Floating Hospitals in Northern Bangladesh
Mount Sinai School of Medicine Global Health Center
Bangladesh Site
(last edited Sept 2010)

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

If you are interested, please contact R Patel, MD for a preliminary application.

Mount Sinai-Friendship Site Goals:
1) To improve the health care of a water-locked population in Bangladesh through Mount Sinai’s expertise in 1) research, 2) education, and 3) clinical care
2) To provide medical trainees, faculty and other graduate students an opportunity for research and clinical experiences in an international, low-resource setting

Clinical Elective Information:
Eligibility: Any year of undergraduate or medical training
Duration: Any duration
Specialty Topics: Rotation sites will be tailored to the trainee’s interest
Pre-Travel Orientation: Lectures on Tropical Diseases, Public Health/Epidemiology, etc.
On-Site Orientation: Includes a Bangla language primer session, country introduction, NGO developmental work lecture, Dhaka City Tour, etc.
Required reading with onsite syllabus text books
On-Site Educational Seminars: Lectures given by both the trainee and Friendship staff
See below for a complete set of available onsite resources
Costs: Contact R Patel; Note costs vary by season and by the number of trainees
Rotation Sites (all will be visited by the trainee):
1) Urban Hospitals (Dhaka)
2) Rural Semi-Urgent Care (Floating Hospital)
3) Rural Island Satellite Clinic
4) Microbiology Lab (Floating Hospital)

Research Elective Information:
All clinical elective information applies.

Bangladesh Site Research Topics:
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 antenatal care (ANC) visits (maternal health indicator as outlined in the WHO Millennium Development Goals 5)
5. Assessing the baseline number of births attended by skilled health personnel (maternal health indicator as outlined in the WHO Millennium Development Goals 5)
6. Child malnutrition and stunted growth baseline assessments
7. Creation of a skilled birth attendant (SBA) 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 birth attendants in neonatal health in the isolated chars
11. Tracking prevalence rates of family planning methods
12. Perceptions and practices on antenatal care (ANC), childbirth, and postnatal care (PNC) 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 Infections (STI) and HIV/AIDS
1. Baseline assessment of risk factors among this specific population- interviews and diagnostic testing
2. Determine prevalence of STI and HIV/AIDS in the population served
3. Determine the level of awareness of STI and HIV/AIDS among the population- focus group and individual 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 on specific topic areas (e.g. implementation of WHO IMCI for pediatric clinical medicine)
3. Assessment of the effectiveness of community health workers within the water-based health care delivery model within the char islands
4. Implement an emergency management training program

4. Health Care Staff Training (i.e. hired NGO health care providers)
1. Formally identify staff turnover causes
2. Pre and post medical topic training assessments to evaluate effective training methods
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
3. Patient attitudes towards and patient satisfaction of health services received

7. Technology
1. Effectiveness on health from a planned telemedicine service for community workers

Bangladesh Site Description:
Bangladesh (population 155 million people) is located between Myanmar and India. It is the 8th poorest nation with > 40% of the population living < $1 per day. The majority religion is Islam and the country was formed in 1971. (WHO Report 2007)

The elective site is on Friendship’s fleet of health care delivery ships. Friendship, a non-profit, non- governmental organization (NGO), has 2 floating semi-urgent care centers, over 200 island outpatient clinics, and 2 ambulances. Friendship serves a nomadic population of 8-15 million people whom reside on migratory river sand “char” islands in rural northern Bangladesh (Districts: Kurigram, Gaibandha, Jamalpur). The population has a particular problem with access to health care because of the unique geographical isolation. The floating hospital and island clinic services include treatment of common infections (diarrhea, pneumonia, etc), prenatal health care (check up, vitamin distribution), surgical services, limited serum laboratory testing, and simple radiographic imaging. The NGO reaches >350,000 residents per year. Friendship is largely funded by private donors (including Emirates Airlines, Lifebuoy Unilever, Carrefour International, etc.).
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 by the World Health Organization.

Faculty Mentors:
Rupa Patel, MD, Infectious Diseases
Stephanie Factor, MD, MPH, Infectious Diseases
Xana Miguelez, MD, MPH, Obstetrics/Gynecology
Isha Mehta, MD, Obstetrics/Gynecology
Other Faculty Members

On-Site Clinical and Research Elective Personnel:
Dr Masud, MD/MPH, General Physician
Other medical physicians
Translator/Chaperone/Logistics Coordinator
Paramedics (by specialty)/Research Assistants
Microbiology Laboratory Technicians
Operation Room Assistants
Ophthalmology Assistant
Dental Assistant
Health Educators
Anthropologists/Qualitative Researchers
Statistician/Database Manager

Available On-Site Equipment:
Computers (Desktop and Laptop)
Printer
Scanner
Fax
Movie Camera
Camera
Voice Recorder
Internet
Cellular Phone
Library: Textbooks, Microbiology Slides
Microscope

Accommodations:
Dhaka: Friendship Guest House (private room with bathroom)
On-Site: Ship

Transportation:
Dhaka: Private Car with Driver
Bus
Hired Boats
Rickshaws