Apollo Hospital, Dhaka has responded to The Only Way Is Dhaka!

To the 42,379 people who have (to date) read my recent blog post about my experiences at Apollo Hospital, Dhaka for clarity I would like you all to know that the hospital has responded with their own blog entry. Since they did not put link to my blog in their response, I am not going to put their response link to my blog either, and more over I do not intend my personal blog to be a corporate marketing tool. 

I find it interesting that the vast majority of comments I have received gives me the impression that there are many victims and dissatisfied patients at Apollo.  Of course there are also happy customers as well – as I was when I first went to visit them which I have already mentioned once here in a previous post.  I have no reason to be vindictive towards that hospital.  However, the stories I have read here indicate that victims of medical negligence in Bangladesh do not get any redress and the hospitals internal investigations about their own negligence or unethical practices are to be considered absolute and final as to the truth.  In the absence of an independent regulator or legislative framework to bring action against negligent medical practitioners and institutes the situation will remain one side’s word against the other.  The whole situation is such that “us” on the patient side is always considered wrong and the hospital side is always right.  They can do no wrong.  They are so right that they won’t even let us see a copy our own medical records whilst being treated or provide us with a copy of our lengthy consent papers.  They will never admit their guilt and therefore change and improve their practices.  I was not the only person who has had a bad experience at Apollo Hospital.  What about the numerous other cases I have heard about on this blog and on the web?  What about the disgruntled Mayor of Rangpur? And countless others?  We must all be wrong then.  The only right side is the hospital.  Since that is the case the patient side has no redress but to speak out and raise awareness amongst the patients before they are victimised.

I initially planned to take this matter up to the media but having read other stories my case appears insignificant.  Apparently the legal regime here is such that doctors are only investigated by their peers and in many instances they are simply immune to prosecution and in luxury hospitals star doctors are beyond the reach of any action by the State.  Conveniently this particular hospital even has a stakeholder who is a member of Parliament and therefore it is no surprise that they are beyond the reach of anyone.  So perhaps victims should form citizen’s action groups on the web and in the social media to register their grievances for others to read and make up their mind because it is simply an individual against a corporate behemoth.

In the country that I come from strong rule of law mean that citizens have redress in the Court and there are criminal and civil sanctions over negligent behaviour.  In a developing Country like Bangladesh where the State is restricted from doing any form of regulation for fear of staving off foreign and domestic investment and other such concerns citizens have to be wary before they take a decision about their medical care.

Again I must reiterate by no means the experience I have had is any worse than the horror stories I have read.  My experience only reflects an unethical practice of profiteering.  Others have suffered far worse.  I am not the worst victim of Apollo but the point is that there are people who have made serious allegations which involve cases of serious bodily harm and in some cases death.  These people have had no redress against the hospital.  These are a handful of other stories I have read:

http://www.daily-sun.com/details_yes_25-09-2013_RCC-mayor-to-sue-Apollo-Hospital-for-Tk-5cr-compensation_626_1_1_1_3.html  (The case of the RCC Mayor)

http://www.daily-sun.com/index.php?view=details&archiev=yes&arch_date=08-07-2012&type=&pub_no=197&cat_id=1&menu_id=1&news_type_id=1&news_id=40152 (The case of Lunar)

http://www.daily-sun.com/details_yes_05-07-2012_Patients-held-hostage-at-Apollo-Hospitals_195_1_1_1_2.html (The case of Ripa Sarkar)

http://newagebd.com/detail.php?date=2012-03-23&nid=4908#.Ut1AK9JSmt8 (The case of Nahid Mehjabeen Hossain )

http://www1.bssnews.net/newsDetails.php?cat=7&id=261906&date=2012-07-03 (Government Minister promising action against Apollo’s negligence)

The above news stories are just from English Newspapers published in Bangladesh. There are plenty in Bangla news papers I hear. My bangla is not that good yet. There are many more horror stories that I have heard from people who have emailed me personally but of course I cannot speak for them.  Readers have their own mind and it is for them to decide what is best for them.  I do not speak for or against anyone – I only wrote what happened to me and my daughter.  I am not here to change the World but if in any way if what I have written is helpful for others then I will consider that I have made a positive difference.

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Giving Birth In Bangladesh – Appalling Apollo Hospital, Dhaka

Our beautiful daughter – Nina Emily Fouzia Chowdhoury was born at Dhaka Apollo Hospital on the 3rd September 2013.  Whilst our little family is now doing very well and we could not be happier with our new addition my birth experience here in Dhaka was not ideal.  I deliberately decided to postpone blogging the details so I could give a more balanced view now that my baby is thriving.

Nina in Mummy’s tummy

The first part of my labour story I guess starts on the evening of the 1st September when I stopped feeling baby’s usual kicks.  The next morning we decided to check things out so we made an unscheduled appointment with our consultant Dr Mrinal.  He put on the ultrasound and did a quick scan. Our baby’s heartbeat was loud and clear on the sound system but the doctor, in a serious face, told us that he wanted me to be admitted to “see if the baby is still alive”.   My husband and I were very confused as obviously we had just heard a firm heartbeat but our instinct at the time was to go with what the doctors were telling us as we were now anxious that our baby could be in immediate danger.   Whilst I was taken to the maternity ward and placed on foetal monitoring my husband was directed to the billing counter to pay a deposit for my hospital stay.

After the initial 40 minute test my baby’s heartbeat was normal but I was still finding it difficult to pick up her movements.  I was then taken for a full ultrasound. The screening doctor there initially told us that the baby was moving and seemed fine.  She calculated that our baby’s weight was around 2.3 kg and explained that she still had a way to go and would gain more before delivery.   We explained that I had been sent for a full ultrasound as our consultant felt an emergency c-section might be necessary due to my baby’s reduced movement.  Instantaneously this Doctor then did a U-turn and distanced herself from own assessment!  She then said she wanted to recheck the size of the baby and increased the baby’s approximate weight to 3.3kg.  She reassured me that actually my baby was ready to be born now (a complete back track on her initial assessment) and confirmed that Nina would be “good size and perfectly healthy”.  Of course my husband and I really did not know what to believe at this point and we were nervous as we knew that Nina had still four more weeks to go.

I was then returned to the ward and placed in my own room.  Later that morning we were informed by the nursing staff that Dr Mrinal had made the decision to deliver my baby the following day by c-section.  Dr Mrinal did not consult us or even advise us about this himself – he took the decision unilaterally and told the nursing staff to book the operating theater.  Again we were confused as the nursing staff were only able to tell us that our baby had scored “highly on the foetal assessment” but that the baby still needed to be delivered then next day.  My husband and I discussed the possibility of getting a second opinion or transferring hospitals but we rationalised that this consultant knew us best and that handing over the care at this late stage might not be best.  At the time we were very vulnerable and did not have much time to decide what to do.

During the afternoon of the 2nd September 2013 I started to feel my baby move and her movements returned to normal.  My husband and I tried to consult with Dr Mrinal during ward round and the medical team throughout the afternoon and evening to see if we could postpone delivery but I was repeatedly advised that my baby was now ready to be born at 36 weeks.  Among the medical team there was a strict hierarchy where the junior doctors and nursing staff were literally frightened of the consultant.  They failed to address or escalate our anxieties about a premature delivery and could only reiterate that our baby was full term.  Sadly I felt that the duty doctors did not understand or want to listen to what we were saying.  My husband and I were deeply anxious about the decision that had been made and we felt steamrolled into undergoing the procedure – there were certainly a lot of tears before I went down for surgery.   With hindsight we should have sought a second opinion though at the time we were vulnerable and frightened of losing our baby after the panic that had been instilled.

At 4.10pm on the 3rd September my baby daughter was born.  She was 2.5 kg in weight. Due to her prematurity our daughter required immediate special care in the neonatal care unit.  Our baby required immediate resuscitation and showed signs of respiratory distress.  She required 18 hours of oxygen support.

My baby had to be placed on gastric feeding at 20 hours of age and I was only able to attempt to breastfeed when she was two days old. Without our knowledge, consultation or consent our baby was placed on antibiotics via cannula for septic screening.   We were advised by the pediatric team that our baby was actually premature by five weeks and that Nina was in fact only 35 weeks gestation!  We were then told that these sorts of complications were expected where babies that are delivered that early!

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With Nina in NICU

It immediately materialised that Nina was not ready to be born after all.  Cleverly as soon as delivery had taken place Dr Mrinal took no interest in our baby or her condition as his role was now limited to monitoring my c-section scar/post-op recovery.  He was not prepared to discuss Nina’s prematurity, her admission into special care or our anxieties that this would happen.  It soon materialised that at in Apollo’s private health care system the obstetrics and gynecology department are a completely separate limb from the pediatric team who looked after Nina.  These different departments do not work together to ensure a positive outcome and there was certainly no inter-departmental working to collectively weigh up the risks of a premature delivery.  Instead the pediatric team at Apollo welcomed the premature delivery of our daughter with open arms as conveniently her special care boosted our hospital bill.  WE HAVE SINCE BEEN ADVISED BY OTHER OBSTETRICS AND GYNECOLOGICAL CONSULTANTS THAT THE TREATMENT PROPOSED BY APOLLO WAS UNNECESSARY, INAPPROPRIATE AND UNETHICAL.  We have since been told that the sound and reasonable practice would have been to monitor and reassess the situation on a routine basis once Nina’s movements had resumed.  Had Nina’s condition been truly life threatening there would not have been a 30 hour delay in her delivery.

Seeing my baby in the special care unit was extremely traumatising and I don’t think it is something we will ever forget for all the wrong reasons.   At the time we had trusted Apollo as a place of  clinical excellence but sadly Apollo are only interested in the unethical practice of maximising hospital bills at the cost of the suffering of a little new born and her parents. We hear that even the public healthcare sector of Bangladesh, which is not as fancy as these private, foreign owned hospitals, has been performing better. Indeed Bangladesh has been getting high scores in reducing infant and mother mortality during child birth although this has nothing to do with these fancy operators.

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Nina out of special care looking at her Mum!

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Getting to know the new addition!

Sleeping with Daddy!

Sleeping with Daddy!

Breastfeeding

Breastfeeding was a struggle for me as some physiological problems meant that my baby had difficulty latching. The hospital was not able to provide support with lactation or with feeding issues in general.  My pediatrician Dr Istiaque refused to discuss using formula despite Nina’s low birth weight and inability to take breast milk.  During a follow up appointment six days later my daughter’s birth weight had slumped to 2.3 kg (she had lost 15% in weight) and the doctor still refused to discuss alternative feeding options.  Our stress levels were in overdrive at this point.

Other Challenges

Whilst some of the nursing staff were very kind during my hospital stay many did not speak good English.  Fortunately my husband’s first language is Bengali so was able to translate.  Those who did speak English often responded in Bengali so I sometimes felt removed from the whole process.

We found that there was no consultation process like in the UK – the doctors give their opinion and you either accept it or go elsewhere.

Apollo do not give you access to your child’s medical/feeding records and we were not permitted to attend ward rounds when our baby was in special care.

On the Neonatal Intensive Care Unit the medical team was very awkward around me.  I was frequently stared at – I assume because I looked different and perhaps the language barriers made them feel embarrassed.   This was deeply frustrating at a time when I really needed some emotional support. This was totally unexpected given that foreigners do frequent the hospital when in need

Fortunately my bad experience at Apollo is now a distant memory as I now have a happy, healthy 4 month old.  My husband and I are pursuing a complaint following our experiences and we have been proactive in warning family and friends about what happened.

If we are lucky enough to have another baby in the future I would decide to return to the UK for the pregnancy and birth.  I would certainly never return to Apollo.  More than the delivery experience itself I think I missed out on the wider support network that exists in the UK with antenatal care and home visits from midwives to carry out care in the community.  I think that childbirth in Bangladesh is much more of a clinical process though in my experience more extensive community support is provided here by large family networks rather than healthcare professionals.

Needless to say I also really missed my own family during this life changing time and I would not choose to “go it alone” next time.  As for other foreigners I have met in Dhaka – one or two have delivered their babies naturally in different private hospitals in Bangladesh with mixed experiences.  Most have delivered their second babies in Bangladesh after delivering the first back in their own countries.  Many foreigners and wealthier Bangladeshis also choose to deliver children overseas with popular choices being India and Thailand.

Finally I thought I would finish this post with a few recent and happy pictures of our daughter Nina who is a complete blessing to us….

DSC02580272ninanina2

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Domestic staff – the forgotten people of Bangladesh?

Benefiting from the labour of drivers and part-time or ‘live-in’ servants in the domestic arena is commonplace throughout Bangladesh.  The number of staff and the services required may vary according to the needs and demands of individual house owners but the point is that this unique and arguably archaic practice is wholly rudimentary where even the smallest and simplest of households usually benefit from at least one ‘live in’ helper.

In this post I briefly discuss the work and lives of the staff I have met both in my own household in Dhaka and those working in the households of friends and family which represents the situation for many domestic workers in Bangladesh.

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Preconceptions

When I moved to Bangladesh I knew that living and dealing with domestic staff would become an inherent part of my daily activities.  I remember not feeling entirely comfortable with the idea of people I did not know being part of my private space but I chose to keep an open mind at a time when I already had much to think about with moving overseas.  In my pre-departure days friends would joke about me ringing a bell to summon assistance or servants washing my smalls (underwear!) however as the discussion turned serious the majority admitted that they would feel uncomfortable with the concept of having staff.  In the developed world servants are now confined to the period dramas of Downton Abbey or have been replaced with highly paid nannys or ‘au-pares’ specifically employed to assist with the specific task of child-rearing.  Having been raised in an environment where we are generally expected to be independent with all daily living tasks many felt it would be unnatural and unnecessary to pass over this responsibility to a stranger who would share your living space.

Interestingly no thought was ever given to the staff I would inherit.  In part I think it was ignorance about who these people were and where they might come from.  Subconsciously maybe we also wanted to ignore the uncomfortable reality that it was highly probable these individuals were an exploited group – fictitious figures whose power and position in society was negligible.

Help available in Bangladesh

Whilst levels of assistance vary it is traditional for Bangladeshi families to hire a ‘live-in’ maid or maids who will work and reside at their employer’s address.  The servant or maid is usually female and their age can vary dramatically with teenage children often being employed.  Parents often advertise their children’s services through agencies who then place them according to job availability.  Agencies will expect commission for placements which will not be returned if the worker is unsatisfactory.

Many staff migrate from villages across Bangladesh to households in Dhaka.  Sadly many families in rural communities are forced into this decision for financial reasons where they cannot afford their child’s living expenses.  Often a sibling (usually the eldest male) will benefit from a rural education whilst his siblings move into work.  Whilst the remittance is extremely poor it is felt that at least the expenses of these children are borne out by employers.  Sometimes in their late teens girls may leave domestic work in order to seek a financially slightly more rewarding role at a garments factory.  Boys may later train as domestic drivers or enter garments work with better salary opportunities or return to their village once marriageable age is attained.

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Typical garments factory in Bangladesh

Servants are, in theory, on duty at all times and their treatment good or bad is dependent solely on their employer’s goodwill.  Placements can be risky and young people can be vulnerable to abuse in undesirable households.  From what I have seen maids are requested to carry out all sort of domestic work – washing, cleaning, cooking… and there are no taboos in terms of washing underwear or cleaning toilets.  Experienced maids are often mentally resigned to their fate and carry on the tasks in hand without hesitation.  Whilst family members may complain about a maid’s inefficiency or lack of initiative I am yet to see a maid that has refused to do specific tasks.

Traditionally older women can remain servants though many take a more definite role as cook or child-carer when families expand.  More labour intensive chores tend to be left to younger individuals.   Where there is more than one servant per household there can often be dynamics and power struggles over who does what work and when.

Contrary to the common practice back home foreigners living in Bangladesh also frequently take advantage of domestic help.  Many think of it as a ‘perk’ to an otherwise difficult placement in a developing country.  The level of help accessed often varies dramatically from ‘live in’ or part-time assistance through to a nursemaid or ‘Ayah’ who may visit several times each week to assist solely with childcare.   Typically expats expect to pay more for servants (around $150 per month in addition to food/accommodation) who can speak some English and/or have special skills such as a certified ability to cook continental food.  Many families also look for first aid or child related training when childcare is a priority.  Once these individuals work amongst the expat community their services are often advertised differently – usually on notice boards at expat clubs or through special facebook groups (ie the closed group Deshperate in Dhaka or the Dhaka Moonshine Baby group) so that foreigners who are relocated can hand their existing staff over to incoming expats.  A servant’s CV and references are often expected by recruiting families and it is good practice for departing families to assist their maids to find alternative work.

Both local and foreign families usually employ at least one driver.  With such high dependency on car ownership and usage in a city with desperately lacking public transport facilities driving in Dhaka can be chaotic and highly stressful where road traffic rules are completely flouted.    Workers use travel time for conducting business on laptops or phones whilst letting the drivers take the strain.  Drivers traditionally work a six day week with 4 days off per month – this is often a Friday which is the Islamic holy day.  Hours are not fixed and pay is dependent on experience.  A typical salary is 10,000Taka to 13,000 Taka per month which may or may not include lunch and tips for duty late into the evening.  An annual Eid bonus is also expected.  Once again foreigners can expect to pay significantly more for English speaking drivers or those who are more professional overall.

Managing domestic helpers and their treatment in the home

Domestic help is a big issue in Bangladesh and the constant search for an honest, reliable servant is a topic that women (often full-time homemakers) frequently discuss.  However in my experience Bangladeshis who are raised with servants as children are generally more comfortable at managing and dealing with domestic helpers than foreigners (see below).  Locals generally appear confident in dictating the tasks to be carried out that day and naturally accept that they are more superior to those whose role it is to serve.  Under this prevailing hierarchy culturally different behaviours often exist that I, as a westerner, have not always found myself comfortable with.  For example it is perfectly acceptable to expect servants to clear food wrappings/peelings off the floor and even to clear up food debris that has been placed directly onto the table straight from the mouth.  At times I find myself thinking what my parents would say if they caught me doing such a thing!  I also find it amusing that for the sake of exercising authority tasks that could have been more efficiently performed by one-self are instead delegated down the line.   As I have learnt respect for hierarchy in the home as well as the office is a huge cultural difference in Bangladesh that is ingrained in daily life.  As a foreigner I must appreciate that difference even if I do not agree with it.

Expats (and particularly us sensitive Brits!) tend to tread more carefully with the treatment of employed staff.  Often foreigners show higher levels of kindness when work has been performed well and there is a tendency to be more generous with payment (this is may be in part due to the attractive remuneration packages of many working overseas).  There is also more of a cultural preference for part-time assistance rather than ‘live-in’ help where the home is seen as a place exclusively for family members.  I suggest that the reasons behind this better treatment may include inexperience or embarrassment regarding language difficulties.  Whilst it may not be politically correct, I also think that there is generally a greater tendency for foreigners to treat people more equally where, for many Bangladeshis, there is arguably an ingrained sense of class division.  However, I have also seen first-hand foreigners who have behaved aggressively to drivers and household staff.  I cannot account for this level of overassertedness – perhaps it is simply due to personality type, a power trip or the frustrations that come with living overseas.  Again I have felt very uncomfortable as an observer to this type of confrontational behaviour when it occurs.  It can often be completely unexpected and from those who are otherwise extremely polite and hired in the most senior of roles.  However, as a friend once said to me – “you may like your friends and family but it does not necessarily mean you will like the way they treat their servants”.

Domestic workers as forgotten people?

Whilst I have now accepted and appreciate the support our maids past and present have provided it would be wrong to say that I have completely come to terms with the arrangement.  Practically I find that I do a lot of my own cleaning and cooking out of habit and against Bangladeshi custom find myself continually thanking our staff for their help due to the way I was raised.  Because of my own life experience I find it hard to think of our helpers as anything other than equal human beings who happened to be born into less fortunate circumstances.  Behind every person is a very human story and I find it difficult not to show some level of interest or care regarding the very people who ultimately share our home.

From the way my family manages our servants in Chittagong I know that it is not really appropriate to be friendly with our current servant here in Dhaka – the idea being that servants should know their duty and their place.  Whilst I respect this view (I have heard of stories where staff members have exploited a trusted position) I struggle to deploy the same level detachment to someone helping me to make my family’s life easier.

When the opportunity has arisen I have been able to ask our young maid in broken Bengali about her village (near Mymenshingh) and she has told me a little about her own family – besides her parents she has two brothers and a younger sister.  She told me proudly that her eldest brother goes to school.  I was able to reassure her that were both living away from our families the implication being that I also miss home.  It was actually a very emotional moment though I know that I am probably more than twice her age with some family support.  Sadly it was clear that this minimal level of kindness is so rarely shown as her reaction was one of sheer elation that I would ask about her and her own family.  How desperately sad I can sometimes feel.

The practice of hiring servants seems set to continue in Bangladesh.  With millions of families living below or on the poverty line this habitual practice is a more than just stable source of income on which many rely.  For many brassic rural communities it is a lifeline for overpopulated families.  In a country where washing machines, dish washers and other modern conveniences are limited to the very rich (we do not have them!) it seems that at least for the foreseeable future there will always be domestic work available for delegation.

Will domestic workers remain a category of forgotten people in Bangladesh?  In my view Bangladesh is not yet ready to challenge the rigid social hierarchy that exists in the domestic sphere.  Interestingly similar hierarchical structures also exist in the work place here which provides many challenges for cross-cultural working.  I suspect that at the present time the active promotion of social hierarchy is due to specific cultural and religious reasons in Bangladesh where many believe that God or Allah has dictated one’s role and place in society.  However, with a secular government presently in power social groups such as the Human Rights Watch and influential politicians should seek to secure the safeguarding of domestic workers both young and old through legislative means.  In time perhaps servants could be registered to households or house owners and allocated to a warden responsible for domestic staff welfare in different localities.  Sadly this level of social welfare remains a distant dream.  Until such regulation is achieved news stories will continue to appear regarding the fate of abused or tortured domestic workers – a category of forgotten people in Bangladesh  – powerless individuals who are neither seen nor heard.

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Traditional beliefs and rituals surrounding pregnancy and childbirth in Bangladesh

Like many other cultures and civilisations around the world Bangladeshi people have their own traditions and beliefs surrounding pregnancy and childbirth.  Pregnancy in Bangladesh is seen as a condition in which women are expected to proceed with caution. Even from an early stage expectant mums naturally seem to take life at a slower pace.  It has often amused me that being with child is akin to a sort of mild but enduring illness, where women are encouraged to rest, sit and wait patiently to recover.

Pregnancy and food…..

Amongst my Bangladeshi (Chittagonian) family I have been encouraged to eat a lot! (I haven’t disappointed as I have put on almost 13kg so far!) Only a few foods have been off limits – tea-leaf tea or cha (too much caffeine) and anarosh (pineapple) which is thought to bring on early contractions (a belief similarly followed in other cultures).  Having dipped into the reams of “official” dietary advice available on-line their helpful guidance seems to tally with the professionals.  Here there are no fears about undercooked meats (particularly beef) as all meats are cooked through in curry style dishes.  Fears of blue-veined, bacteria encrusted cheeses are also a non-issue as these are not enjoyed by the locals.   My Apu (Nufel’s elder sister) encourages me to eat one egg and a glass of milk a day and in the early weeks she made a point of sending me some tamarind sweets to suckle to help with the sickness.  Bangladeshi women traditionally enjoy sour foods in pregnancy including pickles to satisfy cravings.

My doctor has advised me not to eat raw vegetables or fruits that I cannot peel.  Dirty water used for “sprucing up” tired leaves and the humble potato carries obvious dangers for people – pregnant or otherwise.  For vegetables and fruits sold in the market stalls, there is also a widespread practice of formalin use – a chemical containing formaldehyde solution which prolongs the shelf-life of these degradable foods. Hence caution is justified.

Pregnancy and superstitions…

In truth I expected many Bangladeshis to feel auspicious about pregnancy – I am not sure why, perhaps it was solely due to a sense of heightened piety in Bangladesh.  Like with marriage where there is often a mixture of strong religious and cultural traditions the creation of a new life is a similarly significant event in which I expected similar rituals.   I have heard of a number of beliefs about what women should or could do to bring good luck or to remain healthy and safe in pregnancy but I suspect that I have only scratched the surface of these myths and traditions. I suspect that as a foreigner and a non-muslim my exposure to some Islamic and or cultural practices is limited.  My reading about Bangladesh and its communities also suggest that myths and traditions in lower caste communities are much stronger where education, particularly in relation to pregnancy and birth is limited and faith and/or hope is essential as a coping mechanism for daily living.  Many women in rural or slum communities have a fatalistic attitude towards pregnancy and put their faith and trust in Allah in the event of an emergency.

Amongst my social and family circle here are a few common beliefs I have come across:

  1.  Pregnant women, (as well as ill people) can wear specially ‘blessed’ ribbons around their stomachs to protect the baby from harm and to give good luck.
  2. Pregnant women are encouraged to look at cute baby pictures as it is believed that this will increase the chance of you having a handsome/beautiful baby.
  3. Pregnant women should avoid sitting or sleeping in corners as they will be caught by an ‘evil eye’ (chokh/nojor laga).
  4. Women should keep their baby bumps covered as much as possible to prevent an evil or bad eye.
  5. Many women keep their pregnancy secret as people may give an evil eye ie.look on with jealousy which could channel negative energy towards the baby.
  6. It is believed that the prayers of pregnant women will be heard by Allah over and above those of other individuals.  Since I have been pregnant I have had random requests – to pray for good exam papers and even a request from a student for me to pray for her father to bring an IPAD back for her from the USA!

Pregnancy and the baby shower/Shad

My friends in Bangladesh surprised me with a baby shower on the 28th June 2013.  Here, as I have learned, baby showers known as ‘shad’ take place during the seventh month of pregnancy and traditionally centre on the Mother-to-be and her impending delivery rather than the baby.  Women sit together to exchange advice about childbirth and childcare and offer positive words, prayers and good wishes for the baby.  At my event our friends were very generous – they bought and dressed me in a saree and we enjoyed delicious local foods including sweets and a special “Emma Mummy” cake to mark the occasion.  Here are one or two pictures that were taken:

Baby shower at Nazma's home

All the lovely ladies together...

All the lovely ladies together…

Beliefs and superstitions aside I left work to go on maternity leave on the 4th July 2013.  On this occasion – as per tradition, I was given a wonderful send off:

Now that I am a full-time housewife and mummy-to-be I hope to dedicate more time to my writing – particularly my blog!

Me in my 28th week of pregnancy

Me in my 28th week of pregnancy

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Healthcare in Bangladesh

Nufel and I are to become first time parents in October.  I am a late starter amongst my friends and now feel embarrassed that after several comments to my husband about my facebook turning into “mums net” I too am posting comments regarding “all things baby”.  I have no doubt that this will continue as I bond and revel in my expanding bump.  My blog is not a pregnancy blog but it is inevitable that my experiences as a Mum–in-the-making do now form part of my life in Bangladesh.  I’m sure at least some of you will be interested to know how I negotiate my maternity oversees including my experiences with the Bangladesh private healthcare system (I am a product of the NHS or National Health Service which is a free for all universal health care service in the UK).  In later posts I intend to discuss Bangladeshi perspectives on pregnancy and motherhood and developing our own identity as a mixed ‘Bangla-bideshi’ family.

Apollo Hospital Bashundhara, Dhaka

Our first obstetrics and gynecology appointment was at Apollo Hospital in January.  It is one of several international standard hospitals located in Dhaka (others include United Hospital and The Square) and in terms of hygiene and healthcare is equivalent to the NHS hospitals I have had exposure to in England.  My consultant took my full medical history, located baby-to-be on an ultra sound scan and ordered routine tests before sending us on our way.  The only amusing event was the delighted reaction of the blood sampling technician upon learning that I was married to a Bangladeshi. 

We have been back to Apollo for several check-ups now and overall my experiences have been positive.  Some members of staff do not speak English but I anticipated that this would be the case and it does not concern me so long as I can communicate with my Doctor.  Nufel seems to notice that as I am categorised as a ‘foreign patient’ I am treated with some extra care, attention and efficiency.  I have heard receptionists relay to nursing staff that an ‘international patient’ is waiting to be seen so perhaps this is true.  In general I have been given plenty of time during my appointments and feel I have received a good level of care and service. 

Private Healthcare in Bangladesh  

The obvious difference in seeking medical assistance in Bangladesh is the operation of a privately funded healthcare system.  All appointments and interventions are, where appropriate, pre-booked and paid for in advance – usually at a designated departmental reception.  Being completely unaware of the private medical fees charged worldwide the expenses we have incurred so far seem reasonable – just to give you an idea:

1,000TK/roughly £8.20 for an appointment with the consultant (including a basic scan)

2,200TK/roughly £18 for a full ultrasound scan (including 4D scan)

7,800TK/roughly £64 for a full blood testing/urine profile

The hospital offers a tour of the maternity unit combined with some antenatal sessions for 4,000TK/roughly £35 which we are yet to book and as it stands we don’t know the expected cost of delivery (naturally or via cesarean section) so my opinion could change! 

The differing agendas of the Private and Public Medical Models

Although I do not have a medical background the differences in how care is delivered under the public and private medical models is readily identifiable.  Under a privately funded system only those with financial security have access to the best level of healthcare either in Bangladesh or overseas in countries such as Singapore, Thailand or India which are renowned for their own particular specialisms. Patients willing to pay a premium for healthcare can also enjoy receiving medical intervention quickly where appointments or treatment can be accessed on the day or even on the spot if they can accommodate!  Unlike the UK system which is blighted with imperfections – including queues at the local Doctors Surgery/Clinics and lengthy hospital waiting lists for routine procedures, under the private model healthcare is more readily accessible in Bangladesh.   

On the down side subtle exploitation in the private system can mean that unnecessary care, attention and testing are provided which will conveniently exacerbate your medical bill!  This method operates on a business based model whose agenda differs to that of a public healthcare regime financed through substantial taxation.  In Bangladesh and worldwide more patients, more appointments, more testing and more admissions means more profit.  This leaves vulnerable individuals in a position of potential exploitation where the frail and frightened could easily be talked into tests and perhaps treatment which may be nothing other than an indulgence or a “fishing expedition”.  

In the UK I am told that women can expect a routine ultrasound during their 12th and 20th weeks of pregnancy.  In Bangladesh, my consultant confirmed she wanted to see me monthly and then fortnightly from month eight.  I was pleased to have to report with such regularity as it would provide me with more opportunities to check in with my baby.  However, whether this number of appointments is clinically necessary is another matter altogether. 

It is quite ironic that I used to work for an NHS hospital social work discharge team in the UK where hour by hour a multidisciplinary team of staff made impromptu arrangements to send medically fit patients home to make hospital beds available.  We were often faced with annoyed relatives who wanted their family member to be discharged at a time convenient to them – “maybe at the weekend” or “when my sister gets back from holiday”.  I wonder how many individuals would be quite so keen to delay discharge where a daily fee of say £150 is charged per person, per bed, per day.  I also wonder how many individuals would miss their Doctor’s appointments if asked to pay a fee to secure their slot. 

That said the publicly funded model with which I am more familiar has also been criticised.    Beyond the potential abuse of services, waiting lists and difficulties securing Doctor appointments many are offended by the policy of treatment based on a “lottery postcode” – your address determining whether your local authority/primary care trust are willing to fund certain types of medical treatment.  This has been the case particularly with cancer recovery and fertility services.  Many are dissatisfied with the increased taxation required to fund free public healthcare and have often criticised the failing level of care in some parts of the UK (most recently with scandals surrounding MRSA and poor hygiene standards).  I am not attempting to propose alternatives to the prevailing systems in my blog but the differences are telling and interesting to see played out in practice.

Healthcare for everyday people in Bangladesh

Large segments of the population in Bangladesh are deprived of a fundamental right: access to basic health care.  The vast majority of Bangladeshi citizens rely on government hospitals to deliver medical attention and treatment at an affordable price tag.  These hospitals are funded through minimal taxation subsidies and other sources.  Amongst the Bangladeshi population government healthcare is perceived to be of a much lower quality standard where rudimentary expectations of cleanliness, skills and expertise are not met.  Such institutions are frequently ill equipped and for those entering the system there is an informal expectation that tips are routinely paid to guarantee that a service will be done or an appointment time secured etc.   Unlike the competition driven private sector these hospitals have no market incentive to motivate them to provide a higher quality of service so standards remain low. 

An article I read about the service quality of public and private hospitals in Bangladesh by Syed Saad Andaleeb entitled “Public and private hospitals in Bangladesh: service quality and predictors of hospital choice” suggests that a number of strategies and incentives need to be applied to improve the quality of government healthcare services.  He suggests that these hospitals should be subject to evaluation systems by patients about the quality of services provided and that the allocation of funding should be based on performance and/or ranking.

Like so much of Bangladesh the quality of life and indeed the quality of healthcare is based on one’s ability to pay.  Unlike the operation of private healthcare systems elsewhere ie the USA there are no insurance schemes to fund either partially or fully treatment that is required.  The reality is that urgent, ongoing medical treatment may require the release of life savings or the sale of land or property to honour payment.

Healthcare and our spending mentality

I recently discussed with Nufel the issue of payment for medical care in Bangladesh and with an open heart described how unnatural it felt to pay upfront for maternity services.  My husband, having spent his formative years in Bangladesh thought this was amusing as this system is what he has grown up with no matter what the illness or condition. 

Whilst I have indirectly contributed to the availability of healthcare in the UK through the taxation of my income many UK citizens will relate to the collective feeling that our healthcare system is “free” as the financial assistance we give to public services are deducted from our salary before we have a chance to spend it!  Whilst we are contributing without the physical exchange of cash the mental process of “payment” is absent.  The system is also designed to cover the expenditure of the unemployed, pensioners, children and those otherwise unable to contribute.  As an NHS baby I cannot imagine not being able to access free treatment as and when I need it without a second thought as to how to pay for it.  Inevitably in thinking about this situation more deeply it is inevitable that without the anxiety of healthcare fees and for that matter school fees (also paid for on a private basis in Bangladesh) UK citizens feel more confident in indulging their consumerist tendencies.  I often tease my husband for being a saver and not a spender but as I have found this is a common trait in Bangladesh.  Money is spent but the consumerism I was raised with in the UK is not to be found in Bangladesh.  Not only are there fewer opportunities to spend in a developing nation but money tends to be instinctively saved for necessary expenses – such as for emergency medical intervention.

It will be interesting to see where the future of healthcare in the UK and Bangladesh is headed.  If foreign media reports are to be believed it appears that in the UK we are also headed towards privatisation of not only our healthcare systems but also our vital social services.  This transition had been discussed at least on paper at the time I left for Bangladesh last year but is yet to gather momentum.  I will be interested to see how the change in healthcare provision affects our economy and whether we will follow the US insurance scheme pathway.  In Bangladesh there are talks of a cheaper publicly funded healthcare scheme for poorer communities but again this is only at an embryonic stage. I suspect that in reality only by increased taxation rigorously monitored by the authorities that enough funding could be generated for this vital public service. 

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The permanent expat – an honest perspective

As an expat I know that statistically there are not many of us here in Bangladesh.  Of those who do come many reside in the capital, Dhaka whilst others have pre-arranged lodgings further afield – ie in Chittagong (many female travellers work or volunteer at the Asian University for Women) whilst others migrate on to field based projects working with church related organisations, charities or NGOs doing important work with selected groups of Bangladeshi people in the more remote regions.  Many of those that do come for volunteering, travelling or paid work opportunities write personal blogs for pleasure, for reflection, for those back home and to document their journey and the cultural experiences they face.

I’ve read many such blogs and by dipping in and out of random posts it is interesting to see common threads dominating routine logs.  As expected many refer to those initial sensory experiences we all tend to remember when we reach a new destination ‘….as I stepped off the aeroplane I walked into what felt like an oven that was Bangladesh’.   This is often followed by the shock of insipid poverty and the inescapable disparity between the Prado drivers and their rickshaw slogging counterparts.  These bloggers, often young women, are generally affected enough to mention the need to adopt a different and more conservative wardrobe to reflect prevailing cultural sensitivities as well as to deflect unwanted stares.  Posts then dwell on weekend trips to Sylhet or Cox’s Bazaar, the eastern shopping, getting around by CNG (compressed natural gas vehicle) or by rickshaw and the sights and smells of the ‘developing world’.

All seem to follow the same trend.  Ultimately there will then be a post about a host or a hospitable Bangladeshi family who are quick to embrace the newcomers with plenty of home cooked food and the introduction of extended family members.  Many are also welcomed as an addition to the family after initial introductions – a gesture that is often well received by those who cannot escape the reality that they are often thousands of miles from home. 

However, for many individuals coming to Bangladesh this is where blogs start and end.  Individuals who are often posted here for periods of a few months fail to deal with the real challenge of social and cultural integration into a starkly different environment to that of their western home comforts.   I recognise the signs of the seemingly light hearted posts being tweaked so as not to worry anxious Mums back home and experiences of those being lost en route whilst not speaking the language has been airbrushed into an exciting adventure.  Whilst brutal, Bangladesh is not tourist friendly and foreigners, especially women need to use their common sense to keep safe.  Whilst some long-term expats may hold a different opinion it seems to me that short term visitors, once faced with the realities of Bangladesh and the overwhelming physical and mental adjustments that genuine integration would involve such individuals never really engage or embrace with Bangladeshi culture instead preferring to ‘adopt the costume’ but opt out of exploring the host mentality.

Sensibly, it may be noted that those ‘passing through’ may be said to have no real need or sense of obligation to integrate in any meaningful way as their return ticket awaits them.  But what about those who stay long-term? Particularly those who are married or who are considering marrying a Bangladeshi and living here?  For these individuals (including myself) whilst we have experienced a foreign upbringing many of us feel the obligation and indeed the need to UNDERSTAND if not embrace many of the cultural practices and expectations of our new host country.  In-laws and extended family members can have expectations that foreign spouses will  adjust and adapt quickly.  For some expectations may include the need to adopt a new religion (publically if not privately!), the need to find your role and place in a family hierarchy, to adopt the language and embrace national/new religious holidays with the excitement expressed by your new family.  Critically, in Bangladesh where arguably national and cultural identity is more structured and perhaps rigid in comparison with the diversity experienced in the western world which supports multiculturalism (in theory if not always in practice!) that it is easy for one feel isolated at times when the adoption of new practices and a new mentality is slow and the reassuring safety net of your short-stay return ticket is non-existent.  Like many short stayers I have managed to successfully adopt the ‘costume’ but am still making that critical mental transition.

Essentials for permanent ex-pats

Language

 The most challenging factor to integration thus far has been the inability to learn Bengali as quickly as I would have liked.  Whilst most of my relatives and spouse’s friends speak English, Bengali is naturally spoken more frequently as a matter of habit. Often, quite unintentionally, I can be sitting with my family and still do not understand what is being said.  So much can be gained about the views and prevailing attitudes of a country by communicating with its people.  In not being prepared for the commitment to learn a new language a permanent expat will often struggle to fully adapt.  Without language a permanent expat will struggle to retain a certain level of independence.  Using transport, shopping, directing a new team of domestic staff becomes difficult.  Without language job opportunities are limited to those only requiring English speaking skills – co -orporate roles or those in an English Medium School setting.

Patience and ability to compromise

Spouses who stay may also need to be patient.  Here we work on Bangladeshi time.  In the west we are often raised to be individualistic – to nurture our own wants and needs.  In a South Asian context with this being a “high context” society needs and decisions are often met on a collective family basis which can be an adjustment to those with high demands.  An ability to compromise is essential – something that short term stayers will not have to negotiate.

Remembering who you are

With such focus on integration and embracing a new lifestyle (maybe because I am British?) it can feel that you question your own identify at times as a permanent expat.  Whilst experiences will differ from person to person and expat to expat many individuals can feel lost about the change to their environment and the effect that this may have on them as a person.  It is normal – especially as change can be felt on a daily basis and as stated, particularly during special occasions or dates of celebration back home (Christmas, ‘Kate and Wills wedding’ , the Olympics and recent jubilee celebrations) that are not followed with interest in Bangladesh.  At times it may feel that the adjustment is one-sided where all the negotiation of boundaries and learning is one-way.  It is not always plain sailing and often the experiences you have make you quite patriotic as you yearn for all things related to home.

That said long-term stayers can find support in each other.  There are facebook groups such as the “C3club” (cross cultural club Dhaka) a club especially for women married to Bangladeshis who are a group of incredibly supportive women who can laugh and share similar experiences especially of those first few weeks and months.  I remember this club being a lifesaver when I first arrived in Bangladesh as the women could relate to what I was experiencing. 

There is also another recommended line of support on facebook called “I married a Bangladeshi guy…” Whilst a small community at present it is still a useful way for new arrivals to connect and make friendships.  In time I hope my blog will be found by those moving to Bangladesh who I am keen to help where possible with their new transition.

I hope that this post has given you some insight into the challenges that are faced by those who come to Bangladesh and stay.  I’m sure that similar experiences arise in other cross-cultural transitions where at times it can feel like you have bitten off more than you can chew!  I’d be keen to know about the experiences of other westerners who moved to Bangladesh or other developing countries.

I genuinely respect those who come to Bangladesh (in the short, medium or long term) to see for themselves the country and whom experience first-hand the people that make Bangladesh the country that it is.  It is surely a life changing experience even more so for those who stay and who seek to make this their home. Like many Bangladeshis who travel to the UK to live l am proud that I am able to survive living in two very different cultural environments where the variation in culture and daily life is so vast.

 

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‘Dos ’ and the ‘Don’ts’ in Bangladesh

Next month marks the first anniversary of my arrival in Bangladesh.  Apart from the language difficulties which are of my own making (my bangla lessons slipped since starting work!) I think I am able to say that I am more than just a freshi bideshi!

It has been quite a year especially after normal life resumed following our move to Dhaka.  I am still learning to balance being me in a culturally very different environment but as each week passes I feel a little more comfortable in my own skin.

In this post I wanted to explore some of the ‘dos’ and the ‘don’ts’ of living in Dhaka – reportedly one of the world’s most difficult cities to live!

The Do’s

Do approach expat strangers!

Unlike London and the veil of stand-offishness that increases as you head into Fenchurch Street railway station foreigners are encouraged to make eye contact (shock horror!) and approach strangers in coffee bars.  Having routinely adhered to the head down, no interaction etiquette of England’s capital it is strangely pleasant that expats are genuinely friendly to one another from the initial ‘hello’ and that life stories as well as numbers and email addresses are exchanged without awkwardness during that first meeting.  This took a bit of getting used to especially when people called back when they said they were going to just to check in and make sure that I/we are OK.  How very neighbourhood watch!

Already I have met a broad spectrum of people – Bangladeshi nationals, politicians and civil servants from every sector as well as a raggy-doll mixture of expats including kind hearted NGO/charity workers, highly educated (and highly paid!) consultants for international organisations and overseas governments departments, garments buyers,  journalists as well as diamond buyers!  You never know whose path you will cross….

Do get a whole new wardrobe!

Shopping in Bangladesh is a unique experience.  With no high streets or identical out of town shopping complexes shoppers often mix short shopping trips to known boutiques or create their own clothes using local tailors.   Bangladesh does have one or two chain stores ie Aarong (http://www.aarong.com)  and Jatra (my favourite!) (http://www.jatrabd.com) whose goods are considered as akin to famous national brands.  A sale in Aarong can send many a bangladeshi woman’s heart a flutter.  There are two stores in Dhaka including their flagship store in Uttara , one in Chittagong, Sylhet and a few others in well populated towns across Bangladesh.  They sell clothes and accessories for the whole family as well as home accessories.  Jatra, a shop that portrays itself as a very ‘desi’ store linked to rural communities that produce their goods does not actually seem to be fair trade.  The good quality clothing and home wear items are a delight to those desiring western styles with eastern flavour.  Items at this store cost a little more due to the relaxed shopping environment but the price is still comparatively reasonable when compared to similar fashion houses in the UK.

Otherwise, women not requiring a ‘brand’ tend to browse and purchase from smaller outlets which stock sarees and salwaar Kameezes either stitched (ready to wear off the peg) or unstitched (ready to sew for those who exceed the average 32”/34” deshi’bust size!) whose fabric, design and price range enormously.  As a white foreigner expect to pay more (see below).  I have also heard that rich local ladies have special bespoke exclusive “boutiques” where the materials are sourced from more “expensive” destinations, i.e. Pakistan and India.

For those with a creative streak or at least a good template more determined women haggle for fabric and head to their favourite tailors who can custom make bespoke outfits for next to nothing.  Even at foreigner rates I do not expect to pay more than about eight to ten pounds for a unique and flattering top including the materials and the work done by the tailor.  To stitch an unstitched salwaar kameeze (long top and pants) costs about 300 taka or two pounds fifty pence.  As such shopping may take a little bit more time and effort but it is sure worth it when you are modelling your new outfit and can proudly announce “I designed it myself!”

Many expats here are linked to the international garments industry.  I have personally met buyers from Next, Marks & Spencers and Walmart (USA version of ASDA) and there is a H&M garments sale locally on the  1st March where seconds that did not quite make it are sold off at 150 taka per piece (about one pound ten pence).  There are also random shops like Artisan and market sellers who sell rejected factory items at next to nothing.  With patience many items from home can be found but you need to be prepared to search and to haggle!

Do eat out (but be careful!)

Street food aside (though some of my ‘deshi friends swear by it!) eating out and enjoying excellent food can be experienced on a budget in Bangladesh.  From traditional Indian style cuisine at Sajna’s in Bonani  or Khazana’s in Gulshan 2 to Chinese at Golden Rice in Gulshan 1, through to Japanese at Samdados, thai at Soi 71 al in Gulshan 2 through to wonderful burgers, salads and steaks enjoyed poolside at the Splash restaurant at the five star Westin Hotel Dhaka.  Clearly you are spoilt for choice.  Apart from the Westin (limited to special occasions) you can expect to eat delicious, high quality and filling cuisine for about ten to fifteen pounds per person including drinks.  The quality of the food far exceeds the chain eateries in the UK and the US which, let’s face it all have very predictable menu choices.  I have also had the opportunity to try foods that I would not routinely try – favourites include the chilli cheese paneer with butter Nan at Sajnas and the Dal Mahkani in Ajo’s cafe, Dhamondi .  Luckily the list of ‘must eat again’ foods keeps on growing……….

Dhaka now boasts a range of starbucks equivalent coffee houses for those in the need of good coffee and wi-fi access.  Of course this does not beat the comfortable side street cafes or those which offer fantastic views from the 7th floor but it is good for Dhaka days when the city seems too much.  North End café (run by a traditionally US family) serves brownies, cinnamon whirls and carrot cake muffins that are second to none and gives you a taste of home as you curl up into the sofas.

Deshi’ Street food can be hit and miss and often depends on the hygiene practices of the particular eatery.  I have enjoyed wonderful samosas and shangrias (pyramid like samosas!) as well as rich, delicious Bangladeshi sweets that leave you wanting more but to be honest I have tended to play it safe.  Some expats seem to have stomachs of steel whilst others have been instantly struck by typhoid and have been ‘off road’ for days.  Raw foods that are likely to be washed in unfiltered water should not be consumed by unaclimatised foreigners and common sense should dictate what risks are reasonable to take.

Do get on your bike!

Whether by rickshaw or push bike Dhaka can be enjoyed most by cycling. Whizzing through the traffic jams, through back alleyways and over unsavoury manholes can be thrilling if not nail biting at times.  Sitting on a rickshaw on the way home in the rain is one of my happiest memories in Bangladesh so far.  However, those wishing to travel need to be ready to jump off at any second.  Rickshaw-whallas often break quickly or take sharp turns as they race against mega buses and middle class owned Corolla cars that fill up the roads.

Each rickshaw is designed and decorated by their owners – colourful paint works of famous bollywood actresses sit alongside bloody images of the 1971 War as well as local flowers, trees and animals set in nature.  Often Wallahs paint their name and number hoping for regular customers who will ‘dial a ride’.  All Bangladeshi’s love their mobile phones!

One of my more adventurous Bangladeshi friends belongs to a very active cycling group called BD cyclists.  As push bike cycling can be dangerous on busy roads keen cyclists join weekly to explore Dhaka and beyond on routes specially designed for beginners, moderate as well as avid cyclists.  The group has approximately two hundred members making the pack of riders a safe number on what would otherwise be precarious cycling conditions.  Trips are designed to incorporate both on road and off road cycling.  Professionally run, cyclists have to put safety first – their motto is simply – “no helmet – no ride!”  This is a great way for deshi’s and bideshi’s young and old to keep fit and keep a pace with their ability level.

Do have an open heart and mind…

The British in Bangladesh have a tendency to be well regarded by Bangladeshi’s as being tolerant and open-minded.  We are laughed at with our poor bangla and pitied for our bland food choices but generally British ex-pats are acceptable bideshi’s.

An open mind and heart are a necessary must in such unfamiliar surroundings.  I will always be something interesting to stare at as I go about my day to day business.  A white lady is still an unfamiliar sight particularly outside of Gulshan and Baridhara Diplomatic Zone.  However, whilst it is easy to get frustrated at the unwanted attention there are unexpected moments that can be enjoyed so long as you are willing to keep that open mind.  On a family visit to Cox’s Bazaar our car turned off to explore Inani beach (one of the lesser known beaches in the area).  As we marched off towards the bridge that connects one sand bank to another I used my best bangla to introduce myself to some local street boys of no more than 7/8yrs old.  I told them where I was from and in a giggly state they told me their names.  I told them my name and they told me that the cigarette packets they were holding were used for card games.  It was a moment that could only be enjoyed with an open mind.

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Pictured with the friends I made on Inani beach

The Don’ts….

Don’t expect, expect, expect…

Coming from the West I have discovered that I have a natural, inbred impatience.  I have high expectations and tight deadlines which I have learnt to meet through rigid self-motivation.  Bangladesh operates on a softer, slower mode where things will happen….in the end!  Those expecting the efficiency of the west will be disappointed and frustrated especially in the workplace where the pace in my former office (I worked in social work at a Hospital Assessment Team in Essex) ranged from manic to super manic!

I have also learnt that I should not expect to be treated like a local.  Not only will white, foreign people (particularly women) get unwanted glances and attention they also fight to challenge the status quo that women of a certain class tend to maintain a largely indoor lifestyle.  Sadly all identifiable expats are the targets of persistent and often aggressive beggars who pester for payment and are not afraid to reach out and touch you to secure your attention. I don’t mind being hassled but unwanted poking crosses my line of acceptability.  Anyone who tries this on me will hear me assert “tumi amake dhorbe na!” or “don’t touch me!” followed by one of my dirty looks!!

Non-fixed price market stalls and shops will also take advantage of ex-pats who it is assumed all enjoy luxurious foreign salaries complete with travel allowance, living allowance, food allowance etc. which I am certainly NOT in receipt.   One day, in need of a plastic jug the very same plastic jug was quoted at 400 taka then 300 taka then 150 taka before we finally bought it elsewhere for 100 taka (Nufel went on his own!).  Sadly I have to accept and EXPECT the inevitably there is an unofficial ‘white tax’ that seems to operate.  Now, I either send Nufel for negotiable items and fend for myself in the fixed price supermarkets or pay the extra where I want to exercise my choice.  Sometimes a girl just misses good old Marks & Spencer!

Don’t compare the UK with Bangladesh

I have learnt to develop a sophisticated split personality according to my current address.  That is not to say that I cannot be me just that I have to accept and assume two very different cultural identities according to when they are appropriate.  My life in the UK is well known by all – shopping, eating out, trips up to London, the seaside and freedom of roaming in my car.  A largely independent lifestyle.  In Bangladesh my life is unavoidably more dependent on others.   Helpfully we have a driver and assistants to help us at home which makes life easier but one’s ability to just go and wander off is just not possible in this hectic city.  I try to enjoy the pros and the cons of each city and I am proud that I can successfully adapt fully into two different environments – something that immigrants in the UK do every day.  Strangely as a British citizen I am treated with curiosity as a some sort of minor celebrity in Bangladesh – if only they knew I come from Basildon!  It makes you realize what a bad press immigrants in the UK unfairly receive when they are just looking for a better life.

And finally……Don’t upset your in-laws!

Family dynamics operate differently in Bangladesh.  Generally I have found that families tend to be physically and some say emotionally closer and many live with family members in the same block or work with relatives in family businesses.  Parents expect to contribute financially towards their off spring until well into adulthood when they finally become self-sufficient.  Obligations towards family members seem to be subtle but strong – there is more of a collective thinking when decisions are made which is unusual in the UK where we all thrive to be individualistic and independent.  Elders tend to fend for their children until the favour is returned in their old age.  Unlike the UK elderly family members migrate to relatives’ homes to be cared for on a full time basis.  Care homes are virtually non-existent in Bangladesh where still a largely unemployed female population has the time to carry out a nursing role.  Bangladesh seems to be akin to an England of pre- World War One.  As the cost of living inevitably increases I wonder for how long women will remain home makers.

Regardless of the do’s and the don’ts Bangladesh is developing at a vast rate.  In the environment I live it is not the horror westerners experience on their TV sets come comic relief.  However, sadly Bangladesh does not seem to be coping well with the rapid pace of its own progress, the infrastructure is inadequate and in some ways Bangladesh is a victim of its own progress.  There is an expanding middle class and plenty of money amongst these individuals but it is not spent on the greater cause of poverty reduction.  Instead individuals are more concerned about increasing their own wealth, buying more property and cars or spending the money overseas.  The divide just seems to perpetuate the extreme inequality that exists.

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