Podcast episode 1

The speaker discusses the healthcare system in Bangladesh and the challenges people face in accessing healthcare. They mention that only a small percentage of the population has health insurance and the majority have to pay out of pocket for healthcare. This leads to many people opting out of receiving treatment due to cost. The speaker also explores the legacies of colonialism in the healthcare system and the differences between Western and Eastern medicine. They mention the uneven distribution of healthcare services, with rural areas having limited access to hospitals. The speaker also discusses the role of NGOs in providing healthcare services and gives examples of NGOs working to address specific health issues. They mention a public hospital dedicated to COVID-19 that has now been converted to treat dengue patients. Overall, the speaker aims to explore why access to biomedical care hasn't increased in Bangladesh despite the rise in popularity of biomedicine. So imagine it's a random Tuesday and you wake up in the middle of the night feeling sick. You've got a headache, you feel feverish, and your body starts aching. It gets even worse and you're forced to go to the emergency room. You and your parents suspect it's the flu, which is later then confirmed by doctors. All will be well, you just need some antibiotics and the vaccine if you haven't gotten it yet. We have that privilege to feel that everything will be alright because of the healthcare system that we are provided. Worst that will happen is a bad waiting time at the emergency room and an overpriced hospital bill. These two aspects, especially the hospital bill, can have major effects on people who live in the US. Most of the time it has a huge effect on the majority of the population. Me being able to say that the worst can happen as if it's nothing is still a very, very privileged point of view that I'm grateful to have. I wanted to start with a vision like this just to put everything into a bit of perspective. So according to multiple data sets, including National Health Institute of Health, about half of the US adults say it is difficult to afford healthcare costs and one in four say that they or a family member in their household had problems paying for healthcare in the past 12 months. Again to put things into perspective now, only approximately 2.5% of the population possesses any form of health insurance and around 70% have to pay out of pocket for any type of health costs. Because of this, the majority of the population resort to opting out of receiving any form of treatment from hospitals. This has been an ongoing issue I've always been aware of. The majority of my family lives in Bangladesh and I have always heard my parents calling back home and having long, long discussions about one of my grandparents or family member's health and hospital trips. This is what got me initially interested in studying the healthcare system in Bangladesh as my project for this year. As I continued doing research and further thought out the questions I want to answer throughout this year during my studies, I started focusing on the specific aspects of biomedicine in Bangladesh and access to it. In addition, as I continued with my research during the second semester, I decided to focus on legacies of colonialism within the healthcare system as a whole and compare Eastern and Western medicine and how colonialism has played a factor into that. In addition to this, I as well see how it is affected by the way access to healthcare looks like now. So through this project and this podcast, I wanted to raise a central question of course as to give an objective to all the information I will be discussing. So if biomedicine has risen in popularity in Bangladesh, why hasn't access to biomedical care increased along with it? How have the legacies of colonialism seeped into present day obstacles to care and concepts of health slash illness and disease? So I decided to set up my podcast as a two episode series, basing them off of the questions that I just said. So in the first one, which is what you're currently hearing, I will focus on access to healthcare in Bangladesh and biomedicine and what that looks like in Bangladesh now. For the second one, I will discuss the colonial state and what healthcare looked like under colonial rule and how that has affected the way healthcare is received in Bangladesh, as well as how that has affected the way Western and Eastern medicine are perceived and used today. So as part of my project, I interviewed my mom, who recently went to Bangladesh a couple of months ago because my grandmother unfortunately got sick. She is completely okay now and doing well, so don't worry about that. But I thought getting her input would definitely be a new perspective to add to all the data and research I had been doing. So this is the main part of my research that I'll be delving in today. So before I begin with that section, I wanted to give some background info and knowledge on how the healthcare system actually works today. Okay, so to start off, just really giving some basic, basic info, essentially from the population, what I got from some of my research are some percentages. So 13% of treatment seekers use government services, 27% use private-slash-NGO services, and 60% use unqualified services. So this uneven distribution because of the dense population of demand is creating unmanageable pressure on a few reputable public hospitals. So a lot of my research in the first semester had to do with rural versus urban hospitals and what that looks like. I found a lot of research on very much like rural areas and areas called charlands, which I will talk about later because my mom discusses more about it. But essentially what I found through my data and all my research was that a lot of the times in these rural areas, there's not a lot of access to healthcare at all. There are maybe like one or two public hospitals that are in cities nearby, but there aren't any in the villages, and the villages in Bangladesh are actually very common. A lot of people end up living in these small villages and there are communities within these villages, but if you want to reach a hospital from these villages, it's pretty much you have to travel a couple, like 30 minutes to an hour. And it's not that bad traveling-wise, but definitely when you think about it in perspective to Bangladesh, it's definitely a bit much just because there is a lot of foot traffic there and car traffic, so it's very, very congested in these specific areas, less so in the rural areas, but it's still a good amount of time to be able to reach any type of hospital, which should definitely be nearer, even if it's a clinic. And there aren't a lot of like, like I just mentioned clinics, like private clinics. There are the three main hospitals or healthcare systems that I found were public hospitals, private hospitals, and like NGOs. And so the NGOs weren't really necessarily clinics because they can all provide for separate things, and I found some examples of those that I wanted to share with you guys. So some of them include, one of them includes the Friendship NGO. So basically what their whole, one of their bigger ideas and their bigger objectives for Friendship NGO was to kind of work with the government and come up with a different like one health approach, which understands and addresses the different factors in order to create a comprehensive and sustainable solution that can be developed to mitigate a specific issue. So for the example that I'm talking about, it's for the impact of dengue outbreak. So they've been trying to work with the government of Bangladesh to foster this one health philosophy in policymaking and execution of public works. So you have the integrated vector management, which basically includes like regular cleaning of water storage containers, proper waste disposal, and use of larvicides and breeding sites. It includes healthcare infrastructure enhancement, which strengthens healthcare facilities to accommodate a surge in dengue cases during outbreaks, which involves adequate training for medical professionals, ensuring the availability of diagnostic tools and maintaining sufficient medical supplies, as well as surveillance and data sharing, which basically just tracks dengue cases, mosquito populations, and environmental changes, which are essential to this. And essentially that collaborating with government agencies to share and analyze data, which enables timely interventions for this dengue outbreak happening. That's essentially what this specific NGO is focusing on. Another NGO, though, that is doing something different, for example, is BROC NGO essentially does some of the same stuff as Friendship NGO, but they don't necessarily work or trying to work directly with the government. Some of their like social development projects include just eliminating extreme poverty, expanding financial choices, humanitarian crisis management, climate change and emergencies, gender equality, pro-poor urban development, investing in the next generation, my apologies. But also one other thing that they do focus on as well is universal access to healthcare. So they like to focus on water, sanitation, hygiene, and on top of that, BROC NGO offers specific nurses and specific little clinics within some villages where they teach specific women and children how to take care of themselves, hygiene, because no one really is able to teach them and they don't fully know the proper way sometimes, depending on where they live and what village they live in, and how much access to education they have as well. They also, on top of that, offer the basics of healthcare. So whether that be, you know, if something is wrong, whether you're sick and something that they can easily fix with the supplies that they have and with what they, you know, the information that they have. And yeah, that's one other NGO that I talked about, and I kind of researched in my first semester. Something else that's not really an NGO, but also something that I found really interesting was this specific hospital that was dedicated to COVID-19. And this was a public hospital, and essentially they had this dedicated hospital to the COVID, and it was the only specialized hospital in Bangladesh to provide emergency life-saving healthcare services to COVID-19 patients of Dhaka City, along with all over Bangladesh. So Dhaka City is the capital. And essentially it was a huge deal, obviously, because it is the only specialized hospital for COVID at that time. And they've actually converted that to be a hospital to only dedicated to dengue patients, which I think is really, really interesting. So this basically urban hospital, this public hospital is taking action to basically take active steps to combat the outbreak. And you know, a lot of these hospitals that I've done research on, a lot of public hospitals I've done research on, which I will go into depth in a little bit later, don't really have the necessary means for like enough resources or things like that. But this hospital is taking active steps to combat this outbreak, which I haven't seen a lot when I did my research. And when I was doing my research back in like early in the fall, there was a current dengue outbreak going on. And I'm pretty sure it is still going on, but it isn't at its peak. It was at its peak when I first started doing research. So it was definitely really interesting to see that this was the only hospital I could find information on. Yeah, so essentially, these are some of the NGOs. And again, one public hospital that I discussed, but a lot of these NGOs are placed in like the more rural areas, I would say. And because there are so many public and private hospitals in the urban areas, there's no really specific need for the NGOs to be at these public, I mean, at these urban areas. Also, obviously, there are issues with the way that rural areas have trouble to access health care. It is almost the same for places for people in urban areas, which, you know, you would think it would be better just because urban areas, there's a lot more hospitals, you have the public and the private ones. But unfortunately, the populations within the urban areas are so dense and so congested that it actually isn't as helpful. So the public hospitals, which we will be able to get more of a perspective on with my mom's interview coming up, basically, they don't have adequate, you know, resources. They don't have enough space with the amount of people that are coming to a single hospital. So these public hospitals, you don't have to really pay for and if you do have to pay for it, it's not that expensive, and it'd be out of pocket. So essentially, a lot of people obviously have to resort to these hospitals because they don't have enough resources and they don't have enough space. They tend to not be able to treat everyone that walks into the door. On top of that, you also have the private hospitals, which are a lot more expensive than the public hospitals. Those are the ones that do have more adequate resources and do have more, I mean, not necessarily always space, but the only reason they tend to have more space sometimes is because not a lot of people can end up affording these private hospitals and the treatment that they give. But these hospitals, from what I've heard and from what I've seen, are the hospitals that really get adequate treatment and where you can go to get the treatment that you need and the medication that you need or whatever that you need to help, you know, whatever is going, whatever is happening and whatever is wrong with your body. But again, these hospitals do tend to be a little more pricey, but instead of just continuing on and continuing blabbing and talking, I'm going to go ahead and dive into my mom's interview. So here we go. So after the surgery was complete, she was put into an observation room. In the U.S., there's typically only one person that stays in said observation room, but in Bangladesh, because there are so many people and these hospitals are so densely overcrowded, there's typically a lot of people who end up staying in one room. They don't let anyone, just anyone in the rooms. Only my brothers were able to go inside and see my grandma, and out of all my sisters, I was the only one able to go and see her because I was from America and they gave me this special treatment. In the U.S. operation rooms, there are typically really big monitors next to the beds, but in Bangladesh, they don't really have these big ones. The technology has for sure developed, just not to that extent yet. So she was obviously given oxygen and IV, which was, of course, all there. There was just no big monitor, but there was a tiny one and a smaller one that had all of the vitals and necessary things. So as my mom was talking to me about, you know, the quality of the observation rooms and what they look like and really comparing them to the U.S. and talking about the monitors, it really reminded me of a specific part of my research that I did earlier and the specific test that I had found. So in the specific, it was like an exit interview and it was like this experiment that the scientists were doing. So essentially, they sent out 400 exit interviews and they were conducted using a structured questionnaire that addressed the probable factors of the quality of healthcare services in a five-point interval scale. So they had eight variables that they were testing, which was the empathy of physicians, availability of physicians, assurance plus competence of physicians, empathy of nurses, responsiveness of nurses, availability of drugs, tangibility, and perceived cost. So all of these were specific questions that were on the exit interviews that were used for the patients to kind of give their opinion on and see how they felt about the hospital. So each factor was analyzed using the Kaiser's Egan value of greater than or equal to. It's a very specific way of like using specific numbers and math that kind of help understand what these, the numbers mean and what this means for the tests and the answers that given. But essentially, the answers and the results that they found were that the quality of service in private hospitals scored higher than that in public hospitals for nursing care, tangible hospital manners, examples like cleanliness, supply of utilities, and availability of drugs. So the overall quality of service was better in the foreign hospitals compared to that in the private hospitals in Bangladesh in all factors, even the perceived cost factor. Another study conducted by the Health Economics Unit of the Ministry of Health and Family Welfare, Government of Bangladesh found that the unavailability of doctors and nurses, their attitudes and behavior, lack of drugs, waiting time, travel time, etc. contributed to the low use of public hospitals. So my mom's interview really reminded me of this part of my research, just because this test and this specific test that has to do with like patients and citizens in Bangladesh, it just goes to talk to the fact and goes to speak on the fact that my mom was talking about of the operation rooms. You know, they have bigger ones in foreign countries, even and I spent my mom specifically talked about in the US. But when I was doing my research, and in my research, the foreign countries they talked about weren't only the US, but definitely countries around Bangladesh, which included like, mainly India and Pakistan. And top of that, my mom mentioned that it she was talking about the oxygen and IV and the technologies, which weren't amazing. But she did say that they definitely have improved over the years. And I think this specific research and the specific test and experiment specifically spoke to that, because it talks about, you know, private hospitals and how even though they're not up to that part, they are still more favorable than public hospitals, which a lot of patients still don't use, which I will speak be speaking on in a little bit, because my mom ends up mentioning it later. The surgeons at the hospital were my nephew's friends and teachers. Do you think that because you had these connections, they helped with your mom's treatment? Yes, we got a lot of discounts for price and we could tell that they took time taking care of her. If we didn't have these connections, it would have been a lot more difficult to go through the entire process. We also have a lot of family members who are doctors, so that allowed us to get many opinions on how to best help my mom. The nurse and IA cleaned everything. How did they clean it? They have IAs, which are below the nurses, and they help clean the patients as well as the room. They get paid very little. So for a whole month, they get paid $100. Nurses get around two to three times more than that. The nurses take care of vitals and any basic treatment while the IAs simply clean. My siblings and I helped out as much as we could, but we couldn't do everything, of course. So this information was something really new to me and something that I didn't fully find in the research and I thought was actually really important into discussing the health care system in Bangladesh. I obviously, I mean, parts of it that I did know would be just having the connections. I feel like that's something that's literally can happen anywhere in the world. Whatever connections you have, obviously, those connections are going to help you in wherever the connections are. So obviously, in this case, my mom got really great, like really lucky. And obviously, my family is grateful enough to be able to have these connections because my grandma got the best care that she could receive. And that is one of the main reasons why these connections are so, so very important. I think that's so important to know when talking about health care systems, especially Bangladesh health care, because I didn't really go into depth about this. But one thing that I remember wanting to mention and wanting to talk about in the in my research was the government and how the government hasn't really done anything to help the Bangladesh health care system and how my mom has always talked about how the government in Bangladesh is really corrupt and they don't really like do anything to help. And it has a lot to do with the prime minister. So I think this is a big part of it. And obviously, again, like your like connections exist everywhere. And it's not only in Bangladesh. And I'm not saying that connections are technically corrupt, but they definitely, you know, create the system and they egg on the system of like if you have these connections and obviously only very specific people have connections on a lot of people in Bangladesh who can't afford education, can't afford that. Obviously can't become doctors. And the reason why we have so many questions is because my family and my cousins had that privilege to become doctors and to have teachers who are doctors that were able to perform on my grandma. So it's really just like this very. It has a lot to do with like this social standing that you know that exists in Bangladesh and how health care is received, which I think is very interesting to know and very important to note when discussing Bangladesh health care systems. I just I could get public government private private hospital. Private hospital violation. We were at a private hospital. So how does a private hospital function? A couple of doctors own the separate private hospitals, and it's typically around 20 doctors who own one hospital. What are the differences between the private and public hospitals? The public hospitals don't really take amazing care of their patients. Are they much more expensive? No, not at all. The public hospitals are free. They have free treatment and medicine, but it's not good quality. Unfortunately, a lot of people who can't afford the treatments will resort to going to these public hospitals and get whatever minimal treatment they can. These hospitals are mainly in the cities and up the zillas. Each city has an up the zilla. For example, NYC has five boroughs. The up the zillas are like that for each city. In each of these up the zillas, there are there's around one public hospital. Are there a lot of private hospitals? There are an abundance of private hospitals within the separate cities. The public hospitals in comparison are much worse. There's trash everywhere. All the equipment is really old, and they have patients and family that have to wait outside on the balcony. The doctors typically work at the public hospitals for a couple of hours and then work at their own private hospital. A lot of doctors in Bangladesh function like this. They don't make a lot of money at the public hospitals, so they're forced to work at other private hospitals. Okay, so when my mom was talking about up the zillas, it reminded me of some research I had done up the zillas. I had read about them, and I had read about like hospitals and how they work in the up the zillas. And I had also read about char lands or chars. So essentially, these are areas of land in Bangladesh that are formed by sediment deposited by rivers. These areas are often located in flood prone regions and are frequently affected by natural disasters such as floods and cyclones. So these chars are typically isolated and have limited access to infrastructure and services, including healthcare. They are also often home to marginalized and vulnerable populations, including women and children mainly. Due to their isolation and lack of access to services, char lands can experience significant health service gaps. So I kind of like thought that it was interesting to think about the up the zillas and the chars just because they are very different. So for example, like what I was talking about in my introduction earlier in my background, the difference between rural and urban. This is kind of like the epitome of rural versus urban. You have these char lands that are really marginalized and far away from kind of the rest of the cities. And then you have these up the zillas, which are like the boroughs and the centers of the cities that are in Bangladesh. So just talking about like my mom explained the difference between the public and private hospitals in the cities and some of the research that I found, a lot of the research I found about these char lands talk about these health service gaps. So essentially these health service gaps refer to a difference between the health services that are needed by a population and the services that are currently available to them. So they can be caused by a variety of factors, including inadequate funding and resources, a lack of trained health care professionals and inadequate infrastructure and facilities. So one major challenge that's faced by the health care system in Bangladesh is the shortage of trained health care professionals, particularly in rural areas and in some cases, urban slum areas. And like my mom had mentioned, there's a long wait time and difficulty in just accessing care. My mom had mentioned like how a lot of the times patients and family members have to wait on balconies just to be able to get treatment. And those are like the lines that they have to wait on in order to actually be able to talk to a doctor. This was a specific study that was happening in the research that I did. So it used, again, a quantitative approach where a survey method was applied. Essentially, the biggest gaps that they found were one of them was the client's expectations and the service provider's perception of those expectations, which is really interesting. And then another gap was the client's expected level of service quality and their perception of what level of service quality they actually received. So those kind of go really hand in hand. And it really has to do with just the difference between what the patients need and what they expect. And then in comparison, what the hospital and what these doctors in turn give them and what they instead end up receiving. Like my mom or like I had mentioned earlier with the hospitals, with the private and public hospitals, like these doctors working in both, a lot of the times they don't get paid very well in the public hospitals. And I can only assume that because of that, they don't put as much effort into these public hospitals. And, you know, there's just so much that they can do with the equipment that they're given and the facilities that they're given compared to a private hospital where they're probably giving more care to their patients. And, you know, they're getting paid more as well. So, you know, this part of my mom's interview really helps me solidify that difference between these upazillas and these charlans. The hospitals haven't really proved much because there's so much stuff in Bangladesh. For example, there's typically a line of people who wait for medicine. So if a patient needs three doses of a medicine, someone will steal two of them and sell them to the people outside. There's always too many people at the public hospitals because everything is free, which causes this cycle. In the villages, there are no hospitals at all. So when my mom is at her house in the village, we have to drive and take her all the way to another city. It doesn't take too long to get to these hospitals. However, because there's so much traffic in the cities, it always takes longer. On top of that, a lot of people don't have cars, so it's even more difficult to travel. Okay, so this part of the presentation, I also really didn't find any information on when I was, you know, doing my research. And I think it's really important to know this specific information because I found it really interesting, similar to what I was talking about earlier about the connections that my mom made and how those were really important to my grandma's surgery, to making sure she got the best care. I think my mom talking about theft happening, and that's the reason why, a big reason as to why it's not. The public hospitals are also failing in Bangladesh. I think it's very, very important to note that. I think that has a lot to do, again, with the government and also just like with the idea that people really do, you know, need the help and this is what they have to resort to, unfortunately. And just if there was a way for the government to step in and help out these citizens more, it's very, I think it'd be very possible to have, you know, more people be able to actually use public hospitals properly and not for theft reasons or anything like that. All right, so I think you've made it to the end of my first episode. I hope everything makes sense and that it was all informative. I am really happy with the way my research for this part of my episode turned out, for my series turned out. I'm actually really, really happy with how everything panned out and I feel like my mom's interview really did help me get a grasp of a new, of like a different perspective on all the data I was doing and just solidifying some things that I knew and adding some new information to what I already knew and to the data already and the research already had. Yeah, so thank you so much for listening and I hope you enjoyed it and on to the next episode.