Day visit cd batch completed

DEPARTMENT
OF
COMMUNITY MEDICINE
SHAHEED SUHRAWARDY MEDICAL COLLEGE
SHER-E-BANGLA NAGAR, DHAKA
DAY VISIT REPORT
2nd Professional Examination- July, 2014
ROLL NO. :
REGISTRATION NO. :
SESSION :

CONTENTS
Day
Visit
No.
Name of Organization Date of
Visit
Page
No.
01. Water Treatment Plant 18.03.2014 1
02. Pagla Sewage Treatment Plant 19.03.2014 5
03. Expanded Programme on Immunization
(EPI) Headquarter
20.04.2014 9
04. Institute of Epidemiology, Disease Control
and Research (IEDCR)
21.04.2014 16
05. Institute of Public Health (IPH) 22.04.2014 24
06. International Centre for Diarrhoeal Disease
Research, Bangladesh (ICDDR, B)
23.04.2014 30
07. Mohammadpur Fertility Services and
Training Centre
24.04.2014 35
08. Infectious Disease Hospital 26.04.2014 40
09. Centre for Rehabilitation of the Paralyzed
(CRP)
27.04.2014 43
10. National TB Control Project (Chest Clinic)
Disease
28.04.2014 50

1
DEPARTMENT OF COMMUNITY MEDICINE
SHAHEED SUHRAWARDY MEDICAL COLLEGE, DHAKA
Day Visit No.1
Name of the organization Water Treatment Plant
Type of organization Government Organization
Date of establishment It was established in 1878
Location of the organization Chandnighat, Lalbagh, Dhaka
Date of visit 18.03.2014
Goals and Objectives:
To supply safe water among 15 lakhs of people of old Dhaka City.
Existing Resources Available at the Organization:
1. Economic Support:
a. Water bills from consumers.
b. Government contribution.
c. Foreign country contribution.
2. Manpower
3. Plant Equipment:
a. Conventional equipment
b. New equipment from JAPAN Government.
Achievements:
The organization provides safe water supply about 2.5-3 crore liters/day
among the population who reside the area extending from Lalbagh to BDR gate.

2
Treatment of River Water to Supply Safe Water
Flow Chart of Water Treatment:

3
Problems/Constraints:
1. Load shedding, low voltage.
2. Lowering of ground water levels.
3. Drying up of rivers.
4. Lack of pipe replacement due to limitation of fund.
5. Mechanical faults.
Personal Observation and Opinion Regarding the Visit:
1. Lack of manpower.
2. This water treatment plant depends totally on the availability of water from
the river Buriganga, which in dry season can’t meet the need of water
adequately.
3. The use of Maxfloet is very appreciable because of its strong purifying
action.
Conclusion:
Dhaka water works is one of the best water treatment plants in Dhaka. But in
dry season it can’t provide adequate water supply to the people. So to make this plant
more effective, more water should be received from other sources like river Turag,
Dhaleshwary. It is necessary to use pure water to prevent water borne diseases and for
better life. So, Government should pay more attention about this.

4
Organogram of the Organization:
1. Executive Engineer-01
2. Assistant Engineer-01
3. Sub-Assistant Engineer-01
4. Foreman-01
5. Laboratory Assistant-01
6. Pipe Line Inspector-01
7. Filter In-Charge-01
8. Filer Operator-06
9. Pump Operator-12
10. Electrician-01
11. Driver-01
12. Helper-02
13. Mali-01
______________________ _______________________
Signature of the teacher Signature of the student
Date: Date:

5
Day Visit No.2
Name of the organization Pagla Sewage Treatment Plant
Type of organization Semi-Government organization
Date of establishment 1973 (modernized in 1992)
Location of the organization Pagla, Narayanganj
Goals and Objectives:
Treatment of sewage of Dhaka city and thus reduce pollution..
Existing Resources Available at the Organization:
Provided by Bangladesh Government
Existing resources are not sufficient.
● Activities and achievements:
Activities:
1. Treatment of sewage and disposal of treated sewage
23 Lift pump stations in Dhaka
↓
Inlet of plant
↓
Course screening
↓
3 Lift pumps

6
↓
Grit chamber
↓
Fine screening
↓Gravitational flow
Distribution chamber
↓
4 primary sedimentation tanks
Effluent Sludge Scum
Lagoons A & B Sludge pump
(Biological treatment)
Buriganga River Drain
2. Testing the quality of effluent by BOD and suspended
solutes
Achievements:
The plant treats 4000 cubic meter of sewage daily. It serves
1/3rd
area of Dhaka city.

7
Organogram:
Management Division
1. Executive engineer – 1 1. Driver – 1
2. LDA cum typist – 2 2. Peon - 2
3. Cashier – 1 3. Mali - 1
4. Store keeper -1 4. Cleaner - 1
S.D.E/ Assistant Engineer -1 S.D.E/ Assistant Engineer -1 Laboratory
•Assistant microbiologist-1
•Lab Assistant -1
Operation & cleaning for Maintenance of Pagla S.T.P
Pagla S.T.P & all other sewer lift station
1st
Shift 6 am – 2 pm
•Sub assistant engineer -1 •Sewer cleaner – 8
•Foreman – 1 •Electrician - 1
•Pump operator – 5 •Treatment plant 1st
Shift 6am – 2 pm
•Wireless operator – 1 assistant – 1 •Sub assistant engineer - 1
•Generator operator – 1 •Peon – 1 •Foreman - 1
•Electrician - 1
2nd
Shift 2 pm – 10 pm •Helper - 4
•Sub assistant engineer – 1 •Sewer cleaner - 8 •Wireless operator -1
•Pump operator – 5 •Treatment plant •Mechanic - 1
•Generator operator – 1 assistant – 2 •Driver - 1
•Helper – 2
2nd
Shift 2 pm – 10 pm
3rd
Shift 10 pm – 6 am
•Pump operator – 4 •Sewer cleaner – 3 •Electrician - 1
•Generator operator – 1 •Treatment plant •Helper - 2
Assistant – 2 •Driver - 1
•Helper - 2
• Security & intelligence division
1. Head guard – 2
2. Guard -

8
Problems
1. Insufficient fund
2. Insufficient security system for the plant area
3. No measures for protection of workers from hazards of sewage
Personal observation and opinion
It is the only existing sewage treatment plant in Bangladesh which covers only 1/3rd
of the Dhaka city. We observed all the machineries, plant lagoons and other facilities
by which the waste products are treated. It really seems to be a master plan to cope
with the population growth of the Dhaka city. But lack of modern technology,
insufficient laboratory facilities and manpower shortage are its main obstacles.
Conclusion
In 1923 the sewage system was 1st
established in Dhaka city. The Dhaka WASA
established a lagoon in Pagla in 1977 which was modernized during 1989-1992 in its
present status. More financial support from Govt. and mere international co-operation
is required for the establishment of new plants.
______________________ _______________________
Date: Date:

9
Day Visit No.3
Name of the organization Expanded Programme on Immunization (EPI) Headquarter
Type of organization Government Organization under the supervision of Health
& Family Welfare Ministry
Date of establishment 7th April, 1979
Location of the organization Mohakhali,Dhaka- 1212
GOALS AND OBJECTIVES
 To achieve & maintain by 2005, 90% vaccination rate against all seven
vaccine preventable diseases all over Bangladesh.
 To eradicate Poliomyelitis by 2008 & maintain the eradication status.
 To eliminate maternal & neonatal tetanus to less than 1/1000 live births in all
districts from the present 2.3 per 1000 live births by immunizing mothers
under TT5 program.
 To expand Hepatitis B vaccination & reduce prevalence of chronic HBsAg
carriers by 80% by 2010 compared to 2003.
 To reduce Measles mortality & morbidity by 90% of 2006 compared to 1999
Estimate
 Hibis included in EPI schedule on 2008 as a pentavalent vaccine with DPT &
Hepatitis B to reduce the morbidity & mortality.
EXISTING RESOURCE
MANPOWER
 The headquarter is run by a competent staff comprising of-
 1 Programme manager.

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 1 Deputy programme manager
 6 Assistant directors
 8 Medical officers
 1 Logistic officer
 1 Store manager &
 154 other officers & staffs
FINANCIAL SUPPORT
 Only 16% of the routine EPI vaccines are financed by the Govt. of
People’s Republic of Bangladesh.
 WHO, UNICEF and other donor agencies like USAID, World Bank,
Rotary international, American Red Cross, GAVI of governments of
other countries provide financial & technological support to this
programme.
LOGISTICS
 Vaccines, e.g. BCG, DPT, OPV (Polio), Measles, Hepatitis B & Tetanus
toxoids, Hib Vaccine
 Vitamin A & anti-helminthes.
 Vaccine preservation rooms: Cold storage &freezer compartments.
 Instruments consisting of the following:
o Steam sterilizer.
o Sterile syringe.
o Sterile needle, cotton & forceps.
o Timer to count time for sterilization.
o Blue coloured plastic bowl to keep used syringes.
o Ampoule cutter: to cut BCG & diluents ampoule.
o Cotton holding pot.

11
ACTIVITIES
 Expanded Program on Immunization throughout the whole country through
1,35,000 vaccination centers.
 Conducting supplementary immunization which includes
 NID (National Immunization Day)
 Mop up campaign (where 90% coverage is not achievement)
 NNT campaign
 Measles campaign
 TT campaign
 Immunization against tetanus of all woman of child bearing age (15-49
years)
 Provide cross border immunization to people.
 Provide training for the workers.
 Provide cold storage and transport facilities for vaccine.
 Various training courses for doctors & other health professionals. Launching
Vitamin A campaign to provide high potency vitamin A to all children under
5 to prevent nutritional blindness.
 Above all, EPI has been working tirelessly to achieve the international goals
set by WHO in the field of vaccination through setting up national targets,
devising strategies to achieve them & involving the community for actual
realization of its goals.

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ACHIEVEMENTS
 Valid coverage for fully immunized children increased from 52% in 2001 to
>75%in 2010.The access to immunization has been continually high.
 The BCG vaccination rate of 1 year old children has reached a prestigious
99%through EPI programmes at the end of December 2010.OPV, DPT (89%),
OPV3 (94%), Measles (89%).
 Polio vaccination was given in four doses with 98% of the children receiving
the first two doses,96% the third dose & 94% completing the full
immunization course by taking the fourth dose(December 2010).
 Coverage of the first, second & third dose of vaccine were 96%, 95% &
94%respectively at the end of 2010.
 Measles vaccine was successfully administered to 89% of the children at the
end of2009.
 EPI successfully introduced vaccination against Hepatitis B on 12th
April,
2003. Although initially it was confined to 25 districts & 5 city corporations, it
has now been expanded nationwide with a vaccination rate of 95% in case of
first & second doses & 94% in case of third dose of Hepatitis B
vaccine(December 2010):
 Immunization of pregnant women & women of child bearing age by Tetanus
Toxoid (TT) is being carried out under this programme. Thus Bangladesh is
now on the verge of eliminating neonatal tetanus.
 According to the statistics at the end of 2010, the coverage rate of vitamin A
supplements stood at 89% & more than 12 million children had received
deworming treatment through reinforcement measures of this programme.
 One of the most outstanding achievements of this program is the mass
awareness on the importance of vaccination, which led to active community
participation & current high rate of vaccination coverage.
 The activities of this programme have consequently led to a reduction in the
incidence of the 7 vaccine preventable diseases as well as mortality &
morbidity resulting from them.
 In 2004, EPI introduced nation-wide use of auto-disabled syringe in 23rd
June
2009 & introduced Hib vaccine nationwide as pentavalent vaccine which
included DPT, Hepatitis B and Hib.

14
PROBLEMS & CONSTRAINTS
• Supervision & monitoring systems are inadequate.
• Distribution of vaccines is clustered to urban areas & rural areas with better
transport facilities. This inadequate & improper distribution is a major constraint
of EPI.
• Due to lack of awareness, a large number of people left out & they never take any
vaccine. This left out population is difficult to detect unless home visits are paid.
• Preservation facilities are not up to the mark at the field levels.
• Drop out of vaccination is a serious hindrance in achieving the goals of this
programme. (Some people after taking the first dose of vaccine, do not return to
vaccination outreach centers to take the subsequent doses & to complete the
schedule. This incomplete vaccination does not provide the adequate level of
immunity against the particular disease.)
• Subsequent dose of a vaccine is often given before completion of the minimal
time interval resulting in decreased efficacy of the vaccination.
• Maintenance of the vaccination card is poor. So, record of full completion of the
vaccination schedule of individuals is not accurate.
• Precise statistics about vaccination coverage is difficult to obtain due to poor
record keeping. On one hand this hampers planning & policy making of national
health system; on the other hand monitoring the progress towards achievements
of the goals becomes difficult.
• Due to lack of appropriate financial support DT wp (Diphtheria Tetanus, whole
cell pertussis) vaccine is given instead of DT ap (Diphtheria Tetanus, acellular
pertussis) which sometimes give rise to convulsion

15
PERSONAL OBSERVATION AND OPINION
The activities of institute of EPI have not yet reached up to the mark. Administrative
system is not so good & there is lack of adequate skilled power & sufficient
equipments. But in the organization, the workers are very co-operative & there is
good relationship & understanding among staff working there. The staff at EPI is one
of the finest we have seen. The standard followed by them is indeed of international
quality. However, it should try to make the procurement of vaccines easier by taking
steps to reduce the national import expenditure.
CONCLUSION
Children of today can be a great resource & help a lot in the development &
prosperity of a country because they are the future citizens of the country.
On the contrary, they could be a burden when they are victim of eight most dangerous
diseases which may make them cripple. Children as well as women comprise a large
proportion of our population & they are the most vulnerable group. So, they must be
protected from all eight preventable diseases that makes them burden to the society. In
this field, EPI is playing a pioneer role by providing various vaccines & immunization
programmes. Reducing the mortality & morbidity of the newborn could make a lot of
difference in the health indicators of our country. EPI with its fine line up of
professionals is trying to give their best.
______________________ _______________________
Date: Date:

16
Day Visit No.4
Name of the organization Institute of Epidemiology, Disease Control and
Research (IEDCR)
Type of organization Government organization
Date of establishment 1978
Location of the organization Beside DGHS, Mohakhali, Dhaka-1212, Bangladesh
DESCRIPTION OF THE ORGANIZATION
IEDCR is a government organization dealing primarily with epidemiology of diseases
of public health importance. The six stored IEDCR building span over approx 30,000
sq ft. of space, adjoining the DGHS, Mohakhali, Dhaka. It conducts researches
through and well equipped departments. The departments are -
 Department of Epidemiology
 Department of Microbiology
 Department of Virology
 Department of Parasitological
 Department of Entomology
 Department of Zoonosis
 Department of Biostatistics
 Department of Medical Sociology
It has a three storied infrastructure. The first floor is having Virology, Medical
sociology, Epidemiology, Parasitological & Biostatistics department along with the
chambers of the administrative officers.

17
HISTORY OF THE ORGANIZATION
IEDCR was established in 1978 through a bill approved in Parliament. This institute
previously known as the malarial institute of East Pakistan an (MIEP) was relocated
to its present site from a government building in old Dhaka. Central Malarial Institute
of East Pakistan itself was bisected from Central Malarial Institute of India (CMII) in
1947.It was attached with NIPSOM and its laboratory in 1978.Due to different
objectives of the institutes the goal of creating IEDCR was not implemented.
Accordingly the government of Bangladesh separated IEDCR from NIPSOM in July
1981.
OBJECTIVES OF THE ORGANIZATION
 To conduct research on communicable and other prevalent disease vectors.
 To establish epidemiological baseline data and formulate the ways and means
for their effective control.
 To determine specific disease pattern and formulate the ways and means for
their effective control.
 To establish a network of epidemiological surveillance.
 To monitor the incidence of communicable and non-communicable diseases of
national importance and act as a central monitoring station of an
epidemiological intelligence service.
 To assist the government in reviewing, planning, and formulation of various
disease control programs and improvement of primary health care service.
 To offer training in applied epidemiology and field oriented research and
diagnosis in order to develop health man power in these fields.
 To disseminate information of epidemiology and related health matters.
 To develop the laboratory facilities of the institutes to act as reference labs on
specific diseases and to strengthen the peripheral labs to act as sentinel
surveillance sites.

18
ORGANOGRAM
Donor’s Support
Group
Board of trustees
Public
Health
Service
(control
Mat lab
and All
Field Site)
Health
System and
Infection
disease:
Vaccine Trial
(Rota Virus
Pneumonia)
Director (Executive Director)
Clinic
Science
Laboratory
Science
Director’s
Division

19
TECHNICAL EXPERTS AVAILABLE IN THE INSTITUTE
Department Name of degree Experts
Administration Administrative officer 1
Others 33
Epidemiology Chief Scientific officer 1
Principal Scientific officer 1
Senior Scientific officer 1
Medical officer 1
Others 13
Medical Entomology Chief Scientific officer 1
Principal Scientific officer 1
Secondary Scientific officer 1
Medical officer 1
Scientific officer 1
Junior Scientific officer 2
Others 13
Parasitology Principal Scientific officer 1
Secondary Scientific officer 1
Others 4
Virology Chief Scientific officer 1
principal Scientific officer 1
Medical officer 2
Microbiology principal Scientific officer 1
Others 10
Zoonosis Chief Scientific officer 1
principal Scientific officer 1
officer 1
Others 4
Bio-statistics principal Scientific officer 1
Scientific officer 1

20
FACILITIES AVAILABLE
 Various kinds of laboratory equipment like-
 Minus 70 degrees Celsius freezes.
 Fluorescent microscope
 Refrigerated centrifuge
 Colorimeter.
 Chemicals.
 Reagents including various antigens.
VEHICLES AND SUPPLIES
 There are one microbus, four jeeps, one car and several motor cycles.
 Availability of computer/ data analysis services.
 Availability of other services like financial personal management, structure to
monitor field studies communication including
 Six telephone lines
 Internet system.
 Fax facilities.
 Access to study population in and outside Dhaka.
ACTIVITIES AND SERVICES OF THE ORGANIZATION
 Establish weekly epidemiological surveillance and information system that
ensures gathering data about six communicable diseases from all over the
country as well as other diseases from the endemic areas. Provide feedback
based on the information through analytical views and suggest appropriate
measures to the authority concerned.
 Maintain an epidemiological database and help in formulation of health
policies and plans.
 Assist the govt. in reviewing planning and formulation of various disease
control programs.

21
 Conduct various researches (basic and applied) on communicable and other
prevalent diseases and disease vectors and behavioral aspects of population.
 Monitor the incidence of disease of public health importance including the
emerging and re-emerging diseases and act as a central monitoring section of
epidemiological intelligence service.
 Conduct testing of antimicrobial susceptibility to various samples.
 Impart training to the health personals of different strata of National Health
System.
 Conduct outbreak investigation and suggest measures to control and contain
health emergencies.
 Test the susceptibility status of vectors to insecticides (Geological efficacy
testing).
 Maintain hatchery for breeding mosquito for their biological study. Conduct
research on transmission of vectors of different disease.
 Perform as central referral dept. for insects of medical importance.
 Production and distribution of direct agglutination test (DAT) antigens for
diagnosis of Kala-Azar in different health settings of the country.
 Conduction of research on social aspects related to health, sociological,
demographic, nutritional problems and behavior.
 National referral lab for dengue antibody detection and performing sero-
surveillence of probable cases.
 Central referral institution for national surveillance of probable cases.
 Central referral institution for national surveillance of HIV/STD/AIDS as
entrusted within the HPSP.
 Testing effectiveness of insecticides for the city corporation and agriculture
department.
TRAINING
 Field training.
 Laboratory technicians training.
 Orientation and re-orientation programs.

22
ACHIEVEMENTS
 Introduction epidemiological information system. (EIS).
 7th round of STD serosuvey research by microbiology department.
 Outbreak investigation.
 Setup direct agglutination test (DAT) for Kala-Azar.
 Sentinel surveillance.
 Setup of upazilla epidemiological teams and district epidemiological units.
 Periodic conduction of communicable disease survey.
 Surveillance on STD/HIV/AIDS and dengue.
 Conducted study on filariasis.
RECENT ACTIVITIES OF THE INSTITUTE
 Phase 4 trials for Miltefosin to treat Kala-Azar.
 Phase 3 trials for Inj. Amphoteresin B for Kala-Azar.
 Epidemiological investigation of Jaundice in Jheneidah.
 Epidemiological investigation of Nipah virus for past 4 years.
 Investigation of Obesity pattern in Dhaka.
LIMITATIONS AND PROBLEMS FACED BY THE ORGANIZATION
 Most of the departments have no senior competent employee related to that
department, but at the junior level (SSO, MO, SO) competent employees were
seen.
 Periodic work, only when there is an outbreak.
 Some employees are reluctant to visit the field.
 Unlike private or NGOs, IEDCR has got no financial freedom of its own. It
has to look for funds from sponsoring agencies like WHO, UNDP, BMRC.
FUTURE PLAN OF THE ORGANIZATION
 Equip IEDCR with the state of the art logistics.
 Build up a highly spirited team of dedicated, disciplined, dynamic,
professional, skilled, efficient and effective scientists and support staff.

23
 Create an attractive working environment and maintain it.
 Contribute towards the prevention and control of disease, disability and death
through conduction of useful surveillance and other information system.
PERSONAL OBSERVATION
The building is an old one and needs renovation. It has been proved to be an effective
organization to take preventive measures against some of the communicable diseases.
But better efficacy can be achieved if proper logistic support is given. Frequently it
faces the problem of power supply.
CONCLUSION
IEDCR is playing a very effective role in controlling disease and thus improving the
health sector of Bangladesh. But unfortunately it is not being able to perform with its
full efficacy due to some administrative problems and also due to lack of proper
financing. It is expected that the govt. will take proper measures to make this
institution an internationally reference one.
______________________ _______________________
Date: Date:

24
Day Visit No.5
Name of the organization Institute of Public Health (IPH)
Location of the organization Mohakhali, Dhaka-1212, Bangladesh,
 To produce vaccines, sera & other biological with assured quality to support
the primary health care activities.
 To play an effective role in quality assurance of drugs & vaccines.
 To assist the government, to prevent & control the major health hazard caused
by contaminated & adulterated food & water.
 To provide curative & preventive service by diagnosis of various infectious
disease including dengue, HIV/AIDS & polio.
 To organize training programs in the field of diagnosis, control & prevention
of infectious disease, food &water supply.
 To conduct various research activities in related fields of public health.
 To collaborate & cooperate with other national, international organizations
&agencies in the promotion of public health to keep abreast of recent scientific
& technological advances, developments & their adoptions.
EXISTING RESOURCE
 Skilled manpower.
 Financial supports from government.
 Logistics.

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ACTIVITIES
IPH is the only Institute in the country having biological production, quality control,
diagnosis &research facilities. The activities are performed in different units of four
major sections.
1. Biological production section:
a) Intravenous (IV) fluid production unit
This unit is engaged in production of adequate amount of several high quality
lifesaving fluids such as Glucose in aqua, Normal Saline, Glucose Saline, Cholera
Saline Haemodialysis and Peritoneal dialysis fluid, 3% Sodium chloride and Baby
saline for both the public and private sectors.
b) Blood Bag production Unit
The unit produces CPD blood collection bags (single, double, triple, quadruple, and
baby bags), infusion and Transfusion sets to meet the demand of public sector.
c) Pasteur cum Vaccine Institute (PCVI) Unit
The unit of IPH produces Anti Rabies Vaccine (ARV) using sheep brain and fixed
virus. The vaccine is constant supply at a subsidized rate to the people of the country.
The laboratory planned to produce new generation tissue culture vaccine.
d) Tetanus and Diphtheria Toxoid and DPT production Unit
The laboratories of this unit produce WHO standard tetanus toxoid vaccine to support
the EPI in Bangladesh. The unit has the technology to detect antibody of tetanus and
diphtheria toxoids in human sera. The unit is planning to produce combined DPT
vaccine.
e) Antisera Production Unit
Production of Polyvalent Anti Snake Venoms Serum (ASVS) against four different
snake venoms using horses in Antisera unit is a new dimension to the production line
of IPH.

26
f) Reagent Production Unit
To support, the laboratories in public sector this unit produces thirty different types of
diagnostic reagents including glucose, bilirubin, creatinine and urea estimation kits.
g) Oral Rehydration Salt (ORS) production units
Five ORS production units of IPH located at Dhaka, Comilla, Jessore, Barisal and
Rangpur district & produce adequate amount of ORS to control diarrhoeal epidemic.
h) Quality Control Unit
The internal quality control unit performs all the physical, chemical, biological and
immunological to assure the quality of vaccines and IV fluids produced at IPH
2. Public Health and Drug Testing Laboratory:
a) Public Health Laboratory
The public health laboratory is the only National Laboratory engaged in analysis of
food and water samples according to the Bangladesh pure food ordinance, 1959, the
Bangladesh pure food rules, 1967 and international food cods. The laboratory
implements food safety program in collaboration with WHO.
b) Drug testing laboratory
The laboratory was established as per drug legislation of the country. It is a
government appellate authority in respect drug testing. It functions as the National
Control Laboratory (NCL) for vaccines and biological products. The laboratory takes
part in GMP inspection of pharmaceutical industries and clinical evaluation of the
products in collaboration with WHO.
3. Microbiology Laboratory:
The microbiology laboratory consists of three functional units.
a) Virology Unit
National Polio Laboratory, a WHO accredited laboratory assists Bangladesh to
eradicate wild poliovirus from the country with the support from WHO and acts as a
part of SAERO-WHO polio network. The laboratory is involved with the serological

27
study of measles and rubella to support Measles Control Program. HIV/AIDS
laboratory acts as one of the reference laboratory of the country.
b) Bacteriology Unit
The unit is actively involved in routine diagnostic work and various researches. Their
research is mainly focused on Respiratory and Diarrhoeal diseases.
c) Epidemiology Unit
The unit renders support to diarrhoeal and other communicable diseases control
programs in identifying causative agents, to combat disease outbreaks. This unit
performs researchers involving emerging and remerging viral and bacterial diseases.
4. Administrative Section:
The Director, Deputy Director, Assistant Director & the Units Heads administrate the
activities of the institute.

28
ORGANOGRAM :
ACHEIVEMENTS
IPH was awarded gold medal in the preventive sector for the eradication of small pox
in the year 1980.
 The institute produces a total of 15 lakh bags of IV fluid and 16 lakh vials of
anti-rabies vaccines per year.
 It introduced Monsur's media.
 IPH has set up polio isolation centers to eradicate poliomyelitis.
 It is the only national laboratory for testing and analysis of food and water
sample.

29
 Modern laboratory equipment is inadequate,
 Some of the vaccines are no longer produced as a result of
lack of logistic support
 Flaws in the administration
 Lack of skilled technician and manpower
 Anti-serum production has declined due to lack of animal
supply
 Human immunoglobulin is in demand now.
 Lack of appropriate modern laws for food & drug quality control
Rabies is a very fatal disease having 100% mortality rate. Prevention is the only
option available. This organization is providing anti-rabies vaccine and thus reducing
its mortality. Intravenous fluid is produced by the institution which is lifesaving &
thus contributing to the national health.
CONCLUSION
IPH has reputation for production of IV fluid, vaccines etc. The processes of detection
of purity of food and sterilization of IV fluid are good. Government should take
adequate steps for improving its present condition. By improving this hospital a big
step can be undertaken to improve the overall public health of Bangladesh.
______________________ _______________________
Date: Date:

30
Day Visit No.6
Name of the organization International Centre for Diarrhoeal Disease Research,
Bangladesh (ICDDR, B).
Type of organization Independent international non-profitable organization for
research, education, training and clinical services.
Date of establishment In 1978 as a successor of the Cholera Hospital which was
established in 1960to study the epidemiology, treatment and
prevention of cholera in its new name ICDDR,B
Location of the organization Mohakhali, Dhaka-1212.
Vision:
All the people specially poor can become healthier and can reach their full potential
through the application of new knowledge.
Mission:
To develop and promote realistic solution to the major health problem & nutrition
problems facing the poor people of Bangladesh & other settings.
EXISTING RESOURCE AVAILABLE:
1. Expert Manpower :
The workforce employed here is a mixture of local and international persons
including:
 Public health
scientist
 laboratory scientist
 Clinicians
 Nutritionist
 IT professionals
 Epidemiologist
 Demographers
 Experts in old & new diseases.

31
2. Finance:
Financial support is mostly derived from donors (Japanese Sasakawa Institution,
WHO). There is a system of taking payment of tk. 30 from the patient. But it is not
mandatory.
3. Other:
 Highly efficient laboratory services.
 Very rich library with latest articles, scientific publications of health related
states and events.
 Outdoor patient service department.
 Indoor patient service department.
ACTIVITIES
The centre maintains its activities through four divisions-
1. Clinical Science Division (CSD)
 Clinical & metabolic research
 Mother & child health services
 Nutrition programmes
 Community research
 Child Development Unit
 Clinical research & service centre
2. Health Systems & Infectious Diseases Division (HSID)
 Programme on infectious disease and vaccines sciences (PIDVS)
 Health system economics unit
 Health and family-planning systems
 Infectious diseases unit
 Surveillance and data resources unit
 Fields sites unit
3. Laboratory Sciences Division (LSD)
 Microbiology
 Acute Respiratory Infections
 Virology

32
 Parasitology
 Molecular Genetics
 Immunology
 Biochemistry
 Animal Resources
4. Public Health Science Division (PHSD)
 Epidemic control & preparedness unit
 Matlab health research centre
 Reproductive health unit
 Child health unit
 Health & demographic surveillance unit
 Social and Behavioral science unit
 Chakaria community health project
 The centre conducts hospital and community based clinical research on diarrhoeal
diseases, respiratory infection, nutrition and child development.
 The institution provides scientific laboratory based technology to address
diarrhoeal diseases and related health problems of the underprivileged population.
 The information science division facilitates the two-way transfer of knowledge in
and out of the centre.
 The centre in co-operation with the Government of Bangladesh conducts
community based family health research on maternal and child health,
communicable diseases, immunization, nutrition, reproductive health and health
care delivery system.
 It provides library and information services to the staffs and outsiders who have
library membership card.
 The centre conducts researches and training in collaboration with partner, from
research and academic, institutions throughout the world.
 The center provides clinical services on inpatient and outpatient basis.
 It is has created a population based field site at Matlab, Chandpur, Bangladesh.

33
ACHIEVEMENTS/AWARDS
 UMCEF's Maurice Pate Award - 1984
 USAID's Science &Technology for Development Award - 1987
 The best diarrhoeal disease hospital in the world - -1996
ORGANOGRAM

34
 ICDDR,B depends on the donors for maintaining its activities and services.
So, when there are fewer donations from the donors for even a short period,
the centre has to minimize its services and activities.
 Indoor facilities are sufficient in most of the time. But if there is epidemic
during the summer or rainy season, it faces enormous troubles to manage all
the patients properly. During this time it has to set up the temporary tents for
the patients. As number of patients is increasing day by day during epidemic,
all personnel have to remain busy at that time.
ICDDR,B is an international organization. The environment of the institute is
excellent and the hospital is well equipped. The doctors are very much skillful in the
care and handling of the patients properly. It has a rich library. This institute may play
a vital role in delivering quality health services in country like Bangladesh.
CONCLUSION
ICDDR,B has served not only the people of our country but also people of the whole
world by its innovative traits in managing patients with different diarrhoeal disease. It
is a national pride that such an institution exists in a country like ours.
______________________ _______________________
Date: Date:

35
Day Visit No.7
Name of the organization Mohammadpur Fertility Services and Training Centre
Location of the organization Aarongojeb Road, Mohammadpur, Dhaka- 1207
 To strengthen family planning activities
 To reduce total fertility rate(TFR) from 3.2 to 1 at least below 2 by the year
2015
 To increase couple protection rate (CPR) more than 60%
 To achieve net reproduction rate(NRR) - 1
 To provide service to the infertile ones
 Ensure and enrich reproductive health
EXISTING RESOURCES
 Manpower-total personnel of 74 of which 6 are first class officers, 9 are second
class officers, 34 are third class employees and 25 are fourth class employees.
 Financial support- Govt. of Bangladesh, outpatient services, hostel tuition,
MR and D&C services.
 Other facilities:
 Two 4 storied building having-
- Separate room for specific type of care,
- Operation theatre,
- Training and class rooms,
- Well decorated air conditioned seminar
room.
 Hostels for trainees with 2 & 3 seated rooms.
 Has own microbus, ambulance, jeep.

36
ACTIVITIES
 Outpatient services for infertile patients, pregnant woman and children below
15 yrs.
 Family planning services which comprise of initial counseling and
offering the clients a variety of options from which they can choose. This
is called ‘Cafeteria’ choice.
1) Provided family planning services are -
 Oral contraceptive pills-regular
 Depot Medroxyprogesterone- 3 month interval period
 Norplant implantation for 5 year protection
 Male and female condom - family planning officers
always
 Teach their clients how to use them
 Vasectomy (NSV) and Tubectomy
 IUD (Copper T)
2) Other services are-
 Laboratory facilities where blood grouping, Hb%, TC, DC, estimation
of sugar, lipid, billirubin, VDRL, test for Hepatitis B virus, routine
urine examination and semen analysis are usually performed.
 USG, Hystero-salphingogram, TVS, TORCH is also done.
 Hormone profile (Prolactin, FSH, LH, TSH, Estradiol, Testosterone)
 The centre provides medicine free of cost.
 Hostel service for trainees (both medical and paramedical personnel)
 Special counseling corner for improving and monitoring maternal and child
nutritional status
 Provide antenatal, postnatal care to pregnant mother
 Check and treat for sexually transmitted disease in pregnant mother
 Immunization programme for newborn, children and women of
reproductive age group. All EPI schedule vaccines are given here
including TT.
 MCH based preventive, curative and promotive service for under 5 children

37
 Service to protect against the consequences of unprotected sex (Emergency
contraception method)
 Service for clients with unwanted pregnancy, MR, D&C, suction, several
different methods for abortion, Post abortion care and follow up.
 Management of complication following contraceptive use.
 Special services for infertile
 Artificial insemination
 Transvaginal ultrasonography
 Recanalization of previously ligated or blocked fallopian tube
 Hormonal treatment
3) Training programmes for doctor and paramedical officer for variable duration.
‘Clinical contraception service delivery’
 Counseling the client
 Reproductive tract infection, Sexually transmitted infection, H1V/AIDS
 Univalve MR service
 International training on “Non scalpel vasectomy(NSV)”
 Contraceptive management training
 USG
4) The centre has also a research unit
5) They encourage females to adopt family planning measures. They awake
consciousness by psychological counseling.
6) In patient services include
 Child delivery
 Ante natal care
 Post natal care
 Neonatal care
 Infertility centre
ACHIEVEMENTS
1. In 2012 the centre is a 200 bedded hospital. More facilities and services are
available now
2. Technology of in vitro fertilization (IVF) is going to be established in 2012 which
will help many infertile couple

38
3. In 1974, CPR in Bangladesh was just zero. Now-a-days contraceptive
prevalence has raised many folds. Mohammadpur fertility centre has a
obvious participation in this achievement.
ORGANOGRAM:

39
1. The centre has no field level workers. So they can't conduct any community
level activities and the chance of dissemination of knowledge about family
planning among the people is very limited.
2. Limited space often create unwanted hazard.
3. Manpower shortage. The limited number of doctors and other employees find
it hard to meet the demands of large number of clients. Though a large
number of 3rd
and 4th
class employees have retired, the Govt. hasn't taken any
steps to fill in their posts.
4. There is not enough publicity about the existence of the centre through posters
or advertisement or any other means. So many people don't know about the
centre and don't have access to its services.
5. Any development project has to go through the wrangles of rules of
Government which is very time consuming.
It was a great opportunity for us to visit the institution. All the staffs were very much
helpful to us, in spite of having their limitations. The surrounding of the institute was
neat and clean maintaining the healthful environment congenial for client
management. I think more such institute to be established in our country.
CONCLUSION
The contribution of this institute to reduce the population size of our country is
appreciable. It is playing a pivotal role in this sector. By introducing family planning
methods it promises people a happier and healthier future.
______________________ _______________________
Date: Date:

40
Day Visit No.8
Name of the organization Infectious Disease Hospital
Location of the organization Mohakhali, Dhaka.
Type of organization Government hospital.
Date of visit: 26.04.2014
GOALS AND OBJECTIVES OF THE ORGANIZATION
1. Prevention and treatment of infectious diseases.
2. Reduction of mortality & morbidity due to infectious diseases.
EXISTING RESOURCES AVAILABLE IN THE ORGANIZATION
Provided by Bangladesh Government which is not sufficient.
ACTIVITIES
1. Providing treatment facilities for infectious diseases
• Tetanus
• Diphtheria
• Rabies
• Measles
• Mumps
• Chickenpox
• Viral hepatitis
• Whooping cough
• AIDS
2. Diagnosis of infectious diseases.
3. Providing outdoor & emergency services.
4. Administration of Anti- rabies vaccine.

41
ACHEIVEMENT
Tetanus mortality rate has been reduced to 40% in children and 10% in adults.
ORGANOGRAM

42
PROBLEMS
1. Administrative problems: There is no separate administrator for the department
of administration. The senior consultant has to govern the administrative
section as well as other sections. So it becomes complicated for him to deal
with.
2. Equipments are not sufficient for the hospital.
PERSONAL OBSERVATION
From this visit we were informed about the incidents of different infectious disease in
our country and known how they diagnosed, management of infectious disease.
Authorities explained the lacking of some facilities that intensive care unit,
diagnosing facilities of AIDS patients and lack of doctor stuffs, nurses. The
emergency service should be improved.
CONCLUTION
The infectious diseases need to promote diagnosis, specific treatment and isolation of
the patient from healthy persons. Infectious disease hospital play a great role in
reducing the incident of infectious disease and reducing mortality and morbidity from
there infectious disease.
______________________ _______________________
Date: Date:

43
Day Visit No.9
Name of the organization Centre for Rehabilitation of the Paralyzed (CRP)
Type of organization Non- Government Organization (NGO)
Date of establishment It was established on 1 1th
December, 1979. Initially it was
known as "Rehabilitation Centre for Paralyzed Patients".
Location of the organization Chapain, Savar, Dhaka- 1343.
 To ensure the inclusion of disabled peopled into main stream society.
 To promote an environment were all disabled people can have equal access to
health rehabilitation, education, employment.
Specific Objective:
 To provide proper and adequate treatment to the paralyzed &to reduce
mortality and disability.
 To raise awareness regarding management of the paralyzed patients.
 To improve the quality of life of paralyzed so that they will not be a burden to
the society.
 To develop manpower in this field by running various training courses.
EXISTING RESOURCE AVAILABLE
Manpower:
There are 359 staffs in CRP a significant number of who are highly trained and
experienced. The number of Health professionals is 109, among them 70 are male &
39 are female.
The resources of CRP are:
 Beautiful nursery.
 Wood workshop which produces furniture and a range of toys.
 Metal workshop produces field mobility aids and other appliances.
 Orthotics and prosthetics workshop.

44
 Special seating workshop for individually crated seating units for disabled
children.
 Handmade card and calendars and other handicrafts.
 Medicine store.
 Wheelchair and other mobility devices, providing services to the patients.
 Spacious guest house.
OTHER FACILITIES
 Operating theatre for spinal and orthopedic surgery.
 Multi-sensory room with visual, tactile, and auditory materials such as colorful
lights, shiny paper, sound making toys and other types of sensory stimulations.
 Physiotherapy department for in-patients and out-patients.
 Occupational therapy department for in-patients and out-patients.
 Half-way hostel where patients prepare for returning to their home and
community.
 Social welfare unit assisting with a variety of issues for CRP's users.
 Paediatrics unit with residential and out-patient care for disabled children.
 William and Marie Taylor school which provides inclusive education
 Bangladesh Health Professions Institute (BHPI) which trains the health
professionals of the future.
 CRP has three bungalows in Govindpur near Moulvibazar which are used by
guests.
 CRP-Mirpur designed to enable CRP to expand its service and enhance its
financial sustainability.
 CRP-Gonokbari is a residential vocational training and independent living centre
for disabled women and girls.
ACTIVITIES
A) Service provision for spinal cord injured patients:
i) Multi-disciplinary Approach.
CRP follows a comprehensive multi-disciplinary team approach towards patient care
and management. CRP's multi-disciplinary team cares for patients from the day of
admission up until their re-integration into the country.

45
ii) Surgical intervention in spinal cord injury:
It is only performed on patients requiting it with injuries such as cord compression
and grossly unstable spinal. The development of surgical shills at CRP has been
enhanced through exchanged visit between CRP and Leeds Teaching Hospital Trust
in UK.
iii) Nursing management in spinal cord injury:
CRP has highly skilled nursing staff complemented by input from foreign volunteers.
The nurses are engaged to look after the patient's physical condition. This includes
urinary disorder, bowel and pressuresore management.
iv) Physiotherapy management for spinal cord injury:
Physiotherapy at CRP aims to enable patients to achieve maximum potential of
movement and independence. It consists of
 Initial assessment
 Respiratory care
 Maintaining a normal range of movement
 Strengthening exercises
 Preparation for rehabilitation
 Reintegration
v) Occupational therapy management in spinal cord injury:
Occupational therapy at CRP uses a collaborative approach between patients and
therapists which aims to achieve maximum functional independence occupational
therapist looks holistically at a patient's performance such as seat care, leisure and
productivity using adjunctive, skill training and compensatory techniques.
vi) Social welfare in spinal cord injury:
The social welfare unit provides services in three main settings the hospital, the half-
way hostel and the community. Various supports are provided to poor patients
according to their need.
vii) Counseling in spinal injury:
Counseling is a helping process that leads the client to improve self-confidence, self-
control and self-responsibility and developed feelings of independence. Counseling
services are provided at CRP's hospital and half-way hostels.

46
B) Pediatrics Services:
i) Paediatrics unit runs both in-patient and out-patient programs as well as providing
a service for the special needs education unit in CRP's inclusive school. The two
week in-patient (residential) program is designed to integrate children with cerebral
palsy into family and community life.
ii) CRP provides back-care education, health education, disability awareness
programs for parents, a tour of the CRP complex and a group visit to the nearby
national monument.
iii) The out-patients program provides therapy and follow up treatment for forty-forty
five children per day. This is usually for children with conditions such as, cerebral
palsy, muscular dystrophy, Down's syndrome, behavioral problems and flat feel.
iv) Once a fortnight an autism group is conducted by out-patients occupational
therapies.
v) Special seating for disabled children these enables the user to maintain seating
posture thus improving breathing, swallowing and development of line motor skills.
C) Assistive devices:
As part of its commitment to holistic rehabilitation CRP produces a wide range of
wheeled and non-wheeled mobility aids and assistive devices. A metal workshop
produces three models of wheelchairs which have been specially designed for local
conditions. Walking frames, standing frames, knee support splints and special Stryker
frame beds, low trolley are among items made in the metal workshops.
D) Orthotics and prosthetics:
Ther orthotics services are provided to clients with physical disabilities such as
cerebral palsy, post-polio complications, scoliosis, spondilitis, drop foot, club foot and
congenital deformities. At present CRP is producing only lower limb orthotics like,
ankle foot orthosis (AFO) and knee ankle foot orthosis (KAFO).
E) Awareness rising:
i) CRP social welfare department tries to improve people's understanding of disability
and tries to raise awareness about its causes and consequences. Social welfare officers
from CRP often go on home visits to check up on ex-patients and monitor how they
are coping since returning to the community.

47
ii) CRP holds regular awareness raising rally and produces a number of publication
aimed at increasing awareness about disability. Information is also disseminated
through CRP's website and national mass media.
iii) CRP's road safety program is a vital component of its awareness raising activities.
CRP started its "Savar Accident Prevention Zone" campaign in 2000 using the main
west bound highway leading out of Ohaka as its focus.
F) Community Based Rehabilitation (CBR):
CRP has operated several programs since 1994 working in collaboration with the
social services department, government of Bangladesh. The program includes:
 Self-help groups.
 Awareness raising and disability prevention.
 Mobile clinic.
G) Education:
i) William and Marie Taylor School: Children with special needs are accommodation
in four class rooms within the same building as other children. The possibility of
doing integrated into a main stream class exists within the school.
ii) CRP played a key role in motivating the government to place inclusion on the
educational agenda.
iii) CRP runs a course entitled "Certificate in education for special education" which
is affiliated with the ministry of primary and mass education. It aims to focus on the
special needs of disabled children and to increase awareness of educational inclusion.
iv) BHPI Library: It was established to support study research and clinical activities
of teachers, students and staff of BHPI and CRP.
v) Vocational training: CRP runs vocational training projects which aim to enable
trainees to live functionally independent lives. CRP's Madhob Memorial Vocational
Training Institute works comprehensively in assessing the needs of a potential trainee
securing a place on an appropriate course and assisting with job placements on
completion of the course. Courses offered are certificate course in computer
applications, electronics repair and tailoring and shop management.

48
H) Research and evaluation:
This unit supports the multi-disciplinary team by conducing user satisfaction
evaluation. The feedback of these evaluation reports is conveyed to the team and
administration so that they can improve their services.
I) Publications:
i) The publication "Paralysis News" includes information for patients as well as
interviews and articles on disability issues and rights. It is produced three times a
year,
ii) BHPI Newsletter.
iii) Shwakantha ("Self-Voice"): This bi-annual publication is a voice for disabled
people and contains poems, stories and reflections of their experiences.
J) Documentation:
CRP has produces documentaries about different problems faced by disabled people
including road safety and accessibility. Two notable documentaries produced by CRP
are "Glorious 25 years" and "Angikar".
K) Feature films:
CRP has now produced two full-feature films; these are "Bihoago" and "Radio Bhai"
ACHIEVEMENTS
 Because of CRP's relentless lobbing to place inclusion on the educational
agenda in July, 2004 the government circulated a policy to all district
education offices ordering that all primary schools should include disabled
children living in their catchments area.
 CRP is now acting as ASCONS (Asian Spinal Cord Network) chairperson
and CRP is hosting the 6th
ASCON conference, 2006 from 4-6 December in
Dhaka, Bangladesh.
 From July, 2005 to July, 2006 CRP provided in-patients medical services to
375 patients 986 children were treated through pediatrics unit.

49
 Lack of adequate fund.
 Insufficient help for the government.
 Shortage of adequate number of interested volunteers.
 CRP is situated in Savar which causes a transport problem for many of the
patients.
 Some patients cannot afford special mobility aids and others don't come for
follow up.
 Non-cooperative behavior of social and political leaders is one of the biggest
obstacles in the success of CRP.
CRP is a pioneer organization in our country in the aspect of taking institutionalized
care of the disabled. It not only but also rehabilitates as its name goes. It is situated in
a serene environment that gives it a healthy look. The staffs here including those from
the abroad are very much efficient in their work and affectionate to the patients. The
institution also has an auditorium to arrange cultural programs and it has its own
publications tool.
CONCLUSION
Physically challenged people comprise a large number of working population in our
country. To convert this disabled people into human resources this institute is working
satisfactorily. This organization sets a high standard for medical care, as well as
compassion for the disabled. It not only provides assistance but also imparts
confidence and self-esteem to these people.
______________________ _______________________
Date: Date:

50
Day Visit No.10
Name of the organization National TB Control Project (Chest Clinic) Disease
Type of organization Government organization
Location of the organization Sher-E-Bangla Nagar, Dhaka- 1207
Date of Visit 28.04.2014
 To reduce the mortality and morbidity rate of tuberculosis patients & thus
decrease the transmission of infection.
 To prevent emergence of multi-drug resistant tuberculosis.
 To detect at least 70% of sputum-positive tuberculosis cases.
 To increase cure rate of sputum positive tuberculosis cases from 40% to 85%.
 To increase case detection rate from 30% to 70% of estimated incidence
EXISTING RESOURCE AVAILABLE
 Manpower- Trained physicians, technologists and other auxiliary staff.
 Money- Govt of Bangladesh, Netherlands, Sweden, W.H.O.
 N.G.O.s -BRAC, Demand Bangladesh, HEED Bangladesh.
ACTIVITIES:
 Treatment of TB patients under DOTS strategy free of cost.
 Early detection of sputum positive tuberculosis cases.
 To organize training program and its conduction.
 Supervision of drug delivery centers (There are 120 centers under this
institute).
 Dissemination of knowledge regarding tuberculosis to patients.
 Vaccination against M. tuberculosis.

51
ACHIEVEMENTS
 Cure rate has increased to 92% in 2003.
 Detection of 72% cases in 2003.
 In the year 1993 NTP introduced Directly Observed Treatment course (DOTs)
and also introduced short and long course regimens.
 Standard registration card has been developed recently
 Epidemiological studies are conducted
 Regarding floating people, case detection is not properly conducted
 Dropout rate is very high
 Lack of adequate skilled manpower and supporting staffs
 Patient compliance is very poor in many cases
 Problems in keeping records.
ORGANOGRAM

52
The environment of the institute is not so healthy and the hygienic conditions should
be improved. The process of case detection is really praiseworthy and the people are
doing it quite seriously.
CONCLUSION:
Tuberculosis is one of the major communicable diseases in our country. Government
should take adequate steps for improving its present condition. With improvement this
hospital can go a long way in resolving the problem.
_____________________ _______________________
Date: Date:

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