Satellite clinics are an effective way to provide basic primary healthcare services to people living in chars, particularly women and children. A satellite clinic consists of a team of one paramedic, one health educator and a medical assistant or nurse (all routinely supervised by a medical doctor) who join with the trained community member, the FCM, to set makeshift camps on the chars to treat the isolated population. Satellite clinics head out daily for different locations via boats with clinics held at regular intervals (weekly, fortnightly or monthly depending on need and funding) in a particular location. These groups set scheduled weekly clinics in a designated area in most of the chars, which is communicated to the char dwellers ahead of time, through Friendship Community Medic-Aide (FCMs) or trained community health workers.
The satellite clinic address rural social education, primary health care, maternal and child care, diet and nutrition especially focused at pregnant women and children, family planning, provide subsidized medication and identify needs for secondary care interventions and many other issues. It also plays an important role in raising community awareness on vital issues such as immunization, safe delivery, family planning, nutrition, ante and post natal care and limited pathology as well as dispensing free medicines, documenting patients in the chars as well as referrals for the hospitals. Using the documentation done by the satellite teams, the need for a particular service, such as tumour removal or cleft-lip surgery, can be assessed and a health camp planned accordingly.
In the past, Satellite clinics proved essential during the time of severe flooding, Cyclone Sidr and Cyclone Alia. During the time of Cyclone Sidr, fifteen satellite clinics were set up in Amtali, Saronkhola and Kuakata. Friendship also organised medical camps in five southern districts and treated over 14,835 patients affected by Cyclone Sidr in 2007 and 10,722 patients were treated who werer Cyclone Aila affected in 2009 .
Services provided by Friendship Satellite Clinics:
A. General Treatment:
General Treatment of communicable diseases and limited curative care
Paediatric Care including immunization, ARI, diarrhea and limited curative care
Reproductive Health Care including ANC, PNC, family planning and STI/RTI
B. Health Education/BCC:
Group Meeting/Health Education session and Individual Personal Contact
C. Referral Services:
From Satellite Clinics to Lifebuoy Friendship Hospital, GOB facility or any available NGO/private clinic or hospital
Lack of family planning services and awareness, as well as unavailability of contraceptives means birth rate is very high in the chars and riverbank areas. Friendship’s family planning programme has a special focus on long term methods and offers motivation and counselling, contraceptive distribution (oral pills and condoms), NSV, tubectomy, injectables and inserting norplant and IUD. To ensure uninterrupted availability, Friendship Community Medic-Aides are stocked with non clinical contraceptives (pills and condoms) so that community members can access them even in the absence of satellite clinics.
Friendship arranges child immunisation sessions at regular intervals to minimise maternal and infant mortality rates among char and riverbank-based populations. Through the national Expanded Programme for Immunisation (EPI), working alongside the government of Bangladesh, Friendship tries to bring women and children under its wing. Under this immunisation programme, children aged between 0 to 1 years and women aged between 15 to 49 years are given vaccines for prevention of life threatening diseases.
The majority of the char population are malnourished, especially children, a condition that is related to poverty but compounded by a lack of awareness about nutrition. Friendship implements a nutrition programme aimed at children under 6 years as well as pregnant and lactating women. Every month a total of 292 satellite clinics visit 104 chars and each clinic receives approximately 50-60 children and 10 pregnant or lactating mothers into the nutrition programme. The programme includes health education/counselling, cooking demonstrations that attending mothers participate in, feeding children under 6 years of age, growth monitoring and maintenance of personal hygiene.
Behavioural Change Communication
Although harsh environment and poverty is the leading cause for low standards of living in the chars, lack of education too plays a large part. Friendship organises behavioural change communication with the men and women of the chars to encourage healthy behaviour and to increase awareness of about many different health issues. Some of the issues addresses are proper treatment at home of sick people to minimize morbidity and mortality (e.g. proper care during diarrhoea), care of pregnant women, personal hygiene (e.g. importance of bathing and use of latrine), importance of nutrition and identification of and response to emergency cases.