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.