Find the Missing Millions campaign among the indigenous people of Rangamati, Chittagong Hill Tracts.
The National Liver Foundation of Bangladesh (NFLB) is a non-profit organisation dedicated to the prevention and treatment of, and education and research on, liver diseases, with special emphasis on viral hepatitis. It was the first organisation of its kind to be established in Bangladesh.
By Professor Mohammad Ali, National Liver Foundation of Bangladesh.
The Chakma tribe is the largest indigenous tribe in Bangladesh, consisting of 444,748 people. The Chakmas mostly live in Rangamati, Chittagong Hill Tracts and have their own language, culture, tradition and history.
The Chakma people often subsist on the edges of mainstream Bangladeshi society. Largely medically underserved, many hold strong misconceptions about health and healthcare. According to doctors in the region, the majority of people don’t know anything about hepatitis B and C. As a result, most people living with chronic infection are either maltreated or receive delayed diagnosis at end stage liver disease or when they have already developed liver cancer.
Due to these factors, the Chakmas are vulnerable to viral hepatitis infection. So to mark World Hepatitis Day 2018, we decided to use the Find the Missing Millions programme to reach out directly to them and conduct a testing drive.
When we started planning it soon became clear that we needed to bring policy-makers from the Rangamti region on side to help us conduct the testing as flexibly as possible, in line with the Chakmas’ needs. We engaged with local politicians to educate them on the importance of hepatitis testing and motivated them to not only facilitate our event but also take action themselves.
Local NOhep activists from our “NOhep Network Bangladesh” worked to build relationships with the local people to promote the upcoming event. Our NOhep activists developed a partnership with student clubs from the local college. They demonstrated the safety of testing among the students and advocated them to go home and raise awareness amongst their networks.
On the day of the event, a team of 11 of us drove from Dhaka to Rangamati in our Find the Missing Millions branded minibuses. We took all the laboratory materials needed to conduct the screening, as well as awareness posters, leaflets and banner, with us. Once there, we set up a temporary screening lab and invited everyone and anyone to get tested.
After the event, we took the positive samples back to Dhaka in an ice container for confirmatory testing. We made sure to carefully take records of everyone who tested positive so that we could get back to them later.
The event would not have been possible without all the actors involved working together to ensure we could conduct the testing in accordance with the needs of the Chakma people.
Top tips for success
Our activity was a success thanks to the following factors:
- Indigenous peoples should be communicated with in their own dialects and languages. We therefore created awareness materials, including leaflets and banners, in the Chakma language.
- People need to be convinced about the safety of screening. Patient stories from people who have been tested and treated can help show people that getting screened is not dangerous.
- Our collaboration with the local government health authority, local doctors and civil society also helped make the activity a success. The project would not have been possible without our local NOhep activists working on the ground.
We did face some challenges, though, including:
- People within the Chakma tribe are medically underserved and many hold misconceptions on health issues, meaning those living with viral hepatitis are unlikely to seek treatment and instead visit traditional healers. We sought to address this by changing attitudes through building trust with and then educating people.
- Many people were scared by the idea of getting tested. We therefore had to show them that getting tested in safe and easy.
- The Chakma tribe has its own language and dialect. Many people don’t speak Bengali and many more can’t read either. We made leaflets and banners in their language, as well sketch posters showing the spread of viral hepatitis, so that we could communicate with everyone.
Achievements to date
Our achievements so far have been:
- On the day itself, we tested 810 people for hepatitis B and C, diagnosing 40 people with hepatitis B and two with hepatitis C.
- We educated countless people of the Chakma tribe about viral hepatitis, raising awareness amongst a key at-risk community in Bangladesh.
- We built links with and educated members of Parliament representing the Chakma peoples, meaning they are now motivated to raise the issue of viral hepatitis in our national Parliament.
- Diagnosing at-risk communities is key to achieving the elimination of viral hepatitis.
- Parliament and government officials representing at-risk groups must be informed about viral hepatitis and its consequences so they can take action in their communities.
- We need to work together to achieve our shared goal of elimination.
Find out more
If you’re interested in finding out more about how to advocate with policy makers to do testing as flexibly as possible for people from vulnerable populations, contact Professor Mohammad Ali at email@example.com.