Bridging the Gap

This personal essay was written by Dr. Hossain Mohammad Shahed Sazzad during a Writers Without Borders workshop in Dhaka, Bangladesh, in January 2008.

I was sweating a little. It was the start of the spring, and a gentle breeze was blowing, but I was still feeling suffocated in the small room in the Kalwalapara slum in Dhaka. I was supervising Halima, a field research assistant, as she collected data that determined the cause of death in cases of infectious disease. Halima was doing very well. She was asking all questions of the questionnaire in a very friendly manner. I was thinking about the data collection training. It was very effective.

“The road to hospital was endless,” said Sabina, a seventeen-year-old mother whose two-month-old baby, Munni, had died recently. “The wheels of rickshaw turned very slowly. Five minutes’ journey seemed to me an hour.”

Surveillance is one of the largest projects of programme on infectious diseases and vaccine science carried out by the International Center on Diarrhoeal Disease Research in Bangladesh (ICDDR,B). One of the objectives of Halima’s study was to determine the cause of death of children under the age of five by interviewing mothers or people who knew a considerable amount about the illness of the dead child. Our study area was the catchment areas of two of the largest pediatric hospitals in Mirpur, Dhaka—the Dhaka Shishu Hospital and the Shishu Shastha Foundation. The slums of Mirpur have made it most densely populated area of Dhaka.

Kolwalapara slum is like many of the other slums of Dhaka. As I went around monitoring our data collectors, I was very careful to avoid slipping into the open drains, which were full of black turbid water with floating objects. Some of the sewer pits were open, and yellowish foul-smelling stools were floating in them. After a while, I barely noticed the odor.

Every day, we had to randomly select one child under five years of age from Shishu hospital from every twenty cases diagnosed as pneumonia, sepsis or meningoencephalitis. Within the past year, we had interviewed 7000 households in which a child of five years of age or less had died. Munni, Sabina’s baby, was one of our dead cases.

Sabina and her husband Solaiman lived in a single-room dwelling. Sabina had been living there for the last 6 months. When she came here, she was 5 months pregnant. Her husband, Solaiman, was a rickshaw puller. They came to Dhaka from Rangpur, in the northwest of Bangladesh, for work.

The floor was of polished cement. The partitions were made of bamboo mat with old newspapers pasted over it. A dirty red piece of cloth lined the ceiling. A broken mirror hung near the door. The only furniture of the room was a big wooden couch. Solaiman was sleeping on the couch, covering his head with a torn katha.

When we entered her room, Sabina was cutting vegetables for cooking. Pale, nearly five feet tall, and clearly in ill health, Sabina drew her Sharir Achal over her head. We introduced ourselves, explained our reason for visiting her home and asked permission for our interview. She agreed. We didn’t want to disturb Solaiman, so we let him sleep.

Munni had been Sabina’s only baby, and as she described her symptoms, she began to cry. Halima tried to console her. I was curious about the cause of Munni’s death. Halima asked Sabina what symptoms had preceded her baby’s death. Sabina answered confidently. It sounded as though Munni had died of severe pneumonia, I thought.

“I kept putting my hand in front of my baby’s nose to see whether she was breathing or not,” Sabina said. “She was too lethargic. When we reached at the Shishu hospital, I rushed towards the doctor’s room.”

During data collection mothers say a lot of things that are not related to the cause of death. It takes a lot of time. But it is an emotional situation and we become very sympathetic to the mother. If the mother becomes too emotional, we may postpone the interview.

Nearly forty minutes had passed. We were anxious to complete a few more interviews after this one. Halima looked at her watch. I prompted Sabina to know what happened when she arrived at hospital.

She took a long breath, paused for a moment, then suddenly shouted, “The doctors killed my baby!”

I had heard this kind of thing before. “How?” I asked.

She started crying. “My baby was so ill,” she sobbed, “but they refused to admit her. The doctor told that she would get cured. But they didn’t even give her any medication.”

Halima was looking at me. I asked Sabina, “Did you really hear that from the doctor?”

“No, not personally, but he talked to the doctor,” Sabina replied, pointing to Solaiman.

Just then, Solaiman woke up. “Hello,” I said to him. He didn’t reply. He left the room. I started to feel guilty: I, too, am a physician.

We were almost at the end of interview. I thanked Sabina for her time and left the room.

“Excuse me, sir.” I looked back. Solaiman was calling me.

When I go to a field site, people often want medical advice when they know I’m a doctor.

“Would you please give me one minute?” said Solaiman.

“Sure,” I replied.

“I have something to say,” Solaiman asked.

“Okay,” I said.

“I can only say it to you, if you promise that you will not disclose it to my wife.”

I assured him.

“The doctors didn’t kill our baby,” he said. “When we reached the hospital, the doctor told me to admit the baby and buy some expensive injections. But I didn’t have enough money. I have no relatives in Dhaka to lend me money. So I lied to my wife that doctors suggested the baby be taken home.”

He was wiping his eyes with a torn ash colored gamcha. I could not find words to console Solaiman. I hoped Sabina would never know the truth.

It took one and half years to complete our baseline study. Now we have started data analysis. Soon we will be able to declare the burden of respiratory diseases in the mortality of children under the age of five. The versatile pathogens are obviously responsible for that. We have sensitive and expensive antibiotics to combat against those. We also have well equipped health facilities.

But there are some gaps. We have been enjoying our freedom for the last 36 years, but are we really free? When will our economic emancipation come? When will Sabina and Solaiman return from hospital, smiling, with their baby?