Back to Bangladesh -- Day 4

We got up early (again) to brave the Dhaka traffic -- since there's no apparent way to beat it -- and headed southwest out of the city to Matlab for a day with ICDDR,B. It's a mouthful of an acronym but an incredible organization that conducts invaluable research, as well as service delivery and advocacy to implement interventions proven here at a national scale and also in other poor countries suffering similar challenges.

After a 90-minute drive we were treated to a boat ride to reach our final destination. It was a nice break to get out of the hectic Dhaka bumper-to-bumper mentality and catch a glimpse of Bangladesh from the inside out, passing fishermen, waving back to children playing on the river banks and even getting the amazing thumbs up from a fully burka'd woman passing over a bridge.

We got to Matlab and had a brief conversation regarding ICDDR,B's 40-year history and its approach as a research-based institution. The organization, from its beginnings, originally focused solely on cholera (still a timely issue as outbreaks continue to emerge in countries like Zimbabwe, Pakistan and Haiti in recent years). We have ICDDR,B to thank for the innovation of oral rehydration salts which can help save the lives of patients suffering severe diarrhea. Over the years the scope of their work has evolved significantly, so much so that they've added service provision to serve the populations where they are conducting research, which include a wide range of related global health matters including broader child health, maternal health, HIV/Aids, etc.

The purpose of our visit was to focus on their work in maternal and child health. We'd already learned of the startling statistical turn around in maternal mortality in Bangladesh, but Matlab's service area's rates have improved even faster. ICDDR,B has piloted a package of interventions that help save lives in pregnancy and childbirth and they are now working to advocate for national scale up with the government and through key implementing partners like BRAC.

We went into the community to see their methodology applied firsthand. Like other programs we'd visited, ICDDR,B is community-based, but unlike others, the first contact is with a demographer who is constantly tracking the health and well being of each household in their jurisdiction. We happened to join one such field worker as she was making a house call with a woman named Mariam who was in need of a pregnancy test. She seemed happy to share this intimate and personal moment, that so many women go through with mixed emotions. We all eagerly watched her face as we heard that she was indeed pregnant. She was pleased with, if not a little self conscious, about the fanfare she received from the audience.

Women who test positively will receive their antenatal care (ANC) in sub-center facilities (of which there are 41 in Matlab) and the facilities and care they receive appeared to be top quality. The health worker we visited explained her check ups (four routine checks), which each include an ultrasound. The fieldworkers use a device to enter their data that was created by Hewlett Packard. This is a great example of the technological innovations and advances in the field.

Women are encouraged to deliver in these sub-centers but are given Home Based Life Saving Birth Skills (HBLSS) as well so that they are able manage deliveries in the event where there is no time to deliver in a sub center. They also learn the signs to look for if the newborn is not responsive afterward. We watched a skilled birth attendant give training in HBLSS and the women going through the training seemed very engaged in the information being shared. A community health worker then continues the home visits for the first 28 days of the baby's life, which are the most critical, before referring those babies to a fixed site center near their home for ongoing care care and immunizations. We visited one fixed care site in the home of the health care worker who had been providing these services for 35 years.

We made a final stop to visit a few moms with premature babies in Kangaroo Care. This is skin-to-skin contact that basically provides incubator-like warmth for infants which is also life saving.

Overall, we were left impressed by the Matlab model -- where women are tracked in a system and are provided a comprehensive set of services. It's always reassuring to see what can be done even in the most poor and rural settings. Challenges of course remain in terms of replication and scalability, but proving the model and interventions is an incredible indication and example that there are solutions. As we boated back toward Dhaka, the sun beginning to go down as people bathed in the river, I think we all felt that the people of Matlab were pretty fortunate to have ICDDR,B at hand.