lfe report

LFE Report – Autumn,2016

Venue: Proshika, Manikganj

By Junait Husain Rahul

INDEPENDENT UNIVERSITY, BANGLADESH (IUB)

LIVE-IN-FIELD EXPERIENCE (LFE)

AUTUMN, 2016SECTION- 06

Submitted To:

Dr. S.M. Raysul Haque

Amrita Khan

Submitted By:

Name: Junait Husain Rahul

ID: 1310911

Independent University, Bangladesh 1




LETTER OF TRANSMITTAL

24th January, 2017

Dr. S.M. Raysul Haque

Senior Lecturer, School of Public Health

Independent University, Bangladesh

Bashundhara, Dhaka-1229

Subject: Submission of LFE report on Condition of government hospitals in the villages

and the unwillingness of going to government hospital among the villagers.

Dear Sir,

It’s our great honor and privilege to submit this report as part of the requirement for

completion of the undergraduate degree. We were assigned to prepare a report on LFE of

Condition of government hospitals in the villages and the unwillingness of going to

government hospital among the villagers..

Our area of survey was Golora, with the help of our coordinator, other faculty members and

monitors; we have tried to apply the knowledge, obtained during the field survey in

preparation of this report. This research is based on primary and secondary data base. The

report writing itself has been a learning process and has added to us limited knowledge in

rural dynamics.

We hope that you will kindly accept this report as the requirement for the fulfillment of

undergraduate program and provide us an opportunity to defend the findings whenever

necessary.

Respectfully yours,

Junait Husain Rahul





ID:1310911





Acknowledgement

We would like to thanks our university for giving us this wonderful opportunity to introduce with nature and rural perspective. The “Independent University of Bangladesh” is the only university that arranges a unique program, LFE “Life in Field Experience”. We the young generation are the backbone of the country and we must know how the great majority of the people live. A large portion of our country is directly and indirectly related with the villagers. But it is also true that, the life blood of our country (Villagers) is affected with Poverty, Malnutrition, Illiteracy and unconscious about health.

LFE-Live-In Field Experience is one of the distinctive courses offered by IUB to its students. The course is designed to impress upon young minds the socio-economic realities of the rural Bangladesh as the majority portion of our population live in the village in the rural areas. Through this course, we have an opportunity to get direct encounter with rural people.

For making our LFE great and successful I would like to thanks our honorable Sir ‘Dr. S.M. Raysul Haque’ and ‘Amrita Khan’ Miss. Without their guidance it should be impossible to complete the whole LFE. Thank you again, encouragement and helping us in every problematic situation in these twelve days, I would not have done without you.

I would like to give a big thanks to “PROSHIKA” and their stuff for helping us on the field and they also guide us for the right term. “PROSHIKA” help us to know about the village and many of curriculums which we not familiar before.





Topic Name: “Condition of government hospitals in the villages and the unwillingness of going to government hospital among the villagers.”

Introduction: Live-in-Field Experience:

Every day we wake up in the early morning with a great feel of natural atmosphere. Within twelve days we feel like a family. Every day we learn new things which we are not familiar before. In the morning we visit the village with our group members which are directed by our honorable faculties and monitors. LFE introduce us with “Proshika” which help us to make a deep bonding with the village people and also help to understand their culture.

The young generation of our country we must know that how the great majority of the people live. Most of the young generation people have little or no idea about village, LFE introduce them with the village. The village people of Manikganj are affected with poverty, innutrition, illiteracy and unconscious about health. They are always serious about their occupation and household work. The people of village are very hard worker but they are not enough worried about their health and nutrition. They face many kind of disease but they are not willing to go at hospital or clinic. In Manikganj have one government hospital “Adhonik Sadar Hospital, Manikganj” which are maximum six kilometer distance from the village and one government health clinic “Golra Community Clinic” which are maximum one or two kilometer distance inside the village. There have two options for health checkup. But they not worried about their help. Approximately 80% of people in the Manikganj village are taken their health tips from their nearest “Pharmacist”. Those are not very experienced and not very helpful for all disease.





The pharmacist suggest them some medicine without any checkup. Some of the village people take some herbal medicine for their health problem.

Condition of government hospitals in the villages: There have two types of hospitals in the village of Manikganj. One are “Adhonik Sadar Hospital, Manikganj” and another are “Golra Community Clinic”. But these hospitals need more equipments and seats for the proper treatment. “Adhonik Sadar Hospital, Manikganj” have 250seats but its work for 100seats which is very minimum capability for a hospital.

Doctor and health worker are not available in this government hospital. Patients are not found the schedule of doctors. The emergency service of this hospital is very poor. This hospital is open 24hours but sometimes it faces some electricity problem. The doctors of this hospital are not deal for the big operation they always referred the big operations in Dhaka or some big hospitals in the city. For the shortage of equipments and health worker/nurse, they always delay to show the medical reports to the patient like surgery, X-ray, blood test and many kinds of medical checkup. The operations theaters are not contain full of equipments. Many kinds of important equipments are not available here. The unheeded reason many of operational and medical equipments getting spoiled. The publicity of this hospital is very poor. People are not familiar about the advantages of this government hospital. There have no ambulance from the government hospital. The pharmacy of this hospital is not very good





many of medicines are not available in this pharmacy. The big problem is that people not get enough medicine free from the government hospital but government provides many of medicines which is totally free for the poor peoples.

There have a small health clinic in Manikganj. This is located at ‘Golora’ village. It’s very small for the entire village. The name of the clinic is “Golra Community Clinic”. This clinic is so active for provide their services.

This clinic provides health service with the small number of health worker and nurse. They specially provide services to the pregnant women and children’s. They also provide health service for simple diseases like fever, cold cough, tuberculosis etc. They also arrange many kinds of health services program like blood donation, polio vaccination, and jaundice vaccination etc. People are willing to use those health services but the clinic doesn’t provide the full facilities. There have shortage of chairs, medicines, equipments etc. The clinic also faces the problem of finance. Government not provides enough finance for this clinic. This clinic not has fixed doctor. Approximately two or three doctor is providing the health services. Some of interning medical students spends some times for giving the health service to the village people. The “Golra Community Clinic” provides minimum level of medicines to the village people. But they have no specific pharmacy in the village or town. They have





no emergency call service. They have no ambulance service in this clinic. This clinic has needed more space to work in the village.





The unwillingness for going to government hospital among the villagers:

In Manikganj village approximately 60% people are illiterate. Many of peoples are not conscious about their health. More or less 80% of peoples are manual labor. They worked in the field, agriculture land, day labor, business in the market etc. In this village we saw much kind of religion, different culture, and different characteristics of peoples. In the Golra village we found about 80% people is who are working in the field. Those people are very busy with their work.

We found many facts for unwillingness to go government hospital among the village

a) There have not enough free medicine.

b) Doctors are not available.

c) No emergency appointment.

d) Village tradition.

e) Still using herbal/kabiraji medicine.

f) No available ambulance service.

g) Household are not interested to go with her wife in the hospital.

h) Village people don’t know that how to get the health service from the hospital.

i) Very lower publicity for the hospital.

j) Village people don’t know which services are available.

k) Believe to take medicine from the pharmacist.

Most of the time we visited Golra village which are the big village in Manikganj. We noticed many of characteristic of the peoples. They are not very healthy but they are feeling sick but they won’t go to the hospital. They took medicine without any checkup. The village people think it’s a big trouble to go hospital and take health service, checkup or anything else. Now I am going to discuss about the reasons.

There have not enough free medicine

In this village hospital have shortage of services, equipments, health worker etc. But those hospitals have specially shortage of medicine. They have no pharmacy from the government. Government hospitals give medicine but it’s not enough for the people. Government provides





some medicine like gastric, fever, cold, and cough disease. But the village people want more medicine that’s why they are not willing to come in the government hospital.

Doctors are not available

Government hospital always provides specific numbers of Doctors for giving the proper health service. But in Manikganj government hospital have no enough doctors. Doctors are not available here. Patient not gets appointment within a perfect time. Duty doctors are busy with their own hospital. The minimum levels of doctors are not able to giving the health service perfectly. For that reason people are not willing to come in the hospital.

No emergency appointment

Sometimes people need emergency appointment. But in those hospitals have no option like that. They have no emergency phone number or emergency health service. Sometimes medical students are in this government hospitals giving emergency health treatment. But it’s not enough for the whole village people. People are not feeling safe to come in hospital with an emergency case. In the emergency time people try to select the shortcut or other option.

Village tradition

Village tradition makes a great impact for unwillingness to go to the government hospital. Especially women and girls are facing those problems. Some women are not raising their veil that reason they are not going to the government hospital. These types of women are not willing to checkup their health condition from the male doctors. In the village if any unmarried girls are suffer any health problem then parents are not willing to go to the hospital. They try to solve it at home or privately solve with the village doctors or kabiraji medicine.

Still using herbal/kabiraji medicine

In the village of Manikganj there have many of people who are believe in the medicine (allopathic). They still use herbal or kabiraji medicine. But these types of peoples are too rare in this village. Approximately 5percent of peoples are willing to take this type of medicine. The old people in the village are believed on those matters. About 70-95 years old people are still believe about the herbal treatment. If anybody is noticed that any kinds of medicine (allopathic) are not working for the specific health problem then they should try the herbal or kabiraji medicine.





These types of people are increasing the number of unwillingness for going to the government hospital.

No available ambulance service

In the government hospital in Manikganj have no ambulance service. This is very major need for a hospital. In a hospital many time it face many major occurrence that time the ambulance need badly. In an emergency situation an ambulance helps a patient too much. For an ambulance a patient should be being safe and it should be make a great timing for the treatment. Ambulance should ensure the secure travel for a patient. That reason people are not feeling safe to go to the government hospitals and not willing to take the health service.

Household are not interested to go with her wife in the hospital

In the household head are always busy for their work. They are not feeling easy end of the day. Sometimes they ignore some of health problem. Sometimes their wife suffers from some health problems but they don’t worry about it. He didn’t think about the disease of her wife. He didn’t think about needed of any kind of checkup. Maximum time he takes suggestion from the nearest pharmacy and takes some medicine. That’s reason household head are not willing to come in government hospital with her wife.

Social Stigma and Privacy Issues

In rural areas of Manikganj, where there is little anonymity, social stigma and privacy concerns are more likely to act as barriers to healthcare access. Residents may be concerned about seeking care for issues related to mental health, substance abuse, sexual health, pregnancy, or even common chronic illnesses due to unease or privacy concerns. This may be caused by personal relationships with their healthcare provider or others that work within the healthcare facility.

Village people don’t know that how to get the health service from the hospital

Many of village people are don’t know that which kind of health treatment are available in the government hospital. About 60percent people are illiterate they don’t know about health or health treatment. Many of village people think it’s like a panic. They not try to get the facilities. They





don’t know that many kinds of medicine government provide free. They think if they go to the government hospital than it will be a longer procedure like treatment, health checkup, health test etc. Many of people are not able to read and write these reason they are feeling afraid to go to the government hospital.

Very lower publicity for the hospital

People know that government hospital is here but they don’t know how many service it have. Many of people have no ability to read and write so they don’t know about the facilities of government hospital. The government hospital of Manikganj its outside of the village for that reason many of people are not get enough information about the government hospital. Which types of operation occurred, medicine available people didn’t know about it.

Poor Health Literacy

Health literacy, which impacts a patient's ability to understand health information and instructions from their healthcare providers, is also a barrier to accessing healthcare. This is a particular concern in rural communities, where lower educational levels and higher incidents of poverty often impact residents.

Village people don’t know which services are available

People of the village don’t know about which service are available. They are not able to know that which service are always open or not. They don’t know about the free medicine. Many of people think that government hospital may cost too much. Many of peoples are not familiar about the government hospital and its curriculum. That reason they feel unwillingness to go to the government hospital.

Believe to take medicine from the pharmacist

About 80percent of people in Manikganj village are still take medicines from the pharmacist. The village people usually use the shortcut. They always take health related suggestions from the nearest pharmacist. The nearest pharmacist suggests medicine for the specific health problem. Maximum time village people avoid government hospital facilities just for the pharmacist.





Conclusion: In this situation I think it’s time to improve the whole system of hospital service in the entire village of Manikganj. If every hospital and clinic opened a help line service in a mobile phone network then it will be very helpful for the rural people in Manikganj. Telehealth can allow rural patients to see specialists without leaving their communities, permits local providers to take advantage of distant expertise, and improves timeliness of care. If every month a team organized a health awareness program in the village and give them the idea to the village people about healthcare. In the Manikganj there have three village the village people need more health clinic like “Golra Community Clinic”. Shortage designations are used to identify and assist areas that lack access to healthcare providers. Some programs to improve access to healthcare in Health Professional Shortage Areas. Health center program, rural health clinic program, national health service can inspire the village people for taking the health service. The closure of rural healthcare facilities or the discontinuation of services will have a negative impact on the access to care in the community. Factors impacting the severity of the impact may include distance to the next closest provider, availability of alternative services, the availability of transportation services, and the socioeconomic and health status of individuals in the community. Having to travel to receive services places burden on the patients including cost and time. For people with low incomes, no paid time off of their jobs, physical limitations, or acute conditions, these burdens can significantly affect their ability to access care. Maintaining pharmacy services in rural towns can be a challenge, particularly when the town’s only pharmacist nears retirement. When a community’s only pharmacy closes, it creates a void in services to which residents must adapt and find alternate ways to meet their medication needs. Rural residents rely on local pharmacies to provide pharmacy and clinical care management and coordination. The absence of a pharmacy may be disproportionately felt by the rural elderly, who often have a greater need for access to medications and medication management service. Increased distance to the nearest pharmacy may result in decreased access to pharmacy services for this population. Access to medications may be maintained through phone-order, delivery, or tele pharmacy; however, providing clinical and in-person consultative services to remote populations may be a challenge. Healthcare workforce shortages have an impact on access to care in rural communities. One measure of healthcare access is “having a regular source of care” and having an adequate health workforce to provide that regular source of care. Some health researchers have argued that determining access by simply measuring provider availability is not adequate to fully understand healthcare access. They argue that access measures should include healthcare service use and nonuse. For example, including people who could not find an appropriate provider of care. In order to increase access to care, rural communities may look to other providers, in addition to physicians. Providers could include physician assistants and nurse practitioners, public health workers, community health workers, community paramedics, care coordinators, and health coaches, which all provide new roles for healthcare teams.





References:

http://www.slideshare.net/sshojib90/lfe-report http://www.daily-sun.com/post/98771/Most-govt-hospitals-running-in-unhygienic-

condition

https://www.ruralhealthinfo.org/topics/healthcare-access

THANK YOU


https://www.ruralhealthinfo.org/topics/healthcare-access