Newsletter No. 423

No. 423, 19.9.2013 3 「孟 加拉國家貧困，然而醫院的設施卻比我想像中 完善，是我意料之外，使我印象深刻。」賽馬會 公共衞生及基層醫療學院（JCSPHPC）公共衞生碩士生 鄭詣殷 ，於7月與八位該院師生到孟加拉交流六天，得到 以上體會。是次考察為全球衞生暑期課程的其中一部分。 是次交流旨在讓學生了解發展中國家的公共衞生情況，實 踐所學的全球衞生理論，並與孟加拉的公共衞生界開展持 續的合作和交流。 另一位參加者碩士生 袁晞勤 表示，此行令他眼界大開，收 獲豐富。他稱：「透過出席講課、參觀醫療設施，以及與當 地學生交流，我們對這國家的基層醫療服務與及市民如何 使用該等服務，了解更全面。」 師生抵達孟加拉首都達卡時，適值是回教齋戒月的 午夜，他們坐小型客貨車往醫科學院Green Life Medical College（GLMC），發現沿途沒有交通燈，道路連行車線 也欠奉，街上交通一片混亂。根據孟加拉的國家交通部門 數字，每年該國的道路意外死亡率為每萬輛汽車85.6人。 孟加拉的脊柱受損或癱瘓病人中，原因主要是嚴重交通 意外，亦有不少是人為災害。交流團訪問了當地的癱瘓患 者復康中心，看到病人年紀輕輕便沒了手腳，大家都不禁 心裏一酸。今年4月於首都的工業大廈拉納廣場倒塌，造 成一千一百二十九人死亡，被稱為世上最嚴重工業慘劇之 一，康復中心也特設病房照顧是次意外的傷者。 腹瀉的專科醫院十分罕見，而孟加拉便有一所。師生到訪 當地的國際腹瀉疾病研究中心，原來腹瀉是導致孟加拉兒 童死亡的主因之一，該中心設有新生嬰兒的深切治療室、 兒童營養不良復康病房，以及愛滋病患者的隔離病房。 院內設置專為腹瀉病人而設計的病床，床中央開了洞，下 方放置塑膠桶，既承接病人的排泄物，亦可量度其脫水情 況。目睹醫護人員靈活運用有限的設施和資源，致力提供 最佳服務，眾人皆深受感動。 他們此行亦抓緊機會，與GLMC的醫科生交流，發表公共 衞生專題報告，並進行小組討論，課題包括衞生財政、城 市規劃、流動人口衞生、氣候變化、災害管理、青少年健康 及臨床篩檢等。 率團的JCSPHPC全球衞生中心主任 葛菲雪 教授說：「孟 加拉之旅給我們深刻的經驗─親身體會貧窮造成的困 境，以及施行公共衞生措施的重要。我們將續與當地同行 及友儕聯繫，交流經驗。」她並透露，全球衞生中心已與 GLMC簽定備忘錄，會續辦暑期課程，除碩士生外，公共 衞生的本科生也可參與。「我們並計劃開展孟加拉家庭衞 生調查，期以協助當地改善衞生系統。」 交流團成員及JCSPHPC臨床專業顧問 Anisha Abraham 教授說：「學生此行獲益良多，不但讓他們了解發展中國 家的環境衞生、腹瀉疾病及人口膨脹等公共衞生問題的複 雜性，並能實踐所學。」 ‘G iven that the nation is relatively poor, the hospital facilities at Bangladesh are better than I expected. I was quite surprised and impressed by them,’ said Ms. Maria N.Y. Cheng , Master student of public health (MPH), Jockey Club School of Public Health and Primary Care (JCSPHPC), who spent six days in Bangladesh in July with other eight students and teachers from the school as part of a global health summer course. The trip allowed them to gain exposure to developing countries and to experience global health principles in action. It also enabled the school to establish ongoing collaboration and mutual exchange with the Bangladesh health community. According to Mr. Higgins H.K. Yuen , MPH student, the trip was really fruitful and eye-opening. He said, ‘Through listening to the lectures, visiting the health care facilities and discussing with local medical students, we could gain a more thorough picture on how primary care services are delivered and how people can gain access to the services in this nation.’ When the team arrived in Dhaka, the capital of Bangladesh, it was almost midnight and it was in the midst of Ramadan. A small van carried them to the Green Life Medical College (GLMC). They were surprised that there were no traffic lights or lanes and the street was extremely chaotic. According to the Road Safety Cell of the Bangladesh Road Transportation Authority, the annual fatality in road accident in Bangladesh is 85.6 per 10,000 vehicles. Many people in Bangladesh suffer spinal injuries and paralysis not only from the heavy road traffic accidents but also some man-made disasters. The team members went to visit the Centre for the Rehabilitation for the Paralyzed in the Centre Savar Occupational Recovery Clinic. It was a moving experience when they saw young men and women who had lost their legs and arms. There were even special wards for victims from the Rana Plaza tragedy. Rana Plaza collapsed in April killing 1,129 people. It’s also known as one of the worst industrial accidents in the world. It is rare to have a hospital solely for diarrhea patients. However, there is one in Bangladesh and the team visited the International Centre for Diarrheal Disease Research, Bangladesh. Diarrheal illness is one of the leading causes of child mortality in Bangladesh. The hospital also has a special Intensive Care Unit ward for newborn babies, a children malnutrition rehabilitation ward and an isolated ward for HIV positive patients. They were surprised by the unique treating bed for the patients with diarrhea in hospital. There was a hole in the middle of the bed and also a plastic bucket under the bed collecting the waste, which was to assess patient’s output of dehydration. Team members were all impressed by the facilities and the health care people who were dedicated and doing their best with the limited resources. The team interacted with medical students from the GLMC, gave presentations on public health topics and led interactive small group discussions. Discussion topics ranged from health financing to urban-planning, from migrants health to climate change and disaster management, as well as adolescent health and clinical screening. Prof. Sian Griffiths , director of the Centre for Global Health of the JCSPHPC, who led the team, said, ‘Visiting Bangladesh was a powerful experience for us all—one which allowed us to see first-hand the problems of poverty and the importance of public health measures. We will continue to develop our link and share experiences with our colleagues and friends in Bangladesh.’ She also revealed that the Centre for Global Health and the GLMC have signed the MOU to continually carry on the global health summer course in Bangladesh. MPH students as well as BSc public health students will be brought to the field. ‘We are planning a household survey in Bangladesh communities focusing on health care and hope the study will provide valuable statistics and political recommendations for improving health care system there.’ Prof. Anisha Abraham , team member and clinical professional consultant of JCSPHPC, said, ‘I thought it was a wonderful opportunity for our students to understand the complexities of public health issues in a developing country such as sanitation, diarrheal illness and over-population. The trip to Bangladesh helped to put theoretical concepts into a real world context.’ 近觀孟加拉 醫療系統 A Closer Look at the Health Care System in Bangladesh 左起：（前排）Anisha Abraham教授、葛菲雪教授、公共衞生碩士生Michelle Wilson、（後排）Abu Adamu Ismaeel、陳俊彥、胡小劼、鄭詣殷、黃凱基及袁晞勤 From left: (front row) Prof. Anisha Abraham, Prof. Sian Griffiths and Michelle Wilson, (back row) Abu Adamu Ismaeel, Aaroy Chan, Catherine X.J. Hu, Maria N.Y. Cheng, Wong Hoi-kei, Higgins H.K. Yuen, Master students of public health 專為腹瀉患者而設的病床 Special beds for diarrhea patients 街道衞生環境惡劣 Streets are full of rubbish