ophthalmologist and general practitioner from Berlin.

Thursday, June 26th, 2008

I have been back in Bangladesh for five weeks and a lot has already changed. Right now, there a two projects running simultaneously. First, we support the General Hospital in Khanjanpur / District Jypurhat. At the moment, the possibilities of the hospital are still limited. There is neither an emergency room nor an operating room, no possibility to examine stool or blood samples and no stationary care. A treatment is hardly possible under those conditions. In consultation with the hospital management, Cap Anamur drew up a list of about 60 different medicinal devices (from ultrasound scanner to operating light). We compared costs and qualities of different producers and dealers and will buy the devices in the next days. Apart from the medical equipment, we provide a sufficient amount of about 100 different pharmaceuticals, which are needed for diverse parts of the hospital. For this, some structural and small constructional measures are necessary.

Additionally, a nutrition programme is planned for malnourished children, who are supposed to be provided with a special dietary supplement once a week. About 50 % of all children under the age of five are malnourished here. In Bangladesh, there are so called “Health Care Worker”, who are sent by district administrations and local NGOs to the villages in order to explain common diseases to the general public. It is their main task to recognize those diseases and tell the persons where it is possible to be treated. Cap Anamur will organize free training sessions for those “Health Care Workers” here in Khanjanpur.

The ratio of citizens to doctors is about 1:5000 in Bangladesh – in Germany, there it is one doctor for 270 citizens. You can easily imagine how important an improvement of the existing medical circumstances is. The ironic twist to this statistic is that there is a legally required ratio in Bangladesh: 10 stationary patients max for three doctors and three nurses. A completely absurd demand, which not a single hospital in Bangladesh can fulfil. However, each clinic must pay a bribe money, because they cannot comply with this law. Officially, public hospitals treat their patients for free. In fact, those hospitals do not have the financial means to do so. Therefore, if patients want to be treated in a public hospital, they themselves have to pay for all material, all drugs, and the anaesthesia and so on.

For example, an appendectomy costs at least 120 euros. The average income is about 0,78 euro per day. There is hardly a person who can afford a health insurance and even among the high-income earners, health insurance is not very common. Regarding this project, I am very confident, because there is already a well-working infrastructure in the hospital and the eye clinic runs very well. Moreover, the paediatric nurse Frauke Esten from Germany will support us from August on.

The second project of Cap Anamur starts parallelly and involves the planning and building of a new school building for 160 to 200 pupils of the Pahananda School. The area is also in district Joypuhat and is managed by the mission. The new school building is constructed with a reinforced concrete skeleton structure. It will have a slightly tilted flat roof made of concrete. A big roof overhang will protect the classrooms from rain and sun. Flat roofs made of reinforced concrete are widely spread in public buildings and are more cost-effective than zinc sheet roofs. The top layer of a concrete roof consists of a very fine render, which protects the concrete from water and needs to be changed after 50 years. Wood as a building material is very hard to get here because Bangladesh has nearly no forests anymore and I would not use tropical timbers for construction. Additionally, the quality of the “ordinary” woods is pretty bad. The massive building construction will not easily be blown away by a tropical cyclone. However, before we start with constructing the schoolhouse, we need to build a 120 meters long sheet pile made of reinforced concrete and brickwork, in order to shield the here located village’s lake’s bank border from further erosion.

Every time I enter the construction site, a crowd of about thirty neighbours gathers within a few minutes. With so many spectators, it must be a good manual mixing… On Thursday, June 17th, 2018, the official construction start took place. Traditionally, the Imam as the religious head, the exile architect from Hamburg and the contractor tossed the first shovels of concrete into the foundations. Afterwards, there were sweets for the attending villagers and workers. Every time something new begins or if something special happens, the affected person has to provide the neighbourhood with sweets. In Asian societies, the community has a great interest in the fate of the individual.

Wednesday, July 2nd, 2008

The 120-meter-long bank reinforcement is nearly finished. Now, “only” the new school building is missing.