All Posts

Volunteers Recall Memories of Bangladesh

Nancy and Emily at the "Mini" Taj
Emily Hagg, a ICU RN at the Foothills Medical Center in Calgary, and Nancy Campbell, a Registered Nurse with Alberta Health Services, recently returned from Dhaka, where they volunteered with the Bangladesh Health Project. We asked Nancy and Emily to regale us with their favourite stories and most memorable moments from their trip.

Emily: “I was in Bangladesh from Jan. 11th to April 3th, so I was there for almost an entire semester. My official role was as a Post-Graduate Research Fellow, which mostly entailed being available as a mentor to the nursing instructors already in place and helping out with whatever I could in the classes and clinicals.

Nancy: “I arrived in Dhaka March 7th and left April 8th. My arrival was easy for me as Emily was already there! Emtiaz from the IUBAT Nursing College met me at the airport and I felt supported for the entire time. My official position was the same as Emily’s: Visiting Research Fellow, and my role was the same as well, to support the Nursing Faculty in the clinical and classroom settings. I also had the opportunity to work with the Sajeda Foundation on the development of their Home Care Program and their Seniors’ Supportive Housing Facility project.”

Emily: “What I especially loved about my experience was how friendly people were in Bangladesh, from the instructors, the students, to people on the street: just big smiles wherever I went. Initially, I had to adjust to the attention and the people just wanting to know about you and get close to you, which is very different from North American culture! I also will always remember how respectful the nursing students were! They stood when we instructors came into the room, calling us “ma’am”, earnestly listening to every word we ever said, and being protective of us when we were out in public together, etc. They were so polite and pleasant to work with!”

Emily at the Pink Palace in Old Dhaka

Emily at the Pink Palace in Old Dhaka

Nancy: “Yes! The thing I will always remember is walking into a classroom that first afternoon and all of the students standing up when the faculty entered. That just doesn’t happen in Canada. As I got to know them, I was humbled by their commitment to their education: the daily challenges they had just to get to school, on top of having to learn in English – nursing education is tough enough without these challenges. There wasn’t single day that I didn’t have an interaction with one of them that made me smile. They included us in their annual picnic and it was an incredible day, full of surprises and adventures.

IUBAT was similarly great: a sanctuary created by the school with the tea in the cafe, the guards that helped you cross the road in crazy traffic and of course, the long lineups to use the elevators. The faculty of the nursing college were simply amazing. They mentored us on “life” in Dhaka as much as we mentored them on nursing education.

It was interesting to be stared at and be asked to take pictures with total strangers. Add to that the population density that I hadn’t yet ever experienced – I didn’t know what to think at first. While it was unusual to have my activities/freedoms curtailed, I did not ever feel threatened or unsafe. Also, everyone should ride in a rickshaw at least once in their life! One cannot think of Dhaka without thinking of the traffic and the noise; there are absolutely no words that adequately describe the travel by van in that city.”

Emily: “I was definitely surprised by the instant celebrity status we seemed to develop by just entering the country and how hard that was to get used to. I didn’t think it would be quite the extreme that it was. It would have been nice (and easier to move around) if we were more ‘invisible’.” 

Emily and Nancy at the guest house

Emily and Nancy at the guest house

Emily: “If I had any advice for those interested in volunteering, it would be to be prepared to ‘go with the flow’! Things change rapidly and your day seldom works out as you initially planned it. It’s important not to get stressed out about stuff like that. Also, the accommodations are better than the volunteer manual makes them out to be! There’s hot water showers, a washing machine available, etc. It’s also so nice not having to prepare lunch and supper everyday! Finally, Caucasians should be extra prepared to be an object of fascination every where you go. It often takes longer to move around because of this fact.”

Nancy: “Anyone who is open to a new experience should go. I would encourage my nurse colleagues to go and experience a world where you can truly mentor nursing leadership AND grow an appreciation for the respect that nursing receives in Canada. Perhaps a practical piece of advice would be to get your visa before you arrive – I spent 2.5 hours in the VISA on arrival booth and an additional hour when I left because I had overstayed by 2 days. Despite that, it was amazing to be able to have a small impact and change the world of nursing in Bangladesh. I hope to go back very soon.”

A big thanks to Nancy and Emily for sharing their favourite recollections of Bangladesh; we love hearing from our volunteers! If any potential volunteers are interested and would like more information, please go to the Volunteer section on our website.

Mourning Dr. M. Alimullah Miyan

P1010575-001The pioneer of non-government universities in Bangladesh and Founder and Vice-Chancellor of IUBAT University Prof Dr M Alimullah Miyan passed away on May 10, 2017. This is a great loss not only to his family and friends in Bangladesh, but also to many people around the world. Dr. Miyan’s passion for education and his inclusive approach inspired many international faculty to volunteer at the remarkable university that he founded.

Dr. Miyan was an eminent global academic, bringing together the best ideas from many countries to create a uniquely Bangladeshi university. He balanced religious, cultural, social and educational values to create an “environment built for learning.” His life-long commitment to social justice is being implemented through Knowledge-Based Area Development. He consistently promoted teaching excellence and encouraged academic freedom and innovation.

For the College of Nursing in particular, Dr. Miyan planted the seed that has blossomed into the only independent non-government nursing college in the country. He was a pioneering advocate for the nursing profession in Bangladesh and worked tirelessly to overcome social taboos and institutional obstacles. At every major nursing function at IUBAT, Dr. Miyan spoke movingly of his vision for nursing, his ambition to develop professional leaders and his pride in the students and graduates.

We mourn our loss of this unforgettable, larger-than-life personality; we honour a life-long example of what can be achieved through courage, hard work and idealism.

Updates from BHP’s Advisor of Health Sciences

Alex IUBAT 2017
Alex Berland, Advisor of Health Sciences at IUBAT and founding member of the Bangladesh Health Project, reports on his recent visit to IUBAT.  He writes:

“The university is overall busier than ever with new construction underway to meet the demand for good quality higher education. College of Nursing enrolment remains disappointing, mostly due to proliferation of private colleges with cheaper fees; guardians may not consider quality in making decisions, especially for their daughters. IUBAT is now reducing BSN tuition fees with scholarships for strong students.

On a brighter note, I was happy to observe in both classroom and hospital the quality of current students. Obviously, our faculty are doing a terrific job promoting English use, encouraging critical thinking and pushing students to use problem-solving skills. Dr. Masud, Coordinator of the College of Nursing, is building a strong faculty team of graduates from IUBAT as well as other good colleges. After several meetings with faculty, I feel very positive about their ability.

Our library collection and nursing lab benefitted from re-organization by visiting faculty Anne-Marie Hummelman. Spring semester volunteers, Emily Hagg and Nancy Campbell, shared their positive impressions of faculty that they have been mentoring. Also, I visited an excellent practice site, Universal Medical Hospital, led by a visionary chairwoman who has hired IUBAT graduates as senior managers. Similarly, at Sajida Health Programs, IUBAT graduates hold senior roles managing innovative programs. Several IUBAT graduates recently sent news about their career accomplishments, so I am feeling very positive about the impact of the Bangladesh Health Project through its many supporters and visiting faculty over the past 13 years.”

Bangladesh’s Progress Highlighted in Medical Publication

The BMJ, an international medical journal, recently published an article entitled, “Why has Bangladesh done so well?”  In the article, Richard Smith, the chair of the Board of Trustees of icddr,b (formerly known as the International Centre for Diarrhoeal Disease Research in Bangladesh) discusses the elements that may have helped improve the standard of living in Bangladesh.

Bangladesh has had a tumultous past, rife with episodes of civil unrest, war and famine, with each event resulting high mortality rates.  However, it has now become one of the few low income countries to achieve the Millenium Development Goals: life expectancy has increased from 50 to 70+, child deaths under 5 years have dropped from 25% to 4%, and maternal mortality has fallen from 700 per 100 000 to 150.  Almost all children go to school, and the literacy rate of ~67% is equal among both males and females.

The author discusses several relevant cases of health improvements in Bangladesh, exploring why the country has made such major strides in its development. For instance, Richard Smith explains the role of factors such as education, research, cultural sensitivity, social science and female empowerment in the usage of oral rehydration treatment (ORT) to treat roughly 80% of cases of childhood diarrhoea, the highest rate in the world.  Lessons such as these has helped Bangladesh work towards becoming a middle-income country within a decade.  Despite all of the progress, there are still obstacles that Bangladesh has yet to overcome; amongst the issues are a moderately high maternal mortality rate, security, child marriage and loss of land due to climate change.

For more details and an in-depth analysis, please read the blog post on BMJ.com.

 

Project Lauded for Innovative Instruction

Since it’s inception, the Bangladesh Health Project has relied on the generosity of overseas volunteer faculty who have taught students, developed courses and mentored local faculty.  Many of the volunteers originally visited IUBAT as nursing students themselves, through the arrangements that their own school had with the Project.  Some students came solo, others in groups with an instructor.

One such academic partnership was with the University of Vermont (UVM) through Professor Rycki Maltby. The relationship between the two institutions was featured in the book, Innovative Teaching Strategies in Nursing and Related Health Professions by authors Martha Bradshaw and Arlene Lowenstein. The immersion course, offered to senior nursing students, was highlighted as a unique learning experience and noteworthy for instructors as a teaching example. IUBAT and the Bangladesh Health Project welcome future partnerships with academic institutions and any students that may have an interest in getting involved.

The Bangladesh Health Project has accommodated many volunteers in our guest house.  We are grateful for volunteer faculty, as we could not have succeeded without their assistance in building the scholastic foundation of the Project.  For pictures of the guest house, please check out our Flickr page and to read about volunteer opportunities, please visit our website.

Bangladesh Health Project Plans for 2017

As the Bangladesh Health Project (BHP) progresses, we focus on new priorities and needs. With IUBAT alumni now taking more senior roles as nurse educators and managers, our volunteers offer more mentoring and coaching and less student teaching. Looking ahead, these are our objectives:

  1. Provide mentoring support for faculty of IUBAT College of Nursing

BHP has completed mentorship and training of several cohorts of BSN students.  Our next goal is to strengthen nursing faculty capacity.  Through phone contact, e-mail and visiting faculty volunteers, we will assist with program development, classroom teaching, clinical supervision and student evaluation. As feasible, we will continue to supply textbooks and teaching materials. We will provide demonstration lectures for IUBAT nursing students and for staff at our teaching hospital sites.

  1. Support IUBAT graduates in their professional development

In recent years, we have supported IUBAT alumni working in hospitals, colleges and NGOs with mentorship for issues related to advanced education, nursing administration and access to technical information. We will continue supporting our graduates as they advance in their careers and undertake leadership roles.

  1. Develop resources to promote nurse education in Bangladesh

We will continue to offer textbooks to local nursing colleges, ideally establishing a central library for advanced materials, to be used by faculty and senior hospital staff. We will continue developing our Open Education Resource, an open-source collection of BSN curriculum materials for faculty to use in lesson preparation: www.OR4NED.com

  1. Build relationships with colleges and NGOs to improve health services in Bangladesh

We have good relationships with many health care organizations; some are practicum or internship sites for IUBAT, others offer good-quality education or health care services. Most are in Dhaka, while a few are in outlying areas. We will support these agencies as requested, with consultation and educational materials.

  1. Support research projects on quality of health education and health services

We will arrange student internships and projects to link local and global researchers. We have the potential to support some applied research projects on quality of health services, particularly for training and mentorship in research.

We continue to welcome volunteers, either working from home, or at our guest-house in Dhaka. Please contact us about current opportunities.

Part II – Challenges in the Real-Life Clinical Setting

In our last post, we shared the story and dilemma of one of our graduates, who was recently promoted to a higher office position of Nursing Superintendent.  The wards at her hospital faced many issues, such as coworker discord, lack of patient confidentiality and an absence of aseptic procedures, amongst others.  There were many areas requirimg her focus, and we are glad to report that progress has been made in the workplace since she was promoted.  She writes:

“We had a difficult task at hand, but we believed in ourselves and we worked even harder to improve matters.  After six months of careful observation and assessment by our Nursing Office administrators, it was evident that things needed to change. We proposed many changes to the hospital authorities; some were accepted and some were postponed for the future.  One of the accepted changes was ongoing training for the nurses.  We have recently finished skills and knowledge development sessions.  All of the nurses (including the General wards and the Critical Care wards) were involved in the 3-month long program, however, the content differed slightly for the general ward nurses and the Critical Care nurses.

We were able to involve the doctors for teaching nurses and as we thought, the doctors started to see situations from the nurses’ perspective, which helped build teamwork and camraderie.  So far, it’s hard to gauge exactly how successful the training session has been, but I can see many changes in the wards.  I can see the nurses being interested in knowing the rationale behind procedures.  We also plan to take a small written exam as a part of the evaluation process.  Furthermore, we have also recently introduced the handover format to our nurses.  In it, I referenced the care plan from our classes at IUBAT and modified it for our hospital.  It was challenging for those nurses not comfortable with English, so there was an extra class for those needing more help with the material.  As a team, we go on rounds and note any issues with maintaining the handover sheet.  We hold weekly meetings for each ward to address their problems with workable solutions, and I am overjoyed to say that it is working!

I also noticed that the nurses were demotivated in their roles, so we set out to find out why.  We completed a survey on 100 general and Critical Care nurses, and although there seemed to be a variety of reasons behind this dissatisfaction, the main 3 issues that were raised were the low pay, the low overtime pay, and the attitudes and behaviours of fellow colleagues.  To address this, our Nursing office sought a higher salary and overtime pay rate from the hospital authorities.  After a very long discussion, the request for higher wages was approved, along with the overtime requests, after the hospital authorities realized that they needed to change their part of the problem as well.  Since this wage increase, I have seen a higher amount of respect from the nurses for the Nursing office.  They trust us as a representative for their collective voices and this unity has already been shown to have positive effects in the wards.

I must give credit where credit is due.  The hospital Chairperson, Vice-Chairperson and Director were all very cooperative with me, and consistently supported my work.   Furthermore, I had the chance to work with the hospital Chairperson of International Affairs.  As a part of this close collaboration, we are getting closer to an international joint venture with a hospital in Bangkok wherein annually, five of our nurses will travel to their site in order to learn, experience the nursing standards and apply their knowledge in practice at home.

Our Nursing office had to fight a lot with the hospital authorities for many things, but we never lost hope even if the result wasn’t what we were looking for.  I must say we are progressing and it takes much effort and work to achieve the goals.  I am happy with all we have accomplished so far, but there are still challenges left to solve.  For example, there is still conflict between the nurses.

In one unit, the nurses do not even want to talk to the other unit nurses; they do not have any collaboration and respect for each other.  This is creating a huge problem for the hospital and is even affecting the patients.  It makes me recall the conflict management workshop in the final year of the program at IUBAT.  I never realized that I would encounter such scenarios in my actual life when I was a part of that workshop.  Now, I am experiencing it and everyday I realize that IUBAT has prepared us in every possible way. Frankly speaking, it has been really tough for me to address this issue, but I know it takes time to bring about change in any attitude and behaviour.  I am optimistic that my training from IUBAT will continue to help me in this post and with improving this hospital for years to come.” 

We appreciate this graduate sharing this anecdote with our readers, and explaining how her education at IUBAT set a standard of care that she implemented in her workplace.  It was also revelatory to see how her training helped with the resolution of some of the problems that she encountered in the hospital, both technical and interpersonal.  These experiences that this graduate has shared are not specific to Bangladesh; rather, they appear globally, across a number of different industries, in one form or another.  Interestingly, these conflicts between nurses is not uncommon in Canada either (http://hospitalnews.com/a-hidden-truth-hostility-in-healthcare/).  It is prudent to note that expectations should be set about civil behaviours amongst colleagues; those who work together do not need to like one another, but they must act professionally in the best interest of patients, their families and the hospital.

Part I – Challenges in the Real-Life Clinical Setting

The clinical skills and science learned in the classroom are invaluable for the healthcare workplace, however, it is the soft skills, the art behind the science, that often needs to be applied in the clinical setting as well.  For a real example given to us by one of our graduates, please continue reading.  We will outline the issues that our graduate faced and describe how they continue to work and progress through these factors that impact patient care in a two-part blog series.

One of our nursing students who is now is working in a hospital in Dhaka, began working in April 2015 as a cardiac nurse and was later promoted to the position of Joint-Nursing Superintendent in January 2016.  She has expanded upon her skill set since graduation and has experienced a variety of both triumphs and tribulations.  She writes,

“I was excited to start my position as a cardiac nurse and was eager to work with both new and old colleagues within our ward and other wards.  Since ours was just a four-bed ward, we had a smaller workload in comparison to the other wards.  Nevertheless, it would be so hectic when 4 patients came at once for coronary angiograms!  We had plenty of time to apply the pragmatic knowledge we gained from IUBAT in practice – it made us stand out from the crowd.  We got a lot of compliments from the patients we cared for, from those who were undergoing the coronary angiograms, to the critically ill patients from the Critical Care Unit.  Our patients used to say that they would wait for us to start our shifts during their hospital stay.  The majority of the patients who were stable and getting moved to other wards used to demand for a spot in our ward; they remarked especially on how professional our ward was.  To this day, we have had more than 60 patients who have waited for hours just to say hello to us while they are in for a follow-up.  It really made me proud of myself!

While I was at bedside, I had many experiences that conflicted with my expectations that were formed during training.  I explored many ethical dilemmas and learned by being a curious observer and keen investigator of the physicians and nurses.  Some were very encouraging of our curiosity, but unfortunately, some preferred to neglect.  With Professor Karen Lund’s encouragement, however, I persisted.  We new nurses had many adjustment problems: physicians questioned our use of the stethoscopes, the need for our thorough assessments, and the senior nurses resented that the patients preferred our care.  Because of the intertwined nature of the nursing care, however, it was especially challenging to manage the attitudes and behaviours of the other nurses.  It was very difficult to work alongside some of the senior nurses, some of which had little respect and confidence for our methodology.  At the end of the day, we had argued, we had conflict, but we eventually accepted one another and finally, we mingled.  I learned skills, I developed confidence and I stood firm to my beliefs.  It became easier for me to initiate new ideas and standards once I felt “a part of the team”.

All the while, we were gaining the attention of higher management and the chairperson would often call me for help with translation and special tasks.  Soon after that, I was given an offer letter informing me that I had been selected for interviews for the post of nursing supervisor.  Initially I declined, but they insisted that I at least sit for it.  I did get promoted, however, to joint Nursing Superintendent, not supervisor!  I gladly accepted the job, but was so worried about my duties and responsibilities.  For the first few months, I was totally lost and felt horrible because nothing was clear to me.  I did not receive any guidance nor did I understand what my duties and responsibilities were because the previous Nursing Superintendent had resigned from the post a week before I was appointed.  I faced a worse problem than I had expected; looking after a ward and after an entire hospital was wholly different – I was bearing a huge responsibility.  To complicate matters, my reporting supervisor was not very cooperative; however, I got two newly appointed supervisors as helping hands shortly after.  Though I was well acquainted with this hospital since 2014, I saw things so differently the day after attaining the higher position.  That day I realized that a lot of things have to be changed.  I, along with my team, had to work so much to make things better.

There was chaos in every ward due to huge communication gaps between co-workers. Every day I used to go on rounds and see the things that I never saw before.  There was no proper handover system (which always creates a major challenge in quality care), no use of aseptic techniques for any procedure.  The patient ethics, rights, privacy and confidentiality seemed to be optional, and would take years of training to achieve.”

This graduate wrote to our faculty for recommendations and tips to help ameliorate the problems that she saw in the hospital in regards to nurses and their practices.  Tasked with improving operations, there were many aspects that she needed to work on, but it is always a difficult task to change fully entrenched patterns.  Nevertheless, with the goal of better patient care in mind, it is a worthy endeavour.  In our next post, we will revisit this case and reveal the progress and changes that have occurred at this alumna’s hospital.

 

 

Strides Made in Recognition of Alumni

The Bangladesh Health Project team has advocated strongly in the past for IUBAT’s Nursing Program and their graduates, working hard to allow alumni the opportunity to receive national accreditation, despite barriers along the way.  The recent hiring of 14 IUBAT Nursing graduates into civic service has been very significant because it represents acceptance of the program from the government and the medical community.  Furthermore, to get hired into government service, nurses must take the Public Service Commission Exam.  Previous to this exam, there was no merit-based appointment and nurses would enter government service due to seniority.  Currently, here is some pushback to this new change, but the serious senior nurses see the induction of this exam as a step toward the right direction.  Anecdotes from our alumni also indicate more respect shown to them by their colleagues in senior positions (even in different sectors, such as military officials), which is a much different reality than even several years ago.

We are thrilled to hear about the strides in acceptance of our graduates and recognition of their accomplishments and skills.  Through hard work and thorough training, the nursing alumni have shown their competence in the classroom, on exams, and at the workplace.

 

Greetings from Alumnus in the United States

20160829_185715
Isata Jalloh, a 2013 graduate of IUBAT’s program of nursing, writes to us about her latest achievement and her new position in the United States of America.

I was inspired by two people to pursue nursing: my mother, who is my greatest inspiration and always believes in me. Additionally, my sister, who passed away 14 years ago, helped me understand the true meaning of caring, the desire to help people and make a difference in their lives in their time of need. It brings joy in my heart to help in this way. I passed my NCLEX exam on April 1st, 2016 and I am currently practicing at the Meritus Medical Center in Hagerstown, Maryland as a trauma unit nurse since August 8th, 2016. I perform comprehensive physical exams and health histories, make daily compliance rounds on my assigned unit, supervise direct care staff and make decisions about patient care needs. I also administer medications, treatment, wound care and provide direct care to patients according to physician orders. With all of the diversity that I have been exposed to for the past 12 years of my life while travelling, I am really enjoying my job here in the US. I believe every new role comes with its challenges and I am learning every day with a goal of making a difference. Once again, a big thank you to Alex, Karen and IUBAT Bangladesh for giving me the opportunity to become a better nurse.

We love getting updates from our alumni, and are thrilled that the impact of the Project is reaching all of the corners of the world!  Isata, we are grateful that you can share your progress with us, and please continue to keep us updated throughout your career (and your travels)!