I am finally in the field! My first day for enrollment went fairly smoothly, and with a few things to watch out for, I think I will be right on track. On Sunday (which is the first working day in Bangladesh, Friday and Saturday being the weekend), Dr. Akhtar arranged a WHO vehicle to take us, including Zakia my research assistant, up to Bogra. In fact, another man accompanied us, Dr. Salamat, whom Hugh and I know from a meeting with Andrew Trevitt of WHO, during our visit to Bangladesh in April. As it turns out, Dr. Salamat is also Zakia’s maternal uncle!

We went straight to the office of the civil surgeon, Dr. Nahar, where we met with Hannan (the assistant health inspector who did the baseline survey of shipbreakers in Sariakandi this past summer). We discussed the logistics of where and when we will meet each week for enrollment of subjects, and how we will instruct the subjects to meet us in Bogra city for interviews, etc. This is not as easy a task as it should be as there is always quite a bit of ambiguity in the answers to what I think are clear and straight forward questions. Also, there are always people coming in and out of the office, distracting Dr. Nahar for signatures; no meeting can ever go uninterrupted every two seconds! After some frustration and repetition of questions, I was generally satisfied with the answers, and you reach a point where you have to wait and see what happens. No matter how much you prepare, things will always change later on anyways! In fact, Zakia’s uncle was far more clear and helpful than anyone else and I was grateful for him being there. Maybe by working with Andrew Trevitt all the time, he understands the kind of clarity us foreigners seem to crave!

Next morning we left for Sariakandi town (the main town of the region of the same name where the shipbreakers are located in little villages) and I was under the impression we were just visiting the Sariakandi Health Complex to meet the Sariakandi region health officer, Dr. Emdad, before Dr. Akhtar and Zakia’s uncle left us to return to Dhaka. I thought we had the rest of this week to start enrollment of subjects for interviews the following week. But then, surprise again, we ended up at a village, where we were to begin enrollment right away, and I was a little frustrated because I was not exactly mentally prepared. However, I did have all my materials with me, although I needed copies of the Bangla consent forms, a process that ended up taking 2 hours; Dr. Akhtar had wanted to be there for the first subject enrollment but could not wait that long, so they returned to Dhaka, while Zakia, Hannan and I remained behind.

This is not exactly how I had envisioned my first day of enrollment. If you remember there are six different job groups in shipbreaking: Loaders, cutters, fitters, wire/cable pullers, hammerers, oil group. Loaders are the most frequent and I wanted to go to villages with shipbreakers with other than loaders first, but we ended up in two towns, both with only loaders. In fact, with the baseline survey of shipbreakers Hannan prepared for me, with over 200 names, including their village, job group and first year of work, I have a basic enrollment strategy planned, and I found myself already having to change around these plans. Like I said before though, working here, you really have to learn to be flexible.

Well, perhaps this was better for this first week, while we test out how appointments, interviews and x-rays work out at the hospital next week. I have already let Hannan know where I which villages and people I would like to target for enrollment next week. One idea I discussed with my committee was to go first to villages with job groups other than loaders and try to find more. My only worry with this now, and why it may be wise to stick to the original list of 200 people Hannan recorded, is because at that point there was no mention of reimbursement money. Now, after today, they know because of having the consent form read to them that there will be reimbursements and travel costs, and word will spread like wildfire. So perhaps it is better to stick to enrolling those already on the list only, and not look for new people at this point, even if it means most of my data will only come from the Loader group.

While Zakia is a physician and will be very helpful I am sure at the hospital in Bogra when it comes time for interviews, x-rays and physical exams, Hannan, is amazing in the field! Dr. Akhtar thought it would be best for him, instead of Zakia, to read the consent form to the subjects as Hannan knows how to get the message across better, and he works in this area frequently. Even while we were getting organized, he was not wasting any time; he was instructing all the curious visitors gathered around about the importance of tetanus vaccination especially for women, measles, and TB vaccinations. Once I was ready, he read out the consent form and I followed along with my English version and it sounded like he stuck to what was written exactly. He took the initiative to come prepared with referral cards he made up the night before so the subjects know exactly when to show up and where, and has promised it will be his responsibility to make sure they go. The chain of command out in the villages is impressive, with about 30 health assistants working for Hannan, each health assistant is responsible for health services for 4-5000 villagers. The husband of the health assistant for the villages we were in today, accompanied us all day.

We ended up enrolling 9 people from the first village, Bibirpara, and another 3 people from the second village, Haorakhali. They were provided with referral cards for visits to the hospital over four days next week. I will try to stick to enrolling in Sariakandi on Sundays, and then seeing subjects in the Bogra District hospital on Mondays-Thursdays.

It is difficult to explain the chaos that occurs in these otherwise peaceful villages during enrollment. Every villager comes out to see what is going on; it is quite impossible to get the shipbreakers completely on their own. Kids are crying, villagers are yelling, people are pushing and inching their way towards the centre where we are. Every once in a while someone will yell and push everyone back to try and give us some space again, but instantly the crowd starts inching their way forward again.
However, this is fine, of course I expected it, and I loved it, being in the field finally! Enrolling subjects amongst green paddy fields, walking through them to get from one village to the next, taking a rickshaw van to another spot; recruiting in a rickshaw van just how I imagined! By the way, a “van” in Bangladesh is not a vehicle with sliding doors. It is a flat wooden platform on wheels, peddled about like a rickshaw. You simply sit on the platform. The rickshaw driver asked if I was Saudi Arabian or Malaysian. Zakia told him neither; why did he only ask those two countries? He replied, because they were the only two countries he had ever heard of. Well, now he has heard of Canada.