Round two of indhakatrination

I arrived in Dhaka around 4AM on Monday morning, after about 24 hours of relatively uneventful travel (highlights included paralyzing fear that I'd be stuck in snowy London without winter clothes, lamb cutlet brunch as one of the plane meals, and Mama Mia, possibly one of the worst movies ever made). Evidently Susan Davis, the CEO and Executive Director of BRAC-USA, was on my plane as well and staying at the BRAC Centre Inn, so I had a chance to meet her. Always ironic when you e-mail with someone who works relatively close to you (her office is in NYC) and you meet them for the first time thousands of miles away.
Today was my first day out in the field. I had a chance to return to Dhaka Medical College--the largest public hospital in Dhaka--and see the DOTS corner. One of the two women working there has worked with BRAC for 28 years, making her one of the first health workers. The clinic was quite busy; they invited me to sit in their office and ask questions, but all the while people came by with referrals for testing and/or treatment, and the women skillfully jumped between our conversation and their responsibilities. I also had a chance to see the massive paper record they keep for BRAC and the National Tuberculosis program. They are extremely diligent about data collection and recordkeeping, but I couldn't help but wonder what an electronic system would do for their ability to analyze the data and follow up on patients. As it is now, they send a patient's information form to the treatment center closest to where they live, and once the center receives it AND the patient begins treatment, they send it back. If both of those criteria are not met (or the letter gets lost in the mail either way), the patient will either not be treated or not recorded. A letter came in from a treatment center while I was sitting there: that patient has been tested on November 13 and was now on treatment. Is that indicative of how most patients behave? I am not sure.
Afterwards, I had a chance to visit a BRAC center in the southern part of town (older Dhaka). As you head south in the city, the roads become narrower and cars become less and less frequent. By the end, we were virtually the only car on the road, surrounded by colorful rickshaws and bicycles with trailers attached. This particular center was in a slum--BRAC is committed to helping the poor move out of poverty, and particularly interested in the economic development of women. There I had a chance to meet the program officers, along with the head of the microfinance program and health program. BRAC always amazes me with their ability to have very little overhead (including physical space!) for huge programs--the microfinance program alone had over 3,000 members. It forms the basis of all of their programs in the rural area, though it appeared to be less central in the urban context.
The POs took me to meet two shasthya shebikas (health volunteers--one of whom, Reina, is pictured here)) and a patient on treatment. As soon as I got out of the car, I was surrounded by children. They are beautiful--all look curious, some a little fearful and others mischievous, but it is painful to take in the poverty that they all are growing up. Most don't wear shoes, their clothes are worn, and they are extremely thin. BRAC provides some educational opportunities in the slums, but it is obvious that more resources are desperately needed.
Last time I was here, I was overwhelmed by the poverty for most of my time here and could not move past my emotional reaction to it. This time, I find myself more analytical about it--still moved emotionally (I truly hope I never lose that sense of humanity), but perhaps with more depth. What I find myself most troubled by these days is a new issue: there is so much evidence here of ingenuity, creativity and intelligence, used to create new means of survival. Looking out of the window of the BRAC office, one sees a growing slum, surrounded by water (pictured below). One of my mentors commented that 20 years ago, there was a big lake there, with no island. People have literally built from the ground up--adding their foundation as they go. The economy that has sprung up around the slum, with everything from building materials to rowboats to shuttle people back and forth. While this is all very impressive, I can't help but wonder, what if instead of putting energy into struggling to survive on under $2 a day, we could put these minds to work on some of the most critical global priorities of our time: global warming, new cures and treatments for diseases like HIV/AIDS, or solving the financial crisis. The fact that almost half the world lives on under $2 a day (purchasing power parity) means to me that half the world's brainpower is extremely underutilized (as in, it must first and foremost be focused on survival at all times). Maybe more, given the number of people around the world who spend their lives trying to figure out how to improve quality of life for people in resource poor settings (myself included). Moral imperative aside for a moment, this to me seems unconscionable from a perspective of a wasted resource. Not that I blame those living in poverty or those working with them--millions of lives are at stake. But sometimes I feel like we need to take a step back and say, why is the context of resource limitations and poverty a given? Why hasn't this changed after decades of advocacy? And will we ever be able to galvanize the global will to do so? I cannot come with reasons that justify the inaction. We might fail by acting, but we fail without doubt by not acting.
We should not put the moral imperative aside--I hope that future generations will look back on this time and wonder how we stood by not only during genocides, like Rwanda in the 1990s and in Sudan now, but as we watched millions struggle to combat poverty, with so many dying of hunger and conditions related to malnutrition and other poverty-related afflictions.
For all of these reasons, I feel like it's important for me to be here. So that I can write about BRAC and help build effective programs elsewhere, but primarily as a global citizen to bear witness to how others are forced to live.
I find myself constantly reminded of a very poignant quote whose origins are unclear, but are attributed to an Australian Aboriginal activist: "If you have come to help me, you are wasting your time. But if you have come because your liberation is bound up by mine, then let us work together."
I hope that my work here and elsewhere embody that philosophy.