Cover Story

Taking Care of Banchharampur's Health

Shamim Ahsan

Health care in Bangladesh is in a shambles. While the well off minority can afford to get some degree of care, that too not always the best, the poor have to grapple with low quality health services that are often out of reach. In the rural areas it is much worse where getting hold of even an MBBS doctor can be quite a challenge. Conditions of the upazila health complexes established to take health services to the poor rural people are in a pitiful state. Absence of doctors, unusable essential medical equipment and or lack of medicine have turned most of them into deserted places. More people die from lack of treatment than bad treatment in these rural areas. In the midst of this desperate situation five courageous brothers have set up a clean (till now at least), well-equipped, charitable hospital in their village home to give quality care to people and and with the hope that their endeavour will be replicated by others.

As the rickshaw stops at the hospital gate Ratan Saha quickly gets down from it and starts putting on the panjabi that is placed across his shoulder. "We were in such a hurry that I did not have time to put on it," Ratan, a 56 year old farmer, confesses shyly. Saha hurriedly pays off the fare and then vanishes into the hospital. His daughter-in-law keeps sitting on the rickshaw and on her lap lies 6-year old Rubel. Rubel's eyes are half shut and in his struggle to breath he is panting. "He has fever for some days, but we thought it would go away. But since last night he has been vomiting and this morning he cannot even breath properly," the worried mother relates as she keeps a folded newspaper a few inches above Rubel's face to save him from the scorching May sun. Soon Saha returns with a wheel chair and Rubel is wheeled off to the hospital.

Looking at the brand new, shiny, three-storied hospital building it is difficult to believe that it is actually situated in a remote village named Rupasdi, under Banchharampur Thana in Brahmanmaria district. An otherwise nondescript village, Rupasdi has become famous all over the upazilla for the Mahbubur Rahman Memorial Hospital which has brought hope and well being to thousands of people.

The interior of the hospital is even more impressive. The spacious reception area has a sitting arrangement for some 30 people. On one side are the doctors' chambers and on the other a pathology lab. The pathology lab is air conditioned and equipped with state-of-the-art machinery. "They are brand new and of the latest model. You won't see them in most of the hospitals and clinics in Dhaka," claims Atikur Rahman, Managing Director of the hospital as well as one of the five brothers who extablished this hospital..

On one side of the second floor are a few cabins shared by four to six patients. On the other is the operation theatre, which too is well equipped. A large OT light shines on the OT bed. In a corner stands a steriliser used to cleanse the tools for operation. Everything is spotless. Facilities for ultra sonogram, X-ray and other tests are also available and trained people are there to conduct them. "You will find such medical equipment only in the most expensive clinics and hospitals in Dhaka," says a technician at the pathology lab, who has worked in a number of clinics in Dhaka. The residential doctors corroborate the claim. "I have not come across such modern instruments in Barisal Medical College Hospital, neither in any other hospitals and clinic where I have worked," says Nilratan Sarkar, one of the six residential doctors.

Specialist physicians are also available to provide specialised treatment at Mahbubur Rahman Memorial Hospital

The Mahbubur Rahman Memorial Hospital in this remote village has been a blessing for the poor villagers who have little or no access to any kind of health service. Only a month ago most of the several lakh people of Banchharampur Thana had to either depend on the village Kabiraj (quack) or pani-pora (blessed water) from the Hujur of the neighbouring village. And only when the patient's condition got really bad, villagers would go to the upazilla health complex in Banchharampur. The few better off would rush to Narsingdi the nearest district town, about 30 km away from Banchharampur or even go as far as Dhaka. But for the overwhelming majority access to quality health service was next to nothing. Now with this modern hospital in the middle of Rupasdi, health care for thousands of people is only a rickshaw ride away.

The urgency of a hospital in this remote place is evident by the number of patients the hospital receives every day. "It has been just a month, many people do not even know about it, but still we are receiving about a hundred patients each day almost from the very beginning," says Shafiqur Rahman, the second of the five brothers. The hospital is a charitable organisation and treatment is provided at a subsidised price. "One has to buy a Tk 20 ticket to consult a doctor. We have six MBBS doctors who are available 24-hours a day," he says. He then points to the three-storied building just behind the hospital which serves as living quarters for the doctors. Along with the doctors' quarters, there is also a four-room tin-roofed house for the six nurses, Rahman informs. And to ensure uninterrupted power supply, a generator has also been placed within the hospital complex.

Nurses are always around to take care of the patients	The medicine shop inside the hospital is open round the clock

Significantly, the hospital is very well kept and carefully maintained. The floors and walls are neat and clean. The toilets with mosaic floors and running water are also quite clean. A cleaner is seen sweeping the floors every hour. The stairs are spacious. Healthy distance has been maintained between beds in the general wards. There is a verandah and large windows to allow for cross ventilation.

In addition, the hospital arranges visits from specialists three days a week. On Fridays six specialists including two medicine doctors, one paediatrician and a skin specialist come to the hospital to deal with specific ailments. On Sundays an eye specialist and on Thursday a gynaecologist are also at the hospital to provide specilised treatment. They are all well-known physicians of the country, Rahman says. However one has to buy a Tk 200 ticket to visit a specialist.

It's a Friday morning. The spacious reception room is filled to the brim. One would think that the TK 200 ticket reserved for consultation with a specialist would deter most patients who are generally quite poor. But the large turnout clearly indicates that these patients find it worth it to save up for this visit. Alamgir, a part time farmer and part time rickshawpuller has brought his cousin Saiful to the hospital. Saiful, sitting next to him readily pulls up his lungi to show a nasty wound in the lower part of his leg. Five to six months ago he got injured by a piece of broken glass left on the road. For the last two months or so the wound started to get worse and at one point Saiful was forced to leave his work, Alamgir narrates. "We were thinking of taking him to Dhaka, and then we heard of this hospital from one of our neighbours and so I have brought him here today," Alamgir relates.

Alamgir and Saiful have come from a village called Nabinagar about 2 km away from Rupasdi where this hospital is situated. "We just hired a rickshaw for Tk 20 and it took us a little over one hour and we are here. Apart from conveyance I have to buy a ticket for just Tk 200 and that's it. But if I had to go to Dhaka I would have to spend Tk 300 only to go to Dhaka, and then there are thousands of other difficulties like getting the right doctor, admitting the patient if needed, arranging my or Saiful's relatives' lodging, spending for food etc. If I get proper treatment here I would be saving thousands of takas," Alamgir shows the logic.

The hospital is equipped with the state-of-the-run medical instruments and trained technicians

The hospital has been a great relief especially for mothers to be. The absence of proper medical facilities and sometimes social taboos have made many women dependent on the traditional and untrained midwives (dai). Without modern facilities and proper training in basic obstetrics many babies and mothers die of birth-related complications. Mahbub Memorial hospital would certainly help reduce the number of such deaths at least in this area. In fact the hospital is receiving a large number of delivery cases. The women ward on the first floor has six mothers with their newborns. Ranu's husband Majid Mian, who runs a tailoring shop at a local market says he came to visit the hospital about two weeks back learning from his neighbour that this was 'a great hospital'. "So when the pain became acute I did not hesitate to bring her here immediately," Majid relates. Shamsher Ali, a carpenter who lives in a neighbouring village, Fordabad, learnt the tough way. "I called Sona Dai when I was going to have my first child. But something went wrong and the child was born dead. Doctors believe the child could have been saved if they had taken help from qualified doctors. I decided right then that I would take her to Narsingdi the next time," Ali says sadly. When the time came for the second baby to be born there was Mahbub Memorial and Ali did not have to take his wife all the way to Narsingdi.

"Two things are most difficult to get by in this country -- one dispensation of justice and the other getting good medical care," Mujibar Rahman, the eldest of the five Rahman brothers who have worked hard and spent generously to make this hospital a reality, says a former deputy secretary Mujibar Rahman says he and more precisely all his brothers have inherited this desire to do something for the poor from their parents. "We have heard my great grand father, who was a close friend of Dhaka's Nabab Salimullah, was a philanthrope and we have seen my parents especially my mother help the destitute with her moderate capacity. Now, when we had the capability we established the hospital," Mujbar explains.

Patients' relatives have queued up to buy tickets for visiting the doctor

The five Rahman brothers- Mujibar, Shafiqur, Mirzanur, Atikur and Mostafizur Rahman own Rahman Knit Garment Ltd in Narayanganj. Helping the poor is not something they started with this hospital. In the past too they have donated cows, built houses and arranged jobs for the villagers in the garment factory.

The Rahman brothers have many more plans centring their dream project. They are planning to separate the outdoor, set up facilities for dental treatment, arrange for an

Atikur Rahman, Managing Director of Mahbubur Rahman Memorial Hospital

ambulance, appoint more doctors and nurses, upgrading the existing 65-beds to 100. "We have set up the hospital to serve the poor and have spent around seven and a half crore. At present we are providing subsidy and will continue to do so for say six months. But after that we want to turn it into a no-profit, no-loss organisation. We are not seeking anybody's help, but if one comes forward and helps us we won't mind," says Mujibar.

Mujibar says the hospital is already earning about 70 percent of its total expenditure and if we can sustain and improve our service we will very soon be able to turn it into a self-sustainable organisation. About any possible government support Mujibar says the best the government can do is construct the road that connects Rupasdi with Banchharampur, which is in a really bad shape. Patients have to come braving this terrible journey. (In fact the very day this writer was visiting the hospital a residential doctor of the hospital got injured when the cab carrying him fell into a road-side ditch.) "An ambulance will also be quite handy. It's tough on our part to buy one at this moment, so if the government donates one it will be a great service for the people", Mujibar adds. One particular problem the brothers are facing is that the doctors are reluctant to stay in this remote village. "Even nurses do not want to stay here. We are paying them twice or even more to keep them here," Shafiqur laments.

Mahbub Memorial Hospital can be a great example and inspiration for scores of other wealthy people to come forward with such charitable enterprises. Mujibar also has similar hopes. If even a small portion of the rich people built hospitals in their respective native villages giving the entire population access to quality healthy services would not be so difficult, as it seems now.

Copyright (R) thedailystar.net 2006