Shah, Bansari

School of Medicine

Fellow

Bangladesh

My training goals include developing the essential skill set required to accurately map the needs of a community in order to develop community-based emergency care interventions in low resource settings.

Acute injury and illness continues to be the largest burden on mortality in Bangladesh; 45% of deaths can potentially be saved with emergency medical services. The objective of this elective is to define and map the role of community health workers (CHW) in the delivery of emergency care to low resource settings in Bangladesh. I will work with at the Center for Injury Prevention and Research, Bangladesh, a long-term partner of JHSPH, which has a large community based program. 

Last month, I went to Bangladesh to do a needs assessment for a community-based acute/emergency care program.

I partnered with a local non-profit in Bangladesh for my project and have been working with them from the states since February. The Center of Injury Prevention and Research, Bangladesh (CIPRB) is a non-profit based in Dhaka that has mainly focused on reducing drowning incidents, roadside injuries, and maternal and fetal health. 

My first day here, I met Dr. Rahman, the person I have been in contact with the last few months. He introduced me to three others who have been working with him on my project behind the scenes. They had planned a four-day visit to Raiganj where we would be able to conduct interviews and focus group discussions. Two of them, Kaniz and Burhan would be coming with me and assisting me. We reviewed each day's plan and went over the questions to be asked.

After reviewing and finalizing plans in Dhaka, we traveled to Raiganj and began interviewing different healthcare providers and holding focus groups with community members.

Bangladesh is divided into 64 districts which are further divided into Upazilas. The Upazila is a subdistrict. Raiganj is one of the subdistricts and it is further divided into 9 unions. 

Within a union, for every community of about 6000, there is a community clinic. There are between 10-15 clinics in each Union. There is also one family planning and child welfare clinic in each union. Each subdistrict has a health complex which should have about 30 hospital beds. Finally, each district has a hospital which has 50 beds. The district hospital is supposed to have all major specialties available.

Our eventual goal is to create a community-based acute/urgent care program. In order to build one that would be sustainable and fit for the rural parts of Bangladesh, we are carrying out a thorough needs assessment. This involves visiting the healthcare facilities at each level and interviewing the healthcare providers about their ability to provide emergency care, what they see as barriers and what would help their situation. The other piece is the thoughts, perceptions, and needs of the community for which we are holding focus groups. In order to make sure we get to hear from all parts of the community, the focus groups are held with men, women, and the elderly separately.

In four days in Raiganj, we held 8 focus groups and interviewed 8 healthcare providers from different levels of the healthcare systems in 6 different unions.

While often the answers are as expected, like they lack the resources or appropriate training, the energy was up lifting. There is a reason I have always been drawn to community level work, and more specifically in rural areas. The people are kind and inviting. They are sincere and hard-working. They are also candid and open. So though you may not have electricity and other urban conveniences, the circle of plastic chairs in a front yard surrounded by fields is actually just perfect.

The local CIPRB office had done such a perfect job in coordinating our proposed schedule that the challenges one would expect in the rural area (I.e. road blocks, participation hesitation, Ramadan challenges) were non-existent. To say I was impressed would be an understatement.

Dr. Kaniz and Burhan (the two research associates who traveled with me from Dhaka) conducted all of the interviews. Their abilities to engage each participant and expand the suggested question list was skillful. I don't think I could have done it as well even if the groups were conducted in English.

Though we have yet to officially translate and analyze the results, there are some themes that arose through the process. Some of the obvious findings like lack of resources (medications and supplies) were mentioned. Both the community and the healthcare providers expressed a lack of training for emergency care, that they didn't feel prepared to handle these situations. And most importantly, everyone expressed interest in improving the current situation through community efforts. 

From my visits and initial understanding of the community, I think a joint training program that involves the community level health providers and volunteers from the community focused on first response interventions will be most effective. Once the recordings are transcribed and translated, we will hopefully be able to extract more information on barriers and needs. This will help us create an appropriate program for the community. 

The last couple weeks have been productive and informative and put us on a steady path forward. With many short and long term goals in place, I'm excited for the opportunities ahead.

People

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

Caitlin Kennedy, PhD MPH,BA

Co-Director, MPH concentration in Social and Behavioral Sciences in Public Health; Associate Director, Center for Qualitative...

Joanne Katz, ScD MS,BSc

Associate Chair, Director of Academic Programs

Noreen Hynes, MD MPH

Director, Geographic Medicine Center of the Division of Infectious Diseases

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

Robert Bollinger Jr., MD MPH

Director, Johns Hopkins Center for Clinical Global Health Education (CCGHE); Associate Director, Johns Hopkins Center for Global...
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November 2018

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