Postcard from Bangladesh: Front-Line Health Workers
Mukul Begum, a shasthya shebika (community health worker) for BRAC, stands in front of her home in Barisal, Bangladesh. Begum delivers basic health care, counseling, and treatment to people in her community.
Text by Molly Marsh / Photos by Laura Elizabeth Pohl
BARISAL, BANGLADESH---Mukul Begum reaches into a plastic jar for tuberculosis medicine and brings it to 70-year-old Amjed Ali Sikder, who sits on a bench outside her front door. She pours a glass of water from a clear pitcher, watching closely as he puts the pill in his mouth and swallows it. Satisfied, she gives him the water.
Begum, 37, is a shasthya shebika, one of about 80,000 health workers trained by BRAC, an international nongovernmental organization, to deliver basic health care, counseling, and treatment to people in their communities. BRAC’s social, health, and economic empowerment programs operate in each of Bangladesh’s 64 districts, reaching about 110 million people.
Shasthya shebikas such as Begum are the engines of BRAC’s work—in 2010, they treated 1,650,673 people, the vast majority in rural areas where medical information and care is limited.
For five years, Begum—a formidable but jolly woman—has made door-to-door visits to counsel people in Barisal, a district of Bangladesh, about safe sanitation, basic hygiene, and nutrition. She currently looks after 263 households; 2 percent of these receive what BRAC calls “Directly Observed Treatment Short-Course.” In other words, if Sikder hadn’t come to her house to take his medicine, she would have gone to his to make sure he took it.
People in the community also visit Begum’s house, a low concrete building that sits under a thick canopy of coconut trees, for help with a variety of ailments. Begum listens and then reaches for a shasthya shebika’s constant companion—a small blue plastic bowl that holds medicine for fever, dysentery, diarrhea, gastric ulcers, skin diseases, and allergic reactions. It also contains home pregnancy tests and pills for calcium, vitamin B, and birth control.
Begum purchases the medicine from her local BRAC office, which she can then sell to her patients at a slight profit. She also receives money when pregnant mothers deliver their babies in a hospital or when patients complete treatment—for example, she’ll receive 500 taka (about $6.50) when Sikdar finishes his 6-month treatment for tuberculosis.
Before they embark on their caregiving, shasthya shebikas receive 15 days of training at a BRAC learning center on health basics and communicable diseases. They also gather for refresher classes once a month, in which they and shasthya kormis (health supervisors) review training themes and discuss issues that have arisen in their communities. Shasthya shebikas also meet once a month with a BRAC manager to report their activities.
It’s a role Begum seems to enjoy. “In the community, people believe I’m a doctor,” she said through a translator. She stands in her front doorway; behind her a clothesline stretches down the hallway, filled with colorful clothes. To the left of her house sits a small shack with items for sale, including toilet paper, candy, bread, and snacks.
BRAC’s main health program, called Essential Health Care, targets poor people—especially women and children—with medical care using seven different components. They include programs that focus on malaria, tuberculosis, and vision problems, and on the needs of pregnant mothers, infants, and children.
Shasthya shebikas are critical to each of these efforts, in many cases receiving additional training to be able to diagnose and treat malaria, for example, or identify vision problems. Begum and others are the front line of care in their communities—not just in dispensing medicine but also referring people to clinics when ailments are beyond their expertise.
Molly Marsh is managing editor and Laura Elizabeth Pohl is multimedia manager at Bread for the World. You can follow Laura on Twitter at @lauraepohl.
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