1. Overview
2. Qualifications for working in the Thanarbaid Health Care Program
3. Salary Rationale
4. The Thanarbaid Approach to Health Care: An Interview with Dr. Edric Baker by the Musgraves
   1. Q: What is the philosophy and practice of your approach to health care?
   2. Poverty is a state of Emergency
   3. Thanarbaid Health Program's Message to the Church
   4. Q: What are the unique features of the Thanarbaid approach?
   5. Q: How do the poorest help in the program?
   6. A Diabetic Program for the Poor
   7. Q: Do you think the Thanarbaid Approach could be duplicated, and if so what advice would you give?
   8. Daily Communal Prayer
   9. Closing Comments
5. Diversity of Staff
6. Poems from Bengal

The Thanarbaid Health Care Program seeks to be a religious and humanitarian motivated health movement, or the stimulus to such a movement among the rural poor. It strives for the health of the poor of 3 communities: Bengali Muslim, Tribal Hindu, Tribal Christian--rendering services of teaching, disease prevention and disease treatment. The Program desires to promote and be a part of a health movement of the poor, and as an essential requirement for this seeks to be involved with the poor in their health problems and to involve the poor as directly as possible in the health activities. It is always necessary to remember that the most needy are the poor, and they are the poor of the 3 communities, and that the most needy among them are the women and small children.

Thanarbaid Health Care Program is not a hospital, nor does it desire to be a clinic-focussed or career-oriented Health Program. The Program is not aimed at promoting an institution or a particular community, but is inspired by faith toward promoting true community in the community at large. Thanarbaid Health Care Program does not desire to be a cover for conversional activities. On the other hand it is strongly committed to being by virtue of its nature and actions the proclamation of a religious message of enormous power--and it would not be at all distressed if any of its staff of whatever religious group were to explain that in terms of their own religious conviction to people of their own or any other group. The program is inspired and energised by the Jesus-religion. The staff need not be Christian, however they would need to accept that the concept of Jesus' immersion and self-giving is a valid motivational concept.

Staff must display a strong motivation to serve the poor community. This motivation must not be allowed to be stifled by one's own personal or economic problems, or distorted by preoccupation with one's own economic improvement. Anyone not having a love for the poor, would not be qualified to work in the Program.

The aim of the Program is to be part of a health movement bringing about changes in the 3 communities for the improvement of health. The aim of the staff is to be a stimulant and a part of the health movement and a part of the people, working with them to bring about changes. Thus, the salaries must make it possible for the staff to give their minds and their time to the work, but not be such as to separate them from the poor. Salaries must not be such as would create class distinctions amongst the staff, thus eroding the motivation of the lowest paid who are in fact the most critical to behavior change. The highest salaries must never be more than 3 times the pay of the lowest paid worker.

Thanarbaid's basic concept is health care by the people, for the people. Because the majority of the people here are very poor, they suffer more illnesses, and are less able to cope with the illnesses they get. There is no need to do community health with the rich.

The vast majority are poor. 60% are landless. It is known that malnutrition predisposes to infection. There is an enormous population and a small number of illnesses easily treated and easily prevented. The government will never have enough money for sophisticated health care for all the population, therefore the obvious answer is that health care actions must be simple and that the people must do them.

When I was in Vietnam I came to this conclusion. Just as in time of war a state of emergency is declared, and in effect there is a dictator government, so extreme poverty is also a state of emergency. For example--people get washed away by the sea in Bangladesh because they are forced to live in low lying unsafe areas, they die of starvation, cholera, malnutrition and easily preventable and treatable diseases. This is a state of emergency. Little children, people, families and communities grow up warped and distorted. This is a state of emergency.

We who are Christian have found salvation and faith in Christ's coming to us and especially in his Cross. But this salvation and faith is for all. Christ's compassion and love reach to all. Within that compassion and love we have to move to the suffering poor. In the World and in Bangladesh the numbers of the poor and suffering are vast and are increasing. In life we find that the greatness, power and diversity of creation manifest to us the greatness and beauty of God. We find that the love of mother, the caring of parents, friends, church reveal to us the love and care of God. Pain, crises, rebukes and punishments reveal to us the severity of God. The sufferings of the poor reveal to us the grief of God and the suffering of Christ for the human situation--but this we cannot understand if we do not go to the poor in their suffering.

The numbers of the poor are vast and increasing. Lenin said their condition will never change until persons from the elite class declass themselves and identify with, motivate and lead the poor. Then will come the "People's Movement" with revolution and change. Lenin could not identify sufficiently with human weakness--his revolution has failed. Jesus identified perfectly and established the People's Movement, the Church and the Kingdom. We must go to the poor and ensure that the people's movement and the Kingdom continue in the new generation. The Thanarbaid Health Program is in the stream of the People's Movement. It is a program of the poor with special features. It is revolutionary and it is important. The staff must be of the people--motivated, oriented, low paid. We must keep it a program of the poor.

People of low educational level give awareness to others about the reality of their health problems. They know the problems of the poor community because they are a part of that community. They learn to analyze the health problems and are able to persuade others of actions about which they themselves are convinced.

Momiron, one of our cooks is illiterate, but has become a superb manager of diarrhea. Momiron is a woman of the earth, and a woman of the people, like Mary. She doesn't build barriers between herself and other people. People of the earth bleed for the sufferings of others, they feel the pain, and when they see what to do they do it.

Reiza is one of our best village workers. She is only class 4. She came from a low middle class family in the village community. They have no land. Her husband fishes. Some of their children are being educated at the mission school. Not only does she do teaching, but she also monitors children's growth rate, diagnoses nutrition problems and takes appropriate action. She also treats simple diseases, pneumonia, diarrhea, dysentery, skin infections, scabies, eye infections . . . She grew up in Purdah until she and her husband moved to our area. Now she confidently goes on her own around Muslim villages.

Another of our workers is Chengu. About 5 years ago he almost died. Coming from a traumatic family situation he was repeatedly sick and couldn't work. He belonged to the almost despised Bormon Tribal community. He was admitted to the clinic for treatment. He recovered and stole my cycle. I sent 2 "sleuths" and got it back. He lived on the premises and worked--we taught him a bit. He learned to read and write. He ran away with a Mandi girl and they became Catholics! He is a very good village worker, monitoring children's growth rate. He is now father of 3 children, 2 girls and a new baby boy.

We admitted 3 diabetics. We said: "help each other." They did. Unless diabetics help each other and take control of their problems and program they have no future. Diabetes is a life-long disease, but it is not top priority for the community. We have gradually attracted more and more patients who have no other alternative for treatment. We now have 36 patients in the program.

Because of the unrelenting poverty in Bangladesh, health action must be extremely simple and must engage the participation of the people. A doctor or other health professional supporting or directing a program by and for the poor must be willing to be extremely adaptable both in health problem solving and in life style, and able to accept that ordinary people of low educational level can be trained up as health workers to handle common problems. It would be necessary for such a doctor to recognize and accept that the professional staff work in a close friendly brotherly / sisterly relationship with local staff (who are of low educational level), patients and village people. From a practical point of view this involves adopting a simple life style, and eating and praying together with patients and staff.

Daily prayer is essential because it places both individuals and group in relationship to each other and to God, reinforcing relationships which are the basic reality and essence of the Program. It brings them face to face with each other's problems--the problems of the sick and the poor. This relationship reality motivates to heartfelt concern, haunts with anxiety and stirs to actions of determination and love.

The only way to make medical care available to the poor is to keep the services extremely simple, avoiding all non-essential investigations and medicines, and to employ non-certified and voluntary staff to do almost all the work, trained and supervised by a very small number of committed and suitably oriented professionals.