Reportage
The nation witnessed the passing of an unequivocally great Bangladeshi this week, as Gonoshasthaya Kendra founder, freedom fighter and tireless advocate of people's rights, the one and only Dr Zafrullah Chowdhury, died while receiving treatment at the Gonoshasthaya Nagar Hospital in Dhanmandi, near his home in the capital. He was 81.
Dr Zafrullah took his last breath in a life lived breathlessly, always fighting, always standing up for something, or up to something, right until the very end, at around 11pm, on Tuesday, April 11th, said GSK press adviser Jahangir Alam Mintu.
A day earlier the veteran physician - although he will always be remembered as a pathbreaking public health activist and advocate - was put on life support at the hospital as his health deteriorated. A medical board led by Professor Brigadier General (Retd) Dr Mamun Mustafi, was formed on Sunday.
Dr Zafrullah had long been suffering from kidney-related complications. One may never have guessed it from the number of causes he remained involved in till the end, but both his kidneys gave up on trying to keep up with him years ago. He was undergoing regular dialysis throughout his last years, a painful and cumbersome process that eats up time and money. Thankfully a cheaper, without compromising on quality, dialysis facility was one of GSK's most successful programmes.
Zafrullah Chowdhury was in the UK for his postgraduate studies in medicine when the War of Liberation broke out in 1971. Still barely 30 years old, he would return to set up, in collaboration with Captain Akhtar Ahmed, the Bangladesh Field Hospital, a 480-bed facility for freedom fighters and the refugees.
Run by a team of Bangladeshi doctors, medical students and volunteers, and women with no previous training in healthcare who were trained within days to help out the patients - the forerunners of the Shasthya Sebikas who would later become the backbone of the country's rural health infrastructure - it was the only one of its kind. The idea behind that revolutionary offering would evolve into a philosophy for public health delivery after independence, when Gonoshasthya Kendra was born.
He was also the architect of the country's first National Drug Policy, adopted in 1982, that is still felt to be a central instrument in the country's success in the field of public health - an unforgivingly difficult task for the size of the population in Bangladesh. The implementation of the recommendations in the NDP enhanced local production of pharmaceuticals and improvement in quality of drugs, elimination of harmful and nonessential drugs and regulation of prices and imports.
Zafrullah Chowdhury was born on December 27, 1941. He spent his early childhood in Kolkata and later his family settled in Bangladesh. He founded the Gonoshasthya Kendra in 1972. The proposal was first presented in a concept paper in Dhaka titled "Basic Health Care in Rural Bangladesh."
Zafrullah was one of 10 children born to his parents. After finishing his education at Nabakumar School in Bakshibazar, he attended Dhaka College. He became acquainted with communist political views while attending Dhaka Medical College.
He completed his MBBS degree in 1964, earning a distinction, and moved to the UK to pursue postgraduate studies in general and vascular surgery. but returned to fight the war, first as a guerilla, before utilising his background to set up the Bangladesh Field Hospital, working with others like Dr M.A. Mobin, and Captain Sitara Begum.
The highest national award of Bangladesh, the Independence Medal, was presented to GSK under Dr. Zafrullah Chowdhury's leadership in 1978, in recognition of its contribution to the development of primary health care in Bangladesh and the delivery of family planning services at the grassroots level.
In 1985, he won the Ramon Magsaysay Award - aka 'the Asian Nobel', in Community Leadership category for his work on the Drug Policy 1982.
He received the Right Livelihood Prize, the 'Alternative Nobel' that is announced one day ahead of the first Nobel Prizes of the year, in the same city in Sweden. He was recognised in 1992 for his exceptional work for health and human development.
While constrained in scope, GSK was a pioneer in the development of less expensive generic medications. A Rural Healthcare Insurance System was initially implemented in Bangladesh by Gonoshasthaya Kendra in 1973 under Zafrullah's leadership.
He was recognised as an International Public Health Hero by UC Berkeley, one of the most reputed public universities in the US, in 2010. And still you must say, for all these awards, Zafrullah howdhury was about so much more.
The universal outpouring of grief at his death, the endless lines who gathered at the Shaheed Minar to stop and pay their final respects to a legend , provided for a rare, bipartisan moment in the public life of the nation, where all agendas and political compulsions seemed to melt away.
Zafrullah Chowdhury endeared himself to the public by living a very simple life, yet never backing down from speaking his conscience in the public interest. This meant although he was never directly involved in any political party, he was inevitably drawn into the political arena to talk about different political issues.
He did play a key role in the formation of BNP-led Jatiya Oikyafront before the 2018 election, and towards the end became known as a critic of the Awami League government. But his overall life's work cannot be held to be partisan, and there were plenty of occasions when his views clashed with the BNP as well.
Afsan Chowdhury reminisces 'The Man from Sector 2'
'The warrior stops, his battles will go on'
He (Dr. Zafrullah) just never stopped fighting his wars even after liberation. It never probably occurred to him to make peace with his battles and move on. In so many ways, he was the closest to what we would call a permanent warrior. He passed away but his battles will go on.
It began in his college days when he was already infected by idealism which met his "revolutionary zeal". The two made a potent broth that Zafrullah bhai drank and never stopped fighting for his causes, no matter how great his opposition was. And it's amazing when both idealism and his sense of social justice are both collectively comatose, he remained loyal to them no matter what.
Zafrullah bhai stands above most of us because he dared to stand taller than most around him. In all the years that I have known him , he has not hesitated to be himself. He followed the right wagon with as much zeal as he did the occasional wrong one's because he was a believer in people's rights.
What separated him from the rest was that he was selfless, totally driven by the idea that health was a right that all had a right to claim. And that it was one of the biggest democratic causes of them all. And he never stopped until death finally called his name.
'He took on the health establishment'
In some way, Zafrullah bhai was the perennial man from Sector 2, 1971 war. He was the helmsman of the Bisramganj hospital that he helped establish in that war zone, not just treating the warriors but training nurses and paramedics too. For many who were part of the 1971 war, it never really stops and he was one of them.
The war days belonged to the warriors but as soon as the war was over, the new state generated new needs and causes and Zafar bhai became a warrior for them. Fifty years later, it's impossible to understand the kind of impact he had on society, emerging from the ashes of the war, who needed a voice to speak as audaciously as he did.
He took on the health establishment like none had done before and in this fight, many of his fellow fighters were his old comrades from Sector 2, led by Shahadat Chowdhury, Editor of the weekly Bichitra. Bichitra gave him a platform to reach out and become a vanguard as Zafrullah bhai launched media campaigns, health rights volunteers and also began to mobilise supporters to begin his greatest adventure, the Gonoshasthaya complex.
The health treatment infrastructure was not a problem but when he began his pharmaceutical company, he faced massive opposition, both national and international. But with all his warrior instincts, he fought back and though he didn't triumph, it was not a sweat for a lost cause. Today, many aspects of the general health sector cause dismay, but in some ways, health rights are more accessible for many than they were in the early days of Bangladesh, particularly in machine availability.
'His politics was about right to health'
I am not sure how committed he was to politics but I think he truly believed that health rights could not be assured unless political rights were won. So from the early days he supported causes and campaigns, supporting candidates, causes and political platforms right from the birth days of Bangladesh. Till the last day, he was doing what he thought was the right thing to do. Due to media exposure, many will remember him more as the political person he had become in many eyes in the last decade or so than the health rights person I saw he was most committed to as a cause.
We have walked together for long though his increasing political commitments and my lack of interest in political media and talk shows made meetings less frequent. But I remember one day, when we were both being tried in the same case -contempt of court- for a petition we had both signed, and were being searched by the High Court security. His frayed trouser end and his keychain got tangled and as he bent down to separate them he laughed in his own way and said, "Sometimes, I think it would be the best if I could go back to my village and become the local doctor."
Farewell Zafrullah bhai, you always were our greatest village doctor.
Zafrullah Chowdhury's Gonoshasthya Kendra
In 1972 Zafrullah Chowdhury took on the challenge of developing an effective rural health care delivery system based on his experience of running a field hospital with young women and men with no previous medical training and Gonoshasthaya Kendra (GK) was set up. The first concept paper on this 'Basic Health Care in Rural Area' presented in Dhaka in April 1972 which was to later become the basis for international discussions on Primary Health Care.
The experience of Gonoshasthaya Kendra became the basis of one of the main working papers on which the Alma Ata Declaration of the World Health Organization was framed.
Gonoshasthaya Kendra (GK) is a multi-faceted community and development programme encompassing activities ranging from agricultural cooperatives, community schools, primary health care centres and hospitals, women's vocational training centres to economic enterprises to help finance GK Trust activities.
Gonoshasthaya Pharmaceuticals, Gonoshasthaya Intravenous Fluid Units, Gonoshasthaya Basic Antibiotics Production Units Gono Mudran (Gonoshasthaya Printing Press) are some of the income generating units owned fully by the Gonoshasthaya Public Charitable Trust (GK Trust).
Gonoshasthaya Kendra has for the last 40 years worked on community health services. It has had successfully introduced innovative community health care services in Bangladesh especially in the field of paramedical training and domiciliary services achieving low maternal mortality rates (MMR) and infant mortality rates (IMR). In most GK's operational areas, MMR and IMR is between 1/3 to ½ of the national average. Family Planning in GK's field practice area is well accepted and the growth rate is 1.5%, while the national rate is 2.2%.
GK had introduced a Rural Health Insurance System in 1973 for providing health care in GK operated Primary Health Care Centres and hospitals. Poor and low income groups are charged lower rates of Health Insurance Premium while rich and middle class pay much higher rates. But all groups receive equal quality health care.
Gonoshasthaya Kendra was the first to introduce the concept of paramedics in Bangladesh, an innovation which was later adopted by the Government of Bangladesh in 1977. GK introduced mini-laparotomy method of female sterilisation (tubectomy) in Bangladesh in 1974.
In addition, Gonoshasthaya Kendra has a research programme under which medicinal plants and vaccine research units have been set up. Another project is the Gono Bishwabidyalay (Peoples University) which has been set up under Private Universities Act 1992 to offer courses in Development and Social Sciences, Local Governance and Health Sciences.
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