"Here we are in
our homes safe and
secure, but who is taking
care of our children today
when they are in darkness and danger."
Shahidul Haque
It is the year 2000 and it has taken a long nine years to draw the attention of a few concerned health, nutrition and agricultural groups to the Rickets problem. But those who should come forward first to solve the problem are still silent and hiding under their papers. For those of us who work for the development of disabled people and for the survival of our children, it is easy to see that the number of people with disabilities will be much greater in the coming generation than it is now. With this in mind, we have to ask why are the donors and Government not coming forward to solve the problems? Presently in Bangladesh, 13 million people are disabled and are either dependent on their families or on the streets as beggars. There are no government programs for them and nothing is being done for them so naturally they are a burden on the country, a burden on our economy. SARPV strongly believes in Equal Participation and Opportunity for all citizens. It is the right of all citizens, but unfortunately in Bangladesh it is a sad fact that from all aspects these rights are neglected or absent. Many see the danger and think that others will help, but it is difficult for them to take any steps themselves for creating a safer community by preventing the unnecessary disabling of our people. Through our complacency are we not leading our nation gradually down a very dangerous path, into a self-defeating position that is neither desirable, acceptable nor honorable? It is becoming an environment of darkness where the blind are leading the blind. Despite this gloomy picture and frustrating situation, the government is trying to free Bangladesh from two old disability enemies: polio, and the blindness that is caused from vitamin A deficiency. Unfortunately, along with the quickly changing times and environment come new enemies that cause disabilities. New enemies like rickets, not to mention the ever increasing disabilities caused by domestic violence, road accidents, disasters, and poverty. These are some of the salient features going unnoticed and under-diagnosed by those in power. We are all a little slow to adapt to our changing environment but the government is exceedingly slow in keeping up with change. Fortunately, where SARPV has been advocating awareness some, NGOs and organizations have been taking notice. SARPV is more aware than most about these new disabilities for we live with them everyday, and we thank God for our position and that we have been able to help draw the attention of Les Amis Des Enfants Du Monde (AEM-France), International Maize and Wheat Improvement Center (CIMMYT-Bangladesh), United States Agency for International Aid (USAID), UNICEF, Institute of Child and Mother Health (ICMH-Bangladesh), International Center for Diarrhea Disease Research-Bangladesh (ICDDRB), Mayo Clinic-USA, Memorial Christian Hospital in Bangladesh, Bangladesh Rural Advancement Committee (BRAC), Helen Keller International (HKI-Bangladesh), and Cornell and Dhaka Universities to rally in response to the problem of rickets. We have come together as the Rickets Consortium in an initiative that aims to research the causes of rickets and to promote ways that will prevent the disease. Our work together also helps promote the creation of a barrier-free environment for people with disabilities where the benefits of food and nutrition are linked and promoted by knowledge, enterprise and an increased standard of living. We have come a long way since 1992 when no one would even recognize that rickets existed in Bangladesh. We now have proven with the help and hard work of ICMH and Unicef that rickets exists at the alarming rate of nine percent in Chakaria. Chakaria is now a community in panic over their children who face unnecessary disability. They are hopeful to learn how to save their children from this danger. BRAC has also furthered our knowledge of rickets in Bangladesh with a wide assessment of the disease throughout Cox’s Bazaar District and other areas of the country. It is to the Rickets Consortium’s credit that rickets has been proven to be a serious public health issue and a dangerous threat. Thanks to our concerted efforts, parents, communities, development workers, local government and administrators of Chakaria are now more seriously thinking about the problem of people with disabilities. People want to help and this is the ray of hope for the future life of persons with disabilities. I thank you all for working for this ray of light so that the "blind will not lead the blind", that an environment of "Love and Life" will prevail with due respect for all!
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Memorial Christian Hospital (MCH)
Everyday the doctors at the Memorial Christian Hospital see at least one or two new rickets patients. The problem is nothing new to them. Recently, a doctor at MCH, John Bullock, who although retired from active practice was back at MCH for a few months on a working visit. Dr. Bullock first came to MCH in the mid 1970s, and has seen the rickets problem grow into it’s current epidemic proportions. Along with Dr. Steve Kelley, Dr. David Staab, Nancie Dellaganna and all the dedicated people at MCH, he is relieved that steps are finally being taken to research and intervene in the spread of this serious condition. Even more commendable is MCH’s active commitment to the local community and to the work of Rickets Consortium. Their participation will be paramount in the next phase of our work, the Clinical Intervention Study.
Clinical Intervention Study
Dr. Jerry Combs, Dr. Steve Kelley (MCH) and Dr. Phil Fischer (Mayo Clinic) are designing the clinical intervention study. This study is essential if we are to prove our hypothesis that calcium deficiency is the main contributing factor for rickets in Bangladesh.
In a planning meeting at MCH recently, their staff agreed to carry out the blood sample collection and analysis at their hospital in Malunghat, Chakaria Thana. We are hoping to begin this phase of the program by mid-summer. SARPV and Dr. Nazmul Hassan from Dhaka University, with help from the local government will mobilize the targeted communities to participate in the study. We see this collaboration as a very positive one that will strengthen the working ties of SARPV, MCH, Dhaka University and the local community of Chakaria, thus insuring long-term sustainability in treating and preventing the disease locally.
National Prevalence Study and Rickets Map
BRAC (Rickets Consortium member) is currently finalizing their report on the expanded prevalence survey study that was conducted this past summer throughout Cox’s Bazaar District. BRAC has analyzed their data and will presently publish a full report from their assessment of rickets cases in Cox’s Bazaar District and other districts in Bangladesh. A summary of that work, published in their 1999 annual report is presented below.
Prevalence of Lower Limb Clinical Rickets: A Quick Assessment, BRAC Research and Evaluation Division, March 2000
Discovery of a high prevalence of rickets (8.7%) among 1-15 years age group in Chakaria Thana in Cox’s Bazaar District (Kabir et al, 1998), indicated the need for a nationally represented survey to see the geographical distribution of rickets and etiological understanding of the disease in Bangladesh. It will help to frame the policy and interventions to prevent the problem.
Thus, Bangladesh Rickets Prevention Consortium requested BRAC to conduct a nationwide preliminary census to identify quickly the high rickets prevalence areas that can serve as a guide for more thorough studies. Considering the technical difficulties in carrying out the study on all aspects of the disease, BRAC decided to first study the prevalence of lower limb clinical rickets in all the seven thanas of Cox’s Bazaar District. Beforehand, the Research and Development Division (RED) conducted a pilot study to test the feasibility of using the existing community networks of BRAC in conducting such a large study.
The Institute of Child and Mother Health (ICMH), Dhaka; Cornell University, USA, UNICEF, Dhaka; and the Social Assistance and Rehabilitation for the Physically Vulnerable (SARPV)-Bangladesh generously extended necessary technical and material support to RED for designing and implementing the study.
The study population was drawn from 28 randomly selected villages representing all seven thanas of the district. Data was collecting during May-July 1999 in two phases from 25,891 children/adolescents aged 1-20 years. In the first phase, 30 locally recruited and trained non-medical interviewers listed 490 children suffering from visible lower limb disability in the study villages. The interviewers demonstrated a multi-color poster containing the features of lower limb clinical rickets to the informants in the villages.
In the second phase, 4 trained physicians physically visited most of the cases listed by the interviewers. They successfully verified and validated 278 out of 364 disabilities in five thanas. Based on the number of valid cases the adjusted prevalence rates for the lower limb rickets were calculated per 100,000 populations. Thus the average overall prevalence for Cox’s Bazaar District was 906 cases of lower limb rickets, with the highest (1,838) for Kutubdia Thana and the lowest (624 cases) for Maheshkali Thana. The prevalence was highest among children aged 1-4 years and lowest (450 cases) amongst those aged 17-20 years. Females had lower prevalence of rickets than males in the target population. Based on this study, quick investigation in other regions of Bangladesh also confirmed rickets cases, such as in Sunamganj and Jessore. The study techniques and tools proved to have merits for a quick assessment of the prevalence of lower limb rickets in the study villages. This method may be used to quickly measure the existence of rickets in other parts of the country.
SARPV’s Agro-Food Nutrition Resource Center
Our goal is to alleviate and prevent rickets sustainably by increasing infant’s and children’s intake and utilization of bioavailable calcium and other micronutrients. To achieve this goal, a food-based approach that employs educational, agricultural, and health services is being utilized in an outreach effort to heighten parental and community awareness about the links between a child’s diet and rickets, while promoting the means for people to diversify and intensify their crop and animal production schemes. Through this approach we hope to address other forms of malnutrition as well.
The Agro-Food Nutrition Resource Center is a base from where we can support our outreach initiative. The "farm" is just beginning to serve it’s purpose as a research facility to test techniques and strategies, as a training center for outreach staff and participants, and as a community resource center for demonstrations, information transfer, and a source for agricultural inputs.
Through CFSP and CIMMYT funding, a 400-foot tubewell and buried pipe water distribution system has been successfully installed at the resource center. This is the very first of it’s kind throughout the Chittagong Hill Tracts. This system is now providing a regular and reliable supply of water for all plantations, livestock and operational needs. A one-story building comprising an office, manager quarters, storeroom and guestroom has also been constructed on the upper land.
With CIMMYT’s assistance, SARPV has also been able to acquire a Chinese hand tractor and a multi-crop seeder accessory to the tractor. With SARPV’s acquisition of eight more acres for the center (for a total now of 15 acres), arable land for cultivation has expanded and increased workloads. The tractor is making it possible to take more land under cultivation and frees up the Center’s Agricultural Workers to become more involved in program outreach work.
Under supervision from the local Thana Livestock Officer (TLO), and Dr. Jerry Combs (long-time poultry farmer), egg laying hens (Fowmi breed) have been purchased and a coop constructed at the SARPV resource center. Egg production has begun and the program promises to be an appropriate business and viable venture in the area. SARPV Agricultural Workers and the TLO will demonstrate and instruct SARPV’s Village Development Workers, and local village groups in the management of a small semi-intensive poultry system, it’s productivity, potential for profit, and contribution to human nutrition. Another scheme that we are currently working on is a new design for an egg production business that will be operated by people with disabilities.
Under the guidance of Dr. Craig Meisner, trial research plots of peanuts and black gram were planted during the previous season to study their performance in the region and growing response under altered pH levels. The soils of the region are among the most acidic in the country and therefore affect crop performance and in turn the food system. At this early stage, we were not able to measure a significant change in pH growth response or crop performance. In support of our analysis of the Chakaria Food System, and this work, a collection of pulses grown in the area has been made and was sent to Cornell University last month for nutrient and mineral analysis. Dry samples of Dolichus lablab (sheem), Phaseolus vulgaris (common bean) and Vigna unguiculata (cowpea, Bangla: palam) make up the collection.
As the site develops and work at the Center progresses, the Agricultural Workers in association with SARPV’s Village Development Workers have moved out into the neighboring communities where they have been promoting more vegetable and fruit cultivation. Village Development Workers (VDWs) traditionally represent SARPV in the field. Through an initiative of linking the Center’s Agricultural Workers with VDWs, as well as involving more local government staff and partner NGOs in our programs, CFSP is improving the effectiveness of it’s community-based outreach work.
The Asian Vegetable Research and Development Center began a collaborative program with SARPV in June of 1999. SARPV workers and the local community have utilized the program well, particularly in our community outreach work. Currently, we are working with over 1,500 households in Chakaria and Lama Thanas. With each successive season, farmers are becoming more confident and proficient with growing vegetables and SARPV workers more professional in monitoring gardens, recording data, and giving helpful technical advice.
At this time, we are at the end of the "Rabi" (winter) season and the traditional Bangladeshi season for greatest vegetable production. Household survey data is showing greater increase in vegetable production and consumption during this time. It is obvious during this season that there is an abundance of vegetables in the markets. Because of the recent increase in vegetable production among project participants, we are realizing a production surplus and a decrease in market value. We are, therefore, initiating with AVRDC technical support, small-scale post-harvest handling and storage demonstrations into our garden demonstration and nutritional outreach programs.
SARPV Village Development Workers and Agricultural Workers, along with project staff, are now working hard preparing for the upcoming rainy "karif 1" season. With the rains and increased humidity, growing vegetables during this season is difficult, and therefore, availability somewhat scarce. It is during this season in our outreach program that we want to place emphasis on increase household production and consumption of vegetables.
Several workshops and training sessions have been successfully conducted at the center and elsewhere that have helped to instruct the local community and SARPV outreach staff. In early February, SARPV staff participated in an AVRDC data collecting training course in Dhaka. Later that same month a nutritional health training session was conducted at the Horticultural Research Center outside of Dhaka. Two of SARPV’s female Village Development Workers participated and in-turn conducted several follow-up instruction courses in Chakaria and Lama Thana area to pass on the training information to other staff members and to target communities. In addition, AVRDC educational trainers have conducted a Home Gardening and Family Health Nutrition Workshop with 30 local participants and SARPV staff at the Resource Center.
The AVRDC program has been very well received by the local communities, and has not only boosted their knowledge of vegetable cultivation but their incomes as well. Several participants are selling their produce and making substantial profits. One farmer I visited, has made Tk. 30,000 from selling produce from the previous summer season from his small quarter acre plot. Another family working in our program has produced and sold Tk 20,000 worth of produce, and then reinvested that income back into a small family poultry operation. One remarkable woman working on only 1 decimal of land (about 40 square meters) has profited Tk 3000 from her vegetable production in just one season. I was told that this same woman had never before held even Tk 50 in her hand.
Wild elephants are still a serious garden pest in the hilly area, especially this time of year when natural vegetation is scarce because of the dry season. We are refraining from planting vegetable and fruit species that they are fond of especially Jack Fruit, Banana, and Pigeon Pea. Monkeys and porcupines can also be a nuisance. If anyone has any proven non-lethal methods for keeping elephants out of one’s garden please let us know.
Prepared by Andrew Daly
E-mail: gfc2@cornell.edu |
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