INDEPENDENT UNIVERSITY, BANGLADESH (IUB)

LFE REPORT
COURSE NAME: LIVE IN A FIELD EXPERIENCE
COURSE ID: LFE 201
Venue: PROSHIKA HRDC, MANIKGANJ



REPORT TOPIC: HEALTH AND MEDICAL SERVICES

SUBMITTED BY:
NAME: MAHTAB MURSHED
ID NO: 0920615
SUMMER 2012
Group No-09




Acknowledgement



First of all I want to say, we are very delightful to have a special
program (Live in a Live in Field Experience) in our university, which is a
very enjoying, thoughtful and unique course in I ndependent University,
Bangladesh (I UB). We are very grateful to I UB for giving as such a practical
experience of the rural life of Bangladesh through the LFE. I really
appreciate the host organization Proshika HRDC, Manikganj for giving us
such an opportunity to explore the area and for helping and guiding us
throughout the course and to for the support of accommodation, food
facilities, and security. My special regard goes to Mr. Latiful khabir and Mr.
AFM Mainul Ahsan who have supported us and helped us all the way
through and took care of all the problems faced by us during the program
.Special thanks go to the LFE monitors Rakibul Hasan (Technichal), Shahin
Pramanik (Technical), Mahira (Regular) and Moinul Karim (Regular) they
were also very cooperative and helpful. All of them have guided us
throughout the course session to achieve our success in collecting the data.







Table of Contents

Section Contents Page No
1.0

Introduction 3
1.1 Objectives 3
1.2 Limitations 4
1.3 Procedure and Methodology

4
2.0 Working Area

5
2.1 The district Manikganj 5
2.2 Proshika HRDC

6
3.0 Health and Medical Services

8
3.1 Introduction 8
3.2 Findings 8
3.3 Resources 9
3.4 Diseases and Health Care Services

12
4.0 Village Doctor

13
4.1 Profile of village doctor 13
4.2 Interview review 13
5.0 Upazilla Health Complex, Manikganj

15
5.1 Condition and Services
References
16
16
6.0 Conclusion

17
References 19
APPENDIX 20







1.0 Introduction

The terms Health and Medical services are interrelated to each other and increasingly
central to our lives. Bangladesh is a land of hard working souls and the major population of
this nation dwells in the rural areas. LFE has been designed to provide a brief knowledge
over the living structure and social and economic and also the health condition of the rural
areas of Bangladesh. The awareness about health and Medical services are increasing day by
day. Like other countries, Bangladesh has a strong commitment to address the health and
Medical services issues. Attempts have been made here in this chapter to figure out the
population, health and medical service conditions of Purba Para, Golora, Manikganj. A major
aim of this report is to formulate the policy-response for achieving development for the
village in our point of concerns the health and Medical services. In the past years, the
health and Medical service problems were treated separately. But this Trend has changed in
the recent years. In most cases, population is seen as an aggregate of Consuming units and
putting stress increasingly on the natural resources leads to Environmental degradation. This
is why there had been many attempts to explore the interrelationship between population,
health and medical services at all conceptual and organization Levels. In reality the inter-
relationship between population, health and medical services is more Complex and multi-
dimensional. Human beings are not always consumers, they are also Producers and some
time they are conservators of nature and environment. The quality and Quantity of the
population of a country have inevitable interaction with its natural resources And
environment. Considering a field study on a certain village I was required to acquire a rough
knowledge about the condition of the people living in the rural areas all over Bangladesh
since the assumption is that the villages of Bangladesh are almost alike. Out of around 93000
villages we studied only one village in Manikganj district. The economy of Bangladesh is
mostly dependent on the contribution of these villagers and though the air of technology and
advancement is blowing over the whole nation we cannot think Bangladesh without villages.
Golora, This village is almost like the other villages all around Bangladesh and learning
about the village to project a scenario of the major population of Bangladesh was my main
objective.



1.1 Objectives

To reflect the state of health, immunization and medical facilities available in the
village.
To visualize the different types of health problems according the villagers.
The name of the common diseases in the area.
To capture the differences of villagers in their health conditions and concept.
The types of health facilities the villagers are getting.
The NGOs operation in the village regarding development of the villagers health care
facilities.
To get the real picture of the present environmental condition of the village, like
source of water supply toilet facilities and kind of fuel they used.
To learn the overall condition of the village and its people.
To explore the socio economic condition and lifestyle and the way of managing the
resources.
To unearth the distance and psychological factors of the villagers that drive them to
lead a different life from the urban dwellers.
To explore the health issues of the certain residents.
To find the medical support they are having in their village.
To find the financial condition of them for their medical support.


1.2 Limitations


The LFE is a very short term research based course where we need to find various valuable
informations about the society we are researching. So the validity of the information
provided remains susceptible to errors. Lack of human resource and shortage of time does not
permit full disclosure of the informations extracted and lack of proper guideline and
condensed questionnaire may lead to wrong information collected as verification of the
collected data is quite impossible within this time. Our survey time was in the morning. At
that time most of the males were out of their house for work and the females were not being
able to provide information properly due to lack of knowledge and were reluctant to speak
with us about their problems.


1.3 Methodology and Procedure


This research work had been done on our internet based cell phone. This survey was
conducted by Real time data. We took data from household members then straight away we
sent our data in the server via Cell phone. We used unique House hold Id for every single
family. To gather all the information I also used some people as tools and self-observation
and estimates of different demographic tools and also interviewed the related persons. Simple
random sampling was the main focus. Qualitative & quantitative data were well thought-out
to analyze this study. To assemble information on community resources, literacy, and
community development programs, health worker, village doctor, Upozilla Health complex
information we did straight way interview. Moreover dispensary and the service of a village
doctor have been done through different observational techniques and open end questions.
Sample notes and on spot handouts have been used to collect information all through the
coursework.


PROCEDURE:
By collecting identity of households.
Collecting data by using questionnaire survey from household members.
Giving collected data as input in IUB internet based mobile website (man.iub.org)
Finding the inside of health condition of the villagers.
By checking the available health care center.
Summarizing the data.


2.0 Working area


A total of twenty five groups of two persons took place in the LFE summer 2012 program
held at Proshika, Manikganj. I worked at the middle of the Golora village which is known
and golora moddho para and Golora purba Para. The Area we surveyed was consisting of
approximately 2 square kilometers east and middle of the land. I also went to the Koitta
bazaar which is the nearest bazaar of Golora to take further information about the village
doctor and other related topics. Not only this I also deployed my best effort to collect the
necessary information from the residents of Golora. I have also communicated with the
visitors to this place. I aslo went to the Manikganj Upazilla Health complex and had an
interview with the medical officer in charge of the health complex.

2.1 Manikganj Overview

Manikganj District (DHAKA division) with an area of 1378.99 sq km, is bounded by TANGAIL
district on the north, DHAKA district on the east, FARIDPUR and Dhaka districts on the south,
the PADMA, JAMUNA and the districts of PABNA and RAJBARI on the west. Annual temperature:
maximum 36C and minimum 12.7C; annual rainfall 2376 mm. Main rivers are the Padma,
Jamuna, Dhaleshwari, Ichamati and Kaliganga. An extensive area of the district especially
riverine area of the upazilas of Harirampur, Shivalaya and Daulatpur become victims of
riverbank erosion every year. Manikganj (Town) consists of 9 wards and 49 mahallas. The
area of the town is 20.59 sq km. It has a population of 53161; male 51.16% and female
48.84%; density of population is 2582. Literacy rate among the town people is 49.9%.
Administration of Manikganj subdivision was established in 1845 and was turned into a
district in 1984. It consists of 1 municipality, 7 upazilas, 65 union parishads, 1357 mouzas, 9
wards, 49 mahallas and 1647 villages. The upazilas are MANIKGANJ SADAR, SINGAIR,
SHIVALAYA, SATURIA, HARIRAMPUR, GHIOR and DAULATPUR. Main occupations Agriculture
37.96%, fishing 1.87%, agricultural laborer 22.25%, wage labourer 3.92%, industry 1.15%,
and commerce 11.97%, construction 1.03%, service 8.43%. Transport 1.76% and others
9.66%.
Source : Internet






2.2 Proshika HRDC







The name Proshika is a Bengali acronym made of initials of three words: Proshikhan
(training), Shiksa (development education) and Kaj (action). Since its inception as a
Bangladesh non-government development organization in 1976, Proshikas aim has been to
create a self-reliant development process among the rural poor by extending support for
getting themselves
organized, becoming critically conscious of their situation and making united and collective
efforts to improve their socioeconomic condition. The promotional organization of the rural
poor
is recognized as the core activity of Proshika "Before you profess, practice yourself". With
this principle PROSHIKA began the Research and Demonstration Project at its Human
Resource Development Centre (HRDC) at Koitta, Manikganj, to develop more sustainable
and productive technologies, management practices and production methods that it asks
others to follow. The objective thus has been to measure the possibility of success and the
risk involved in technologies before they are handed over to the poor group members so that
they do not face any financial debacle later. Besides, the group members theoretical
knowledge acquired from various training programmes needs to be complemented with
practical skills. Otherwise, expected results cannot be achieved.






Currently, the RDP at Golora has the following components:

(a) Ecological Agriculture.
(b) Livestock (Dairy Farm; Poultry Parent Farm and Poultry Hatchery.
(c) Fisheries Farm.
(d) Shrimp Hatchery.
(e) Pest and Natural Enemy Interaction in Low Input Rice Cropping System.
(f) Sericulture (Silkworm Stock Rearing, Silk Reeling, Silk Weaving).
(g) Plant Tissue Culture.
(h) Iron Removal Plant.
(i) Bio-gas Project.



3.0 Health and Health Service


3.1 Introduction


The objective of the study was to find out the health condition of the village and take a fair
idea.
The health position of different age groups and medical services available was the main focus
of my study. Moreover I tried to find out the impact of industrialization on the environment
and whether it has any adverse effect or not. What is the villagers attitude towards their
surroundings and their initiative to preserve the natural beauty was also part of our study.



3.2 Findings


Area masque Golora Modhaya para

Present health condition of Golora village is comparatively quite good. People are much more
aware than before and they are self-driven to remain healthy by consuming good and keeping
their surroundings neat and clean. The roles of NGOs have been a major factor in creating
this awareness. People are also very aware of the environmental issues and are trying to keep
their surroundings clean to avoid the dispersion of various diseases. But the village is lacking
the fruit trees it used to have and the plantation of Eucalyptus has been a dominating culture
now a days which is the only flaw found about the environmental condition of this village.
But one most interesting fact was that most of the household people surveyed were in very
sound health position however those who were ill were suffering severely and helpless in
getting any type of support. The survey questionnaires will serve better to understand the
overall health condition and environment of the village.



3.3 Resources


Water resources and their utilities:

Water no doubt one of the most essential elements of environment and also important for life
and living. Bangladesh is an over-populated country with its demand for its basic
requirements increasing in an unconditional way. As the population is increasing, the demand
for water is also increasing for various activities. Water is a crucial feature for civilization.
Water is used for domestic purpose like drinking, bathing, cooking, washing etc.






Tabular Analysis:


Table: Type of Water resource and their utilities
Source: LFE Field Survey, summer 2012

Analysis:
Its good news to know that the household members of Golora Purba and Madhya para are
properly awarded of safe drinking water. They know that tube well water is safe from every
kind of pollution. They also use tube well water for their other house hold purposes like
washing, cooking and bathing. Although they are little bit anxious about arsenic because
arsenic test is not done in this village.

The sanitation facilities:
Sanitation is one of the most important aspects of the environment. The awareness for better
and cleaner sanitation facilities required for better living is absent in the mind of the people
living in the rural parts of the country in proper format to be executed by all. In other words
we can say that, we can find a moderate awareness of sanitation among village people. Thus
the villagers awareness is the consequence of the efforts from the Government and as well as
NGOs and the health workers. The improved sanitation system has contributed well in
avoiding the sickness and maintaining the environmental and personal Hygiene.
Tabular Analysis:

Types No of house Percentage
Ring slab 09 75%
Hanging latrine 01 8.3%
Septic tank 01 8.3%
Pit latrine 01 8.3%
Table: Types of toilets uses by villagers
Source: LFE Field Survey, summer 2012
Use of tube well
water
No. of Household Percentage
Drinking 12 100%
Bathing 12 100%
Washing 12 100%
Cooking 12 100%


Analysis:
In our fact finding about toilet facility used by villagers we found that, eight percent of
families are using pit latrine that is not a good hygienic system. Seventy-five percent of
families are using Ring slab. Only few of them are using septic tank. After analyzing all the
data I find that urbanization reached to the village. The villagers should avoid open toilets
and welcome septic tank base toilets instead of pit and hanging toilet. Otherwise germs of
disease will get vote to spread.
Waste disposal:


Waste disposal may create a major impact in the environment, health and medical services.
The wastes those are disposed right outside the household may pollute the near atmosphere
and may result in contagious diseases around the area. Although disposal of waste is harmful
to the atmosphere, it may be also be disposed in a certain place, which rather helps the
society as a whole.
Tabular Analysis:

Way of dumping No of household percentage
In a whole beside
the house
09 75%
In the nearby ditch 01 8%
In a specific place 02 17%
No specific place - -
Table: Places of dumping
Source: LFE Field Survey, summer 2012
Analysis:
We got a good figure of disposal of waste in our survey households. We got actually twelve
families responses and among nine of them use fixed hole method which is In a whole beside
the house and the rest dump wastages at In the nearby ditch. All should use fixed place to
dispose their daily wastes. It saves the environment from further pollution. This rotten waste
mixed soil can be used as fertilizer for plants. When the household disposals are thrown in
the cultivable lands, it rather helps the land by increasing its productivity. On the other hand,
the best way to get rid of the disposals is to bury it under the surface. The proper disposition
of leftovers helps us for our better living, this concept in the minds of all is very important
because everybody should be well aware of their cleaner environment.

Types of fuel use for cooking:
To survive people need to eat, to eat people need food, to get food people need to cook and to
cook people need fuel. This fuel can be of many forms as they are used in different parts of
the world according to facility and availability theyve got.



Tabular Analysis:

Types of fuel No of families Percentage
Kerosene - -
Fire wood 12 100%
Leaves and twig - -
Gas - -
Cow dung - -
Straw - -
Table: Types of fuel use for cooking
Source: LFE Field Survey, summer 2012


Analysis:
In a developing country like Bangladesh, more than 80% of the total population still lives in
the rural areas where there are scarcity of resources and overall people are constrained of
using the proper fuel that are friendlier to the worlds environment for mainly two reasons,
either it is that they are unaware of the fact or else they dont have the capital. The main fuels
for cooking purposes used by the people in the country are cow dung, leaves, twigs and
straws. In our study village it was observed that the person uses a variety of fuel types for
their cooking purposes. It is seen that, the major portion of the households relies more on
Leaves and twig. Some of them are also using cow dung and straw for fuel purposes. Smoke
has been created by using this type of fuel resources for cooking. Thus the environmental
atmosphere harm by burning fuel gases. That also affects human, children and trees. Because
of fuel crisis in village sometimes the villagers chopped down trees which create a great harm
to our nature and overall atmosphere.

3.4 Diseases and Health Care Services



Major diseases are seldom in this area but people who are facing stomach disease, asthma,
fever, sometimes chronic fever or other serious diseases are due to their bad habits like
smoking or other bad habits. Normal cold and seasonal flu are prevailing among both
children and adults. But certainly this negligible cold and flu causes serious problems when it
comes to overlooking them. And in this village since people do not consult to a doctor
properly for various reasons, they suffer from various diseases as they grow older. The health
care facility in this village is also very poor. As the private clinics are too expensive to afford
for this low income group, they find their way cure in the local pharmacies. The village is
quite free of superstitions and unlike other village it is free from the dominance of local
priests in curing diseases. Response of the villagers towards the public health care service in
the village Golora there is no registered doctor, so the people have to go to Koitta Bazaar
bus stand to see the village doctor which is 2 km away from the village or Manikganj sadar
hospital. The main problem found is the lack of transportation facilities. The direct route to
the sadar hospital from the village is almost 10-12 km. But there is an alternative way which
is almost inaccessible for a patient to follow. The villagers are very happy with their village
doctor Shorol Chandra Sharkar. This doctor is very dedicated person and tries his best to give
the service .So they are very happy with the doctor. There is a big problem that there is
lacking of medicine. If any patient prescribes by another doctor with a high antibiotic then the
patient will not be able to get the medicine from the local pharmacy. The costs of the
medicines are slightly higher than Dhaka. I asked to the doctor that why they are taking the
excess money from the villagers, he said me the place is far from Dhaka. The suppliers are
charging little bit high for the transportation cost. So they need to sell this in slight high price.



4.0 VILLAGE DOCTOR


4.1 Profile of the village doctor


This is the interview session with the village doctor by me and my group partner on 28
th
April
2012 summary:

Interviewer: Mahtab Murshed & Tanzim Lopa (Group#09)
Interviewee: Mr. Shorol Chandra Sharkar
Designation: Village Doctor (short medicine and paramedic course)
Location : Shorol Pharmacy, Koitta Bazaar, Koitta, Manikganj



Interview session of Mr. Shorol Chandra Sharkar

Shorol Chandra Sharkar is a village doctor and he is 35 years old. He is giving medical
service to the villagers for about last 10 years. He passed his SSC and HSC from a
government school and college. He is from the science group. After passing is HSC he took
some training on village medical studies from Dhaka and Manikganj Sadar hospital. He took
RMP and LLMP course from the hospital. He can give primary medical treatment. But he
cannot give the treatment for chronic and severe diseases. He can only give the medicine
which is not very dangerous.
Shorol Chandra Sharkar has a dispensary of his own. After finishing the course from Dhaka
and Manikganj he started to serve the people through his dispensary at Koitta Bazaar, Koitta
Manikganj. He is always available there. Shorol Chandra Sharkar can prescribe medicine. He
can inject the saline, provide first aid, and also can stitch the cuts. He is well reputed as a
doctor according to the villagers. He is serving the people of Golora village, Burundi village,
Dhankora union and some other place. In his dispensary he invites MBBS Doctors to see
patients. He charges the patients a very negligible amount. He tries to sell the medicine in a
very cheap rate. Shorol Chandra Sharkar is very happy with his service. From his child hood
he wanted to help the people. He thought that there are many ways to help people but to give
the health service is the easiest way to come to the people and help them. Providing the health
service is the best practice to help mankind. Shorol Chandra Sharkar also said that he tries his
best to give the best treatment to the patient. He doesnt charge any visiting fee from the
patient; he takes only the medicine price. Moreover when he visits the people outside on his
personal bike he does not charge for his fuel cost. He said that he want to give them a good
service .He is feeling very happy whenever the patient is getting cured. He said he never
gives doubtful treatment to his patient. If he cannot give the treatment or if he does not know
then he refers the patient to the hospital. He also gives time to consult with them if they want
to go in the hospital or in Dhaka to see any specialist for the particular problem. He helps
them to select the best doctor. Shorol Chandra Sharkar wants to give the very best service to
the village people. But he said he needs More important courses to develop his expertise. He
also said that if he can get more courses then he will be swifter on his work. By the higher
course he will also be able to know about the antibiotic medicinal function. He also suggests
that if the government also starts some free training for the village doctors that will be more
fruitful for them. By these courses they will be able to give better services to the people of the
village and people would not have to go to the hospitals in Dhaka, additionally they can get
service in very cheap rate and the patients will no more be harassed. As his future planning he
wants to take more courses on rural medical treatment. He wants to learn about the
orthopedic working because in his area lots of people get injured working in the field.
Sometimes they are get injured by falling from the trees. So if he can get the training that
how to make plaster then it will be quite easy to make plaster to the injured people. So thats
why e wants at least 1-2 years course on the relative fields. He wants to expand his
dispensary. He wants to take some emergency medicine to his dispensary for example, in that
area there is only 3 pharmacies but none of them keep inhalers for the patient who are
suffering for asthma. There is also no nebulizer for the baby who is suffering from
pneumonia. If he can get more training on the village medical works then he can expand his
dispensary and provide better service. In the long run he wants to establish a hospital for the
poor people in his village.













5.0 Upazilla Health Complex, Manikganj




The Sadar Upazilla Hospital of Manikganj was established with 100 bed. Now it contains 150
bed. Each and every day the hospital gets more than 300 patients. Its located at Manikganj
sadar. For more information we interviewed the civil surgeon of the hospital and also we
interviewed the pathologist of the hospital.



5.1 Condition and Services



Picture:Mr. Shiddheshar Mazumdar (civil surgeon, Manikganj sadar hospital)

Acording to the interview of Mr. Shiddheshar Mazumdar, the hospital gets paiteints from all
over the Manikganj, which covers our research area Golora of Saturiya. Mr. Shiddheshar
Mazumdar discussed a lot of things about the present situation of the hospital. This hospital
has not enough resource, Doctors, Instruments, and Beds for the patients. To cover the
situation they use the time shift theorem and peoples are using the hospital floor as their bed.
Which is not healthy and against the hospital rule, as the people need service them cannot
deny it.


Recommendations


As per my observation in Golora village, Manikganj I noticed a lot of diversity among the
people. I spoke very responsibly with the villagers as well as the chairman. I discussed with
them about the facilities provided by the village doctor and the health worker. Especially the
village doctor comes at the first call of a patient. He always tries to give his best effort to cure
the patient. But I want to give some recommendation for the village doctor:




village medical course

for the village doctors


en try to test any treatment without the proper knowledge





For the villagers:


ers have to be respectful to their village doctor



nt to take to the doctor


For Upazilla hospital:

They should extend their beds (Seats).
They should appoint more doctors.
They should be more careful about patients condition.

For the local authority:


rainy season it is getting more muddy and slippery.


e village because there is no community clinic
s to develop the village doctors



6.0 Conclusion



The topic of my report was health and medical services. Medical services has now been
accepted as the key issue for the rural and country progress and development. Survival of the
world and as well as the human race, directly depending upon environment and the natures
existence. Future of Bangladesh also lies in environmental and rural development efforts
specially on the health condition of dwellers. Health and medical services concerns all and an
effective solution of related problems can never be worked out unless everybody is involved
in such a task. As the ultimate aim of all human activities is to improve the quality of life and
ensure a safe and sustainable future for mankind, it is imperative that all sources and
resources are harnessed towards these ends. This will be possible only when everybody is
aware of the depth and dimension of the problem and spontaneously participates in the
process of health and medical services, conservation and rural development. The country
inherited a system of health care with preference for curative services over preventive
activities since last couple of decade and more stress has been given to recognize the health
service to provide comprehensive primary health care to the people of villages which are yet
to be achieved. Despite sound infrastructure the health care service remain out of reach of the
majority people. The primary reasons, believe experts, was the governments lack of
commitment. Allocation for the health care service sector has never been a priority.

But it is hopeful to know that the government has made tremendous strides in the area of
health care & family planning in the last two decades. The endeavor have reduced mortality
rate to a significant proportion & have attained success in the family planning sector. But still
it has a long way to go towards proving health care to every individual and to ensure it for the
people of the remotest parts of the country. Only then it will emerge as a healthy nation and
many of its problems relating to the improvements of the economic structure will be
dispelled. The agricultural & industrial production will boost & the country will proceed
towards attaining financial emancipation breaking all chains, which previously cursed the
lives of our ancestors.








Reference & sources



Shorol Chandra Sharkar
Village Doctor, Koitta Bazaar (Referred to Golora village)

Asma Begum
Student, Golora

mia
Shopkeeper, Koitta, Bazaar.


Villager, Golora Village


Health worker
Gonoshsatho


Fruit Seller
Nayadingi Bazaar ,Manikganj


Carpenter, Golora

Ashar Alo kindergarten school (Students and Teachers)
Golora, Manikganj

Manikganj


APPENDIX

House Holds details covered by (Group#09)
Done by: Mahtab Murshed
ID: 0920615
Sl. No. House hold head Name House hold ID


0001
12001
Md. Owaz uddin Abdul Hashem


0005
12005
MD. YOUSUF MD. SOBHAN MOLLAH


0010
12010
MOJIBUL MOLLAH LATE SIRAJ MOLLAH


0015
12015
MD. BAIZID CHUNNU MIA


0020
12020
ALI HOSSAIN DORBESH ALI


0023
12023
MOJJAFOR MD. DORBESH ALI


0030
12030
SONA MIA SHEIKH GOPAL


0035
12035
MD. ALI AFTAB UDDIN


0040
12040
ABDUL SALAM MD. OWAJED


0043
12043
ALI HOSSAIN KAJI HOSSAIN


0053
12053
ABDUL MANNAN LATE AMIR UDDIN


0056
12056
KALO MIA LATE NUAB ALI FAKIR