In July of 2002, an independent study was performed in three of the slum areas of Dhaka, the capital city of Bangladesh. Although the government regularly surveys the urban population for health concerns, the slum areas are not included in the population surveyed. This gives a biased result which makes the healthcare situation appear better than it actually is.[1]

This survey showed that 60% of Dhaka’s 17.6 million people live in the slums of the capital city. Of the participants in the survey, 93% had been born in the surrounding villages and migrated to the city in hope of finding better work and a better life. Once they arrived in the city, however, they found themselves trapped in a hopeless situation where their expenses exceed their income; they live in substandard housing with landlords who have little to no accountability for the living condition of their tenants and have no financial means to improve their situation.

Large families consisting of parents, in-laws and an average of 3-5 children inhabit one room bamboo houses. 86% use an outdoor latrine with multiple families sharing a single tube well. Standing water is used for bathing.

Poor living conditions

Diseases consistent with poor living conditions and poverty continue to plague this forgotten population. Over 89% of the residents surveyed describe a unhygienic environment as the leading cause of health problems. These diseases include rheumatic fever, diarrhea, respiratory disease, tuberculosis, infection leading to abscess and kidney disease. Other health complaints include impaired vision and hearing, chronic back pain, intestinal worms and sexually transmitted diseases.

According to this study, 61% had sought health care for these problems but when asked if their families received care, 32% responded with “sometimes” or “never.” This appears to be due to the inability to afford charges by the for-profit clinics currently serving Bangladesh. 62% had prescriptions but were unable to afford the cost.

Drinking water

In addition, there is an increase in arsenic levels in Bangladesh’s drinking water. The leather tanneries, which abound in the city, are cited as the primary source of exposure to hazardous chemicals, pollution of air, water and soil, skin and respiratory diseases and limb amputation from hazardous factory equipment. The government turns a blind eye to these conditions and refuses to enforce labour and environmental reforms.[2]

Although Bangladesh has an adequate health care infrastructure to care for the many needs of the under-privileged class, corruption levels are high. In an interview for Irin, Humanitarian News and Analysis, February 12, 2013, Nitai Kanti Das, secretary of the Health Rights Movement, said, “The government must strengthen its monitoring system to check corruption in public hospitals to ensure health access to under-privileged people.[3]

There are over 500 hospitals which should be providing free, government subsidized care to Bangladesh’s poor population. However, bribery is a common practice among doctors, nurses and other healthcare professionals. Often a patient cannot access service and medication, which should be free, without paying a bribe. This practice even extends to the free community clinics.

Misuse of prescription drugs

Another health concern is the misuse of prescription drugs. People often perceive narcotic and stimulant drugs as a legal alternative to heroin. This has given rise to synthetically manufactured drugs which contain methamphetamine. Other abuses include non-medical use of codeine based cough syrups, Diazepam, pain killers, antihistamines, which contain ephedrine and pseudoephedrine and anabolic steroids and gives way to things like ambien addiction. Providing illegal prescriptions is a lucrative business in an already corrupt healthcare system. Smuggled counterfeit medications are also traded on the black market with little official response. Since 1940, the Department of Narcotics Control has produced several pieces of legislation designed to regulate the manufacturing and distribution of pharmaceuticals. This means that Bangladesh has reforms and policies in place to tackle these issues. The government simply lacks the will to enforce them. Humanitarian activists must focus on raising awareness and lobbying the government if there is to be any hope for all Bangladeshis to be treated equally in all respects.

By Eve Pearce
Written for Restless Beings to add insight to the Bangladesh Dhaka Street Children Project.

[1] Study April – July 2002 performed by Tina Podymow MD, Jeff Turnbull MD, Mohammed Aminul Islam MA, Mahmud Ahmed MA, University of Ottawa, Ottawa Ontario, Canada, Development of Initiatives and Communication Network, Bangladesh Country Office, Dhaka, Bangladesh, Engender Health, Dhaka, Bangladesh.
[2] Retrieved from http://www.hrw.org.news/2012/10/08/bangladesh-tanneries-harm-workers-poison-communities
[3] Retrieved from http://www.irinnews.org/97454/Bangladeshi-health-sector-corruption-hits-poor-hardest

Photo credit: photocrunch.blogspot.co.uk