Health Clinic in Rural Bangladesh

The Big Picture

Despite the recent increase in health care facilities in Bangladesh, and due to the issue of inequality in health care steadily increasing, there is still a lack of affordable and accessible health care, particularly in rural areas. The people most affected by this are the women and the poor, by providing health care facilities we can help empower these people to participate in an economic and public life. Often illness will cause a person to miss several days of work, this along with medical expenses causes a loss of income which in turn makes medical care unaffordable causing the person to become more ill and lose their job, leaving them very poor and in bad health.

There are many challenges that health care services in Bangladesh face, some of the major ones are as follows;

i) Population growth "“ Bangladesh has one of the highest population densities in the world

ii) Poverty "“ most poor people are incapable of bearing their health costs

iii) Changes in the variety of diseases "“ in the last ten years Bangladesh has experienced a resurgence of diseases such as malaria, kalazar, gangue fever, filariasis and tuberculosis, etc.

iv) Poor health knowledge and education "“ the focus of the health system in Bangladesh is a curative one which means the causes of many of the problems are never addressed. Many people have little or no health, nutrition or sanitation knowledge, and many health care facilities employ little understood and often irrelevant western medicines whilst indigenous diseases go untreated.

Whilst, according to UNICEF statistics, the under-five mortality rate in Bangladesh per 1,000 live births has decreased from 143 in 1990 to 48 in 2010, an accomplishment that not only puts Bangladesh well on the way to achieving the Millennium Development Goal for reducing mortality rate but has also been praised by the United Nations. However 22% of infants are still born with a low birth weight and the underweight rate in children under the age of five is between 43-45% depending on the source of the study. Maternal mortality rate has not seen such significant improvements; the UN suggests limited access to health facilities as a major factor in the 350 maternal deaths for every 100,000 live births in 2008. Other factors may include the average age for a women to have her first child is only 16 years old meaning there are often more complications due to the young age and the fact that around three quarters of births take place at home. As education increases these numbers should continue to decrease.

The Project

-Aim

This project will provide a new health care facility in an area where there are no other health care facilities for 4-5km and only limited health care facilities within 5-10km. A significance distance considering the main mode of transport is walking or riding a bicycle. The facilities that do exist have a very high patient load and minimal medicines, resulting in many people choosing not to seek medical care until their condition becomes critical. Our facility will provide free access to a health care professional, as well as educational material and links to specialists and hospitals should further treatment be needed. We will provide basic health, nutrition and sanitation education to help improve the standard of living within the village of Goaldihi. The facilities provided, as well as the design for the clinic has, and will continue to be a matter of consultation with the locals to ensure it fulfils their needs and desires.

- Site

The site chosen is in close proximity to three schools, allowing the possibility of a future link with the local education system to help increase health and nutrition knowledge. It is currently unused land but is surrounded by many fields. The land will allow us to expand in the future if further studies show there is a need for greater facilities in the area.

- Planning / Programme

The facility will provide two rooms for patients to be seen in with adjoining bathroom facilities in case a patient needs to stay overnight for birthing or other reasons. It will also provide a large waiting room with space both inside and out to allow for the family of patients to accompany them. A small pharmacy to ensure most needs of patients are immediately in the area and to provide a small amount of income to the clinic to begin to cover costs. A pathology room for blood collection and simple pathology tests to determine diagnosis of simple diseases such as tuberculosis, malaria, anaemia or typhoid will also be provided. The surrounding garden will provide a tranquil place to sit, fruit trees for the children to eat from and medicinal plants for public use and to provide education on more traditional medicines.

- Materiality

The materiality of the building will be mainly natural, taking advantage of locally produced building products and building methods to produce a building with a low carbon footprint. This will also demonstrate to the general public that local materials are more practical and responsible than many western materials and can be employed in an elegant manner. The main section of the building will be constructed using rammed mud, whilst the waiting room will be out of bamboo to increase ventilation, and hlp prevent the spread of diseases between patients waiting to see a doctor. The hope is that this will start to challenge the common belief that local materials are used only by the poor, and discourage the belief that anything western in appearance is superior. The materiality of the building will be a representation of the vernacular of the area and the people it will be built for.

- Green Initiatives

Solar panels and solar heating will ensure 24hr access to lighting and access to hot water should it be needed. A deep external water pump will provide public access to clean safe water to encourage it's use for bathing and drinking.

- Fundraising

We will be raising money through until the end of February to cover all building and set-up costs for the clinic. Funds will be raised through sponsorship, donations and grants.

- Budget of Project

The building of the project will be funded through fundraising. All money donated will go directly towards the build. The design role is completely voluntary and self-funded. The land to be built on has been donated by Bangladesh Rural Improvement Foundation (BRIF). Any additional money raised, following all building costs being paid, will go towards the setup of the clinic; including purchasing of equipment and medicines, and then towards the salary of ongoing staff.

- Cost Management

All funds will be morally and transparently managed by Project Designer and Manager, Meghan Lewis, during the build. Following the completion of the build all financial records will be handed over to BRIF to maintain and handle in the best interest of the community and the Health Clinic. Once built the clinic will be run and maintained under BRIF (Bangladesh Rural Improvement Foundation). It will begin with a paid nurse to staff the clinic as it is set up. As the need increases trained paramedics will also be employed. All wages paid will be fair and representative of wages paid to other professionals in the area. An optometrist and an ENT (ears, nose, throat) specialist will volunteer once a month to do basic check-ups in the facility and recommend any necessary further treatment. The opportunity for international medical volunteers to work in the facility will also be available. All health care professionals will not have direct access to pharmaceutical companies and will be held accountable for treatment offered to prevent corruption. The facility will operate to the best of its ability for the main benefit and with the priority of the patients at all times.