Dhaka Community Hospital Provides Services at Cost and Effectively Designed the Costing

HARVARD UNIVERSITY

Department of Physics

Cambridge, MA 02138

tel: (617) 495-3387

fax: (617) 495-0416

tel: (617) 332-4823 (home)

e-mail:

December 7th, 2000

Conrad Hilton Humanitarian Prize

10100 Santa Monica Boulevard, suite 1000

Los Angeles, CA 90067-4011

Tel: 310 556 4694

FAX 310 556 8130/2301

Dear Sirs,

I hereby nominate Dhaka Community Hospital Trust (DCHT) for the Conrad Hilton Humanitarian Prize for the year 2001.

I first became aware of the trust and its fine work when they ran an international conference in February 1998 on chronic arsenic pollution, a world wide environmental catastrophe that particularly affects the 70 million overexposed people in Bangladesh. In one village that the conferees visited, I saw 90 villagers with visible signs of arsenic poisoning out of a total of 900 villagers. I have visited twice more since then (all three times at my own expense) and endeavor to help by bring the catastrophe to international attention by mywebsite: that is now looked at by about 50 people a day. Another scientist (Canadian Dr. Sara Bennett),who is working in Bangladesh, also established a website These are volunteer activities.

The Dhaka Community Hospital Trust is the brainchild of two fine humanitarian physicians – Dr Quazi Qumaruzzaman and Dr Mahmuder Rahman, Chairman and coordinator respectively. They were trained in England and worked in England for many years. They decided to set up Dhaka Community Hospital (DCH) to provide medical care to the poor at minimum cost. DCH has effectively designed various options of payment so that majority of common people of the Bangladesh community can afford their services. In addition to the Dhaka Community Hospital itself, Dhaka Community Hospital Trust (DCHT) has trained a number of health professionals to work in the small villages. This extends the work of DCH in a major way.

• The arsenic program

The work that has brought DCHT into international attention (and is the primary justification for this nomination), is the campaign against the mass poisoning of millions of people from arsenic contaminated drinking water. It is important to realize that this problem of chronic arsenic poisoning is a mistake that the whole world made, in some respects with the best of motives. The World Bank and UNICEF were foremost among international agencies in urging, from 1980 to 1995 and even beyond, that Bangladesh use well water instead of surface water. But these and other agencies were slow to recognize the problem of arsenic contamination when it first appeared in West Bengal in 1980 and the published reports which appeared in the environmental literature in 1986 about the problems in Taiwan. As late as 1995 UNICEF were still drilling wells without testing them and the British Geological Survey published a paper saying that the water was safe to drink – although they had not measured arsenic. There is blame for many in the last century - but credit for only a few.

In particular there is a lot of credit for DCH for being the first organization to recognize the problem and bringing it insistently to national and world attention The Dhaka Community Hospital Trust (DCHT) first raised the alarm about 1992 and were not heeded. Dr Quazi Quamruzzaman and Dr Mahmuder Rahman traveled to an international meeting in San Diego in 1995 to bring it insistently to world attention, and to learn from experts what might be done. In 1997-98 DCHT campaigned worldwide. The Trust members Prof. Quazi Quamruzzaman and Prof. Mahmuder Rahman and other workers of the organization spent DCHT’s own resources to travel from Chile to China, attending conferences and seminars, meeting scientists and establishing collaborative contacts with: Harvard School of Public Health in Boston, Massachusetts Institute of Technology in Cambridge, London School of Hygiene and Tropical Medicine in London, and the University of Adelaide in Australia, both learning about arsenic in othercountries and disseminating their own knowledge and experiences on this mass poisoning. They also in the past three years staged three very successful international conferences on the effects of arsenic and highlighted better understanding towards arsenic mitigation focused on water shed management prospects for the region. Only after the successful international conference in February 1998 was the problem formally accepted (and partial responsibility accepted) by UNICEF and the World Bank who are now actively engaged. Two more international conferences raised in December 1998 and May 2000 successfully established the arsenic issue both at the national and the international level.

Although DCHT is the main organization treating arsenic affected patients, and training workers in the field of arsenic mitigation activities, it is not the only one But DCH is the undoubted and unexcelled leader. Using some preliminary funds from the Bangladesh government and UNICEF, DCH surveyed the districts of Bangladesh for arsenic contamination of tube wells and was the first organization to argue conclusively that more than 70 million people are drinking water with levels of arsenic above the present US EPA standard and are therefore “at risk”. The conferences and enthusiasm generated by the first DCH conference in 1998 led professors at the Massachusetts Institute of Technology to seek US funding to study (in conjunction with the Bangladesh University of Engineering Technology (BUET) the causes of the problem and Professors at Harvard School of Public Health to seek EPA funding for joint epidemiological studies. DCHT is the first organization who in 1997 developed various mitigation options, from the immediate ones using a “Kasli” filter using indigenous materials to a discussion of the long term water resources program for the country as a whole. The primary theme, developed with practical experience, is the importance of community participation, in developing procedures for providing arsenic free safe drinking water. In all of this work on the arsenic problem DCHT in the year 1999 worked, and continues to work, closely with different Bangladesh government agencies and with international agencies such as UNDP, UNICEF and the World Bank.

• Innovative program implementation

The arsenic work is only a part of the work of DCHT. The integrated, sustainable and affordable health delivery program for rural Bangladesh, and the health program for the working people are a unique example of innovative programs for developing alternative, viable models of health services delivery for a country like Bangladesh. This enabled DCHT to act promptly on the mass arsenic poisoning. The DCHT community health model is also much appreciated as a successful program by various national and international organizations and its working experiences was later brought into consideration in the nationwide program of the health delivery.

• Establish record of alleviating suffering:

Dhaka Community Hospital Trust (DCHT) in the past 12 years developed a system of integrated health care delivery. Some 600,000 rural and urban people participated in getting the services from this program. Most of the people served are from lower income groups of the community. DCHT is the pioneer organization that by its shear zeal and tenacity, successfully documented the suffering of millions of Bangladesh from mass poisoning due to arsenic contamination of the drinking water.

• Historic achievement and recent performance

Dhaka Community Hospital Trust introduces a sustainable, affordable and integrated health scheme and implemented it with the community participation. DCHT may be a unique organization in developing countries. Their integrated health service delivery model has been successfully implemented without external support and is self-supporting and not donor dependent.

• Organizational Capacity and administrative efficiency

As an organization DCHT is unique because it works on a horizontal plan. There is minimum hierarchal administration. The decisions are taken collectively and programs are implemented by collective participation. This leads to a high quality of work because after program formulation experts, usually volunteers, are drawn from outside, and local knowledge and skills are also incorporated in the program. The unique horizontal administration and decision-making structure lead to transparency of the administration and implementation activities.

The organizational capacity and administrative efficiency of DCHT has been demonstrated by-

1. Development and implementation of the integrated health delivery program for the urban and rural communities. The DCH program is considered favorably in the relevant national level policy program.
2. The success of countrywide screening of tube wells for arsenic contamination; identification of patients; and establishment of alternate mitigation models for arsenic free safe drinking water.
3. The DCH mass media campaigns and the convincing of the World Bank, WHO ,UNICEF and other national and international agencies to address the arsenic problem and modify influencing their work program to address this national calamity which has been called ‘the great human disaster in the history of mankind’.

• DCH collaborates with others and the work is sustainable

DCHT is closely working with various non-governmental agencies, both small and large, in Bangladesh as well as with the Bangladesh government and UN agencies in various fields of health services delivery. DCHT is a non-profit self-sustaining organization, not primarily a program oriented donor dependent organization. DCHT is a community based, and community supported organization that generates its own fund through its delivery of services.

DCHT is also working closely in the field of arsenic research with the Harvard School of Public Health, Boston; London School of Hygiene & Tropical Medicine, London, and also with the School of Environmental Studies, Jadavpur University, Calcutta, India.

• Most importantly, long term impact

The work of DCHT has already had two major long-term impacts. Firstly, in the field of integrated health delivery of Bangladesh and secondly in developing a countrywide model for mitigation of the arsenic problem for Bangladesh.

These two effects are as follows-

1. The DCHT model of integrated health delivery will make a very positive impact in the health care delivery of Bangladesh. It will help to integrate primary care with secondary and tertiary care services and make the total health delivery sustainable. The primary care is free from donor dependency. It will also serve as an example of what is possible in developing countries in other parts of the world.
2. DCHT by its pioneering work in the field of mass the poisoning due to arsenic in drinking water, has contributed very positively towards safe water options and in particular the options that are both affordable and safe. This will make a positive influence towards a better understanding of the overall watershed management of the country.

• Attachments
• Attached to this nomination letter are the following:

(1) Annual report of DCHT

(2) Accounts for the year 1999

(3) Report of the 500 Village Rapid Assessment Project carried out by DCH with funding from UNDP and the Bangladesh Ministry of Health

Yours sincerely

Richard Wilson

Mallinckrodt Research Professor of Physics