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Life on the fringes: the cost of health

The rising cost of living in Dhaka’s urban slums, in Bangladesh, has made healthcare an increasingly unaffordable luxury.

Over the last two years, the price of essentials – mainly food – have reached unbearable heights, leaving the urban poor in a constant state of deprivation.

The instinct of many people is to use the bulk of their earnings on food, especially rice or wheat. Thus foods containing important nutrients such as protein, minerals and vitamins, get struck off the shopping list leading to dietary deficiencies that in turn lead to frequent illness.

A range of problems

Public health services are inadequate and often inaccessible. The few government-run healthcare centres in Dhaka are on the outskirts where only people living in their vicinity can benefit, which excludes most poor urbanites. Private healthcare is out of the question for most people.

Noorjahan Begum, who is about 60, works as a cook for a wealthy household in Dhaka, and earns 2,000 taka (US$ 29.44 approx.) a month. She suffers from multiple problems; long-term arthritis, varicose veins, and cataracts in her eyes that need immediate surgery if she is to avoid total blindness. But going to an eye specialist involves a battery of fees – for the doctor's visit, pathological tests, surgery costs and medicine.

Disturbing trend

Without health insurance, Noorjahan just cannot afford to get treatment. There are private hospitals with subsidised rates but at this point she cannot even afford the fees and operation costs. As for the public hospitals where one has to wait hours before getting any kind of medical attention, Noorjahan doesn't feel confident about them. "I often feel like just quitting", says Noorjahan, "I am always in pain and so exhausted. My employer does not give me any holiday. But how can we survive if I don't earn? I have to think of my grandchildren so I have to sacrifice."

It really is a disturbing trend that even people like Noorjahan Begum, who is better off than most low-income urbanites, cannot afford health care. Her son is a chauffeur for a foreign embassy and earns TK 8000 (US$117.78 approx.) a month but both mother and son's income is spent on rent (TK 5,000 or US $73.61) food, school fees for three children and examination costs for the eldest grandson who will be taking his high school matriculation examination next March.

Garment workers feel pinch

Even those with jobs in the formal sector, such as the thriving garments industry, are feeling the heat of the rising cost of living. The garments industry is Bangladesh's greatest success story, providing export earnings of about US$ five billion annually and employing around three million people, most of them women. This has given many women much-needed economic freedom.

Despite the long gruelling hours, many young men and women prefer working in garment factories because of the relatively higher salaries, overtime and other benefits. Garment workers enjoy a certain amount of affluence compared to others employed in informal sectors such as domestic service or construction work.

Bangladesh's low labour costs – still lower than China and India – means the garment industry is still fairly robust. In fact entrepreneurs expect export earnings to go up to US$ 18 billion by 2010 consequently boosting employment. But of course everything depends on world trends. If orders for goods decline because of recessionary pressures in the US and Europe, it could lead to major shrinking of exports.

Even so, the relentless price spiral of the last two years has taken its toll.

Twenty-one-year-old Rehana Begum has been working for Forens Garments in Mirpur-10 for the last five years. She earns around TK 2,750 (US$40.49 approx.) per month as a sewing machine operator; her stepmother, an assistant operator, whom she lives with, gets TK 1,662 (US$24.47) a month, which is the minimum wage stipulated by the government. The last time Rehana got a raise was in February, a meagre TK 200 (US$2.94 approx.) monthly increment.

Women put off doctor’s visits

Rehana and her stepmother are the earners in the family; her father, a near invalid, does not work. With rent at TK 1,800 (US$26.49) and rice at TK 30 (US$ .44 approx.) a kg, after rent, all the money goes on buying food. Rehana says that they have cut down on meat and fish, eating it only once or twice a month. Their daily meals consist mainly of beans, lentils and rice or potatoes, lentils and rice.

Again, health comes last on the list or not at all. Rehana admits she has been suffering for almost a year with an unexplained pain on one side of her stomach and also has a low grade fever almost every night. She keeps putting off going to the doctor because she can never save enough to cover the fees. Women, being socialised to place their own needs behind those of others, have been hardest hit by the price rises."It will mean spending a lot of money," she says. "Right now we just somehow manage our meals and rent. Maybe later, when my salary increases," she adds dismissively.

Rehana says she has no plans to get married. "Who will take care of my father, if I go away? There are no men who would agree to let my father live in the same house."

Supporting the whole family

Although garment workers may earn more than their counterparts in other sectors, they are almost always the major breadwinners of families with many dependents.

Eighteen-year-old Farukh Mia has been working at Falma Fashion in Ibrahimpur for four years, earning about TK 5,000 (US$73.61 approx.) a month including overtime. His family consists of his parents, two sisters and two other brothers. His sister recently married and moved out, along with her monthly contribution. His mother works as a part-time maid. Now, without his sister's income, the family is feeling more vulnerable than ever.

"Before with the income of the two children and mine, we could more or less survive," says Dulena Begum, Farukh's mother. “But after she went off and got married, we don't know how to pay the rent and buy food. You will not believe what we have been eating these days."

"I have a very bad pain on the left side of my back especially when I have to wash loadfuls of washing," she adds. "But I cannot miss even a single day as the Begum Sahib [a term of respect for her employer] gets really mad and threatens to sack me if I am absent again. What can I do I have to bear all this, otherwise how will we survive?"

Serious illnesses have plagued the family for many months. Farukh's father, mother and sister– have all required extra funds for treatment, raised through loans from local moneylenders and relatives.

"We still owe money to the lenders for my sister's treatment," says Farukh, who adds that with little money to spare the family has had to cut back on food. "We haven't had meat for months," he says, "Even at Eid, we didn't eat any."

See also: Life on the fringes: survival

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Aasha Amin

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01/29/2009

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