Saving Mothers in Bangladesh
Laura Zeidenstein, CNM, DNP and Mary W. Byrne, PhD, DNP, MPH (c)2011
Gonoshasthaya Kendra (GK) is a multi-faceted community and development program in rural
Bangladesh encompassing agricultural cooperatives, community schools, primary health care centers
and hospitals, women’s vocational training centers, as well as self-sustained community economic
enterprises. GK was set up in 1972 by founder and Trustee, Dr. Zafrullah Chowdhury, a Bangla native
and UK-educated surgeon and physician who returned home during the war for independence to run a
field hospital staffed by young men and women with no previous medical training. Dr. Chowdhury then
took on the challenge of developing an effective NGO rural health care delivery system. The first concept
paper on this ‘Basic Health Care in Rural Area’ presented in Dhaka in April 1972 later became one of the
working papers on which the Alma Ata Declaration of the World Health Organization was framed.
GK has for the last 42 years worked on community health services. It has taken the unconventional
approach of training the numerous, indigenous but illiterate and unskilled birth attendants (called “dais“)
and integrating them into teams with skilled birth attendants and health professionals to provide preconceptual, prenatal, parturient, and post-partum care at preventive and treatment levels. GK has also
reinforced the positive social determinants of women’s health emerging in the country, including reducing
child marriage, increasing minimum age for marriage, improving food access and primary education for
girls, and creating economic opportunity for women.
In 2011, Dr. Chowdhury’ sent an invitation to Laura Zeidenstein, Director of the Nurse Midwifery
Program at Columbia University School of Nursing to begin a Maternal Child Health collaborative with
the People’s Health Center in Bangladesh. Drs. Chowdhury and Zeidenstein shared a long history from
the latter’s teen years when she lived with her parents in Bangladesh. The new collaborative work was
launched when the Center for Children and Families of the Columbia University School of Nursing,
under Director Mary W. Byrne, provided a one year pilot grant October 2011 through October 2012.
Drs. Zeidenstein and Byrne are academics, clinician and researcher respectively, and partners in their
long history and passion for supporting the most vulnerable childbearing women and their children.
A truly respectful collaborative partnership between GK and Columbia University Center for Children
and Families has been created. It is based on: a deep shared understanding of the culture of birthing in
Bangladesh, consultation to extend the MCH work of the four decade old GK health infrastructure,
unprecedented escorted visits to the most rural villages in Bangladesh to observe life activities and the
work of traditional birth attendants first hand, trainings for paramedic and traditional birth attendant
teams, and unprecedented interviews of dais. In progress are an evaluation of actual behavior change
by birth teams following new knowledge acquisition, implementing a shared data agreement secured to
assist GK to provide outcomes evidence from its extensive databases, and production of a professional
quality video-documentary to share the successful and holistic GK health services model. Resources
for sustainability of this successfully launched and innovative project are urgently needed at this time.
Transporting
mother home
after C-section.
Ethnographic interviewing of dai.