In a coastal village in Patuakhali in the south of Bangladesh, two women are proving that while babies are born, heroes are made.
For almost 10 years, a social worker named Layli Begum has been working tirelessly to build awareness about safe sex and maternal health in Nilganj, Kalapara Upazila.
Even when Layli succeeds in enlisting women to the village’s only clinic, she encounters a far larger hurdle.
To describe the Union Health and Family Welfare Centre in Nilganj as “severely understaffed” would be an understatement.
The clinic is serviced by a solitary family planning inspector named Ela Rani, who single-handedly tends to the gynecological and maternity needs of over 200 women daily.
Visiting the clinic with Layli, it was apparent that demands have far surpassed the supply a long time ago. Ela was surrounded by more patients than she could possibly pay attention to, but did so nonetheless.
“When I first started working, it was hard to get women to even talk about these issues,” Layli told the Dhaka Tribune. “But in the past two years I have successfully stopped 25 home births, and have managed to convince many women to start going on birth control – just like me.”
With Layli’s help, Ela has been able to administer the ever popular tri-monthly Depo-Provera birth control injections – commonly known as the “Depo shot”.
“Birth control has been increasingly gaining popularity with women preferring the Depo shot because people use condoms sparingly as men seem to not prefer them,” Ela explained. “Women also prefer the tri-monthly shot because they think oral contraceptive will make them fat.”
Layli said that women in the area used to bear an average of five or six children but this has not dropped to three due to the prevalence of birth control that she has helped to popularize.
Given that Bangladesh has an ever growing population - the last census in 2016 put the figure at 165 million - people like Ela and Layli are thankless public service providers who are helping women gain control of their bodies.
Back at the clinic, Ela informs that she alone has to deliver almost 20 babies a month.
“I have repeatedly asked for more staff but my requests have fallen on deaf ears,” she said. “There is not a single doctor, nurse or a midwife here; everything is done by me.”
Ela’s job description does not mention medical services provision but because the clinic is so chronically understaffed, she has no choice but to do all of these things herself.
On one occasion, there were so many women visiting the clinic that Ela had to join two beds together and put three women on it to deliver their babies.
“This in an unsustainable situation and cannot be allowed to continue,” she said.
“Considering population of this area, we need at least four people at the clinic: a doctor, a nurse, a health inspector, and a maid.”
Few people would argue that Ela’s services are indispensable.
Hanif Hawlader can thank her for saving the life of her daughter, who was rushed to the clinic after a home birth attendant made a rudimentary episiotomy (an incision in the perineum) that left her bleeding for hours. Ela stitched up the wound before Hanif’s daughter bled to death.
“Many women give birth at home with unskilled attendants and end up contracting diseases, developing fistula or worse, they bleed to death,” Ela said.
With all the work Ela is doing, the clinic still just has one bed for more than 200 patients. The building is more or less dilapidated with next to no cleaning staff available to serialize the place.
“A lot of the times I have to deliver a baby with the help of the woman’s family and usually without any medicine,” Ela said. “If the birth is complicated then I have to send them to the Upazila Health Complex because this clinic is severely ill equipped.”
Nasir Uddin Mahmud, chairman of Nilganj Union Parishad under Kalapara Upazila under which the clinic falls, said the people of the area feel “desperate and neglected” about the situation at the clinic.
“Despite repeated requests, the government has paid no heed to our plight,” he said. “I have asked the Ministry of Health for help but nothing has materialized as of yet.”