A story heard over dinner---the culture of innovation at icddr,b
Back in 2015, I had the privilege to be at a dinner in Dhaka with Dr. Mohammed Yunus. No, not the Nobel-winning economist, although I’m sure he’s interesting company. Rather, Dr. Mohammed Yunus, the retired, long-time head of the the Matlab health and demographic surveillance system run by icddr,b. Dr. Yunus is as close to a hero of mine as I’m willing to let myself have1, and the approach to health care he and his colleagues pioneered has saved and improved countless lives.
While he was charming a bigwig who was the reason for the dinner, he told a story that I want to share briefly here. It’s not my story, and I can’t tell it like he could, but I realize today it shouldn’t go unrecorded. Any errors in the retelling are mine alone.
In the late 1960s, a few years after the cholera project in Matlab was in swing and saving lives, the doctors running it, of which Dr. Yunus was a junior member, realized that family planning was a huge concern for the families in Matlab. And so these male doctors went out in the villages to teach women about family planning. And after a few years, they realized they’d accomplished nothing.
Politely, their female nurses asked, “can we talk to the women?” And, in a nearly unprecedented move, the male doctors said, “that’s a great idea. Let’s try it.”
This is how the community healthcare worker program started. The nurses identified one woman in each village most receptive to learning about family planning, knowing she would talk to others in the village and be trusted. As time went on and icddr,b proved their value to these women. They offered to train them on basic health triage so they would know when someone should go to a local clinic or the regional hospital, or deal with it at home. And eventually, they asked the women if they would give up a room in their house to serve as a village health clinic, with supplies provided by icddr,b that they could use and share. The women who agreed became the first community health workers. Throughout, trust was growing.
In the 1970s, they pioneered oral rehydration therapy and cholera deaths plummeted. Birth rates were steadily falling by this time too.
In the early 1980s, Dr. Yunus and his colleagues went to the Bangladeshi gov’t and said, “look what we’ve accomplished. Cholera death rates have plummeted. Birth rates are falling. Quality of life is improving. We know how to do this.”
The gov’t said, “that’s great, but you’re doing it with all this foreign money and well-paid talent. We could never reproduce that at a national scale.”
So they all agreed to cut salaries at every level to match the government pay scale. Then they showed they could keep doing it at that pay level. And so the gov’t agreed to try.
icddr,b continued to lead like this through the 80s and 90s, showing what could be done with Bangladeshi resources, every time an excuse about money or education or skills was raised. They continue to lead still as one of the most effective public health research institutes and community care centers anywhere. In Bangladesh, one of the poorest countries, a country that out-performs its economic peers on many major health outcomes.
One anecdote from my brief time in Matlab. From the grandparents on, each generation was roughly five inches taller than the last.
For attribution, please cite this as:
Famulare (2024, Jul 9). A story heard over dinner---the culture of innovation at icddr,b. Retrieved from https://famulare.github.io/2024/07/09/2024-07-09-A-story-heard-over-dinner-the-culture-of-innovation-at-icddrb.html.
-
Not quite trivially, Dr. Yunus a field epidemiologist and physician in his 70s, was by far the most engaged student in a modeling 101 seminar I gave while visiting. To say this is unusual and a testament to his intelligence and deep curiosity would be understatements. ↩