These Heroines of Health are inspiring the next generation of global health workers 

At the World Health Assembly this year, GE Healthcare and Women in Global Health, a movement that strives for greater gender equality in global health leadership, are joining forces to honor and celebrate women in global health. 2018 Heroines of Health, Professor Sabina Faiz Rashid and Professor Malabika Sarker are being honored this year for their work with vulnerable populations in Bangladesh. Both have strong academic backgrounds; Sabina is the first female Dean of the BRAC James P Grant School of Public Health, appointed in 2013, and Malabika is the first female Director of Research. Their partnership and collaboration is key to their leadership and is inspiring the next generation of global health workers. Their research has offered the world invaluable learning on topics such as community health workers, sexual and reproductive health, non-communicable disease, urban health, health systems, HIV – and beyond. 

Tell us more about the work that you do with your organizations. 

Sabina: I head the BRAC School of Public Health in Bangladesh. We have transformed our Masters of Public Health (MPH) so that students learn first-hand in the community. My colleague and friend of over twenty years, Professor Malabika Sarker, shares my vision to transform public health advocacy for developing world needs. I have also focused on gender, sexual and reproductive health, and the health needs of people in urban slums. In 2008, I established a Centre for Gender and Sexual and Reproductive Health and Rights with seed funding from a UN organization, pushing for laws to stop child marriage; providing a safe space for LGBTQI communities and working to develop online resources on sensitive topics that bypass traditional gatekeepers such as parents and teachers. I also established the Centre for Urban Health and Equity in Dhaka, a city of 16 million with 5 million poor. Slum settlements remain invisible to the state – there is no comprehensive urban policy, and the poor lack housing rights, basic services, and suffer from the worst health indicators.

Malabika: I teach, conduct research, and oversee research activities as Director of Research. I coordinate and teach various modules, such as the implementation research and a reproductive health course. I also lead the Center of Excellence for Science of Implementation and Scale Up committed to evidence generation. As a member of the senior management committee, I also oversee the finance and human resource in partnership with the Dean of the school. I regularly mentor 27 researchers working with me on several research projects. For several years, I also worked as a public health physician in BRAC, the largest Non-Government Organization in the world. After completing my doctorate, I startedworking as a researcher/teacher which I’ve now been doing for 13 years.

How did you get involved in this work; what was your inspiration? 

Malabika: When I was 17, I got married. It was an arranged marriage. My husband and my father decided that I should go to medical school even though I was interested in studying Physics or Mathematics. After a year-long training as an obstetrician and gynecologist post-medical school, I started my career as a community-based reproductive health programmer.  One of my primary services was menstrual regulation (MR), which is what abortion is called in Bangladesh.  I was surprised by the number of women who came for MR given the availability of free contraceptives. I realized that the availability of a service does not ensure its acceptability, and I became interested in the social factors which determine health. I then joined BRAC where I worked on a community-based maternal mortality reduction project, and so my journey in public health started.

Sabina: When I was 23 years old I got a job at BRAC’s research division in a village called Comilla in Bangladesh. I’d never been to a village before and six months in that village changed my perception of the poor. They were kind and hospitable, welcoming me and my questions with humor and patience. They taught me that local practices were often pragmatic decisions, made with little money and with traditional home practices often the first line of healthcare. Solutions I’d read in books were not so easily applied in real life and I found that the actual needs and priorities in the community were not always heard. This was my motivation. Following this experience, I decided to do my Master’s in primary research on poor women who were using a type of female contraceptive implant in Bangladesh. Many remained uninformed of the implant, side effects and had to fight with doctors to have it removed.

Can you share a story that solidified why you got into this line of work?

Malabika: When I was working for BRAC in Bangladesh, they launched a ‘maternity waiting home’ (MWH) for pregnant women from the remote villages who were diagnosed with complications or thought to be at high risk. In 1993, Banu, a pregnant woman was admitted to the MWH. It was her ninth pregnancy and she had a history of abortion, stillbirth, and neonatal death. With four children, Banu was restless and kept talking about how her children would suffer without her. She left the waiting home after a day. Three days later, we got the news that Banu had been admitted to the hospital with obstructed labor. I ran to the hospital where I learned that the baby was dead and that Banu needed a craniotomy for delivery. Following the craniotomy, when Banu gained consciousness, she left the hospital and the nurses didn’t know where she was. We immediately went looking for her but by the time I reached Banu’s house, I received the news that Banu had passed away as she tried to walk the six kilometers. This was an extremely traumatic experience for me that made me realize the complexity and value of public health and how simply addressing the clinical need of a patient isn’t enough. 

Sabina: A life-changing moment for me that also solidified why I got into this line of work was when I spent 15 months conducting ethnographic research in slum settlements in Dhaka city, studying the lives of married and unmarried adolescent girls and their sexual and reproductive health needs. Adolescent women and their families there spoke of a constant worry that pervaded their daily lives and resulted in palpitations, insomnia, chest pains, fevers, and other ailments. I began to reflect on how their experiences challenge our dominant model of health interventions, which are biomedical and disease oriented. Do we often blame the poor for the lack of improvement in their lives, for not accessing appropriate services, or not being compliant about taking certain medications or for certain practices that are deemed as backward, without understanding their social worlds? I realized that public health needs to have a comprehensive approach to meet the needs of the most marginalized. I also learned very quickly that reproductive and sexual health for many of the urban poor adolescent women was much broader; it was the absence of social, economic and political rights that impacted created adverse health conditions. I returned to Bangladesh and joined BRAC School of Public Health. Their mission was in alignment with my growing passion to work in an institution that was committed to improving the lives of disadvantaged communities, especially poor women and children.

What’s the greatest piece of advice someone ever gave you?

Sabina: Whenever I felt intimidated by the brilliant and inspiring individuals who I met, my father, who was always very supportive of me, would say: “Sabina, 99% is aspiration, 1% is inspiration”.  Basically, that you don’t have to be brilliant to make a difference, just work hard, remain sincere, committed, and passionate about what you do, and your work will speak for itself. 

Malabika: “Be curious, engage, and involve”.

Professor Sabina Faiz Rashid and Professor Malabika Sarker are two of nine women being recognized at this year’s World Health Assembly as part of the Heroines of Health honors. Learn more about the 2018 Heroines of Health here.

BRAC recently organised an international level training for the transport drivers of the Bangladesh Navy, focusing on awareness building and behavioural change for safe driving. 22 drivers of the Bangladesh Navy participated in the three-day-long training at BRAC's driving school in Uttara in the capital, starting on 22 April 2018.

The course appropriately combines hands-on training and theoretical knowledge with a special focus on the former.

BRAC undertook the training titled 'Road safety and safe driving training', in short 'Surokkha', in 2014, realising that raising awareness and capacity building are critical in reducing the extremely high rate of road crashes in Bangladesh. In this initiative, BRAC has partnered with Hubert Ebner Ltd, an internationally acclaimed organisation specialising in automobile driving training and road safety issues.

Trainees are exposed to lessons related to safety measures on the road, techniques on self-protection while driving, and desired behavioural change. For the practical competency part of the training, drivers are tested on their ability to operate safely through the ‘P-Drive’ technique.

Under BRAC's road safety programme, BRAC Driving School similarly trained over 1,200 individuals so far. It has been observed that drivers who underwent the 'Surokkha' training were reported to have displayed considerable change in their behaviour in adapting to safe driving techniques.

Bangladesh Road and Transport Authority (BRTA), Dhaka Metropolitan Police and Dhaka Transport Coordination Authority in a recent news report attributed over 90 per cent road crashes to rash driving. Experts stress awareness raising and capacity building for skilled, safe and responsible driving to reduce the excessively high rate of road crashes.

A discussion session also took place during the training in which Lieutenant Commander Sanjida Hossain and Lieutenant Commander M Enayet Hossain were present. The speakers at the discussion emphasised that the drivers should mindfully apply their learning in the training while behind the steering wheel.

Every year in Bangladesh, 31 million people confront with legal challenges. A majority of these challenges occur when dealing with neighbours, and the most complicated ones arise when dealing with land related issues. This was among the findings presented at the launching event of the report titled ‘Justice Needs and Satisfaction in Bangladesh 2018’ at the capital’s BRAC Centre today on Wesnesday (May 9, 2018).

This research was conducted and published in collaboration between Netherlands based nonprofit The Hague Institute for Innovation of Law (HiiL), the Government of Netherlands, and BRAC. The framing questions for the research included what kind of legal dilemmas people face in Bangladesh, how they deal with those issues, who or which institutions they seek for help to resolve their concerns, and the level of responses they receive.

The study was conducted through in-depth qualitative interviews of around 6000 respondents who have randomly selected in 64 districts of the country. The study was conducted in August and September of 2017.

The chairman of the National Human Rights Commission, Kazi Reazul Hoque, was present at the event as its chief guest. Also present as special guests were the head of Measuring Justice for HiiL, Dr Martin Gramatikov, and the quantitative justice data analyst of the same organisation, Martin Kind. Programme Head of BRAC's Human Rights and Legal Aid Services (HRLS) Sajeda Farisa Kabir moderated the ceremony.

The key highlights that came out from the study include: 31 million people face legal dilemmas every year. The major types of legal issues they face include, among others, issues with neighbours (40%), land disputes (29%), criminal offences (21%), family disputes (12%), money related issues (12%), social welfare (11%), consumer problems (9%), and accidents and personal injury (8%).

In terms of the severity of the issues, land related legal disputes come out on top of the rest. The severity of the problems as reported by percentage: land disputes (25%), neighbours (22%), crime (12%), family disputes (7%), money (7%), social welfare (5%), housing (4%), and accidents and personal injury (4%).

To ensure more effective dispute resolutions and ensure better justice mechanism a number of recommendations were drawn in the report, which include among others: prioritisation of legal problems to solve them, improve information delivery, design and provide affordable and accessible justice journeys for all, explore the full potential of hybrid justice mechanisms, justice innovation and digital innovation.