Dhaka Health Project
CSI rents a 5 room office/flat in Monipuripara, Dhaka for running its health project. It is the ground floor of a 4 story apartment building. The building is old, but in fairly good condition. The streets are about 16 feet wide in front of the building. Sometimes the sewer drains get plugged up, so at times, we have to be careful about stepping into “puddles”. The CSI clinic/office is about a 15 minute walk from the CSI House (about 0.4 mile). Walking to the clinic means navigating busy sidewalks and streets. Occasionally the streets are so jammed, that it is even hard to walk.
Two church sisters live in a room of the flat and help with managing patient’s, which includes cleaning the office/flat, cooking two meals a day for the patients that are staying the night at the clinic, educating patients on clinic policy, helping take care of the babies, etc. Babies that are in Dhaka for Cleft Palate or Lip repair can stay at the clinic in a large communal room. The sisters also cook Wednesday lunch for the missionaries. This lunch is eaten in the clinic/office room at the table. The baby’s mother or female caregiver is allowed to stay with them. The communal room is about 18 foot x 12 foot and has a small cabinet for supplies and 4 double sized metal beds with hard mattresses. There is an adjoining bathroom. We can keep up to four sets of patients at a time, but there are times when up to six sets have stayed at a time. This is rare and most times, only one or two sets of patients are staying at a given time.
On the way to the clinic, on a busy sidewalk, a poor lady lives under a tarp. She sells flowers that are spread on top of a pallet. There is a fruit shop that sells all sorts of fruit; apples, bananas, mangos, pineapples, dates, oranges, melons, jackfruit (looks like an oblong hedge apple, but about 4-5 times the size), grapes, pomegranates, coconuts, lichu (looks like a strawberry, but the skin is peeled off to eat it), etc. Close to the fruit shop, there are several cigarette vendors. They sell cigarettes and plain tobacco leaves from a table. Many people smoke, so they usually are always busy. There is also a tea and biscuit vendor at the corner of the street.
The buildings in Monipuripara average about 6 story’s tall, which lets in more sunlight than some other areas of Dhaka. It is estimated that there are around 2.5 million buildings in Dhaka and many of those are over 4 story’s tall.
The office/clinic is a 18 foot x 12 foot room that opens onto a 3 foot x 30 foot patio. The gate into the apartment is about 2 feet wide. There are windows on two sides of the room. The patio is covered, which allows patients to wait in a comfortable, albeit small, place. There is one ceiling fan, and two wall-mounted fans in the room. Surprisingly, it does not get too hot, due to being well-shaded by taller buildings on all sides. But there are days when we all sweat a lot, especially if the power goes out, which happens at least twice a week. On the far side of the room, there is a 12 foot x 7 foot tall cabinet. Medicine, powdered milk and various other supplies are stored in this cabinet. The doctor sits behind a table opposite the cabinet in the corner of the room. In the middle of the room, in front of the cabinet, a desk is placed. The project director and the nurse sit at this desk. We have a weight scale, BP cuff, stethoscope and thermometer for patient assessment. The doctor is the one that assesses the patient. The nurse does not take BP or temperature. Once the doctor is ready to see patients, she calls out the number and the patient comes in and sits down on a chair at the table. The doctor assesses the patient and writes prescriptions accordingly. Most patients come in with mild complaints, like back aches, headaches, knee pain, itching, fungal skin infections, eye problems, and of course, cleft palate/lip, etc. Some come asking for financial assistance for major medical problems such as surgeries, medical supplies, medicine, etc. Once the doctor is finished seeing the patient, the patient record is given to the project director and assistance is given, if applicable. We keep a small stock of about 100 different medications; antibiotics, anti-fungal creams, cough meds, Tylenol, BP meds, a few cardiac meds, diabetes meds, a few anti-psychotics, vitamins, lice cream, de-worming medicine, etc. The policy is to usually allow the patient’s to come every other month and if they are poor to supply them with 1 months’ supply of medication. They are then supposed to buy the second months’ supply themselves. If the patient is pregnant, has Cerebral Palsy or other serious chronic diseases, or has cancer, we allow them to come once a month. In these cases, we will give either all of their required medications, or give them a 20 day supply once a month, depending on circumstances (if they are poor, we help them more). Most meds are sold in packs of ten, so this means they have to buy one strip of their medications. This is called making the patient’s put skin in the game... If they come asking for assistance with medical bills, we try to help some. Especially if we sense that they are poor. If it is a serious problem, we may give them up to 12,000 Bangladeshi taka (or roughly $118 USD). We usually only give money to those that have proper cash receipts or memos from the doctor or hospital.
We also stock powdered milk and baby formula. We usually only give this to malnourished children and/or cleft palate/lip babies and children. If budget allows, we like to give each cleft palate/lip baby up to 12 boxes (500 grams) of formula once per month. Sometimes this is possible, but sometimes there are so many babies, we can only give 6- 8 boxes of formula. We try to prioritize giving to those who are underweight, which usually means the mother/father are too poor to buy formula.
When we arrive at 9:45 am on clinic days, there are usually several patients waiting in line. They are each given a numbered card. Most patients are courteous and are honest about who is first. We usually see 20-30 patients in 3 hour period. We operate 10:00 am to 1:00 pm on Sunday, Monday, and Tuesday.
There are many poor people in Bangladesh, which consequently means that we cannot help everyone, but we try to do our part.
Jared Regehr
May 2023