In thinking about this day I am at a loss for words but will do my best to describe my experience. As I sit here in my hotel room listening to the call to prayer outside ringing through the sky I am overwhelmed with emotions and realize I am too hot and exhausted and jet lagged to be able to share this journey in a way that will truly express this day.
I want to begin by saying how astounded and relieved I am that women’s health is a focus in the camps and within the communities. I have never witnessed such a dedication to reproductive health anywhere we have worked with refugee populations. It offers me hope in seeing how it should be done instead of all the frustration and anger I have often felt in working so hard to even get one NGO, one government official to realize how vital this is and to take steps to ensure it is readily available. I am gratefully overjoyed.
I am working with the Hope Foundation for Women & Children in Bangladesh (www.hopeforbangladesh.org) in conjunction with the UNFPA. Currently Hope is providing mobile medical care cycling providers through the various camps. In addition they run a hospital for women and children which has emergency facilities improving the health and saving the lives of members of their community. There is one other NGO providing reproductive health services. For now Hope has clinic hours during the days and referring women to the “fixed” clinics that are spread near each of the camps for after hours. The biggest issue is alerting women to the existence of these clinics and of course ensuring they have the means to get there.
During the day Hope also has teams at each camp walking around seeking out those who may have health issues who cannot make it to the clinic. They are armed with a stretcher and at the bottom of the hill at each road are tom-toms to transport women to the hospital if their condition is deemed too high risk to birth in the camp. I was at Balukhali camp today and was told they have had 8 deliveries there in the last 2 weeks. There is also groundwork being done for a field hospital to be built in the location the Balukhali Camp clinic is now. That will enable more access to critical care services and provide 24/7 care to the women in this camp.
Full access is a concern of mine as the women I cared for today were in poor health: underweight, malnourished, anemic, suffering emotional trauma and experiencing the stressors of living in crowded camp conditions with limited food and safe drinking water. That is the perfect set up for complications during pregnancy and birth and I worry that without a skilled midwife present there will be many maternal deaths. Tragically just this morning there was a maternal death in a camp nearby – the second in 2 weeks. The clinic was not run by Hope and we are still waiting to hear the details so we can train the midwives and clinicians better – but it was news that brought me to tears.
The exam room the midwives use is a corner in the clinic cordoned off with plastic and a drape for a door. The exam table is a sleeping bag like pad on the dusty dirt floor. It is very small and difficult to fit us all in but it works and I am grateful the women have a private place to go. Many women come in wearing niqab (not to be confused with burqah though that is what it is called here) and remove their head dressing so the first time I see their faces is in the room.
I worked with a Bangladeshi midwife, Sharifa, who was very sweet and while new to this calling was confident and excited to learn anything I could share. It was she who welcomed all 8 babies into this camp as she is there every day.
I can’t describe the blank faces of many of the women I cared for today. It was like they were gone – just going through the motions of existing. I heard one tale of a woman who was due any day and arrived last week – she had lost her husband and her young son. Another woman reported that she just arrived and had traveled 5 days without food but didn’t care because her infant was forcefully taken from her ams and killed in front of her. Story after story after story. It felt as if the room was filled with scars, emotional and physical, scars that may never heal.
But there was occasionally a glimmer of joy too. Many women had never had a doppler used in their care (they are not practical due to the expense and hardship of getting batteries and the humidity shortens the working span of the equipment). In fact, Sharifa the midwife I am working with had never even seen a doppler before. For a few women, hearing their baby’s heartbeat was a gift and they smiled for the first time or giggled. Those smiles refreshed me and helped me to not feel the weight of all I was witnessing and hearing.
The camps themselves were bleak places and the heat and dust mixed with the deep mud made them only more depressing. We traveled past several to get to our location. In one camp we passed there strung a long line of people almost 1 km long in line for food and supplies. I dared to hope there would be enough for all. I can’t imagine what these people are going through. I don’t want to – it is too frightening a thought. Yet here they are and this is real.
Balukhali Camp was no different. It went on and on over the hills, trees having been cut down to make room for the waves of people who arrived almost overnight – and keep coming. I could not see the end it went so far. I shudder to think of what will happen when the rains do pour down and how their shelters would be washed away in the mud. But for now this is the best anyone could manage. And like all places that become “home” there was a sense of community and once in a while there would be a child’s laughter ringing out. I have never done more important work in my life.