The Needs of the Few: Reflections from PMAC 2017

By Aisha Siddika, Kuhel Islam, and Tasfiyah Jalil

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We have entered into the age of sustainable development goals (SDG), and this time is very critical, particularly for our target of making societies inclusive.

The inequalities and financial burdens in health care, which are unfair and unjust, are some of the current concerns of public health professionals. Recognising these ambiguities, more than 900 public health professionals, academics, and representatives from civil society organisations gathered in Bangkok, Thailand to attend the Prince Mahidol Award Conference (PMAC) 2017, a highly prestigious public health experts’ congregation in Asia.

 The conference title was “Assessing the health of vulnerable populations for an inclusive society,” which resonates with the third SDG of ensuring healthy lives and promoting wellbeing for all at all ages.

Incidentally, this year’s theme for the World Health Day on April 7 was depression — an overlooked mental health problem globally and an issue that requires more attention in Bangladesh also. Mental health is inseparably connected with people’s physical health, so we cannot ensure physical well-being of people by excluding their mental wellbeing.

About 14% of the global disease burden is related to neuropsychiatric disorders — mostly depression. According to the WHO, about 6.4 million people are suffering from depressive disorders in Bangladesh, which is a very big number.

Unfortunately in Bangladesh, due to social stigma and lack of awareness, mental health patients are often advised to visit local healers instead of seeking professional help.

Evidence says depression is often a result of social exclusion and discrimination and can lead to sufferers developing suicidal tendencies. Vulnerable populations are more at risk as they frequently face exclusion and discrimination from mainstream society.

Considering these issues, it is crucial for Bangladesh to make the health of vulnerable populations (both physical and mental) a priority if we want to achieve our target of an inclusive society.

Everyone has a right to receive the highest attainable standard of health care, as stated at the world health assembly in Alma Ata in 1978. For an inclusive society, we need to ensure quality, and respectful and trust-based care for all, particularly those who are vulnerable.

But, whom should we consider as vulnerable? We have to consider people’s vulnerabilities from our own context. In addition to biological vulnerabilities (eg suffering from infectious diseases like tuberculosis, HIV, etc) and economic vulnerabilities (eg living in poverty), we also have to consider relational vulnerabilities (eg social stigma, class system, etc) while addressing the health needs of populations.

Vulnerable populations (eg women, children, and the elderly, particularly from rural, resource-poor settings, and ethnic communities; migrants displaced because of climate and man-made disasters; people with disabilities, diverse gender identities, and orientations) are often neglected entirely by mainstream health service providers.

However, as the PMAC keynote speaker, Nobel Laureate Amartya Sen, said: “Neglecting the health of some is surely a way to perpetuating social injustice.”

One of the practices discussed at the PMAC was people-centred health care, which refers to putting the particular needs of the patient first. Presenters described successful initiatives where service providers came from the same community as the patients so the patients would trust them more.

Presenters also suggested that patients’ agency and transparency in service provision should receive more attention so as to make the system more equitable and people-friendly.

Better evidence for better interventions is crucial as emphasised by PMAC attendees. If we do not have accurate data on vulnerable groups, they will remain excluded from receiving services and from policy decisions, allowing discrimination and exclusion to persist.

One of the biggest challenges in implementing evidence-based interventions is that factors such as ethnicity, sexual orientation, disability, etc are not considered during data interpretation, thus pushing the vulnerable further to the fringes.

Health care finance was another focal point at the PMAC, underpinned by an understanding that ill-health breeds poverty. Out of pocket expenditure for health is one of the highest in Bangladesh, which can be a major barrier to all our efforts towards an inclusive and equitable society.

Whether to cover everybody with a modest coverage or provide full coverage to selective vulnerable groups is the question. To balance the two, we can consider different health insurance schemes or health benefit packages for different vulnerable groups depending on the nature of their vulnerabilities.

The PMAC emphasised increasing the number of skilled health care providers, in particular skilled mental health first-aiders who can be non-judgmental and neutral in listening to people’s sufferings and can provide primary instructions (eg follow a “self-help” approach or referrals).

We need to reorient our health workforce to motivate them to work in diverse conditions and situations geared towards a rights-based approach rather than focusing only on physical well-being. In order to ensure inclusivity, health care providers need to rise above stigma, exclusion, and preconceived notions, and treat communities based on equity and not just equality.   

Addressing the health needs of vulnerable populations and ensuring quality and respectful care for them is also a matter of social justice, as one of the PMAC panelists, Steve Kraus, director of UNAIDS Regional Support Team for Asia and the Pacific, rightly said.

Vulnerable populations are not asking for any additional rights but the same rights that we are all enjoying. To manifest the changes we want, we first require rigorous political scrutiny and attainable commitments.

We must also put forward human rights and social justice agendas and do everything we can to address the inequalities and unmet needs until we have an inclusive health care system in Bangladesh.


This article was originally posted on Dhaka Tribune. The authors are project coordinators at BRAC School of Public Health. 

How Can Civil Society Help Influence Health Policy?

By Anushka Zafar

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Bangladesh’s health sector has come a long way, reaching several millennium development goals and making foremost improvements in areas of maternal and child health, immunisation coverage and TB control. But the double burden of existing communicable and emerging non-communicable diseases (NCDs) is threatening to undermine the benefits of development and growth that have been achieved over the past four decades.

NCDs are not passed from human to human like many traditionally observed illnesses in tropical countries such as Bangladesh. Instead a person may be genetically predisposed to, or at risk of NCDs from behavioural or environmental factors. The four most common forms of NCDs are cardiovascular diseases (like heart attacks and stroke), cancers, chronic respiratory diseases (such as chronic obstructive pulmonary disease and asthma) and diabetes.

In Bangladesh, there has been a slow decline in tobacco use – one of the main reasons for asthma, cancer and chronic obstructive pulmonary diseases. Cardiovascular diseases account for the greatest number (17 per cent) of all NCD-related deaths (WHO 2014), and more than eight per cent of the adult population suffers from diabetes (WHO 2013). Yet the country’s health system and policies still continue to prioritize the needs of children and reproductive-age women with little preparedness and skills to address the emerging epidemic of the NCDs.

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Having not been addressed in the previous MDGs, NCDs have now been recognized as a major global health challenge and included in the Sustainable Development Goals. As a result, currently two significant policies are being developed in Bangladesh that includes NCDs – the seventh five-year plan (2016-2020), and the fourth health sector plan (HPNSIP 2016-2021).

“While these documents are being formulated, it is high time to discuss, debate, and strategise approaches and interventions to mainstream preventive NCD interventions in the existing primary healthcare infrastructure in a sustainable manner,” said Dr Syed Masud Ahmed, professor and director of the BRAC School of Public Health’s Centre of Excellence for Universal Health Coverage. The School currently hosts the secretariat of Bangladesh Health Watch (BHW), a civil society initiative comprised of multiple stakeholders.

Since 2006, BHW has been monitoring the health sector agenda and programmes, while advocating for the improvement of the country’s health system. The group’s members have joined forces to carefully review health policies and recommend appropriate actions for change that will have a lasting impact on the lives of Bangladeshi people.

The collective is comprised of several key public and private sectors players including high-ranking representatives from BRAC, EngenderHealth, and WaterAid. Others include individuals who were previously holding prominent positions at the National Institute of Population Research and Training, WHO, and government ministries including Health and Family Welfare. BHW also includes members from research hospitals such as the Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders (BIRDEM), think tanks such as Centre for Policy Dialogue, academicians from BRAC University and Dhaka University, as well as members of the media and activist groups. Including a wide range of perspectives and expertise provides BHW with the legitimacy that allows for access to those who directly inform and formulate policy change.

Civil society has already been active in monitoring the country’s progress in various sectors, such as education, with the Education Watch having been established in the late 1990s. Reports released annually by Education Watch have been widely considered a credible source of information used to inform national policy and programming. Similarly, BHW has also been playing a part in influencing the national health agenda through its series of reports. The first report published focused on the theme of health equity (2006), followed by health workforce (2007), health governance (2009), universal health coverage (2011), and urban health challenges (2014).

As a result of its continuous efforts, BHW has become a credible source for instigating policy changes at the top level. For instance, based on findings from the health governance report, governance and stewardship were included as legislative priorities in the next Health, Nutrition and Population Strategic Investment Plan 2016-2021. Additionally, recommendations from the report on health workforce stated the need to restart recruitment and training of additional medical assistants and family welfare visitors as a matter of urgency. Subsequently this was reflected in the Health Workforce Strategy 2008, stating special attention would be placed on improving the production capacity of the institutes responsible for production of nurses, health technologists, medical assistants, family welfare visitors and skilled birth attendants.

This year, the collective has decided to focus on the theme of tackling emerging NCDs. With both the five-year plan and next health sector plan already on its way to being drafted, the BHW group believes it is imperative to release a report and give recommendations to be included in the final policies and operational plans. With already low spending in health resources, along with the rise of NCDs, findings have shown that NCDs can have a catastrophic impact on spending and impoverishment caused by large out-of-pocket expenditures for treatment. Thus one of the recommendations made by BHW is that the government must urgently focus on mainstreaming NCD care in primary healthcare facilities, emphasize prevention over treatment, screening and appropriate referral for early diagnosis and treatment. This will help provide population-based and cost effective services.

However, these recommendations are not a silver bullet, but rather a catalysing force comprised of civil society members capable of aiding greater action and influencing lasting solutions. Much work is still left to be addressed in order to continue the sustainable development of the national health system. NCDs include a large spectrum of illnesses, including mental health and road accidents, which will not be included in the most recent BHW report. However the collective agree that the significance of these problems in Bangladesh are deserving of their own reports as policies continue to evolve to include these immediate and emerging health sector issues.


A version of this article was originally published in the Dhaka Tribune. The author is Communications and Knowledge Manager, BRAC School of Public Health

The Hidden Problem: Shadows of Mental Stress Over Urban Adolescents

By Seama Mowri

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“He had a bottle of poison in his hands and told me he would drink it if I didn’t agree to marry him.” 
– A 16-year-old girl living in a Dhaka slum explaining the circumstances that led her to consent to marriage.

Whilst this might read like teenage melodrama, the girl’s story is not unusual. During the last six months of our research (a project funded by IDRC and led by Professor Sabina F Rashid) in urban slums the research team encountered several stories of manipulative suicide threats and evidence of mental angst among both male and female adolescents and young people. Initially, a love interest may spark such incidents of dramatic behaviour but these are symptomatic of much deeper troubles. The rapid hormonal, physical and mental changes brought by puberty are difficult for any adolescent to navigate but these challenges are intensified when they are experienced simultaneously with the social, economic and structural instability of surviving in poverty in Bangladesh’s dense urban slum communities, where adult responsibilities are imposed on children before they are ready.

The multiple stressors experienced by adolescents in these settings are little discussed but include: fathers abandoning families, parents remarrying, children being forced to drop out of school, unemployment, abusive gossip and rumours about girls’ characters and “morality”, bullying, daily sexual harassment, physical abuse for dowry, taunts regarding dark skin from in-laws, and entrenched gender norms that place unachievable expectations on girls and boys. Any one of these factors – including the dynamics of the overcrowded slums they navigate, living out of cramped one-room households – can have debilitating effects on a person’s mental well-being.

Our research also highlights a complex interplay of age and identity. Amongst the slum dwellers, there is an embedded assumption that ‘married’ implies ‘adult’, and most of these married ‘adults’ are 15-16 years old. In other words, there’s almost no sense of transition about the stages of adulthood that they go through. As we’ve noted, most of the early married adolescent girls face the challenge of forming their adult identity at the same time as they are required to assume the duties of a wife and a mother which can create a great deal of mental stress. But who do they turn to?

“I have nowhere to go, no one to seek help from. I see my nonod (sister-in-law, who is only eight months younger than me) roaming around with her friends, gossiping, going to fairs… but I can’t do any of that. I am ghorer bou (bride of the house). I have to take permission from my husband and my father-in-law before stepping out of the house. The only guidance I get from relatives and programme interventions is related to family planning,” shares Ayesha about her experience after marriage.

The WHO constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Mental health is defined as a state of well-being in which an individual realises his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.

In Bangladesh, there is a dearth of knowledge around systematically-collected data on mental disorders and so the extent of the problem remains unknown. A recent systematic review (by Hossain et al.) suggests that females are more vulnerable to mental disorders in both rural and urban settings compared to males. These findings are consistent with another rural study (Ara et al. 2001) which reported that social stigma inhibits women from seeking medical treatment for their mental problems.

The BRAC School of Public Health has undertaken a number of research projects that focus on exploring mental health issues among adolescents. One of the projects is trying to understand how early marriages change the life opportunities and well-being of girls in urban slums, and their coping strategies in coerced marriages. Qualitative cases pertaining to sexual coercion in early marriages have provided some insight into the challenges faced by adolescent females living in a society fraught with gender disparities. Another research study funded by NWO-WOTRO – “Psychodrama as Transformative Intervention in the SRH of Young Men in Urban Slums” – aims to identify the spectrum of risks and health issues affecting young men. “Sexual and reproductive health (SRH) education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” says Dr Malabika Sarker (Professor and Director of Research at James P Grant School of Public Health) who is leading the study.

As Dhaka transitions into being the sixth largest megacity by 2030, the urban challenges of structural poverty and inequalities, steep social gradients, risky environment, deprived living conditions, entrenched and changing social and gender norms will start to have serious impacts on the well-being of the population at large. What does that mean in terms of the stress resilience of an increasingly urban population? What are the health consequences of higher social stress exposure and vulnerability of urban-dwellers, given that stress is the most likely cause of many mental disorders, particularly depression? And from a policy perspective, what actions can be taken to protect people living under dense metropolitan conditions from urban stressors and their negative mental impact? With this article I wish to stimulate a conversation in the hope of facilitating a more nuanced understanding of how urban living conditions impact our mental health. And it is imperative that we start the conversation sooner rather than later.


This article was first published in The Daily Star on World Health Day. The writer is a project manager at the Centre for Gender and Sexual and Reproductive Health Rights, James P Grant School of Public Health. 

Psychodrama as a New Form of Health Education for Young Men in Dhaka’s Urban Slums

By Rafee Muhammad Tamjid

 

Shujon* is a 19-year-old man living with his mother in Bhashantek, an urban slum in Mirpur, Dhaka. His father left his mother when he was a child, leaving him with too many responsibilities and unable to cope. He feels depressed because of the expectations projected on him by his family and peers. Recently he broke up with his girlfriend, because her parents wanted her to get married, but Shujon was not ready. “If I married her now, I would have to be a rickshaw puller, and that won’t make us enough money.” He admits that sometimes he feels confused and doesn’t have anyone to talk to, which takes a toll on his mental health.

To our surprise, when we explained to Shujon that the research project we were conducting would examine the physical and mental wellbeing of young men just like himself, he was immediately interested to speak to us. His eagerness was probably a reflection of the fact that in Bangladesh there is little to no attention given to mental health education, particularly related to sexual and reproductive health (SRH).

Due to shame and stigma, there is a lack of comprehensive SRH education in Bangladesh. Although several successful interventions exist around family planning for married couples, SRH education is still limited for others, particularly the target group for this research project: young vulnerable men who live in urban slums and engage in risky sexual behavior. While this study will also detect exactly which types of behavior are involved, similar studies in Africa show that risky behavior is influenced by one’s social environment.

Currently Dhaka is one of the fastest growing megacities in the world. By 2025, the UN predicts Dhaka will be home to more than 20 million people. As the population of the city grows, so will the population and size of the slums. Thus it is very important to make sure the wellbeing, including health of men in these slums are attended to just as much as women and adolescents. Generally, SRH knowledge of slum dwellers in Bangladesh is very low and they have a higher probability of being confronted with early marriage, drugs and violence.

This research project aims to identify the spectrum of risks and health issues affecting other young men like Shujon living in urban slum. Psychodrama (a group psychotherapy method) would then be used as a “transformative intervention” to help participants discover alternatives to the choices they would usually make. Psychodrama uses role-playing, dramatisation, and self-presentation to explore and gain insight into one’s life, incorporating theatre and conducted in groups under a licensed trainer, educator and practitioner.

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Young men living in Bhashantek slum. Photo Credit: Rafee Tamjid

Since psychodrama is a very new concept in Bangladesh, we want to adapt this therapeutic approach and create an innovative and interactive educational tool to see if it can be used as new form of health education. It will engage young men to explore existing and alternative attitudes towards their own and their peer’s health and relationships. The hope is to use psychodrama can help these young men evaluate their decision-making process so as to decrease the risky-behaviors they engage in which may adversely affect their health.

“SRH education for young men, particularly those from vulnerable communities like urban slums, is a neglected issue,” said Dr Malabika Sarker (Professor and Director of Research at JPGSPH) who is leading the study. “An innovative approach that blends traditional methods of mental health counseling and SRH education with a more humane touch like psychodrama could help reach this population more effectively.”

*Note: Name has been changed for anonymity purposes.


Rafee Muhammad Tamjid is a research assistant at the James P Grant School of Public Health.

Stay tuned on #VitalSigns for more updates from this project!

Let’s Talk About Universal Health Coverage

By Dr. Nahitun Naher

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Put very simply, universal health coverage (UHC) means “every person, everywhere, has access to quality healthcare without suffering financial hardship.” This goal is rooted in the concept of human rights to health, which also makes sense economically. However health system gaps remain a barrier, jeopardising the lives and financial wellbeing of millions of people globally. There are still too many countries that have failed to invest enough in health.

The journey towards achieving UHC actually began in 1978 through the Alma Ata Declaration of “Health for All”. But almost three decades later, the WHO Health Systems Financing Report in 2010 finally emphasised for the first time that it is possible for every country to mobilise necessary funds towards achieving UHC. Following that, in a historic resolution in 2012, the United Nations unanimously endorsed UHC as a priority for every country.

The momentum towards UHC turned into a commitment when more than 500 organisations across the health and development sector joined the Rockefeller Foundation in launching the first-ever UHC Day with the slogan ‘Health for All, Everywhere’ on December 12, 2014. Ever since, the global consensus that UHC is a smart investment and an achievable goal has grown.

The striking fact that 400 million people around the world lack basic healthcare services while 17 per cent are impoverished by health costs came out in the first UHC Global Monitoring Report in 2015. This triggered the drive towards UHC and was endorsed by 267 economists who declared UHC a smarter investment.

The year 2016 started with high hopes for UHC as world leaders including the G7 and African heads of state launched UHC campaigns in their countries. This affirmed that health is a human right and no one should go bankrupt when they get sick. Finally, in September 2016, WHO Director General Margaret Chan announced the International Health Partnership for accelerating progress toward UHC by 2030.

Throughout this journey, an international coalition for UHC has emerged involving 739 organisations in 117 countries, which celebrates Universal Health Coverage Day on December 12. This has become the annual rallying point for the growing movement towards health for all.

In Bangladesh, high out-of-pocket expenditure for health is driving people into poverty. Inadequate healthcare financing, inequity in health financing and utilisation, inefficient use of existing resource, inadequate health workforce and their skill-mix imbalance, and the rapid rise of non-communicable diseases are placing more barriers in our paths towards achieving UHC.

However it is promising to see that the Government of Bangladesh has expressed a strong commitment towards achieving UHC. This is reflected in the Government’s seventh Five-Year Plan where UHC has been prioritised. The Health Care Financing Strategy 2012-2032, and National Social Security Strategy 2015 have incorporated UHC by focusing on strengthening financial risk protection and extending health services and population coverage especially to poor and vulnerable populations.uhc-day-badge

This UHC Day, you too can “Act with Ambition” to express solidarity towards achieving UHC. If you are in Dhaka, Bangladesh, please do join our UHC Day Rally on December 12. For more information, please check the Facebook Event page here.


Dr. Nahitun Naher is a senior research associate at the Centre of Excellence for Universal Health Coverage at James P Grant School of Public Health, BRAC University.

Keeping Up with Public Health Challenges: Training Opportunities for Practitioners and Stakeholders

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Evolving 21st century public health challenges make it critical for professionals to keep their requisite skills up-to-date. Although in recent years we have seen exceptional health achievements in Bangladesh, public health practitioners must have access to continual training opportunities to keep innovating locally relevant community solutions.

Recognising this demand, JPGSPH established a training unit in 2007 (recently renamed the Centre for Professional Skills Development; CPSD), training over 5,000 development professionals to date. “The Centre aims to expand the breadth and depth of knowledge and skills of professionals at different levels coming from the fields of public health, development and academia,” said Hossain Ishrath Adib, Head of Education at JPGSPH. These include key health sector players – beyond just practitioners – like policymakers, development partners, government officials, advocates, educators, researchers and frontline health workers.

Aiming to serve as a national and international training hub, the Centre offers around 20 courses, workshops, seminars and training every year facilitated by highly qualified professionals. In addition to the School’s in-house facilitators with multidisciplinary backgrounds (ie, medical professionals, anthropologists, epidemiologists, statisticians, academics, social scientists, etc.), CPSD brings in expert trainers from leading international health research institute, icddr,b and others, notably WHO, UNICEF, Harvard Medical School, and more. The School also organises training led by officials from various government ministries, including the Ministry of Health and Family Welfare.cpsd-2

Courses are designed around critical and emerging public health issues, capacity building in key technical areas, including use of statistical tools, research methods, project management, and monitoring and evaluation skills. Taking a more innovative approach to teaching, they incorporate field visits to programme sites and hands-on learning.

Direct access to BRAC’s network also makes the Centre attractive, particularly to those seeking to learn from the world’s largest NGO. In 2015, members of Mozambique’s Ministry of Health reached out the School to come to Bangladesh and see BRAC’s work in nutrition firsthand.

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“As government officials, examining BRAC’s community nutrition programme during the short course at JPGSPH helped us understand the implementer’s perspective.”

Sara Paulino
Delegate from Ministry of Health, Mozambique 

The Centre has also led the way in organising several pioneering courses focusing on issues such as the Ebola Virus, public-private partnership in healthcare, and evaluation of development programmes. Trainings on sexual and reproductive health rights (SRHR) are offered to inspire critical thinking and reflection among practitioners such as the flagship course on Men, Masculinity and SRHR.

“Participating in the course on Men, Masculinity and SRHR allowed us to learn more about how gender and masculinity are connected by patriarchy. This was an eye-opening experience and very helpful for myself and my fellow colleagues as we work in this field.”

Shaikh Md. Mominul Islam
Student of MA Development Studies at North Western University, Khulna, and Community Organiser at Vivid Rainbow 

cpsdfunders.jpgIntroductory courses on universal health coverage are facilitated in collaboration with the Centre of Universal Health Coverage at the School with support from the Health Economics Unit of the Ministry of Health and Family Welfare (MoHFW). The course on urban health and governance took participants on a field visit to the slums of Dhaka to sensitise them to the lived realities of the urban poor when problem solving for solutions. To continue developing capacity of researchers, courses in quantitative and qualitative research methods are also offered, with one of the more popular courses being for scientific writing. The Strategic Communications for Public Health course shows participants how to apply behaviour change communication to interventions effectively.

These courses intend to arm today’s practitioners, researchers, and policymakers alike with the means to continue making improvements to public health programming. “We have innovative teaching methods, and practical hands-on learning that is focused on developing the skills of diverse professionals, who must critically reflect on public health problems and find solutions,” said Sabina Faiz Rashid, Dean of the School. “We want to ensure that they can work cross-sectorally, collaborate on research, and keep building on new or existing interventions and policies.”


For more information on the Centre for Professional Skills Development and upcoming courses visit: http://sph.bracu.ac.bd/index.php/2015-09-08-04-34-47

Inside Look at the MPH Programme

Since 2005, JPGSPH has been facilitating its Master of Public Health (MPH) programme with the aim to develop public health leaders of the future. The School offers a global classroom of learners with diverse disciplinary and professional backgrounds with 476 graduates to date from across 26 countries. Charu Chhetri is one such learner from Nepal, who is part of the current and 12th batch. This month, #VitalSigns brings you an exclusive look at the MPH through the eyes of an international student.


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#VitalSigns (VS): Hi Charu! Tell us a little about yourself.

Charu Chhetri (CC): Hi! I am Charu from Kathmandu, and I completed my MBBS from Universal College of Medical Science in Bhairahawa, Nepal.

VS: You mentioned earlier being really excited about getting accepted to JPGSPH’s MPH programme.

CC: Yes! I became interested in getting an MPH when I was working in the Primary Healthcare Centre in Kathmandu as a medical officer. I wasn’t sure whether I would go for an MD since it takes three years to complete. I always wanted to study something that I can use to work for the community. I began preparing to apply to schools abroad when I came across the programme at JPGSPH, and got to know about the WHO-TDR scholarship. A colleague suggested that this scholarship and programme would help open many doors for my career since the WHO recognised JPGSPH as one of the top six schools in the region promoting and practicing innovative higher public health education.

VS: What was your first impression about the programme?

dsc_1179 CC: I arrived in Dhaka along with three other students from Nepal. I remember first seeing them when we had to take our BRAC University entrance exams. After spending the first few weeks with the rest of the international students, we became acquainted with the Bangladeshi students.

Later we were taken outside the city to BRAC University’s campus in Savar for our official orientation. There we met faculty members like Dr Alayne Adams who coordinated our Anthropological Approaches to Public Health and Qualitative Research Methods modules.

Senior lecturer on Global Health from Harvard University, Richard Cash (winner of the Prince Mahidol Award) is also one of key course instructors who teaches Epidemiology of Infectious Diseases. The programme has had world-class faculty who have come to teach us from other prestigious Bangladesh-based and international institutions. Being able to engage with instructors who are leaders in their field with multi-country expertise has been an extremely valuable component of this experience.

The level of experiential learning we are exposed to is also remarkable. We were able to visit multiple field sites belonging to the School’s institutional partners –  BRAC (the world’s largest NGO!) and its nationwide health programme, and the research and population labs of icddr,b.

 VS: Tell me more about the Summative Learning Process (SLP) experience. 

 CC: The SLP is our final group project, which gives us the chance to apply the full range of public health skills and competencies we have acquired. Each group is assigned a specific and current public health problem to understand and tackle critically. My group and I are working on addressing factors for the rise of C-Sections in Bangladesh. The SLP is extra challenging, because we are also simultaneously taking our other classes, so it is definitely complex and stressful! Group work is not easy, but we are learning to combine our different ideas and support each other as a team.

VS: What do you do when you aren’t doing coursework and working on your SLP?

CC: This year’s batch has become like a family. When we aren’t studying and have some time to spare, we like to explore Dhaka city together, go shopping or eat at different restaurants. A few of our classmates have gotten married this year so we were able to attending their weddings. Besides meeting and learning from people from various backgrounds, and the expertise we are gaining from the programme, I am striving to take in this one-of-a-kind, hands-on MPH experience to the best of my abilities.

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To learn more about the MPH programme visit: http://jpgsph.org/index.php/admission-main