People’s doctor

Moving through the outer ward of Gonoshasthaya Kendra Hospital at Dhanmondi, the hustle of any outpatient department would come to view – nurses running around, patients of all ages sitting with anticipatory calm, children restless. But this is no ordinary hospital. At the end of the corridor, and up two floors, in an office stacked up with almost all the worthwhile medical and public health journals one could think of, sits Bangladesh’s foremost public health practitioner, campaigner and activist Dr Zafrullah Chowdhury. Peering into the pages of a lecture that he would be delivering to public health campaigners and activists from all across the globe, including those from the billion-dollar endowed Bill and Melinda Gates Foundation, Zafrullah was putting the final touches to what he would be saying on the state of the great public health battles for the future. ‘I suppose, be it the war of independence or the setting up of the GK [Gonoshasthaya Kendra], it has all been a struggle. That’s all the better. If I hadn’t faced all these obstacles, maybe many of what you see today wouldn’t have been achieved,’ he says.
   Born on December 27, 1941, Zafrullah had four brothers and five sisters. From early childhood, with a mother deeply engrossed in the idea of ‘social responsibility’, Zafrullah was growing up to know that ‘we do not live for ourselves only but for a greater cause’. As his father was a police officer, they moved from place to place. A part of his childhood was spent in Kolkata, and but they eventually settled in Dhaka. ‘I attended Nabakumar School at Bakshibazar. And the fun thing was that our house was on the borderline between the old Dhaka and the new Dhaka, which was still nascent but growing very fast,’ he recalls. After attending Dhaka College, where his political disposition was already showing, Zafrullah kept his mother’s dream alive by getting admission to Dhaka Medical College. ‘I was very lanky when I was in college. But the mischief I committed those days is nothing less than alarming,’ chuckles Zafrullah, as he pushes back his white hair falling down to his shoulders, and whisker-like moustaches that feature prominently on his dark, large face.
   ‘When I was the general secretary of the DMC students’ union, we held the first press conference ever to expose the corruption at the hospital. It made headlines. I was part of a highly-charged political pressure cooker. Even now that I think of those days, it was quite unbelievable that how I was almost kicked out several times,’ he recounts.
   After a very turbulent student life, where Zafrullah’s grounding in left political ideologies was engrained, he finally finished his MBBS degree with distinction in surgery in 1964. He then left for the United Kingdom to do his post-graduate studies. From 1965 to 1971, he led as he puts it, ‘a very flamboyant lifestyle’. ‘You must understand. I was still young, barely in my mid-twenties. And I always liked to indulge in a bit of luxury as I was doing well, too. I used to drive a Citroen DS, and between my postings in Durham, Leeds, New Castle, and finally Middlesex in London, I enjoyed that life. But then came 1971.’
   ‘The war of independence changed everything,’ he recalls. ‘When the Bangladeshi expatriate community, especially the doctors, gathered to do something for the war, my grounding in my college days took hold. With Abu Sayeed Chowdhury as the head, I started organising the community back there. But something had to be done in the field.’
   Along with another surgeon from England, Dr MA Mobin, he returned in 1971 to set up the 480-bed Bangladesh Field Hospital along the border of Tripura and the soon-to-become free Bangladesh. ‘What we practised there was truly unprecedented. Women with no previous training in healthcare were trained within days to help out the scores of injured freedom fighters and refugees that were coming in to through the hospital.’ In fact, after the war, it was this idea that a grassroots, effective healthcare delivery system can be developed in rural Bangladesh by utilizing women as a primary healthcare delivery platform. The renowned medical journal Lancet hailed this in 1975.
   ‘Basic Health Care in Rural Bangladesh’, a paper presented in Dhaka in April, 1972 was to become the concept paper upon which the GK was setup. ‘In fact, it became one of the basic pillars of the Alma Ata Declaration of the World Health Organisation,’ says Zafrullah.
   Over three decades, the GK has evolved into a ‘multi-faceted community and development programme encompassing activities ranging from agricultural cooperatives, community schools, primary healthcare centres and hospital, women’s vocational training centres to economic enterprises to help finance trust’s activity’.
   ‘I would say that in the field of paramedical training and domiciliary services, GK has led the way not just in Bangladesh but across the globe,’ says Zafrullah. In most of the GK’s operational areas, mainly in the Mirzanagar area of Savar, maternal mortality rates and infant mortality rates are one-third to half of the national level.
   The introduction of a Rural Healthcare Insurance System in 1973 was probably one of the first of its kind in the world. What started out from a field hospital during war times has evolved into a mammoth social movement involving a university, research establishment, basic drugs and intra-venous fluids producing pharmaceutical setup, printing press for promoting public health.
   Some have questioned that the GK’s breadth and reach has been curtailed within a small geographic area rather than becoming national. Zafrullah disagrees. ‘My intention was to develop a model that can be replicated nationally. Public health is a matter for the state to take charge of. It can never be left to the private sector.’
   While the GK has developed, Zafrullah has been one of the most vocal activists in public health. One of his crowning achievements has been the formulation of the Bangladesh National Drug Policy in 1982. Many observers have pointed out that it is the first comprehensive drug policy in a least-developed country, which ensures the availability of essential drugs from the grip of predatory capitalist mechanisations of the global pharmaceutical lobby. ‘It is a crucial matter. If we cannot ensure delivery of even the most basic of drugs then how can you be sure of a public health system,’ says Zafrullah. He also wrote an exhaustive book on the issue, ‘The Politics of Essential Drugs’. Also crucial was his campaigning against commercial food producers from labelling their milk products as substitutes for breast milk. Be it bringing together freedom fighters, starting the Bangladesh Medical Association in exile or ‘raging against the machine’ of drugs, healthcare or pointing out how ‘research’ is used as a new method of colonisation, Zafrullah has been nothing less than a modern-day revolutionary.
   
   Text: Mahfuz Sadique / Photo: Andrew Biraj