Mount Sinai School of Medicine Global Health Center
Bangladesh Site

Contact Information:
Rupa Patel, MD Infectious Diseases
Email: rappupatel@hotmail.com, rupa.patel@mssm.edu
Cell: 001 734 634 9650
www.friendship-bd.org

Research Projects/Questions:

1. Areas of Maternal and Child Health:
1. Assessing baseline maternal mortality rates via household surveys (verbal autopsies)
2. Assessing baseline neonatal mortality rates- as above
3. Assessing baseline child <5 year mortality rates- as above
4. Assessing number of ANC visits (maternal health indicator as outlined in the Millennium Development Goals 5)
5. Assessing the baseline number of births of attended by skilled health personnel (maternal health indicator as outlined in the Millennium Development Goals 5)
6. Child malnutrition and stunted growth baseline assessments
7. Creation of a skilled birth attendants program
8. Prevalence of intestinal parasitic and bacterial infections and its effect on child health and growth
9. Prevalence of acute respiratory infections and its effect on child health and growth
10. Potential role of skilled birthing attendants in neonatal health in the isolated chars
11. Tracking prevalence rates of clinical and non clinical family planning methods and subsequent effect on maternal health
12. Perceptions and practices on antenatal care, childbirth, and postnatal care of mothers in the chars
13. Prevalence of congenital deformities and congenital cataracts
14. Effectiveness of addressing left outs, drop outs and invalid doses for immunizations in decreasing child morbidity and mortality

2. Areas of Sexually Transmitted Diseases and HIV
1. Baseline assessment of risk factors among this specific population- interviews and diagnostic testing
2. Determine prevalence of HIV/STDs in the population served
3. Determine the level of awareness of HIV/STDs among the population- focus groups, interviews
4. Pre-marital and extra-marital sexual intercourse assessment among female and male populations of all age groups

3. Community Health Workers
1. Assessment of baseline knowledge and identify knowledge gaps
2. Conduct training (e.g. implementation of WHO IMCI) and assessment of effectiveness
3. Implement an emergency management training program

4. Health Care Staff Training (hired NGO health care providers)
1. Formally identify staff turnover causes
2. Pre and post training assessment to evaluate effectiveness and learning capacity of staff
3. Assessment of baseline knowledge of service providers and identify knowledge gaps
4. Assessment of training (e.g. implementation of WHO IMCI) effectiveness

5. Community Health Worker Model Intervention Outcomes
1. Outcomes of Friendship Community Medics (FCMs) intervention: post assessment of certain mortality and morbidity markers as above

6. The Friendship Water-Based Health Care Delivery Model
1. Effectiveness of health care delivery through paramedics and community medics
2. Behavioral change communication (BCC) and its role in improving health care and health care seeking behavior

Bangladesh County Background
Bangladesh (population 155 million people) is located between Myanmar and India. It is one of the poorest nations in the world with more than 40% of the population living below 1$ per day. There is no health care infrastructure outside of towns. The country falls in the bottom third bracket for most health care indicators according to the World Health Organization (WHO).

Research Site Description
The site of research will be at Friendship’s Floating Hospital, an urgent care center established on a ship. Friendship (a non profit, non governmental organization (NGO) based in Bangladesh) delivers basic health care services to men, women, and children in rural northern Bangladesh (Districts: Kurigram, Gaibandha). This special population (estimated 5 million) has a particular problem with access to health care because of their unique geographical isolation. They live on “char islands” (sand islands created by repeated monsoon rains and cyclones). The floating hospital travels along the river to different communities. Services provided are medicines for common infections (diarrhea, pneumonia, etc), prenatal health care (check up, vitamin distribution), limited serum laboratory testing, and simple radiographic imaging. The NGO reaches >300,000 residents/year. Friendship is largely funded by private donors (including Emirates Airlines, Lifebuoy Unilever).

This site is equipped with accommodations for foreign doctors with transportation vehicles (i.e. cars, ships), English speaking staff, dedicated translators for foreigners, a research assistant, and a research coordinator/manager.

The area served has no formal collection of data (i.e. population demographics, health indicators, disease prevalence, etc.) by the government, local or foreign non-governmental organizations, or the WHO

Research Site Personnel
Bangladesh-based, on-site MD/MPH
Onsite/Dhaka Research Coordinator/Manager
On-site Research Assistant
On-site/Dhaka Translator/Chaperone
Bangladesh-based/US-based Statistician: per project basis
On-site Laboratory Pathologist
US-based Infectious Diseases specialist: Rupa Patel, MD (also travels to site)
US-based Epidemiologist: Stephanie Factor, MD MPH

Available On-Site Equipment
Laptops for Research Assistant: for data collection, database creation
Printer
Movie Camera
Camera
Voice Recorder
Internet
Cellular Phone
Library: Textbooks, Microbiology Slides
Microscope

Accommodations
Dhaka: hotel
On-site: ship

Transportation
On-site/Dhaka Car with Driver
On-site Boat with Driver

On-Site 1-2 week (evenings) Clinical and Microbiology Tropical Medicine Course
Instructor: Rupa Patel, MD and other foreign and local lecturers (MPH, engineers, etc.)
Curriculum:
1) Tropical Medicine Disease Didactics
2) Hands-On Microbiology Diagnosis (e.g. review malaria parasite blood smears under the microscope for diagnosis, etc.)
3) Clinical Patient Cases Rotation
4) Research: Research Methodology, Basics in Biostatics, Basics in Epidemiology
5) Journal Club
6) Publics Health Topics lecture series: water sanitation, local cultural practices, ethics of medical practice in religious and resource-limited settings, infection control in resource-limited settings, geography/global warming impacts on health care, arsenic and other toxins