CRL Dactar and Bara Dactar at Matlab (Dewan S. Alam)

Time flies! It really does. I did not realize that I just passed 22nd year of joining at ICDDR,B lately. It was February ’85 when I first came to Matlab, a wonderful low lying rural area traversed by numerous canals and a number of big rivers. I still have the vivid memory of my first journey by speedboat over the river Dhonagodha. I was accompanied by a doctor couple who were also traveling for the first time to Matlab to join at ICDDR,B. While going through the river very fast by speedboat we saw a lot of small sailing boats passing by most of those boats, I learned from the speedboat driver, were actually fishing boats. Later I came to know that fishing was one of the major occupations of Matlab population. It took about an hour to reach Matlab Government Health Complex where ICDDR,B was located in one of its buildings. On arrival we were taken to the famous barge where my temporary accommodation was arranged, however, the accommodation for other two doctor colleagues were arranged elsewhere. Barge was famous because the predecessor of ICDDR,B, East Pakistan Cholera Research Laboratory (CRL) started its activity in Matalb area on board this barge.
 
On arrival we were served tea, nice small famous Matlab banana and biscuits. After refreshment we were taken to Dr. Khalekuzaman’s room who was the Senior Medical Officer and were in-charge of Matlab clinical services that included Matlab Diarrhoea Hospital and MCH-FP clinic and some medical support to the field. I got the impression that he would be my supervisor at Matlab. He explained about my responsibility as a project physician for Measles study, I did not know that before though, one of the projects running at that time. He also mentioned that there were only two doctors in the hospital other than him to cover three shifts a day for seven days. So I was told that I would primarily be working for the Measles project but sometimes I might need to work in the hospital. One of the doctor couple, Dr. Eradul Khan joined at Matlab Hospital and the other (Dr. Shamim Kahn, the lady doctor) joined at MCH-FP clinic. I had my name on regular hospital roster in addition to medical support to the measles project. Later it seemed that I had full-time assignment in both places. I used to start my daily routine with hospital round in the morning or seeing patients in the Staff Clinic and then after a short break or often without break I used to start seeing patients referred from the field. There used to be call from the field daily and almost invariably during the later half of the day. I had to go the field to confirm measles cases, sample blood and ensure anthropometric measurements. In most of the evening my supervisor used request me to cover the night duty as there was no other doctor available for that shift, and as other doctor colleagues did the day shift. So there was no good option for me to say anything other than accepting the request. Situation worsened when one of the two doctors at Matlab hospital left. Anyway, that continued for more than one year before I started my full-time work in the hospital after the end of the measles project.
 
In the Measles study room I met Mr. Emdadul Haque, the Senior Field Reseaerch Officer for the measles study who introduced introduced me to other field staff for that project. They included Mr. Monoranjan Das and Mr. Siddiqur Rahman who were the two Senior Health Assistants for that study. Either Mr. Das or Mr Rahman used to accompany me to the field. Mr. Emdad used to make extensive field visits. They taught me several tips how to behave in the field while examining patients and their family members. Although I was supposed to examine the study participants (young children), they explained it was important to write a prescription for other ailing family members of the child to ensure participation and compliance to the study. Almost all the mothers used to complain weakness and dizziness apart from other specific health problems, which used to be very few. Our field workers used to carry extra medicine particularly iron syrup, pain killer tablet, and few antibiotics. The mothers and other family members used to be given treatment mainly to make them happy although some of them had genuine health problem.
 
Speedboat used to be used extensively for field visits except for a couple village neighbouring Matlab ICDDR,B. So it was big fun, at least initially, to go out for field visit. During my first field visit to one village called Lamchari, one of the worst eroded villages in Matlab, we first anchored our boat near the house of our community health worker (CHW). That day I was accompanied by Mr. Rahman, one of experienced field staff at Matlab When we got off the boat I noticed curious people in the village were saying CRL doctor had come. First I thought they guessed me as doctor so were telling one another but soon I realized that they meant Mr. Siddiqur Rahman as the doctor and not me. I knew Mr. Siddique as field assistant but when they called him doctor I was little confused but thought he might be practicing as a village doctor before joining ICDDR, B or still might be doing so. He seemed to accept that without any hesitation. Then Mr. Rahman called the mother of the sick child in a way that sounded like he knew the mother for long time. He also talked with other members of the family asked about their well being. Soon people started seeking prescription for their different illnesses. It took about an hour to finish prescribing. At the end Mr. Rahman asked the porter to give them iron syrup (the most popular one) and some painkiller tablets according to the respective prescription. I was told before that I must write iron syrup if any mother complained of weakness otherwise they would not be happy. When we were coming back I was asking Mr. Rahman that he seemed to be very familiar with the mother and child. He proudly said he knew the mother since her birth (born in another village) and she got married to one person in that village few years ago. He also said his acceptance to the village was exceptionally high compared other colleagues and that was reflected by his confidence during bleeding of the child without much resistance from the family.
 
On the following day I also had to go to the field and the call was received the from the same village as the last day. Speedboat was ready and we equipped ourselves with everything needed. This time my companion was Mr. Das. On the way one of the porters of our study signaled from another village and asked us to stop by and he was carrying message of a suspected measles case from another village. Accordingly we turned the speedboat and picked up the porter and went to another village called Amuakanda. There was no embankment at that time and so we could go deeper into the village. When we arrived in that village we found even bigger crowd than what we saw at Lamchari. Quite a number of people from the crowd were addressing Mr. Das as CRL doctor. He also was accepting that normally as did Mr. Siddique but this time he introduced me as “big doctor” to them and was reassuring that I would be able to treat any problem they might have. I finished with the measles case in about half an hour and then started for the next child before then we had to stop and see some other patients. Mr. Das asked me to write prescription for them as quickly as possible and it was not needed to check pulse, blood pressure or anything even those who were complaining of headache or dizziness. So, I started accordingly but the crowd was gradually increasing. I asked Mr. Das who these people were and what their relationship with our measles child was. He said they not related to our study child but participants in another study called “Oral Cholera Vaccine Trail”. At that time historic oral cholera vaccine trial was going on at Matlab which was an enormous study enrolled thousands of people from Matlab. He said since we were the doctors from ICDDR, B they claimed treatment from us but they did not know that we had not involvement with the vaccine trial at all. Some people seemed to be very angry and complaining a lot about vaccine they had taken. Many had been complaining of weakness and abnormal feeling since vaccine administration. I asked Mr. Das to write some prescription for them but he technically avoided and said they would be happier if I wrote those. By the time we finished it was almost dark. That day we had to come back without seeing the child at Lamchari because in artificial light the rash would be difficult to examine and confirm.
 
In the evening, after we finished all our tasks including following morning mail to Dhaka, I asked Mr. Emdad why the people in villages called Mr. Rahman and Das doctors. He smiled as he was also being called the same, and said all the health assistants/field workers of ICDDR, B were called doctor in Matlab area. Many ICDDR, B staffs were sanitary inspector at earlier time and they used to treat cholera and other diarrheoal disease and earned the fame as doctor and so had Siddique dactar (doctor) or Monoranjan dactar (doctor). He said doctor with medical graduation were called “ “Bara Dactar” (big doctor). I got cleared of my confusion. I noticed if I was accompanying the Mr. Rahman or Das people in village always preferred prescription from me, the “Bara Dactar” not from CRL dactar.
 
Gradually, over the years Matalb, in my view, has lost a lot of its natural beauty and serine silence, that I used to enjoy very much, although more beautiful buildings have been constructed, more mechanical vehicles ply on the road, electricity reached every house in every village, gas and piped water supply has been established. People can no longer move around in their small boat from one village to another to visit their relatives and friends during monsoon. Mechanized boats have replaced sailing boats, fishing population squeezed to a very small minority or nearly disappeared, not because the people who used fish do not like fishing as occupation anymore but rather due to lack of enough fish in the river. Only thing still remained unaltered is the relationship between CRL (ICDDR, B) and Matlab people their popular addressing of “dactar” and “bara dactar” and that will probably continue as long as ICDDR, B continues its operation in Matlab.

P.S. I was inspired by Jean to write a story for David which reminded me that very soon we will be missing our real ICDDR,B Bara Dactar, Dr. David. Sack whose prescription and guidance made ICDDR,B so much strong and famous. We will also miss Jean naturally. Jean’s pleasant personality, endless energy and care for the young children and engaging them in various activities were remarkable. I wish David and Jean a very happy, healthy and long life.