mPower Health is a for-profit mobile health social enterprise founded originally by international development and business students from Harvard University and Massachusetts Institute of Technology (MIT). Their mission is to bring affordable and quality health services to under-served communities, by enabling the creation of proactive and self-sustaining health systems driven by mobile technologies, community-level entrepreneurship, and value-based partnerships.They have been implementing mHealth projects in Africa, South Asia, and the Americas, enabling patients to access quality medical treatment in areas where there is little or no access to doctors.

My field placement in Bangladesh was my first opportunity to work and live in a developing country.  Before arriving, I thought I had an idea about what it would be like in Bangladesh, having studied the country repeatedly in courses during my first year at JHSPH.  While many of the things I’d expected were true, seeing them first hand was a surreal experience. 

Living in Bangladesh allowed me the opportunity to experience Dhaka and daily life in Bangladesh, as I would not otherwise have been able. Instead of driving to work each morning, I took rickshaws up packed streets or walked down the road dodging open holes in the sewage system as I went.  When co-workers and friends invited me to their homes I was lucky enough to glimpse home life and customs I had never before experienced.  While my lacking language skills may have made things more difficult at times, the friendliness, helpfulness, and caring of the Bangladeshi people I encountered was beyond what I could have ever expected and it was these people who made my experience in Bangladesh so rewarding.

The experience of working in Bangladesh was equally eye opening.  Even when I was working in an office in the city of Dhaka, there was a clear difference in working customs.  Start times were relaxed, end-times were extended, and there was a table – tennis table planted in the middle of the office.  Meetings were often interrupted by cell phones and by other employees but this did not seem to bother anyone but the foreigners in the room.  Again, the language barrier came into play as meetings often sidetracked into long discussions in Bangla making it even more difficult to follow the proceedings.  After several months in Bangladesh I learned how best to track these conversations back into English and about how and when to press for a translation.

Something that surprised me very much about Bangladesh was the difference between what I expected to see as the primary disease burden and what it seemed the primary health problems actually were.  Upon entering the School of Public Health, I was primarily interested in infectious diseases.  This interest grew to include other maternal and child health issues as my first year progressed but even though we’d had courses on the burden of chronic diseases and traffic accidents I was not particularly interested in working in that field.  Surprisingly, I found the public health issues that I faced each day were not of the infectious disease nature but that I was constantly surrounded by smokers, smog, and traffic accidents!  In the office other employees were constantly smoking, only occasionally going to the designated “smoking porch”. Each day on my way to the office I watched cars zooming along, narrowly missing pedestrians, the passengers rarely wearing seatbelts. 

While I’m still very interested in infectious diseases and maternal and child heath issues and recognize that morbidity and mortality from these causes is more hidden, the visibility and ubiquity of these other issues is hard to ignore as well.  At this point, the full impact of the phrase, “the double burden of disease” in developing countries was clear – and I hope its something I can help address in Bangladesh and other countries in the future.