Making Well-being Affordable

Sabrina F. Ahmed

Shushasthya Clinic treats three to four thousand cases a year, many of its patients women and children.

I walk into the room and find them sprawled on the sofas, half-dead with exhaustion. After a whole day of performing surgeries, I wasn't surprised. Herbert Cooke, affectionately called 'Herb Abdur Raauf' by his friends in Bangladesh, was sleepily grumbling, "I don't want to see another fistula!” Sharon Greene-Golden smiled at the confusion on my face and proceeded to explain what her team-mate was talking about. This was my second meeting with the eight-member surgical team from the US, here on a little over a week-long mission to provide free surgery to the underprivileged. The trip is just another jewel in the cap for a little-known NGO, but managed by a dedicated band of committed people that goes by the name of Shushasthya.

The concept of Shushasthya began a little over a decade and a half ago when a group of expatriate Bangladeshi physicians realised that they weren't satisfied with simply sending money home to be spent on health-related development projects; they wanted more accountability of how the funds were spent. They decided to collaborate on a project to alleviate the basic health problems of underprivileged Bangalis who cannot afford healthcare. In the words of Dr Ajmal Sobhan, “We also decided that there would be strict guidelines for the salaried staff physicians regarding time spent with the patient (15 minutes per patient) as well as cleanliness and personal hygiene within the premises. We also wanted immunisation/ preventive medicine /and reproductive medicine and education to be part and parcel of the care given.”

This vision was realised when 16 expat Bangladeshi physicians formed the core group and put in the initial funding to establish an organisation called 'Project Bangladesh'. This organisation is a tax-exempt, charitable organisation registered with the Internal Revenue Service (IRS) of the US government. At the same time, they formed a sister organisation in Bangladesh called Shushasthya, which became the name of the clinic and a registered NGO in Bangladesh.

The group in Dhaka draws from a more diverse pool of expertise, consisting of professionals, technocrats, retired army officers and university professors, and interestingly, most are alumni of the St. Gregory's school. Like the group in the US, the Dhaka wing of the project is dedicated in a voluntary, non-salaried basis to providing health care to the needy.

Shushasthya works in the health sector caring for those who cannot afford the services of physicians, and have little access to basic medical facilities.

The founding members of Shushasthya had decided from its very beginning that patients who visit its clinic should receive at least 15 minutes of a physician's attention. This has been followed strictly. The clinic treats some 3-4 thousand cases a year. Many, if not most, of their patients are women and children, and so, keeping the needs of the female patients in mind, Shushasthya acquired the services of a lady doctor, to give the female patients a sense of comfort.

Shushasthya's founders had decided from the clinic's inception that every patient should receive at least 15 minutes of a physician's time.

The illnesses that are diagnosed by the physicians generally tend to be basic and uncomplicated. According to the statistics, based on the clinic's medical records, most of them relate to the respiratory and digestive system and the skin. Colds, fevers, skin and helminthes infections are very common, as are a number of gynaecological and obstetric disorders. Shushasthya was set up precisely to provide primary health care to address these problems.

A careful record on each patient is maintained for future reference. The record includes the diagnosis of the illness and the medication prescribed, besides other personal information. Many patients visit the clinic more than once and the record helps the physician to assist the patient better. Over the years Shushasthya has built up an invaluable volume of epidemiological data.

In order that attending physicians may be able to diagnose illnesses more precisely, laboratory tests are carried out in the clinic when they are required. These include routine blood and urine tests, blood grouping and pregnancy tests. Blood grouping has become an important factor for patients to know in case of transfusion and it is heartening to know that they understand it. Vidal tests are performed to diagnose cases suspected of having typhoid. After typhoid, rheumatic fever is the next highest illness tested for.

In addition to the tests above, the laboratory also carries out some 10 biochemical tests. These are for blood sugar, bilirubin, cholesterol, lipids, triglycerides, urea, creatinine and uric acid. Aside from this, ECG tests are performed on patients suspected of having cardiovascular diseases. It should be noted that most of the diagnostic tests performed at Shushasthya are done for free, while there is a minimal charge for the others, to bear the costs of the reagents. Till the last estimation, the laboratory has performed some 12,000 routine and biochemical tests.

If one ponders over the performance of the clinic it is remarkable that a small team with a small budget can give so much service. The team is a dedicated band of three physicians, one laboratory technologist and five support staff. They work in the evening six days a week and in the morning three days. The doctors diagnose common illnesses, offer medical advice and, if necessary, refer patients to hospitals, while the laboratory technologist is at hand to perform the needed tests.

Shushasthya actively participates in the Dhaka Municipality's Zone 4 immunisation programmes. In doing so it assists the government to immunise the nation's expectant mothers and children free of cost. Shushasthya receives its vaccines from the Government of Bangladesh and UNICEF. Every Tuesday is set aside for the vaccination of expectant (and some non-expectant) mothers and children. The mothers are vaccinated against tetanus and children against diphtheria and pertussis, polio, measles, tetanus and tuberculosis. Polio is administered orally.

Shushasthya provides health care for those who cannot afford the services of physicians and have little access to basic medical facilities.

Being a member of the Zone 4 Municipality Area Shushasthya also participates in the National Immunisation Days in order to make people aware of the needs of immunisation. The slogan of the NID is "Polio Free Bangladesh" and children are given the polio vaccine. Shushasthya is listed under Ward 27 of the Dhaka Municipal Corporation's Zone 4 where children can be vaccinated against polio.

The clinic also distributes Vitamin A capsules, which it receives from the government mostly among the children.

This year, the clinic collaborated with Society for Assistance to Hearing Impaired Children (SAHIC) to host an the Shushasthya team managed to work around the turbulence. Waking up early, commuting via ambulance, they managed to stick to their itinerary, and managed to achieve everything they had hoped for.

Shushasthya lacking its own surgical facilities, the US team performed their operations at the Salauddin Clinic, BIRDEM, Ibrahim Cardiac Hospital and a local hospital at Bhoirab. Around roughly the same time, the UK team, consisting of two doctors and a nurse, worked side by side with the medical officers at the Shushasthya Clinic for a period of three weeks, treating cases.

Just what impact has Shushasthya had on the populace of Bashabho, where the clinic is located? Natalie Tucker, a film student from the UK, has been filming a documentary on the organisation's activities for the past three weeks, interviewing the staff, physicians, and patients alike. “They (Shushasthya) are very dedicated, and take their work very seriously. The reaction of the patients shows how popular and important this clinic is for them.”

Rahima (42), a housewife who lives in Bashabho, confirms this estimation by saying “I have been a regular patient at Shushasthya for over seven years now. I come here whenever I have a health problem, and the people here are very friendly and helpful, and the best part is, I can afford it.”

Munir (36) a driver, says, “I was very ill one time, and needed to get some tests done. I ran from lab to lab and spent some Tk 1,600 on tests alone, but no one could tell me exactly what was wrong with me. Then my employer sent me to Shushasthya, and I had the tests done for free. The doctor here diagnosed my problem and prescribed some medicine and I've never felt better!”

The significant majority of the funding for Shushasthya comes from Project Bangladesh, approximately 20,000 USD per annum. Funding also comes from local donors and from international organisations such as the Canadian International Development Agency (CIDA).

Shushasthya doesn't issue medicines, save for when they receive it in the form of donations. For the past couple of years they've been receiving medical supplies from UK through the efforts of Dr Sheila Webb from an organisation in the name and style of Dig Deep for Bangladesh. Dr Webb had been privileged to be invited, as guests of Professor, Lord McColl of Dulwich, to the House of Lords (Houses of Parliament, Westminster, London) to be presented with a large donation of in-date medicines (surplus to UK requirements) and this donation was presented to Shushasthya. The contents were estimated (by the World Health Organisation) to be adequate for the average needs of 1000 people for a year and they consist of antibiotics, anti-fungals, anti helminthes, vitamins, a variety of creams and other medications, etc. The surgical teams from the US had also brought in medicines, which went to the needy for free.

The immediate concern is to acquire land of its own to set up a hospital with a minimum of 200-500 beds and modern facilities to accommodate patients who can afford on a nominal charge to keep the hospital alive through its own earnings. In the words of Dr. Ajmal Sobhan, “We want to expand the services rendered at Shushasthya as well as to replicate the Shushasthya model in other outlying bustee population areas.”

Natalie Tucker adds, “Shushasthya has reached the point where they can do no better, given the resources they have. They are extremely popular in their area, and they are providing great care, but it's time for them to refocus, expand their services and maybe acquire their own surgical facilities, and do some more community work.”

As for problems, the biggest one is for space. The popularity of the services rendered by the clinic means that it experiences a lot more patients than it can comfortably accommodate. Lt. Col Aziz Ahmad (retd) says, “The idea of a completely free surgical facility (during the surgical missions from abroad) was arrested as we had to depend on local clinics and hospitals for the service of the Operating table. The medical team charges were for free. My intention to highlight this point is because if we had a hospital facility of our own, we could have given our patients the entire care for free. For this we need the support of philanthropic people and organisations, who could come up with help to make this materialise! Furthermore, the lab facilities had been purchased through a donation by CIDA and have begun to show signs of ageing. We would highly be benefited by a replacement. Please be informed that our lab-test results had drawn recognition from all (locals and foreigners).”

Here's hoping they are able to overcome their obstacles and continue with their noble effort in helping the needy.

Copyright (R) thedailystar.net 2006