Imagine going to the hospital in your community to visit a sick relative. The crowding is so bad that there are two people in many beds; some patients lie on foam mattresses on the floor. You help your relative into the washroom: not only is it dirty but you can find neither hand soap nor towels. The doctor has prescribed medicine but you learn that the nurse refused to give that medicine unless she first received a small tip. Most of the time the nurses stay in the nursing station, rarely touching or assessing any patient. Patients needing a bath are washed by an assistant with no nursing training. Sterile supplies are in short supply and even the limited range of medicines may be unavailable.

Bangladesh is a Least Developed Country as defined by the United Nations (UN). It is on the list of the OECD Development Assistance Committee as eligible to receive official development assistance. For several decades, Bangladesh has been a priority country for Canadian development support. Today, the Bangladeshi-Canadian community is estimated at over 100,000 and Canada's 2022 Indo-Pacific Strategy highlights the importance of the region. Current Canadian aid supports mutual priorities in the areas of gender equality and empowerment of women and girls, health, including sexual and reproductive health and rights, skills training and support to the ready-made garment sector. These development priorities are in line with Canada’s Feminist International Assistance Policy In line with these Canadian priorities, BHP focused initially on nurse education because nursing leaders, physicians and outsiders informed us that nursing education was a priority in Bangladesh. More recently we have focused on rural development, primary education, post-secondary skills-training and professional development of nurse educators.

We are not able to answer this very good question. What is clear is that change is happening very quickly, in part driven by public expectations because, as in many Less Developed Countries demand for better health care has accelerated as incomes improve. IUBAT faculty have visited many public and private hospitals as we check out clinical practice sites for students. Practice varies across these sites depending on availability of resident physicians, organizational culture and nurse leadership in the agency. In most hospitals, RNs seem to work more like the Licensed Practical Nurses in the Canadian system. However, in some places, especially community settings, they take on more responsibility than in Canada. Unfortunately, the rapid increase in private hospitals has also led to unregulated staff carrying out duties for which they have had no proper training. It is also important to note that, in our experience, nurses with good training and work experience in Bangladesh possess unique strengths. They show great resilience in coping with tough working conditions and much compassion in working with challenging patient needs.

There is wi-fi internet access at the university and we can set you up with your laptop or a workstation there. (Most people like having their own laptop with them.) At peak periods there are power black-outs which may affect your internet access. An external power supply and/or solar charger is handy.

Bangladesh has a tropical monsoon-type climate, with a hot and rainy summer and a dry winter, with warm temperatures throughout the year, and relatively little variation from month to month. January tends to be the coolest month (13-15C at night, sometimes lower for brief periods). April and May are the warmest months. Most rains occur during the monsoon (June-September) with very little in winter (November-February). The Volunteer Guide has more details. For current local conditions see http://www.wunderground.com/global/stations/41923.html.

Although we have desktop computers available, most volunteers like to bring their own laptops. Electric outlet adapters are not required. The Nursing Office is securely locked when there is no one present. The guest house is also secure, with most rooms having a locking cupboard.

Classrooms are equipped with dry-erase white boards and digital projectors. Most lectures are delivered in PowerPoint. The Nursing Practice Lab has manikins and hospital beds. There are also anatomical models for normal delivery and anatomy.

Before you leave for IUBAT, we can provide the program syllabus that includes outlines of all courses. We can also send you the curriculum guide for your specific courses. Also, you can review the textbook before going to Bangladesh since these are widely used and generally available. Once there, lectures from previous courses are available, as well as a file of all resources related to the course you will be teaching (lectures, lesson notes prepared by other faculty, teacher references, student readings, assignments and exams).

This is not a problem. The university is English medium, so most staff are reasonably fluent. You will need to speak slowly in class and choose your language level carefully so the students can follow you. Outside the university, many Bangladeshis speak English, so shopping and travelling are manageable without much Bangla. There are dictionary phrase books in the guest house.

Generally volunteers find that although they may be the subject of interest, the general attitude of people is very friendly. Although Bangladesh has had sporadic outbreaks of civic unrest, it is usually internally directed at various political factions within the country. Obviously one should avoid public spaces where political demonstrations are underway and observe the usual precautions of any large city. The university community is very protective of visitors and you will have plenty of guidance. Although physical assaults of foreigners are uncommon, petty theft is not. As in any large city, you should be cautious with wallets, cell phones, cameras, and other personal items whenever you are out in public. Do not leave valuables unattended, even around the university campus. The traffic situation is bad and requires special attention. Apart from the frequent gridlock, drivers speed, change lanes without warning and generally behave recklessly. It is best to avoid travel on busy roads in rickshaws. Pedestrians must be very vigilant. The IUBAT coaches are the safest and most convenient means of travel.

You must purchase out-of-country medical insurance before leaving Canada. We can recommend medical and hospital care in Dhaka, if you need it. Most medications can be purchased without a prescription, although it is important to choose reputable manufacturers.

South Asian society is more formal than you may be accustomed to. Please wear business casual dress for teaching and nursing program-related work. The Volunteer Guide below has detailed information for various seasons.

In the guest house, each bedroom has a desk for individual work with internet access. At the university, we can usually arrange for everyone to have a desk with internet access. Occasionally if there are many visitors, you may have to share desk space. Because of differing schedules and off-site supervision duties, this is rarely a problem. The university has photocopy facilities. The College of Nursing Program Assistant is available to assist you in setting up your work space, orientation to the university services, VISA extensions and etc.

Faculty have used various arrangements for salary continuance: sabbaticals, vacation leave and professional development leave. Some faculty come as volunteers on their own time. Because the program is financed by donations only (without any government funding), we cannot pay stipends or airfare. However, we provide room and board for faculty in Dhaka and tax-deductible receipts for travel expenses.

In Bangladesh, a strong network of non-governmental organizations [NGOs] supplements government health and education programs to meet local priorities. Oasis for Posterity [OFP] has been officially recognized by the Department of Social Welfare (2015) and the NGO Affairs Bureau (2018). It is accountable to its Board of 35 members including women, elders and youth who represent the local community. In addition, over the past fifteen years, the BHP leads have developed a strong, trusting relationship with the Founder of OFP. The major activities of OfP tackle the social determinants of health in an under-resourced area of northern Bangladesh. Its programs include agricultural training and development, individual subsidies for education and health care, and community empowerment. Recently, OFP with support from Canadian donors, built a primary school that serves a particularly impoverished community. OFP’s latest initiative is a vocational college that will provide job-training for local youth and space for a rural health clinic.

Established in 1991, the International University of Business Agriculture and Technology (www.iubat.edu/) in Dhaka, is one of the best private post-secondary institutions in Bangladesh. The founder of IUBAT, Dr. Alimullah Miyan, was an exceptional leader with a commitment to social justice and equality of access for poorer students. His mission was to create “Higher Education for Every Qualified Person with Finance for the Meritorious but Needy.”

Through the Mid-Main Community Health Centre, Canadian donors are supporting OFP activities aimed at improving population health as detailed in an Agency Agreement. Consultation advice and project monitoring have been provided on-site at least once a year prior to Covid. Now that monitoring is occurring through frequent on-line contact. In the near future we hope to establish the primary care clinic and develop a paramedic program in the vocational college.

Mid-Main Community Health Centre is sponsoring this international project as a means to contribute to global development. Several of the Canadian volunteers on this project have also served on the Mid-Main Board of Directors. As a progressive service provider, Mid-Main wants to share its successful experiences and support international efforts for population health improvement and economic development. As in all development partnerships, mutual trust is essential. Canadian volunteers support this project entirely at the invitation of our partners in Bangladesh, International University of Business Agriculture and Technology [IUBAT] and Oasis for Posterity [OFP]. As external supporters, we Canadian volunteers follow the guidance of these local leaders who know best how to serve their communities. Similarly, to safeguard the reputation of Mid-Main and the contributions of volunteers and donors, we Canadian supporters must have confidence in our local partners. We have contacted educators, nurses and doctors in Bangladesh as well as Canadian government officials there, in addition to members of the Bangladeshi community in Canada – all are supportive of this project and its local leaders. We use Agency Agreements to monitor management of any funds donated for specific purposes in Bangladesh.

We are doing two things at IUBAT: We are supporting a nursing program that prepares students at the baccalaureate level (BSN) through English-language instruction. We have developed the curriculum for all courses as we proceed. Since 2015, we have adapted and shared this curriculum as an Open Education Resource to support novice nurse educators. It is now available through Nurses International. Starting in 2019, we developed the curriculum for a Masters in Public Health program. Because this is a new initiative, we worked with IUBAT to prepare the application required by the national university regulator. We expect regulator approval and admission of the first MPH students in 2021. Canadian volunteers will have an on-going role with curriculum development, on-line teaching and, when feasible, on-site teaching of the MPH students.

This is an important question that we have tried to tackle sincerely. We Canadians have been invited as partners by Bangladeshis to develop the components of the Bangladesh Health Project. We spend a lot of time talking to our local partners as well as other Bangladeshis at home and abroad. They have encouraged us to focus on international, evidence-based practice supports. We have also tailored the Western curriculum materials to develop vocabulary, enhance problem-based learning and incorporate South Asian scenarios and traditions in case studies and learning assignments.

Our long-term goal is to improve population health in Bangladesh. There are three intermediate goals to achieve this impact: In the medium term, the nursing program at IUBAT – International University of Business Agriculture and Technology will develop future leaders of the nursing profession in Bangladesh. We expect that the IUBAT graduates will be of special benefit for the leading hospitals and many NGOs in the country, particularly in training and directing nurses and paraprofessional staff to provide maternal-child care and other community-based services. Another medium-term goal is to establish a graduate-level public health training program (MPH) at IUBAT. This will provide a career path for many types of practicing professionals to become educators, managers, researchers and skilled practitioners. With a focus on both evidence and values, this MPH program strengthen professional practice and over time, improve population health. The third intermediate goal is to work with Oasis for Posterity to create a rural development model of community empowerment and education leading to improved population health. In addition to the local community benefits, this also supports the other two goals with practice and research opportunities.

We have thought a lot about this issue and understand the concern. A simple response would be to emphasize that we are focusing on education, a necessary activity for advancement of health services and public health in Bangladesh. Looking at the demand for nurses internationally, the system solution would be for Western countries to train enough of their own health care workers. Because of the importance of this issue, we would also offer a more complicated response. Generally, this very legitimate concern is not a significant barrier to continuing with our project, for several reasons: First, every developing country is different. The absolute depletion problems described in some African nations are not so evident in Bangladesh, where the main problem is quality of practice. There exist thousands of unemployed nurses in Bangladesh today; many RNs do not take jobs due to lack of adequate wages for living costs, other nurses are unemployable due to their poor training. Certainly, some graduates of the IUBAT BScN and MPH programs will seek jobs overseas. However, not all IUBAT graduates will be interested in this nor will all be able to work overseas. These nurses will remain in Bangladesh to serve their country. By linking the BScN and MPH programs with the Oasis for Posterity component of our work, we hope to create a pathway for rural students. Global experience suggests that rural students are more likely to work in rural areas after they graduate. We are reassured on these points by the support we have received from hospital directors, both local and expatriate, and from individual nurse leaders.