News and Events

n Bangladesh, the Government, NGOs and other health clinics undertake numerous activities to deal with various health care issues. It is essential that we carry out thorough research and cost-benefit analysis to ensure that the money spent is used in a program which ought to be high in the priority list.    In a resource strained country such as ours it is imperative that this is done to ensure that valuable financial resources are not wasted. In the process of doing due diligence for a project or a program opportunity cost must be taken into consideration. I was part of a team which arranged the Socio-Scientific Conference on Cancer in March 2008 under the guidance of legendary cancer specialist Late Prof. ABMF Karim.  Nobel Laureate Prof Muhammad Yunus was the Chief Guest of the Conference.  As a follow up activity of the conference organizers of the program decided to take on two initiatives:
a)  Conduct a Pilot Human Papilloma Virus (HPV) Vaccination Program
b)  Arrange Continuing Education Program for the young Oncologists of Bangladesh by sending them to renowned cancer centers such as Massachusetts General Hospital (MGH), New York University Hospital, TATA Memorial Hospital, and few other hospitals from Europe, Australia and USA.
Few months before the cancer conference Dr. James Cusack of MGH asked me if we can conduct a Pilot HPV vaccination program in Bangladesh.  My response was if we can get the funds we might be able to do it.  Fortunately Grameen Phone came forward to fund the initiative and in December 2008, 50 young girls from a slum received HPV vaccine. It took almost a year for Late Prof ABMF Karim and his team to complete all the necessary regulatory formalities for conducting the Pilot HPV Vaccination Program. However, we also realized that a massive HPV vaccination cannot be conducted without the funding from the donor agencies.  I, along with Bimalangshu Dey (Oncologist from MGH) and Judy Foster (Nurse Practitioner from MGH) went to Prof Muhammad Yunus hoping he would agree to approach the International Donor Agencies to conduct a massive HPV vaccination program in Bangladesh.  Considering the cost of the vaccine ($250 to $300 at the time) Prof Muhammad Yunus asked us whether we are sure that cervical cancer is widespread in Bangladesh as claimed by many.  We told him there is no scientific data available to conclusively say that cervical cancer is widespread in Bangladesh but it is the leading cause of death among poor women affected by cancer.  Consequently we met Sir Fazle Hassan Abed of BRAC to discuss our venture.  After listening to us, Sir Fazle Hassan Abed said that the HPV vaccine which costs $250 is among the most expensive of all vaccines, he would rather consider early diagnosis and treatment of the disease because BRAC has 8 million Micro Finance borrowers (mostly women), hundreds of health workers and around 50 health clinics.  It was agreed in that meeting that Bimalangshu Dey and his colleagues from MGH would send him a protocol on how to screen and treat cervical cancer through a low cost technique. Everyone was expecting a quick response from the US team to implement a cervical cancer screening and treatment project initially with BRAC and later on with all the major NGOs.
In March 2009 we formed A K Khan Healthcare Trust.  The vision of the Trust was to build a Hospital and Nursing College in Chitttagong.  Around this time I also got an opportunity to travel with Prof Muhammad Yunus to Washington to attend World Health Congress.  At this conference I saw a very interesting presentation by a company called Click Diagnostic.  This company was using mobile phone to send images from a remote place in Africa to a Doctor in a Hospital thousands of miles away.  One of the images was a picture of a Cervix.  I arranged a meeting between Click Diagnostic and Bimalangshu Dey in Boston hoping this might give him some clue on how to screen and treat cervical cancer using a low cost technique.  We saw a nice presentation from Dr A K Goodman on cervical cancer but nothing on how to screen and treat the disease through a low cost technique in a poor country like Bangladesh.
During the trip to USA in honor of Prof. Muhammad Yunus, Harvard School of Public Health arranged a dinner meeting, I was very fortunate that I was able to attend the event.  In my table sitting next me was a famous Professor from Harvard School of Public Health, Dr. Richard Cash but he thought HPV screening would not be a fruitful endeavor for Bangladesh. Prof Richard Cash has been visiting Bangladesh since 1960s, he is also a faculty of BRAC School of Public Health and is keenly familiar with the challenges of our healthcare system.  After my discussion with Dr Richard Cash I was torn between honoring a commitment versus wasting time and precious resources.  Within a few days of the Program at Harvard all of us (Prof. Muhammad Yunus and his team) returned to Bangladesh and my regular activities in Bangladesh resumed.
I approached Prof Sultana Razia Begum, the Chairman of Obstetrics and Gynecology Department of Bangabandhu Sheikh Mujib Medical University (BSMMU) for assistance.  She shared with me how United Nationals Population Fund (UNFPA) was running a nationwide cervical cancer screening program in Bangladesh using a technique known as VIA or Visual Inspection Using Acetic Acid.  Prof. Sultana Razia Begum agreed to help us should we decide to go ahead with the program.  She also gave me a list of equipment which are used to screen and treat cervical cancer at the Bangabandhu Sheikh Mujib Medical University.  Her contribution was crucial for designing and implementing our Outreach Clinic but due to health reasons she wanted her involvement to be limited to six months.  By this time Trust had decided (against my recommendation) to go ahead with the Outreach Program.  Once the decision was made to launch an Outreach Program I gave my full support to execute the project.
I chose Korail slum, the largest slum in Bangladesh with around 200,000 inhabitants, to setup a clinic.  I approached my biomedical engineering friends in the USA to help us select equipment for the clinic.  I sent the final list of equipment to Dr A K Goodman of MGH and she approved the list.  We decided to purchase a Welch Allyn Video Colposcope and Valley Lab Force-2 Electrical Surgical Unit from USA.  I did some customization of the equipment so that the images from the Colposcope could be accessed from a remote location if needed.    A local Oncologist helped Prof. Sultana Razia Begum prepare a protocol for the work at the clinic.  Eventually the clinical work at the clinic started from 2010 under the supervision of Prof. Sultana Razia Begum.  The basic difference between our program and UNFPA’s program was that UNFPA is screening women for cervical cancer whereas we wanted to offer a one-stop service for both screening and treating the disease.  During her next visit to Bangladesh, Dr. A K Goodman trained a few young gynecologists who were involved with the program on how to screen (using VIA) and treat CIN/CIS states of cervical cancer (using Loop Electrosurgical Excision Procedure).
She screened around 30 women in two days and identified 6 patients to be in the CIN state of cervical cancer.  She recommended invasive procedure Loop Electrosurgical Excision Procedure (LEEP) for all of them.  However, biopsy reports of these 6 cases from Delta Cancer Hospital performed by distinguished Pathologist Prof Syed Mukarram Ali, stated that these 6 patients had chronic cervicitis.  To date I do not know whether Dr A K Goodman’s diagnosis was accurate.  Pap Smear takes fluid sample for giving report whereas VIA is done through naked eye.  Unless a doctor is using VIA all the time it might be difficult for him/her to be accurate through this technique.  The bottom-line is proper transparency and accountability must be in place for all clinicians regardless of where they are coming from and who are their target patient.  Internet has enabled people to ask the right questions, information is available and accessible to everyone; therefore it is no longer possible to hide behind technical jargons.
In order to improve the quality of work and activity of the clinic at the slum, in 2011 we recruited three full time relatively young doctors.  Under the supervision of Prof T A Chowdhury, a renowned Gynecologist of Bangladesh, these doctors rewrote the protocol on how to screen and treat cervical cancer and cervicitis.  Compared to screening around 25 to 30 patients per week in the previous months, clinic was now screening around 80 to 90 patients per week.  At Taka 500,000 per month operational expense for the Outreach Clinic, at patient flow rate of 30 patients per week, screening cost for each patient stands at around Taka 4,000 per person and at patient flow rate of 80 patients per week screening cost stands at around Taka 1,500 per person.  Through process reengineering output of the clinic drastically improved.  During the next 12 months the new team screened around 3000 women from Korail slum and only 3 of them were clinically confirmed to have cervical cancer, but quite many had cervicitis and they were treated by giving antibiotics.
Our clinicians are well trained in VIA, Pap-Smear and Cryo-Therapy but only a handful of them have the training on how to perform LEEP.  In the long run the number of clinicians capable of performing LEEP has to be increased.  Bangladesh College of Physicians and Surgeons (BCPS), has a training center for the practicing doctors in Mohakhali, Dhaka.  This training center can be used to train the clinicians on how to perform LEEP.  It might cost only Taka 2,500,000 to equip the center with the necessary equipment (Electrical Surgical Unit, Colposcope, Blue Coated Speculum and Manikin) to setup a lab for the hands on training.  A two-weeks training might be sufficient for a clinician to acquire the skills for performing LEEP.
The author is an Executive Director of Good HEAL Trust

Good Health, Education, and Life (HEAL) Trust is a private not-for-profit organization registered under the Trust Act of Bangladesh, established in 2013 with the aim of improving the quality of health care services in Bangladesh.

Good HEAL Trust brings over 60 years of collective groundbreaking cross-sectoral experience among its distinguished partners and advisors who have come together to envision a bright future for the health and population sector of Bangladesh through comprehensive, long-term solutions to some of the most pressing issues faced by the country.

Good HEAL Trust believes that the quality and outcomes of care can be improved through the combined development of a trained health care workforce, institutions of excellence for evidence- based nursing education and training, creating employment opportunities through vocational training, leveraging technology to provide access to health services at the last mile, and a culture of prevention by early diagnosis and intervention.

Good HEAL Trust’s Outreach clinic at Korail slum, Home Healthcare Service through Bedside Assistant Training Program, Vocational Training for slum dwellers, and Nurses’ Skill Enhancement Program address key issues outlined in the Millennium Development Goals (MDGs) for Bangladesh.

Nurses’ Skill Enhancement Program

Nursing Classes: Nursing classes were held at Birdem 1, Birdem 2 and The National Heart Foundation, covering a whole range of topics. The topics included: Acid Base Balance, Pre and Post-Operative Nursing Management, Universal Precautions, Infection Control and Parental Therapy.

English Classes: To improve the over-all English efficiency of the nurses, English Language classes have been on going with a focus and emphasis on spoken English. Classes were held at Birdem 1, Birdem 2 and National Heart Foundation. The topics covered included: ‘The House’. ‘The Hospital.’ The 5 W’s (who, what, where, when and why). ‘Making Polite Requests,’ ‘Shopping for Groceries’ and ‘Shopping at the Mall’.

Computer Classes: Computer classes were held at Birdem 1, Birdem 2 and The National Heart Foundation on Microsoft Word and its uses. Formatting and different methods of saving files was shown to the students.

Grooming Classes: Grooming classes were held at The National Heart Foundation. Methods of communication with patients and the importance of body language were taught.

Healthcare Project in Korail Slum

Good Heal Trust’s outreach team presented health awareness sessions and general health advice to patients of the Korail Slum. Advice pertaining to personal hygiene, family planning, common diseases amongst women, common diseases present in households and many other issues were discussed. Short field health checkups were also held at different blocks of the Korail Slum. Health services were given to around 320 people. Our in house nurse gave OTC medicine to 50 patients and 14 patients were prescribed medications by Dr. Apurbo from Gulshan Health Care Center.

In addition to the above, Good Heal Trust’s in house nurse, Abdul Mariyam Bee, with the help of other health workers screened/tested 30 females patients for breast and cervical cancer.

Visits and Potential Clients A few hospitals and medical institutes were visited by some of the Good Heal Trust team members. The list visited includes: Square Hospital, Dhaka Medical College (DMC), Bangabandhu Sheikh Mujib Medical University (BSMMU), National Cancer Institute (NCI) and Popular.

The team intends to meet different hospitals and institutes in the upcoming month in order to offer the Nursing Enhancement Program to interested hospitals. The list of hospitals that will be visited include: United, Apollo, Shahabuddin, Prescription Point, Square, Shamorita, Labaid, Ibn Sina and Monwara.

If interested in working with us or in simply finding out more information about what we endeavor to bring to the over-all healthcare system, current/future projects and much more please visit us at: www.goodhealtrust.org

Women in the capital Dhaka’s biggest slum, Korail, suffer from their reproductive health complications, living in a crammed and filthy environment, but do not have access to healthcare.

Doctors at a special medical camp on Sunday said, of the 30 patients they treated in the first such camp, most of them were women.

“They suffer from menstrual complications to botched abortion,” said Dr Apurbo Kumar Saha who attended to those patients in the camp organised by a private body, Good HEAL Trust.

“But most of them (women) took advice from the drug sellers,” he said.

The Trust that joined forces with the Diabetic Association of Bangladesh launched a clinic in April in the most crowded slums to help its dwellers get aware of health and diseases.

Conducting special camps is also the part of their activities.

A patient enrolled in the camp with Tk 30 received a ‘card’ that would ensure their all diagnostic tests and doctor’s consultancy at a discount, an effort that the Trust’s Executive Director Tanvir Raquib said was part of their initiative to launch health insurance.

The Korail clinic provides low-cost healthcare services regularly to the slum dwellers using telemedicine technology.

Click here to visit full news.

Non Communicable Disease Diabetes Mellitus, Health Screening and Home Healthcare Service
As a result of advances in medical sciences and increased access to health care services, people are living much longer, and consequently the demography of Bangladesh is shifting towards an aging population. The population above the age of 60, presently constituting 7% of the total population of Bangladesh, is projected to be 10% by 2025 and 15% by 2050. Along with an aging population, Non-communicable diseases have emerged as the biggest burden of disease for this century. Therefore, it is imperative to create policies and domiciliary services that ensure proper management of NCD’s for the elderly in order to maintain equitable and just society.
Delivering care to the sick and the elderly in the comfort of home is a necessary aspect of healthcare service delivery. Since the turn of the century, the concept and practice of family doctors making house calls has declined. In addition, the acute shortage of both Nurses and Nurses Aid has made it difficult to deliver geriatric care to the elderly at home.  Since the elderly urban population prefers to reside at home with their families, changes in the urban family lifestyle have made caring for the elderly or disabled a challenge with regard to time, safety, privacy, dignity, comfort, and cost.
Good HEAL Trust aims to implement Home Healthcare Service (HHS), an urban home-based, non-medical assistance to the elderly, in order to enhance employment opportunities of the underprivileged  women and girls by enabling them to contribute as an integral part of society.  To become home healthcare service providers, there are no formal education requirements.  Interested individuals (moderately educated) are only expected to complete formal training under the supervision of licensed healthcare professionals for a few months.  At the end of the training program the trainees have to pass a standardized test.  By providing employment generating skills and creating employment opportunity for women, the Millennium Development Goal for women empowerment in Bangladesh can also be achieved.

click here to view full news

If you need help at home to attend to your ailing or elderly family members, just dial 01755660025.

A private body, Good Heal Trust, in partnership with the country’s largest healthcare network, the Diabetic Association of Bangladesh (DAB), is now offering care service for Dhaka residents for a nominal charge.

A group of young women have been trained to look after the elderly at home, in hospitals, or clinics.

They will ensure the prevention of bedsores, monitor blood pressure and blood glucose.

They will also carry physical samples for diagnostic tests, making life easy for many families that find it difficult to move their elderly members through a crowded, often gridlocked, city.

These trained women will make arrangements for home visits by doctors and physiotherapists.

Services like feeding, toileting, bathing, and dressing are also being offered.

click here for full news

On the evening of September 2011, an earthquake took place in Panchagarh. At that time, a nurse named Arjina Khatoon set a rare example of discharging her noble duties at a private hospital in Panchagarh. The hospital source stated that, on the fateful Monday evening, a Caesarian operation was being performed at the city general hospital on a woman named Sultana Begum. The mother gave birth to a boy, but the umbilical cord was not even dissected and detached when the earthquake hit.

click to view full news

In the evening of September 2011 an earthquake took place in Panchgarh. During that time a nurse named Arjina Khatoon set a rare example of discharging her noble duties at a private hospital in Panchagarh.
The hospital source, disclosing this rare incident, stated that on the fateful Monday evening a ceaserian operation was being performed at the city general hospital on a pregnant women named Sultana Begum. A male child was born to the lady through C-section. The umbilical cord was not even dissected and detached when the earthquake hit the town. When the surgeon Kamalakanta Barman, anaesthetist Arifur Rahman and others were running out of the operation theatre in a bid to save their lives even then the undaunted nurse stood alone in the O.T. with the new born child praying to Almighty to save the mother and the child.
Arjina Khatoon 28, said, “I stayed back in the OT, thinking that the lives of the mother and child could be at stake if I left them there. Besides the umbilical cord was not dissected yet. So I could not come out with the baby alone. I decided to stay back at the OT and face the eventuality at its worst. When all the instrument and apparatus were falling down from the operation table due to the tremour of earthquake, I was trebling fearfully and was praying to God for his mercy.”
Zahidul Islam, the director of the hospital describing the incident afterwards, said, “When we all including the surgeon and other doctors ran out of the hospital during the quake, this nurse Arjina stayed back at the OT to save the lives of the mother and the new born child. Such incident is very rare as during such disaster everyone want to save his own life.

click here to view full news

Nurses, like all professionals, must have current knowledge to ensure the best possible care for their patients and communities. Practicing professional nursing requires a commitment to lifelong learning. With the advances in healthcare and technology due to research, it is imperative that nurses participate in knowledge development for themselves and the profession. Nursing has the opportunity to improve the health and well being of their patients by participating in educational opportunities post degree and sharing best evidence for safe practice with others in their care community. The International Nursing Council (ICN) Code of Ethics (2000) stipulates that the practicing nurse “is active in developing a core of research-based professional knowledge” (p. 3)(ICN, 2000). The most effective way for nurses to meet this ethical standard is to participate in continuing education.

click here to visit full news