The world’s largest refugee camp prepares for covid-19BMJ 2020; 368 doi: https://doi.org/10.1136/bmj.m1205 (Published 26 March 2020) Cite this as: BMJ 2020;368:m1205
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I have the opportunity to learn medicine and spend six years of my life in Bangladesh. With my past experiences, I can draw an overall impression on the health care system of Bangladesh and certainly on the preparedness and outcome of Covid-19.
Bangladesh is a small country, with one of the highest population densities in the world. Regarding the healthcare system, as like in India, primary, secondary and tertiary healthcare systems are in place to cater to the needs of people. With more than 20 districts, each district is catered by a government-run medical college as a tertiary care centre. In addition to this, more than 50 private medical colleges and hospitals offer health care facilities to the population.
As soon as the news from China broke out about the emergence of Covid-19, Bangladesh was like other neighborhood nation's busy with worldly affairs. Th e notion of approaching disaster might not have been sensed by any of the office bearers. Inspired by being considered a poor nation, loaded with largest population density and further the home to world's largest slum, Bangladesh must have prepared itself as soon as the local epidemic in Wuhan province broke out. Alas, nobody cares what's happening in the neighborhood. Same happened with Bangladesh.
As a developing nation, most of the activities of WHO and UNICEF are directed towards Bangladesh. Further, institutions like ICDDRB and NIPSOM are a benchmark of public health in Bangladesh, but still the preparedness to face the pandemic was not in place at the right time.
When measures like hand washing, cough etiquette and social distancing should have been advocated on the ground, religious leaders of Bangladesh were calling people from different districts to take part in large gatherings to seek forgiveness from the creator and pray to revoke the epidemic. Further, the national Day celebrated in memory of the father of Nation was widely celebrated all over the country and that too when Covid-19 was peaking in China, Italy, Germany and South Korea. Even the Central Government was allowing people to gather and celebrate the big day.
Forgetting that Covid-19 has gripped almost every nook and corner of the World and many Bangladeshi people work outside the country all over the Globe. There is a higher chance of importing the virus into the population via returning travellers. Health authorities turned a deaf ear to all the warnings that Covid-19 was ringing at their door.
Now in spite of all these unfortunate incidents, a ray of hope among those slum dwellers who ran for their lives from Myanmar was settlement in Bangladesh.
I have read a lot about their living conditions and a sense of impending outbreaks on their heads al the time. Often these slum dwellers hit the news headlines for all the wrong reasons for which they are never responsible.
Implementation of Do's & Don't s of Covid-19 among such a population is really a tough job for the ground workers.
Barriers like ethnicity, language,and cultural differences do play their role but I recommend the behaviour change communication along with health promotion activities could be helpful to carry out the required strategy to avert the Covid-19 threat among the community.
As far as Bangladesh is concerned, due to poor testing facilities the number of positive cases might not have touched the mercury but the truth lies behind those who are asymptomatic Covid-19 positive and are yet to be tested. Those are part of the community and they risk spreading the virus to others. Studies have shown that countriesthat test more are able to detect more positive cases. The scenario in Bangladesh is quiet different and all fingers are crossed to date.
Competing interests: No competing interests