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THE STRENGTH WITHIN

A clinic closer to community

ASHFAQ WARES KHAN
Tuberculosis flares up every other week, but it does not perturb Shaheda Begum. The reality of having no money in the little money-chest she keeps under bed does not unsettle the 50-year-old. She lives on to feed three hungry children at home.
Shaheda's empty money chest did not hamper her chance of suppressing the TB scare -- she did not have to borrow money from local loan sharks at high interest rates. No laborious path for her to tread for an hour or take a boat even longer to visit the health complex at Kalkini Sadar Upazila in Madaripur.
Now on her way back from working on the fields owned by a well-off villager, Shaheda visits a tin-roofed concrete building near the village market, which serves as the community clinic. Shaheda gets to keep tabs on her health.
Four years ago, the long affliction of TB was treated at Kalkini Upazila health complex, an hour away in winter and over two hours in the monsoon
because of flooded roads.
"Sometimes I would cough for two straight days, but I could not afford to travel to Kalkini," Shaheda recalls.
These days, with free treatment of TB -- just 10 minutes from home -- at Alinagar union health centre, Shaheda takes a more laid-back view towards her illness and poverty.
"The disease does not bother me as much as before, since the doctor and nurses take care of me, as I go to the health centre every day -- sometimes only to talk to them. If my condition shows signs of deterioration they always sort it out," Shaheda said.
Shaheda was found chatting with the nurses and the lone doctor at the clinic run by a committee of the local union parishad chairman, NGO workers and community leaders. The clinic provides health service for over 650 members from 12 villages and medical insurance for its members, health awareness for local households and free medical treatment for about 100 ultra-poor
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women like Shaheda.
"I listen to Dada (the doctor at the clinic) a lot more than I listened to the upazila doctor. Over there, we were made to sit on the ground since we are poor. Others who paid more got to sit on chairs. The doctors also scolded us. But my doctor here is like my nephew, so I have to listen to him" a satisfied Shaheda says.
"It is OUR clinic ... It's the poor people's clinic ... it's the union's clinic," says Shaheda, emphasising the role the community plays in sustaining the health centre's operations.
How did people like Shaheda come to receive the services of the clinic? The community participation in the clinic began when the Centre for Advanced Research and Social Action (Carsa), the only nongovernmental organisation (NGO) to work in the area, alerted community leaders to the acute health crisis.
Accompanied by about 20 representatives from the villages, Union Parishad Chairman Shahjahan Howlader sat day after day with Carsa to carve out a plan that came true in the establishment of the clinic three years ago.
On the previous state of health service in his area, Shahjahan says: "The government community clinic established four years ago was always a shady habitation for cattle, as the government did not care to send any doctor here."
"Major NGOs don't want to provide service here because this part of Madaripur is nearly inaccessible during the monsoon."
The fund came from large donations of the affluent and proceeds from Carsa's microcredit operations in the central region. As the villagers came to know about the health centre, they queued up every day to get a membership card and initiated a road to sustainability of the clinic.
"We believe we can make the clinic sustainable soon, it's a matter of strong commitment from the rich in the area and the strength of our will," Shahjahan said.
A membership card costs up to Tk 220 depending on the nature of medical insurance they would like to receive. Insurance helps the members to head off a common problem: inadequate savings at home to pay for sudden medical costs.
But Shaheda is far from all history of the clinic or its accounts and details. She points at the doctor, busy with a patient, and says: "I can just walk in and ask him about my illness, so can my children, but he doesn't get irritated. I think it is because he is ours and he wants to be here."