If You Build It, Will They Come?

One of the things you know if you’re a native of Portland, Oregon, is that umbrellas are for tourists. Those of us born in one of the most rain-drenched cities in the country are used to being somewhat damp most of the year. We’re tough enough to handle the rain. Our pride tells us we don’t need an umbrella.

So I had a bit of a smirk on my face as I relented to raising an umbrella over my head in Bangladesh. Only it wasn’t because of the rain, but the sun. As I crossed makeshift bridges of bamboo, climbed steps carved into dirt hills and squeezed through narrow passages between endless compact shelters, the sun pressed down with an intensity that would never strike my hometown. The umbrella in my hand became a shield.

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A Community Health Worker walks through Kutupalong Refugee Camp with a mother and her child.

There are no tourists in Kutupalong Refugee Camp. And no resistance to umbrellas either. Everyone uses them — aid workers, Rohingya refugees, women on their way to give birth. An umbrella is so vital that they are distributed as part of humanitarian aid packages, and small businesses have sprung up solely to repair broken umbrellas. I saw their necessity in battling the sun, and I’d heard tales of violent monsoon rains that would require their protection as well. No matter the weather, I could see why many of the women I met had been reluctant to travel to the nearby clinic to give birth. Umbrella or no, what woman would want to climb muddy hills, navigating uneven paths, while her 9-month-pregnant belly contracted in labor pains and her body — covered head-to-toe in black fabric — was pummelled by either sun or rain. I get it — giving birth alone at home sounds easier.

But I didn’t get it. This wasn’t about umbrellas.

This is about not knowing what you’re missing out on.

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Health clinics were quickly constructed to meet the needs of a massive influx of refugees in 2017.

As an oppressed minority in their native Myanmar, the Rohingya people were denied access to medical care. The ability to take a sick child to a doctor, rush to a hospital with an injury or safely deliver a baby in a maternity ward was a luxury they could not comprehend. They hadn’t experienced the basic human right of adequate health care for decades.

Then they were driven from their homes in a mass slaughter. Forced to flee for their lives to neighboring Bangladesh. Many died along the way. Countless Rohingya arrived at the refugee camp with severe wounds, life-threatening illnesses and massive emotional trauma. Aid organizations like Medical Teams International rushed to help them. We built temporary clinics to treat the most urgent cases, and eventually transitioned to permanent structures that could provide around-the-clock care. And while more than 100,000 Rohingya refugees came through our clinic doors for consultation and treatment last year alone, far too many women remain hesitant to make the short journey from their homes to receive medical care.

It’s because of the unknown.

Taslima is a volunteer Community Health Worker on a mission to help her fellow Rohingya women realize what they’ve been missing. Every day she visits her neighbors to build relationships, check on the health of their families and share about the resources available to them. She explained that back in Myanmar, people might go to the hospital and end up a dead body. She works hard to erase those fears.

“In our hospital, it’s not a place for death. It’s a place to make you well,”  explains Taslima

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Taslima lays a comforting hand on Tasmin Ara and baby Nur Fatima.

I watch and listen as Taslima converses with new mother Tasmin Ara and her 11-day-old baby girl, Nur Fatima. I learn that starting in the eighth month of her pregnancy, Tasmin Ara would receive daily visits from Taslima, who would ask about labor pains and explain the benefits of a hospital birth. When Tasmin Ara finally went into labor, she was still afraid to venture to a place where none of the women in her family had been before. It took 3 days of gentle but firm counseling before Taslima convinced Tasmin Ara to see a doctor and ease her labor pains.

As soon as she arrived at the clinic, the staff determined Tasmin Ara’s baby was in a dangerous state. Thankfully, the medicines and equipment necessary for a safe delivery were readily available, and Nur Fatima was born without complication just 30 minutes later. Given the prolonged labor, the newborn suffered from hypoglycemia and low movement. She was treated with Vitamin A and K and heating lamps, and admitted three days for close monitoring. Now, Nur Fatima is a healthy baby girl.

Did this experience change Tasmin Ara’s mind about giving birth with the help of medical professionals?

“Of course I will go next time because I was given good treatment.”

Not only that, she is now sharing her story with all of her neighbors.

At a meeting of Community Health Workers in the Kutupalong Refugee Camp, one of the leaders told everyone that a key area to focus on is encouraging women to come to the closest clinic as soon as their labor begins. Shifting the cultural norms is an uphill battle, but it’s one worth fighting. As the birth rate increases, so does the importance of making sure every woman knows that there is a safer way to deliver her child. Sometimes that means the Community Health Worker brings a pregnant woman to the clinic for a tour and an explanation of what to expect, in order to calm her fears. Other times it means arranging for transport of a woman with a high-risk pregnancy. Given the harsh conditions and intense weather, the sooner a woman can make the trek from home to the clinic, the better chance she has of a safe delivery.

Umazahan is another first-time mother who comes from a long line of women who have faced childbirth alone. She came to the clinic for prenatal check-ups, but upon returning home after each visit her family members would encourage her to stick with tradition and deliver her baby at home. She tried, but found it too difficult. Thankfully, a Community Health Worker arrived in time and encouraged her: “Come to the facility — there are doctors, they will help you.”

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Umazahan is thankful she sought help from the medical clinic to deliver her first child.

As her newborn baby sleeps peacefully beside her, Umazahan expresses her confidence in the decision to come to the clinic, “It was so painful at home. Next time I will definitely come here.”

Her mother — now a new grandmother — had to agree. She’s given birth to seven children; Umazahan is the eldest and all the children were born at home. Seeing the difference between her own deliveries and that of her daughter, she declared:

“Delivery at the hospital is good. At home, there is no security that the baby will be alive. In Myanmar, many babies and mothers died. But at the hospital, babies are safe.”

This change of perception is slowly taking root among mothers in the Rohingya refugee camp. An increased understanding about the availability of health care, growing confidence in the medical staff and a realization that no one should have to suffer from preventable and treatable conditions is saving lives. 

And it’s not just newborn babies who benefit. Hot weather, humidity and poor sanitation caused a painful abscess to develop on 14-month-old Asma’s head. For a month, the girl cried as the abscess grew larger. Thankfully, Asma’s mother Shomsum had heard about the nearby Medical Teams clinic.

“When I first saw the abscess, I felt scared. Which is why I immediately came here. Even though my neighbors told me to remove the infection at home, I knew the right thing to do was to come to the clinic.”

Every day Shomsum brings Asma to the clinic for a check-up, a clean change of bandage and oral and topical medication.

Baby, Asma Bibi and mother Shomsum in Bangladesh.
Young Asma received treatment for a painful abscess.

At each visit, the doctor takes the opportunity to remind Shomsum how to maintain good hygiene in her home: try not to let Asma sit on the dirt floor, have everyone wash their hands before tending to the baby. Shomsom has learned how to prevent abscesses from developing in the future, and is sharing this knowledge with her friends whose babies have also suffered from similar infections.

“This is a good, caring clinic. So when anyone in my family has a problem, we will come here.”

Medical care is something we shouldn’t take for granted. It’s also something we can’t assume everyone is aware of. There is something more devastating than a harsh sun or fierce rainfall keeping women from accessing life-saving care — it’s the reality that they’ve never known it was an option being denied to them.

Knowing that now, it gives a greater importance to the role of Community Health Workers. It’s not enough to build a clinic, staff it with medical professionals and stock it with medicines. You have to reach people in their homes; touch their hearts; change their minds. You need to reassure them that they matter. And that they deserve a chance at a healthy life.

Photos courtesy of Nihab Rahman.


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