Bangladesh<\/strong>: Realities of People\u2019s Lives<\/strong><\/p>\n \u00a0<\/p>\n By Fazle Hasan Abed<\/p>\n \u00a0<\/strong><\/p>\n This article by Fazle Hasan Abed appeared in The State of the World\u2019s Children, 1988, a UNICEF publication.\u00a0<\/em><\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n The Bangladesh Rural Advancement Committee (BRAC) is attempting to take ORT to every home in a nation where 250,000 children die every year from diarrhoeal dehydration. So far, 9 million mothers have been reached. The Executive Director of BRAC, Fazle Hasan Abed, summarizes the lessons learned.<\/em><\/p>\n \u00a0<\/p>\n After our first few months in the villages, follow-up surveys showed that only 10 percent of those reached were actually using ORT. So began a long process of learning about the relationship between information and behavioural change.<\/p>\n Our first lesson was that teachers must believe in what they are teaching. I discovered that our own workers were not using ORT themselves. They still believed more in pills and tablets. However, after hospital demonstrations, they were convinced about the salt and sugar recipe. When they began to believe, those whom they taught also began to believe, and the usage rate began to rise.<\/p>\n We also learned that the whole community has to be prepared for new knowledge. If the men have not heard of ORT, they will discourage their wives from wasting time with it. Our male workers always meet with the men first and with constant radio messages to back us up, ORT has become familiar to 80 percent of adult males in Bangladesh. They now expect their wives to know about it. Similarly, if ORT is accepted by the school teachers and the leading people in the community, then mothers will be more likely to use it.<\/p>\n To create this climate of acceptance means using every channel of communication. We even set up loudspeakers and demonstration stalls in the market-places which are important communication centres in rural Bangladesh. We make sure all teachers train their pupils in ORT and encourage them to take health messages home.\u00a0<\/p>\n We have also now begun to tap the potential of the mass media, using television advertising to get across nutrition messages. We know that the poor don't have television but nowadays the most influential people in the community do. And unless they accept new knowledge, the chances of the poor accepting it are very much reduced.<\/p>\n Once the community is prepared, our workers - and there are now 2,500 of them -go house to house, spending half an hour with each mother talking about ORT and other ways of protecting children.<\/p>\n Above all, you have to bear in mind the realities of people's lives. If you tell people to boil water for ORT, this may mean that 50 percent will not use the therapy. So you have to make a pragmatic decision - should boiling water be part of the message or not?<\/p>\n I believe everyone should know about things like ORT and immunisation, birth spacing and proper weaning. Then we will see a synergy between these improvements, leading to a fall in the dreadful death rate among our children. In this way, we can build primary health care in each mother and in each household. That is where the battle has to be won.<\/p>\n However, communities must also demand, and governments must provide, basic health services. An informed community is more likely to do this. And an informed government bureaucracy is more likely to respond. So there is a job of advocacy to do in both directions.<\/p>\n Sometimes I have been discouraged. The knowledge road to health is not easy. We have reached 9 million women. Of those, about 40 percent have begun to use ORT and of those, half are using it correctly. But if we look fifteen years into the future, I am certain that ORT and other vital health messages will not only be known to 100 percent of Bangladeshi mothers - they will also be part of our culture.<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n \u00a0<\/p>\n <\/p><\/div><\/div>\n <\/dd>\n