Parwez Salman Chowdhury

Ashoka Fellow
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Bangladesh
Fellow Since 1994
PARICHARJA
This description of Parwez Salman Chowdhury's work was prepared when Parwez Salman Chowdhury was elected to the Ashoka Fellowship in 1994 .

Introduction

Parwez Salman Choudhury, a dermatologist, has developed a strategy that links medical treatment and health education for impoverished communities in Bangladesh that are at high risk for sexually transmitted diseases, HIV and skin disease. To avoid the social stigma that surrounds sexually transmitted diseases, he advertises his specialized services as a treatment center for skin-related diseases.

The New Idea

Parwez Salman Choudhury and his associates established a series of treatment center that focuses on the consequences of poverty, inadequate education and social discrimination in the spread of sexually-transmitted diseases (STDs). The mission of the center is to provide treatment, conduct research, and raise public awareness of STDs, AIDS and skin diseases. Dr. Choudhury's project has the potential to bring about change across all levels of Bangladeshi society because it is sensitive to the cultural issues surrounding the subject of sexually transmitted diseases in Bangladesh. Rather than create health centers based upon established western models, the organization attempts to work within the cultural strictures of Bangladeshi society. It is also unique in providing specialized skin and STD care at a rate that is accessible to the poor by offering consultations for a subsidized fee of Taka 10 (0.25 US$), compared to an average rate of Taka 300-500 (US$8-13) charged by other Bangladeshi clinics and hospitals. In addition to treating and educating individuals, Dr. Choudhury has launched a far-reaching public awareness campaign to bring about widespread changes in the way Bangladeshis associate behaviors and lifestyles with the spread of STDs. As a physician, he observed that the greatest impediment to eradicating STDs in impoverished communities is misinformation and the lack of dialogue. In order to bring his message to a population with a 35 percent functional literacy rate, Dr. Choudhury has pioneered visual and verbal ways to educate the public such as video films, dramas and songs.

The Problem

STDs and skin-related diseases are widely perceived in Bangladesh to be incurable, and highly contagious; the social stigma associated with these diseases is enough to deter people from seeking help for their basic medical needs. It is estimated that approximately 30 to 40 percent of Bangladeshis suffer from STDs and skin related diseases. With a lack of education and basic medical treatment, Dr. Parvez believes that it will be difficult to halt the rapid spread of STDs and skin disease throughout the impoverished communities of Bangladesh.The ratio of people per physician in Bangladesh is 12,500 to 1. A moist climate and inadequate sanitation levels have led to increasing numbers of people with skin problems. The majority of sufferers live in slums in dangerous sanitary conditions (less than half of the total population have access to sanitation services) with limited access to clean water. As the cost of diagnosis and medicine remains high, it prevents people at the lower end of the social ladder from obtaining follow up exams or precludes care all together.In Bangladesh, there is only one government institution that supports research on STDs and even less attention is given to skin-related diseases. Apart from the shortage of technical resources such as physicians, hospitals and research institutions, preventive measures such as awareness and education programs are rare and often do not reach the people who need them most. The STD epidemic in Bangladesh is particularly threatening to women, who are more vulnerable to the diseases and who face social restrictions that strongly discourage them from seeking information or treatment.

The Strategy

Dr. Choudhury has set up a private organization Paricharja staffed by volunteers that addresses not only health problems, but the increasing social problems associated with STDs, AIDS and skin diseases. His courage is reflected in his work in providing health care for people who are marginalized, bringing an issue that people are still unwilling to acknowledge into the mainstream of national awareness. His organization offers comprehensive and affordable care including consultation, diagnosis, research and treatment for the poor in a densely populated area of urban Dhaka. Dr. Choudhury conducts a wide range of clinical work including skin biopsies for flat fees that are 50 percent lower than the governments rates. The primary goal of Paricharja is to make patients aware of how they got their disease in addition to how to treat it and what steps they can take for prevention and recovery.A central component of Dr. Choudhury's program is a public awareness campaign that seeks to educate the general public about the causes of and treatment for STDs. Dr. Choudhury campaigns with posters and leaflets to raise popular awareness and organizes group discussions so that people can address these issues in a comfortable, supportive setting. Paricharja organizes film shows in rehabilitation centers, slums, brothels, local clubs and other sites where at-risk groups are concentrated. The films are an effective way to approach the subject of STDs in a culture where it is rarely talked about openly. After the film, a health worker facilitates a discussion about the subject and answers questions that the audience might have. Treatment and counseling is made available for those who request it. Dr. Choudhury also offers health camps, in which doctors and nurses volunteer to take a stock of donated medicines and set up one day camps in small towns outside Dhaka. Each camp can treat and educate up to 2,200 patients a day.Paricharja has also established a center in Taanbazaar, a Bangladeshi city in which the number of brothels has skyrocketed. Of the more than 5,000 commercial sex workers in the brothels of Taanbazaar, 40 percent test positive for syphilis. According to the prostitutes, most nongovernmental agencies visit the brothels to collect data and blood samples for their own research needs only, and do not provide treatment or education to help curtail the spread of STDs. Paricharja has adopted a different strategy, visiting the prostitutes twice a week to provide treatment and education on STD and HIV prevention through the use of condoms and safe sex. Dr. Choudhury does not hesitate to ask family and friends to help run his organization: he houses the institute in the ground floor of his father's residence. Much of the equipment in the laboratory and office furniture are donated. The current cost of running the institution is Tk. 43,000 (US$1,075) a year. Dr. Choudhury is inducing 43 people to pay Tk.1,000 (US$25) per year (in installments, if necessary) to meet the core operating costs. In line with Dr. Choudhury's long term plans, this kind of citizen support base will enable him to establish a network of self-sustaining health centers across Bangladesh treating at least 60 patients a day. He sees Paricharja both as an institution and a concept. There will be a Paricharja in every district, which will be financed ultimately from patient care services. The centers will provide curative and awareness programs relating to skin diseases, STDs and AIDS. The Paricharja outreach programs will treat patients in brothels and social welfare centers. Dr. Choudhury sees a role for other existing private care facilities working out of the Paricharja satellite centers, particularly in red-light districts, as a method of direct intervention. Trained nurses and medical officers will be available to provide initial care to the patients. Dr. Choudhury and his team will routinely visit these centers and will also be available for emergencies.

The Person

Dr. Choudhury's interest in dermatology began while he was a medical student in Bangladesh. The concept of establishing health camps first materialized while working for a tea plantation in Sylhet where he observed that the illnesses of the laborers were mainly caused by lack of awareness and poverty. In 1993, he left a lucrative private practice to form Paricharja.