Shihab, Hasan

Medicine

Residency

Bangladesh

During my elective at the International Center for Diarrheal Disease Research, Bangladesh (ICDDR,B), I intend to learn how they have controlled the spread of diarrhea and the latest research in the field. This center, which is more than 50 years old is one of the world's leading global health research institutes that has been at the forefront of improving the health and wellbeing of people living in the world's poorest nations.

I will be working with the research team that is working on a randomized controlled trial of Hospital Based Hygiene and Water Treatment Intervention to Reduce Cholera. My electives will include clinical rotations at the ICDDR,B and Mugda Hospitals, laboratory rotations especially in the study of E.coli infections. I will also working  with the evaluation teams in the field studying how implementation of community based initiatives such as hand washing are being carried out in the slums of Dhaka.

Collaborating Institution: International Center for Diarrheal Disease Research, Bangladesh 

My field placement was based at the International Center for Diarrheal Diseases Research, Bangladesh (ICDDRB). Most of my work was in Dhaka, a bustling and densely populated city with over 15 million inhabitants. Although I am Bangladeshi by descent and have visited the country before, this was my first time working in Bangladesh. Being able to work in a public health arena with my clinical background gave me a totally different perspective and vantage point as I learnt to take care of populations. My expectations from this placement were primarily to learn and gain experience in public health research in a resource limited setting. My experience in Bangladesh has surpassed my expectations by far and has given me the impetus to effect change with my work on a global level.

ICDDRB Hospital, which is popularly known as the ‘Cholera Hospital’ is the ‘go-to’ hospital for patients with diarrhea in Dhaka. This is an amazing faciity that literally churns out patients almost like the workings of an efficient factory. It sees on average more than 200,000 patients per year. The instituition has a strong research base and many landmark studies have been born there.

I was working with a research collaboration team studying an innovative hospital based Water, Sanitation and Hygiene (WASH) Intervention for Hospitalized Diarrheal Patients and their household contacts. WASH interventions promoting household chlorination of drinking water and hand washing with soap have the potential to reduce diarrheal disease incidence in children less than five years of age an estimated 30 to 40%. However, it is challenging for households to sustain these behaviors over time. The team is studying the factors why behavior change is not sustainable over time and is trying to implement interventions that are community driven and stand the test of time.

My initial duties were to familiarize myself with the daily workings of the research team in Dhaka. The research team members and mentors both in Baltimore and Dhaka were extremely supportive and helpful as they quickly brought me up to speed with the study. I was able to provide technical support during the study team meetings especially in finding ways to make the process of patient recruitment and follow up as efficient as possible. They study has many components to it with an intricate randomization follow up pattern.

I admired the diligence of the Field Research Assistants and observed how they go about Structured Observations which to me was a new method of obtaining important data. I learnt the way they deal with challenges of being culturally sensitive especially when doing the Structured Observations in the patients’ homes.

A third of the population in Dhaka live in slums. While doing the follow up visits in three slums of Korail, Niketan and Mugdha Para, I was immensely humbled to see the challenges that people have to deal with on a daily basis. The homes in the slums are extremely crowded, have very poor ventilation and access to clean and safe water is very difficult. The water pipes run alongside open sewers. Needless to mention, there was contamination. I was able to see the effect of providing a clean container and chlorine tablets as a means of ensuring safe drinking water. This experience helped me appreciate my access to facilities that I usually take for granted in the United States.

Many patients did not understand the dangers of using unclean water and witnessed  the effect this study had in educating these families. I was amazed at how appreciative the patients were. Many of them became role models for their neighbors and started teaching them what they had learnt from the team. This to me was Public Health at its best.

Part of my duties were to learn how the water samples and stool samples were procesed in the laboratory. This was out of my comfort zone as I am usually more involved in direct patient care and community outreach projects. The laboratory staff were very patient in teaching me the ropes and it was interesting to get back to the basics of microbiology and biochemistry.

While working with my team, I was introduced to the Public Health Foundation of Bangladesh and presented a talk on Aging as a challenge in Global Health.

Later during my stay, I was also fortunate to travel outside of Dhaka to another study site. Mirzapur is a township in rural Bangladesh, about 3 hours north of the city. This was a site where Geophagy (soil eating) of children was studied. Geophagy has been shown to be linked to stunting in children. This exposure to rural life provided me access to the lives of the population and was readily able to appreciate the way animals and people share common space in many of the dwellings. This practice exposed the children to the feces of their domesticated animals. The study was able to teach them how to manage their livelihoods but at the same time make sure it is safe for children to grow.

Knowing the Bengali culture and language was very helpful in getting to understand many of the cultural nuances and in learning about the studies from the research teams. I started working on a few manuscripts with the team and was able to edit part of their work. This was a great way for me to share a transferable skillset.

This experience has shown me that the practice of Global Health is definitely not a field that you can know without getting your hands dirty. It is important to be right at the forefront and there is always so much to learn from everybody. Having ideas to effect change can only come to fruition if we are able to face and solve the challenges on the ground. Being sensitive and respectful to the culture of a place is very important if any interventions are expected to be sustainable and if one wants to have a collegial working environment. Being completely immersed in the culture, travelling within the city using rickshaws, eating street food and drinking chai from the chai wallahs gave me an experience that I will always cherish. Knowing the nuances of the culture, language and engaging in the local humor helped me develop collaborations and friendships with the people I met. It helped me understand the true essence of Global Health.

I feel very blessed to have received the Paul E. Lietman Fellowship Award without which I would not have been able to have these amazing experiences. I am extremely grateful to the Johns Hopkins Center for Global Health for having enabled me to get this award.

People

Yukari C. Manabe, MD

Associate Director of Global Health Research and Innovation

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

Stefan Baral, MD MPH,MBA,MSc

Director, Key Populations Program

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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June 2020

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