A taka for your thoughts

Welcome to a semi-regular part of the blog where I throw up a random question and ask for your thoughts (for those not used to blogs, you simply need to click on the word 'comments' at the end of this article to add your thoughts to the mix).

So last weekend I went in to Dhaka and visited a different church to the one I normally attend. It was a fairly high/traditional Anglican service, quite unlike the more charismatic one I've been going to. Although I've been a member of this kind of church in the past, the visit this time got me thinking about symbols. The priest had the full robes on, made the sign of the cross repeatedly and paused in the middle of the service to 'Bless the Palms' by sprinking them with holy water.

A lot of people really relish this kind of rich symbolism. They find it helps them understand or experience God in a new and deeper way. I can appreciate this point of view, but I've always been much more comfortable without too much of this kind of symbolism in church. God from my experience and what I see in the Bible is much more interested in what's happening inside you than in external show. The whole point of what Jesus did was to remove the barrier between us and God, so we could go to him directly. It seems counterproductive to put a whole lot of symbolism back between you and God. The upshot is, I feel a bit uncomfortable around lots of religious pomp and obscure symbols. This is an exception for me, because I like my literature, art, music, architecture etc to be packed with rich symbolism. Previously, I would have described myself as someone who didn't like many symbols in my faith.

I say 'previously' because all this anthropology has got me rethinking things. Anthropology used to be only about studying 'savages' in grass huts with funny rituals and illogical customs. Then someone embarrassed us all by pointing out that in fact, 'Western' rituals and customs are no less funny or illogical - in fact, sometimes more so, but because they were part of the home culture of the anthropologists nobody noticed how strange they were.

To return to the point, I've often noticed how much more symbolism there is in other people's churches or services (and indeed in other faiths) and smugly thought there wasn't much of it in mine, but now I find in fact there's just as much symbolism, but it's just more cunningly hidden. In many of the churches I've been to, for instance, the very absence of symbols such as the traditional church layout, stained glass windows, big wooden cross etc was in itself a symbol of those churches' historical/theological beliefs. Look at the massive bouts of iconoclasm and church redecoration that took place during the Reformation. The translation of the Bible you read has become an important symbol of all sorts of beliefs and affiliations in many churches. The tendency of churches today to be built wide and shallow is a very definite statement about inclusiveness and the importance of the congregation. In these churches the minister is often lower down and the congregation looks down to him; in others, the minister (and band) are elevated on a stage. None of these things are accidents - they're symbols of assumptions and beliefs so visceral we often don't perceive or voice them.

So, given that every sphere of human life is inherently full of symbols, my question to you is:

What place does symbolism have in your faith or faith generally? What place do you think it should have?

Thoughts please, and for goodness' sake don't be all worried about breaking Western taboos. I'm in a country where you start a conversation by bringing up religion or politics.

Of dirt, dhat and discoveries

The past three weeks I've been busily engaged in learning about all things anthropological. Being a nosy character, I've welcomed this excuse to pry into people's personal lives. We've been doing a lot of village visits - interviewing people, photographing objects, observing how people interact with each other. It's amazing what you can learn. We've spent a lot of time trying to understand what 'dirty' and 'clean' mean to the locals here. Can you make food 'dirty' by taking it into the wrong room? What makes one water source 'clean' and another only suitable for animals? How often does a 'clean' person shower, and after which activities? The answers are fascinating.

The last two weeks have been entirely taken up by a qualitative study I've been doing into local factory workers' conceptions of work-related diseases. I expected to get a whole list of injuries one can get from various machines in the workplace. To my surprise, the main disease these furniture factory workers complained of was 'weight loss', which they thought was caused by breathing in sawdust and varnish. After probing a little deeper, it turned out that the reason they were bothered about the weight loss was that they thought it was causing dhat syndrome, a faintly hilarious folk illness that is very common all over South Asia. Having determined to avoid the Margaret Mead end of anthropology, I found myself listening to far more than I wanted to know about these young guys.

Folk illnesses are illnesses where locals have developed their own description of the disease, the things that cause it and potential cures, none of which usually have any basis in modern medicine. Lest we get all superior, an example of a folk illness from my own culture is 'the common cold'. There's an almost ubiquitous belief that you can 'catch a cold' from being out in the cold and wet, or suddenly changing your environmental temperature - absolute bunkum, but widely believed by legions of honey-and-lemon sipping virus sufferers. Anthropologists have traced this belief back to a mix of Greek humoral theories and some Celtic stuff about spirit possession, so think of that next time your Mum tells you to put a jumper on.

Anyhow, having found dhat syndrome was a major worry for these workers, I then asked about other diseases from the factory. They told me they were concerned about the high rates of jondiz (jaundice) in the factory. Hepatitis is very common in the community, so I wondered why they were linking it to the factory. "We know it's from the factory" one of the men said "Because they make us wear shoes all day".

Excuse me?

It turned out they saw jaundice as being due to an imbalance of 'wet' and 'dry' fluids in the body. Working in the factory is very hot, and they sweat, thus losing 'wet' fluid. "I used to work in the fields" said one of them "And I never wore shoes, so the healing fluid from Mother earth came up through my feet and nourished my body, replacing my sweat. But now I'm in the factory all day, the fluid can't get up through my shoes, and so I get jaundice."

Well there you go. I confirmed this belief with lots of different workers. It's never been written about in the literature, but it seems to be a heavily folkified version of some Ayurvedic theories. Ayurveda isn't really found in Bangladesh, so it's quite an interesting discovery to see it in health beliefs here. I might try to publish the paper if I get time.

So much for occupational health. I guess it beats talking to union officials about safety harnesses and maximum carrying loads...

Manifesto

First post! (insert bugle solo here)

Welcome to my blog, wherein you shall find all manner of scribblings in re Bangladesh, health, literature and other things that take my fancy. Being a Man Of Science I'm not inclined to decorate with photos, but given I have abjured Hard Science for the muddy waters of anthropology I feel I can now begin to indulge my artistic side a little.

I realise that many of you may have only a vague idea of what I'm doing here - and by the questions I've been getting, many people to whom I've explained myself still don't understand (a common occurrence with me....). I therefore present a 'Your questions answered' column to fill you in on the salient facts.

What on earth are you doing in Bangladesh?

I'm here for a year studying a master's degree in Public Health, and on the side learning some Bengali and travelling around the country.

What university are you studying with?

The university is called BRAC University (www.bracuniversity.net) and is a collaboration between BRAC (the world's largest developing-world-based NGO), several Western universities, and a local public health research institute. It uses visiting academics doing research in Bangladesh, as well as local academics, for the lecture side of the course, but of course the main classrooms are the villages and slums of Bangladesh, and the teachers the field workers in the many development programs running in these places.

So why Bangladesh?

I'm glad you asked. Bangladesh is one of the success stories of public health in the last thirty years, with amazing improvements in mortality rates, disease prevalence and just about any other measure of health you can think of. This is primarily due to the brilliant work done by BRAC (and to a lesser extent, other NGOs) throughout the country in education, development and service provision. It is one of the poorest countries in Asia, which has meant that there has been a huge amount of international money invested into research institutions here to solve their health problems. As a result, there are some world class research institutes here, and the programs and treatments they develop are exported all over the world. For example, oral rehydration therapy for the treatment of diarrhoea was invented and developed in the institution I study with; a treatment program that saves the lives of 3 to 4 million children worldwide every year. Why study anywhere else?

I also wasn't keen to learn about developing world problems while isolated from exposure to the problems I'm meant to be solving. The strength of the course here is that almost every day we see practical illustrations of the principles we are meant to be applying, which for a slow learner like myself is a very good thing!

Does Public Health mean general practice?

Not really. Public Health is probably best described as the 'big picture' part of health - prevention, policy, management, planning; that sort of thing.

Public health people are the ones that:

- run ads to get you to quit smoking or start exercising

- run nutrition or vaccination programs

- administer hospitals

- write national and international health policy

- organise disaster relief

- manage response to epidemics such as SARS or AIDS

- research health treatments to work out which are the best bang for the governmental buck

- lobby for and mobilise international aid for developing countries

If you drop a dollar in a charity box, almost all of it will be spent on things that could be considered public health. I hope you're getting the picture - it's incredibly broad, diverse and (I would argue) exciting and creative. It encompasses all the parts of a traditional health system, but also looks at things that determine your health before you hit the hospital, such as your nutrition, whether you have clean water, what your housing is like, what your traditional practices are, whether you're unemployed..... In short, almost anything has a health aspect if you look hard enough, and my job from now on will be to do the looking!

So when do you go back to working with patients?

I won't! I don't consider myself to be leaving medicine, but I won't have patients or be working in a clinic or hospital. In a way, the whole community will be my patient, and my job will be to diagnose the problems of the community as a whole and come up with solutions for those problems. If I'm doing my job properly, my clinical colleagues will be out of work, because everyone's diseases will be prevented from happening in the first place. Highly idealistic I know, but there it is. I advise you all to train in plastic surgery....

No seriously, when do you take up your stethoscope again?

I sincerely hope I never touch the thing again. Don't get me wrong: I've enjoyed the last two years as a doctor, particularly the patient contact, which I'll miss dreadfully. The problem is that traditional medical practice is almost all Band-aid work - bring 'em in, give 'em a bypass, and send 'em home to eat their MacDonalds and smoke their Marlboros. It's like trying to empty the Pacific with a teaspoon. With all due respect to my fellow medics, I feel that doing this for the rest of my life would be a relative waste of my time - not to mention highly unsatisfying. I'd much rather prevent people from getting sick in the first place. Although it's not as glamourous, a good public health practitioner saves far more lives than the most overworked physician or surgeon.

In addition, my heart has always been for the underprivileged people of the world; the poor, homeless and dispossessed. The main need of these people is not good diabetic control or an appendicectomy. For most of them it's clean water, a couple of good meals a day and a roof over their heads, all of which are the domain of public health. The other medical servies are vital, of course, and I applaud any of you who get into that. It's just not for me.

OK, sermon over.

So (excuse me for harping on this), you're WASTING SEVEN YEARS OF UNIVERSITY?

Hello? Arts degrees anyone? Just because the job you do has little practical connection to your degree doesn't mean it's a waste. Medicine has taught me a great deal about myself and humans in general. It has given me an insight into the difference between what people perceive as their problems and what doctors think those problems should be. I've had the privilege of delivering babies, cutting into people, restarting hearts, and standing with families as other hearts stop beating. It's been an immense privilege, and I will not forget it.

On a more practical note, having an MBBS is a great employment advantage in my chosen field, particularly in this part of the world, where doctors still have some social standing.

Lastly, if I completely fail in my career, I can always come limping home to a locum job somewhere....

So what will you do when you finish this new degree, you poor deluded man?

Start work. My plan is to do brilliantly in my course, write a stunning thesis and publish it in a reputable journal, and then charm the socks off the many contacts I'm making here. In reality, I will probably scrape through and just be able to get an entry-level position with a medium sized NGO. There I will hopefully start learning how to run projects and solve problems on a community level. I'm not fussy where I go (anywhere poor between Morocco and Myanmar), but I am fairly fussy about who I can work with and what I'll be doing. There'll be a lot of work in the next few months to work this out - watch this space!

When will you be back in Australia?

While I have no intention of working in Australia in the foreseeable future, there's only so long you can go without pristine beaches, well-ordered traffic and good coffee, so I plan to spend my holidays in the south of France.

To be serious, I'll be coming back for a holiday sometime in the next two years, and probably every two years after that, depending on finances and time off. They will only be short visits, but I hope to get around to seeing lots of people in the time I have.

But to put the shoe on the other foot, why don't you visit me? Bangladesh is only a short flight from Thailand, Nepal or India, so you can visit surrounding countries as well. I can find you accommodation somewhere while you're here. And Bangladesh has many hidden treasures, including the world's longest sandy beach; a string of coral islands; the last home of the Royal Bengal Tiger; a host of tea plantations; and some of the most beautiful villages you will ever see. Plus, you can see some of the world's most successful and exciting health and development projects going on right here!

So in summary, why are you doing this?

Lots of reasons, but here are the main ones.

Although far from a model Christian, I know God wants me to share my skills, time, faith and life with others, and I know he particularly cares for those that the rest of the world would rather forget. It's not earning me spiritual brownie points, but it is an attempt to be a follower of Christ (which is what 'Christian' means, for you etymologists).

Growing up in Pakistan has given me a particular insight into marginalised people, and also a love for curries. What better way to follow both interests?

I feel that this is the most effective use of my medical training (see above).

It's interesting, exciting, creative and challenging.

It doesn't involve catheters, night shifts or NSW Health.