The Centre for Health and Population Research, Dhaka

Last week I had the privilege of visiting the International Centre for Diarrhoeal Disease Research, Bangladesh (ICDDR,B). It is also known as the Centre for Health and Population Research and is commonly known as the the Cholera Hospital here in Dhaka. The Executive Director of the hospital is Dr David Sack who is also one of the leaders of the Cantemus choir. David's wife Jean, also with the choir and who is a volunteer staff member at the hospital showed me around.

The hospital was first established in 1962. Its main aim was to carry out research into the causes and cures for diseases like cholera. Cholera epidemics around the world have claimed millions of lives, and these epidemics happen regularly in Bangladesh, so it has plenty of raw material for research. Today the centre has expanded to a staff of around 2,000 people and have broadened their spheres of activity to include training, HIV/Aids and Public Health. They continue to carry out world leading research into infectious diseases like cholera and other causes of diarrhoea and have some of the best diagnostic and testing facilities in the region. You can read more about what they do at http://www.icddrb.org/activity/index.jsp?activityObjectID=59

They also deal with any cholera outbreaks that occur. As an example, in recent weeks thay have been admitting and treating up to 600 patients a day (yes that's right, 600 a day). 15,976 patients were treated during April 2005 according to a statistics board I saw at the hospital. Overall the centre treats around 110,000 patients a year. A peak year was 1998 when over 157,000 patients were treated. The centre has the diagnosis and treatment of diarrhoea down to a fine art. They developed what is called Oral Rehydration Therapy (ORT) that quickly gets the patients back to health and which is credited with saving over 3 million lives a year around the world. The ORT formula that the Centre has developed is very cheap and very effective. There are around 7 possible causes for diarrhoea and the hospital is able to identify the cause and treat accordingly.

To give an example of how effective the hospital is, on the 24th May 2005 they had 282 admissions of patients with acute diarrhoea. Of these 185 were treated and discharged in less than 12 hours, and 97 patients stayed longer than 12 hours. The majority of the patients are young children. Diarrhoeal disease is mainly transmitted by water. During bad flood years in Bangladesh the outbreak of diarrhoeal disease increases. As well as treating the patients the hospital also provides the caregivers of the patients training and advice on hygiene, feeding and care so that the message goes out about how to avoid becoming infected and how best to treat the disease if it strikes. Diarrhoea causes severe dehydration of the body which can lead very quickly to heart failure. The right application of rehydration therapy works miracles and saves many lives.

Treatment is free. Apart from a 60 Taka registration fee (about NZ$1.30) nothing is charged. The hospital is supported by donations by generous benefactors from around the world. The centre provides training for medical and research staff. 95% of the staff are locals with only 5% staffed by people from abroad.

Here are some photos that I took at the centre.


The ICDDR Entrance. During the epidemic in April the drive was filled with marquees set up to receive the patients.


Patient receiving area


General ward area


Doctor (seated) checking patients


Mother giving ORT through a feeding tube. Note the baby's hand is wrapped to stop it pulling out the tube.


Every bit of available space is utilised


One of the testing labs


Sample testing lab


Workers (and onlooker) at the sample testing lab


Executive Director, Dr David Sack and his wife Jean. Also members of the world famous (in Dhaka) Cantemus choir.

Mother Teresa Orphanage in Dhaka

Last Friday the Cantemus Choir (which is a group of mainly ex-pats here in Dhaka) went to the Mother Teresa Orphanage in the old part of Dhaka to sing to the children, nuns and helpers. We took along food and drink for afternoon tea, toys for the children to play with and other gifts.

To reach the orphanage we had to walk down one of the old narrow streets of Dhaka, filled with people and with street sellers hawking their wares all down the street: vegetables, spices, clothing, material, knick knacks, all sorts of things.





The orphanage is tucked away in an old building behind the street front shops. There was a statue of the Virgin Mary at the entrance as you can see from the photo. The gentleman on the right in the photo is an American Dr David Sack who is head of the Cholera Hospital here in Dhaka. They do a lot of research into Cholera and other tropical diseases. They call him the King of Diahorrea.



We were given a tour of the orphanage. They have about 15 mentally disabled children in one ward. They were a really sad sight, but they are looked after well by the nuns and helpers. Then there are about 20 - 30 small babies and toddlers. There were about another 20 or so older children up to about the age of five. The children all appear happy, well fed and cared for, and they seem to get lots of cuddles from the nuns and helpers.





Some of the new borns were so tiny. You can see one photo of a tiny baby with my fingers in the shot. My fingers are only slightly smaller than the baby's arm.



We then went into another room where the older children, nuns, helpers and some mothers were gathered and we gave them our concert. The songs included Old McDonald Had a Farm which the children really enjoyed. We sang some Canons and other songs in Latin for the nuns and they all thoroughly enjoyed them.





I had to leave after we finished singing to get to DICC church in time, but the others stayed on for the rest of the afternoon. The children from the orphanage sang some songs and danced, then they all got together for afternoon tea.

It is a great work the orphanage does with limited resources and it was good to play a tiny part in making the children's lives a bit happier.

The Life Cycle of Bricks or a Day in the Life of a Brick

Let me tell you about the lifecycle of bricks here in Bangladesh. There is a huge amount of construction going on in Dhaka and bricks form a major part of all sorts of structures and facilities including buildings, fences, roads and footpaths. There are bricks everywhere.

Bricks start off life as particles of clay. The grey clay is dug out of the ground by hand, then mixed to create a consistent consistency (I don't think that's good English, but you get my drift hopefully.) The clay is then formed into brick shaped bricks (that's not good English either, but I digress), that are left out to dry.



Once dry the grey bricks are put into kilns where they are fired to become the bricks that we all know and love. On the outskirts of Dhaka there are hundreds of these kilns dotted around, all with tall chimneys belching out dirty black smoke creating a hazy atmosphere all around. The bricks after they have been fired come out a lovely red colour.



They are stacked in huge stacks (oops this repeating of words is becoming a habit) awaiting transport and delivery to building sites and road sites all around the place.



The bricks are trucked by truck (there I go again), usually clapped out Bedford trucks, that have been garishly painted with fancy artwork. All loading and unloading is done manually by hand using manual labour (this is getting worse!!)



If the bricks have been really good they will be used in construction of a building or a wall or a road. The brick carriers load a load of bricks onto their heads and carry them up several flights of stairs to the position where they are going to be used. Bangladeshis use their heads a lot (for carrying things that is.) They use baskets on their heads for carrying sand and concrete and dirt and all sorts of things. Its amazing what a team of men and women can shift using baskets on their heads.



Once the bricks have all been cemented together in nice neat lines, they get covered up with plaster cement which is then painted (usually unless the constructor runs out of money, in which case the plaster is left bare.)

Do you want to know what happens to the bricks that haven't been good, or that have got broken in the process of transportation or that are left over and just lying around? These bricks are collected together and men and women, old and young and boys and girls huddle under umbrellas (because of the hot sun) with hammers breaking the bricks into chunks and small particles.



There seems to be two standard sizes, chunks about the size of a marble and small particles like coarse sand. These people spend all day crouching and breaking up bricks, holding the bricks in their hands or even feet and somehow managing not to hit their fingers or toes. They sit on top of their pile of broken bricks which gradually gets higher. The brick chunks and particles are used as filler for concrete or are mixed with sand to make a base for roads, all sorts of uses.



If an old building is demolished the bricks in it are recycled. Again people squat all day cleaning off the cement from the used bricks. Those that are broken get broken down into smaller chunks or particles. Nothing is wasted. It seems it cheaper to employ these people to clean the bricks than it is to buy new ones.

So there you have it. The life cycle of bricks. From Dust to Dust as they say. There's probably a moral in this story somewhere, but after concentrating so hard on writing my English good my brain hurts and I can't think of any morals right now.

Some Sights of Dhaka

The area where I am living and working is in the Northern side of the city. It is the 'posh' part of the city called the Model Town area. Most of the foreign embassies are located here and ex-pats mostly live in this area as well. Many of the residential areas are walled or fenced off with only a couple of access points which are monitored by armed guards to keep the riff-raff out. You have to have the right stickers on your car otherwise they won't let you in.

Dhaka has a population of about 14 million and growing. There are people and traffic everywhere. The streets are mostly narrow with no footpaths and nowhere to park. Parking is a serious problem. They are building high rise shopping centres and office blocks everywhere but virtually no parking is provided. So everyone competes for limited parking space on the street with cars double or triple parking on the road blocking normal traffic. It is a real shambles.

The photos show some sights from around the area where I am living called the Gulshan and Banani areas. Of course the photos don't give any sense of the noise, smell and atmosphere of the place. It always seems to look nicer in the photo than what it is like in reality.


Gulshan Lake Scene

There are quite a few lakes in the area that are used for flood protection, taking the excess water during the rainy (summer) season June to August. You are lucky if you get an apartment overlooking a lake, although it has been known for people to bribe the authorities, "purchase" land on the lake edge, fill in a portion of the lake and build a new apartment block there, thus blocking out your view!!! Gradually the lake areas are getting filled in, reducing the available flood protection and creating worsening flood problems.


Main Intersection at Gulshan 2


Island Slum Area on Banani Lake, accessed by boat.


Slum Area Next to Banani Lake right next door to all the posh apartments. This is an area of about 2 acres where a slum village has been built by squatters. The housing consists of bamboo lattice screen walls and tin roofs on a dirt floor. The conditions are very primitive. They cook over open fires. Remember this is in a "posh" area of the city. The people appear to be relatively happy, healthy and well clothed. However, they would live basically hand to mouth, many of them living on less than US$1 a day. Many of them beg for a living or for extra money.


Typical Back Street. Narrow roads with lots of little shops along them.


Brass Shop. There are some delightful shops like this one. Chittagong in the South West of Bangladesh is an area where they send ships from around the world that are being scrapped. They beach these huge ships on the shore and then the locals pull them to bits for their scrap value. A lot of the brass items end up in shops like this in Dhaka. If you are into brass artifacts, this is the place to come.

Bangladeshi Wedding

I was invited to a Bangladeshi wedding last Saturday. The daughter of one of the local engineers in the office was getting married. The wedding actually takes place over two days. The first day is where they have the ceremony and marriage vows etc. The second day is the wedding reception. We were invited to the reception part. The photo below shows us with the wedding couple.



Mr Ahmed whose daughter was getting married is in the middle at the back. Next to him is Reza who is our office manager (please note ladies, Reza is looking for a wife. He is very handsome as you can see and has a good well-paid job. He would be a great catch. (You can pay me later Reza.)) In the front row on the right is John Kepple (a NZer) who is my boss and the Project Manager for the project I am working on. On the left of the front row is John's wife Itjieh who is from Indonesia originally. The groom doesn't look too happy. Probably sick of all the photos that he had taken. Note that the wife has a ring through her nose with a chain attached. I think the ring through the nose is something that we should take up in NZ to take care of stroppy wives. What do you think?

There must have been about 2,000 people attending the reception which was held in a large hall. They had several sittings at the meal tables just to get everyone fed. Once we had finished eating the servers came and changed the table cloth and put out new plates while we were still sitting there, implying that it was time to move on.

The food we had was Bangladeshi style, rice and mutton, fried chicken and salad and a spicy mango chutney. Very nice. They also served an unusual drink that looked like yoghurt but wasn't. It was spiced with savoury spices and tasted quite nice, a bit like spiced tomato juice, but without the strong tomato flavour.

So that was my first experience of a Bangladeshi wedding (or part of it anyway.)