Page 85 - IBT October 2020
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Medicines, vaccines are                  clinician lead approach, it is very                    our own capacity building. Other issues to   learned, what worked if at all, and   catering to mental
                                                                                                                                                                                                                   health?
                                                                                                                                                                                   the failures from our Covid-19
                                                                                   disease oriented. The messages
                                                                                                                                          consider are quality, prices, availability
                                          not the magic bullet. We                 people are getting is a mixture of                     and accessibility for all. In the longer run,   approaches, and how we can work   In Bangladesh there is little to no
                                          need to go back to the                   messages from the internet, social                     we need to develop our own technological   more efficiently across sectors and   conversation around mental
                                          basics and ensure citizens’              media, television, and other                           capacities because this pandemic will not   have better planning for the   health. It’s stigmatized. We are
                                                                                                                                                                                   future. Budget allocation needs to
                                                                                                                                          be the last one and we need to be
                                                                                   community members. It is important
                                                                                                                                                                                                                   conducting a research with 72
                                          rights are available. We                 to understand the lived experiences                    prepared.                                be increased substantially. It   university students and all of
                                          need a socially just model               in order to have appropriate                           What kinds of changes and or             would be beneficial to have critical   them shared experiencing anxiety
                                                                                                                                                                                   review of some of the challenges
                                          that addresses                           messaging as well as interventions.                    approaches are necessary to              faced, from quality of PPE and its   and depression. Students shared
                                                                                   Fears around quarantine, stigma, the
                                                                                                                                                                                                                   concerns about being able to keep
                                          comprehensively the                      lack of trust on media and news and                    improve the health sector?               distribution, lack of sufficient   up with about online education
                                          needs of vulnerable                      an already weakened health system                      Our health system, in general, is not    equipment, shortage of bed/ICUs   and worried about whether they
                                                                                                                                                                                   in hospitals, absence of
                                                                                   further reduces chances of reporting
                                                                                                                                                                                                                   will graduate, get a job, earn
                                                                                                                                          particularly strong, and it has taken a
                                          populations and only then                and uptake of services.                                further battering as a result of Covid-19.    contextualized communication   money. The uncertainty is
                                          can we address health and                Health is a culmination of personal,                   We also need to ensure that other health   messaging, etc. This will allow us   daunting. Our urban research in
                                          well-being and the SDGs.                 emotional, mental, physical, social                    services are not completely disregarded,   to understand what needs to be   slums found that poor slum
                                                                                                                                                                                   strengthened moving forward. The
                                                                                   and economic factors. Many of the
                                                                                                                                          due to the focus on Covid-19. We have a
                                                                                                                                                                                                                   women were suffering from
                                                                                   poor grapple with all kinds of                         mix of public, private and NGO health    national task force set up was   sleeplessness, loss of appetite and
                                                                                   diseases and illnesses all the time.                   providers in the country. There also exists   mainly clinician led. Public health   spoke of heart palpitations. They
                                                                                   The middle and upper class on the                      a large informal sector of providers that   is helpful for communities, but   were extremely worried about the
                                                   livelihoods in Bangladesh.      other hand have not faced this level                   the general communities/populations rely   health is not just about disease.   lockdown and about their income
                                                   Many segments of the Bangladesh   of uncertainty. Unfortunately,                       upon. Strong partnerships and referrals   We need to bring in            and how they were going to pay
                                                   population are vulnerable, yet the   vulnerable communities are more                   are important and innovative solutions are   multidisciplinary voices and   rent and purchase food.
                                                   Covid-19 response on individual   familiar with diseases and death and                 required to address the workforce shortage   opinions, from different    However, in our country one
               What do you think are the           determinants of health, focusing on   dying. Their lives are about basic               within our context. However, the point is   stakeholders and actors. There   cannot discuss mental health
               public health measures that         individual behavior with limited   survival. The pandemic just                         not necessarily about fixing the health   needs to be an open approach   openly. The everyday stress and
               should be taken to combat the       attention to the personal,      magnified the existing inequalities                    sector, but about meeting basic needs of   because the government cannot do   anxieties which has been
               impending second wave of            socio-cultural, economic and    and inequities that have always                        the most vulnerable. For example, in     it alone.                       aggravated by Covid-19 needs to
               COVID attacks during the            structural factors is problematic.   existed, and a purely clinical                    slums, access to clean water is not always   Stimulus packages have been   be shared. Mental and emotional
               upcoming winter season?             This approach prevents the most   approach will not work. We need to                   a reality, and housing is congested and the   initiated and rolled out. The other   wellbeing is very important and
               We have had a clinician-led approach, a   marginalized from following   address their needs comprehensively.               environment is polluted. Communal        issue is about understanding why   we need to talk about it. We need
               biomedical model of intervention to   national recommendations/WHO   The approach to dealing with such                     latrines and kitchens with poor sanitation   some communities have been more   to talk beyond clinical diagnosis.
                                                                                                                                                                                   affected than other communities
               prevent and/or manage the coronavirus   guidelines. Practicing social   crises in our country is for diverse               and overflowing sewage and garbage is a                                  Generally normalizing emotional
               pandemic. In the context of Covid-19, the   distancing, washing of hands with   stakeholders to come together and          common sight during monsoon. So how      and in what ways. What are some   and mental wellbeing is to bring
                                                                                                                                                                                   of the needs and priorities? Some
               lockdown model was imported from a   soap, and staying at home are   the government can reach out –                        does one achieve a healthy body and a                                    this up in conversations in
               different context, from western or   possible for the better off, but is a   NGOs, private sector and other                healthy mind if there is a lack of basic   of the communities are so     schools, universities and in the
                                                                                                                                                                                   impoverished that they cannot
               developed economies with stronger   non-starter for a majority of the   actors. Even if there is a vaccine in              infrastructural support? Medicines,                                      workplace. Unfortunately, mental
               economic bases and better social safety   urban poor with 6 to 11 members   the future which is made available             vaccines are not the magic bullet. We need   follow prescribed guidelines, and   health is equated with ‘madness’
                                                                                                                                                                                   many increasingly do not believe
               nets for those in need. But for the future,   crammed in one room within   for all, for the most vulnerable                to go back to the basics and ensure                                      and the labels and language used
               is there a better way forward for countries   informal settlements, sharing   groups there will continue to be job         citizens’ rights are available. We need a   in the dangers of the pandemic   to discuss it are derogatory in
                                                                                                                                                                                   anymore and therefore for example
               such as Bangladesh with far greater   irregular water supply, communal   and food insecurities; then what                  socially just model that addresses                                       nature.
               resource constraints? The first cases of   latrines, and cooking spaces.   exactly have we achieved?                       comprehensively the needs of vulnerable   a reluctance to wear masks in   Another challenge is that we don’t
                                                                                                                                                                                   public spaces. Our messaging
               Covid-19 in Bangladesh were reported on   Communication messaging needs to                                                 populations and only then can we address                                 have enough counsellors or
               8th March, 2020, and as of October 03   reflect the lived realities of differing   What kind of policy, plans              health and well-being and the SDGs.      wasn’t always community-context   support systems in the country to
                                                                                                                                                                                   messaging. As I said earlier, it is
               2020, there were over 366,000 confirmed   contexts.  The costs of purchasing   and strategies can the                                                                                               address this. There is a shortage
               cases (WHO, 2020). To contain       sufficient supply of soap and masks   Bangladesh government                            A recent survey revealed, only           important for more social science   of clinical psychiatrists and
                                                                                                                                                                                   research to capture and
               transmission, the state at the beginning   is often an expense that the poorest   devise regarding the                     five percent of the Upazila                                               psychologists. There is shame
               announced a series of “holidays” from   cannot necessarily afford or   import, production and                              Health and Family Planning               understand the realities on the   surrounding mental wellbeing,
                                                                                                                                                                                   ground related to Covid-19.
               26th March, 2020 which led to the   rationalize and this is not feasible   distribution of vaccines?                       Officers (UH&FPOs) hold a                                                  and families object to members
               closure of all public and private   longer term, unless there are   How can cooperation                                    degree in public health. What            In the public health sector     accessing any form of counselling
               educational institutions, offices, transport   subsidies and provision of basic   among the national                       can be done to improve the skill                                         or clinical psychiatric care. I think
               services, factories, retail shops and so   necessities for the most vulnerable.  commission and the                        and competency level of public           there is little to no           people would be happier and
               forth (Dhaka Tribune, 10 April, 2020) and   In terms of research, we need to   current task force be                       health officials in Bangladesh?            resources for mental            healthier if they could share what
               people were asked to strictly stay at   have longitudinal social science   strengthened to ensure                          If this is what the survey reveals, then   health care especially in     they are experiencing and often
               home. Without the option to work from   research, with a community   efficient implementation of                             more training is required. This is a critical   the rural areas, and there   just being able to talk and share
               home, the informal sector with over 50   centered approach, to understand   the vaccine access and                         discussion we need to have, because      is a lack of awareness and      and get good counsel makes a
               million workers (87% of the workforce)   the impact of the virus on peoples’   distribution process?                       post-pandemic we have to strengthen our   taboo surrounding the          huge difference to one’s quality of
               was crippled and the economic disruption   lives, their current fears, concerns,   If we go into partnership regarding     health system. As we move forward, it is   topic. How can the public     life and state of emotional and
               continues to threaten millions of   practices and behavior. When it’s a   vaccines, we should also prioritize              important to reflect on the lessons      health sector start             mental well-being.

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