The legacy of Zafrullah Chowdhury

Golam Mortoza

Sat Nov 3, 2018 12:00 AM Last update on: Sun Nov 4, 2018 01:09 PM

Bangladesh Field Hospital during the Liberation War.

Everyone employed at the hospital is involved in farming—from doctors, interns to general employees as well as its founder. It's not their hobby but part of their job description.

The hospital was set up in 1971 in Agartala, India. Khaled Mosharraf, the commander of Sector 2, was operating in this area. Named "Bangladesh Field Hospital", the 480-bed hospital was founded to treat wounded freedom fighters.

Among those who established this field hospital were Zafrullah Chowdhury and MA Mobin, the only cardiac surgeon in the entirety of Pakistan. A group of volunteers were trained as paramedics, one of whom was Sultana Kamal, now an eminent human rights defender.

In 1972, when the founders tried to replicate their wartime endeavour in the newly independent country, the government had objected to its name. Irritated, Zafrullah went to the secretariat to meet President Bangabandhu Sheikh Mujibur Rahman.

"Mujib bhai, [they] are not allowing us to build Bangladesh Field Hospital," he complained to Bangabandhu.

"If the name contains 'Bangladesh,' it sounds like a government hospital," Bangabandhu explained. "Find another beautiful name for the hospital."

After much deliberation, Bangabandhu offered him a new option. "You come up with three names, and I will come up with three. We will choose the best one through discussion," he told Zafrullah.

In their next meeting, Zafrullah was reading out his list: "Bangladesh Field Hospital, Gonoshasthaya Kendra..." Bangabandhu abruptly interrupted him, saying "Gonoshasthaya Kendra is a beautiful name. It will be the name of the hospital. Ganasasthtya Kendra will not only provide treatment, but it will also have to work on health, agriculture and education."

Zohra Begum, MA Rab, a joint secretary, and Lutfor Rahman donated five acres of land from their family properties in Savar for the hospital, while Bangabandhu arranged a further 23 acres of land. The hospital, now named Gonoshasthaya Kendra (GK), began its journey in 1972.

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In GK, Zafrullah Chowdhury shattered the fixed notions of what women could or couldn't do. He engaged women in unconventional works, employing them as electricians, carpenters, welders, etc. In 1982, many of GK's large truck drivers were women. The hospital currently employs 2,500 people, 40 percent of whom are women.

In its early days, GK introduced a health insurance system. Its Dhaka branches charge patients only Tk 200 for delivery, while its caesarean section costs around Tk 12,000-14,000, without any additional charges in the name of doctors' fee, medicine and pathological tests. Unlike private hospitals, GK always encourages its pregnant patients to undergo normal delivery, unless her medical condition requires otherwise. The cost of pathological tests is half of that charged by an average private hospital. In 1981, GK introduced "Gonoshasthaya Pharmaceutical", which still provides drugs that are far less expensive than those marketed by private pharmaceuticals.

After Savar, Gonoshasthaya Nagar Hospital was built in Mirpur road, Dhaka. In addition, GK operates about 50 health centres in rural and suburban areas of the country.

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Physically Zafrullah is not well. Both his kidneys are almost non-functional. He needs to go through kidney dialysis three days a week. Anyone who has not gone through it cannot understand how expensive the procedure is. The number of patients undergoing kidney dialysis in GK is nearly twice that in all private and public hospitals combined.

Gonoshasthaya Nagar Hospital has a 100-bed advanced kidney dialysis centre. Even India doesn't have such a large kidney dialysis facility. It is the largest of its kind in South Asia, but the cost is unbelievably low. In Bangladesh, the cost of the treatment generally varies from Tk 7,000-8,000, minus doctors' fee and cost of medicine. GK deals with about 250 such patients every day, 10-12 percent of whom get their treatment for free. Twenty-percent patients pay only Tk 800, while the maximum fee is Tk 2,500—which includes all other additional fees.

***

Bangladesh's drug market used to be dependent on import and controlled by multinational companies. Zafrullah approached Bangabandhu about the need to build a local pharmaceutical industry. His suggestion that drugs should be imported from socialist countries was heeded by Bangabandhu.

He persuaded President Ziaur Rahman to follow a similar policy. Ziaur Rahman wanted Zafrullah to join his cabinet and work on the drug policy. Zafrullah declined the offer in a four-page letter, citing the presence of an anti-liberation politician in Zia's cabinet. In 1982, he persuaded Ershad to adopt a drug policy, which banned the import of thousands of unnecessary drugs.

The boom that Bangladesh's pharmaceutical industry has since witnessed was a direct result of that drug policy. Bangladesh now exports drugs, in addition to meeting 95 percent of local demands.

***

Zafarullah Chowdhury has won many national and international awards including the Ramon Magsaysay award. Although he lives a very simple life himself, he has always been very hard-working. He always did what he thought was best for people and never thought of the consequences of his activities. Gonoshasthaya Kendra is not a state-of-the-art hospital but it provides treatment to the poor at the lowest possible cost.

Zafarullah formed Bangladesh Medical Association in London towards the beginning of our War of Independence. In April 1971, during a rally at Hyde Park, he tore apart his Pakistani passport and burnt it, thus becoming a stateless citizen.

There's another interesting incident I want to mention here. In 1996 when Sheikh Hasina was the prime minister of the country, her husband Wajed Mia retired from the Atomic Energy Commission as its chairman. The prime minister did not extend the tenure of his chairmanship, as he might have expected. So Wajed met with Zafarullah and expressed his willingness to join Gonoshasthaya Kendra. The only barrier to his joining the organisation was smoking. Wajed was a chain-smoker. So Wajed quit smoking within one month and joined Gonoshasthaya Kendra as its Science Adviser.

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Zafarullah Chowdhury had made some inaccurate statements recently. Although he apologised for it later in a press conference, a sedition case was filed against him. Following this case, several others were also filed, one after another, on charges of land grabbing, extortion, stealing fruits and fish, etc. against him.

Even his worst enemies won't be able to raise allegations of dishonesty against him. He has lived a very simple life even though he had all the opportunities to live a lavish one. Zafarullah, who played a significant role in our Liberation War is now accused of treason, theft, land grabbing and extortion.

Shaheed Janani Jahanara Imam in her monumental book on the liberation war, "Ekattorer Dinguli" (Days of Seventy One), wrote of Zafrullah:

"Zafrullah Chowdhury and MA Mobin have become familiar faces. Both of them studied FRCS in England. After having completed their MBBS degree from Dhaka Medical College and studied inexhaustibly for four years in Britain, when they were just a week away from their final exam, the war of liberation began in Bangladesh.

These two boys quit their education and partook in the Bangladesh movement. They renounced their Pakistani citizenship. Having obtained an Indian travel permit, they got aboard a Delhi-bound flight to reach the battlefield through Calcutta. The plane belonged to Syrian Airlines. It was delayed for five hours in an airport in Damascus. All passengers, except those two, got off the plane. Thank heavens, they didn't.

A Pakistani colonel was at the airport to detain their two fugitive citizens. But you can't detain someone from a plane because it was traditionally considered an international zone.

Officials of Syrian Airport in Damascus later told them that the plane was delayed for five hours just because of them. They reached the battlefield in late May through such dangers."

***

If those who run an institution are involved in politics, the institution suffers, one example being Proshika. What would happen to GK, which was born out of the Liberation War? One can disagree with Zafrullah and, thus, can criticise him. But that GK, as an institution, has to suffer because of such disagreements is unwarranted for the sake of public interest.

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Golam Mortoza is a journalist

The article was translated from Bengali to English by Nazmul Ahasan and Naznin Tithi

Courtesy: The Daily Star

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Dr Zafrullah Chowdhury: A revolutionary’s journey

 

A revolutionary’s journey

Aasha Mehreen Amin

Wed Apr 12, 2023 12:00 AM Last update on: Wed Apr 12, 2023 01:19 PM

Dr Zafrullah Chowdhury

The first time I saw Dr Zafrullah Chowdhury was in 2007, for a story in our weekend magazine in The Daily Star, on his Nagar Hospital on Mirpur Road, where anyone, no matter how poor could get medical care at subisidised costs. I was not expecting to see a clean, organised, fully-equipped, seven-storey hospital where patients could see a doctor for a mere Tk 20. The place was busy but organised, not chaotic like our understaffed, overcrowded public hospitals. Strikingly apparent was the presence of mostly female staffers -- the receptionist, paramedics, pathologists, nurses, on-duty doctors, and even the drivers of the hospital vehicles. Among the patients were labourers, domestic workers, teachers, civil servants and beggars. It was the first time I heard that patients could get an insurance card -- for Tk 150. Insurance holders did not have to pay to see an on-duty doctor, and to see a specialist the fee was only Tk 200. The most innovative part of the insurance scheme was that it was designed to provide healthcare to people according to their ability to pay. So, for someone who was destitute, the treatment would be free, for a poor person, it would be highly subsidised, for an upper middle-class person the cost would be higher. It was hard not to be floored by the foresight of the individual behind what seemed to me, a fantasy world where poor people had access to affordable, efficient medical attention.

But that is what Zafrullah Chowdhury is -- a larger than life figure who had the vision to realise that it was the lack of access to affordable healthcare that condemned the poor to a life of continuous ill health. His fierce determination to break this vicious cycle led to the creation of an institution like Gonoshasthaya that has made revolutionary changes not only in healthcare but in public perception of women as vital nation builders.

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It’s hard to find another person like Zafrullah

When my team and I went to interview him at the hospital, I was a little taken aback by his appearance; longish white hair and clad in a batik Hawaiian shirt and khaki trousers, sandals half worn, he looked more like an eccentric artist than the founder of a mammoth development organisation. It was hard to gauge his mood as he went on his inspection of the wards, blasting the nervous staff at the top of his voice for some inefficiency and then suddenly cracking a joke to make them laugh, his hawkish eyes twinkling. His staff called him Boro Bhai, no "sir" or "doctor" for this no-nonsense man. But the respect and love he evoked among patients, paramedics, doctors and the staff, was obvious.

And when he met patients, he was extremely gentle and kind.

At present, Nagar Hospital has among other facilities, a burn and plastic surgery unit, cardiac unit, dental unit, surgery, counselling, physiotherapy, Ayurveda, Yoga and of course 24 hour emergency services.

So how did a vascular surgeon looking towards an ascending medical career in the UK end up being the founder of a multidisciplinary organisation in his home country that would be committed to the welfare of the poor and marginalised? The Liberation War of 1971 changed the trajectory of his life. He and his friend Dr MA Mobin left their studies in London to join the resistance by treating wounded freedom fighters. It was pure patriotism that laid the foundation for Gonoshasthaya Kendra. Zafrullah and his fellow doctors set up a 480-bed field hospital near the border with India to treat the wounded and sick. The young surgeon realised that while there were doctors in this hospital, the facility didn't have any nurses. So girls and young women in the refugee camps were invited to learn first aid and assist in operations.

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The legacy of Zafrullah Chowdhury

"I realised that it was not the amount of training that was important in this context but the access to training," he said during the interview. When the war was over, the Field Hospital was renamed Gonoshasthaya Kendra (GK) which relocated to Savar with sub centres in surrounding areas and other districts. From his experience at the Field Hospital, Zafrullah knew how he could build a team of paramedics. GK started training girls and women who had completed their SSC (Secondary School Certificate). Soon it was a common sight to see these young women in the villages, going on foot or bicycle to visit households, telling them about basic healthcare, sometimes giving vaccines, even assisting in deliveries. The presence of these female paramedics gave women a new status. Villagers began to realise their importance and appreciate their work. GK's involvement with the community had a major role in the success of national family planning, immunisation and ORS campaigns. 

Gonoshasthaya Kendra (GK), which is a multidimensional development programme, involves the community as a whole. It includes projects ranging from primary healthcare centres and hospitals, community schools, agricultural cooperatives, women's vocational training centres, training women drivers, to economic enterprises to help finance GK Trust activities. But GK's most obvious success is its primary healthcare programme (mainly in the villages) that benefits over a million people.

GK has proved that primary healthcare can be a successful, sustainable system. In 1982, GK's pioneering effort in forming a National Drugs Policy allowed local companies to produce essential drugs at much lower prices than multinationals did. GK itself produces essential drugs at subsidised prices. GK's Gono Bishwabidyalaya (People's University) trains doctors, paramedics and physiotherapists who will provide primary and tertiary care to poor communities.

The accolades he has received are many. Among them are a 'Certificate of Commendation' for his contributions during the Liberation War in 1971, the Swedish Youth Peace Prize, Sweden for founding Gonoshashthaya Kendra and providing primary healthcare to rural communities, Maulana Bhashani Award, Ramon Magsaysay Award, The Right to Livelihood Award, Sweden, One World Action Award, UK, Public health Heroes Award, UK, Fr. Tong Memorial Award, India, Doctor of Humanitarian Sciences Award, Canada.

His undeterred commitment to the welfare of the disadvantaged was probably because of his unconventional upbringing. His mother, Hasina Begum, a courageous, self-educated woman, who believed in the equal rights of women and men, taught him the value of sharing with the less fortunate. His father, Humayan Murshed Chowdhury, was an honest police officer and instilled in him love for one's motherland. Zafrullah found his perfect match in his life partner Shireen Huq, a passionate human rights activist and one of the founders of Naripokkho, a women's rights organisation. Their children are Brishti and Bareesh.

The basic philosophy that Zafrullah modelled all his endeavours on was to come up with indigenous solutions for all problems. Thus Gonoshasthya's mission was to 'go to the village and build the village'. The GK Savar hospital serves the community and provides all the medical services as well as alternative medical treatment such as ayurveda and acupuncture.

In fact, he has been unequivocally, an advocate of local medical expertise. In 2019, GK inaugurated its second dialysis centre in the Savar hospital, the largest such centre in the country. During the pandemic, he tried to popularise a locally made antigen testing kit and was ready to help set up a 2,000-bed Covid hospital which did not receive the support it warranted during the most challenging moments of the crisis. For his own treatments which included regular dialysis he would come to his hospital even when he was on life support. There are few individuals who can display such conviction of their own principles. 

Considered at times a controversial figure for his incendiary remarks in public, he remained unapologetic and brutally frank all throughout, a fighter till the end. Battling with formidable ailments, waging a war against crippling poverty and ill health of people, to bring some solace to the most vulnerable and neglected, his contributions to this country cannot be listed within the confines of this article. 

[Some information has been taken from Star Weekend Magazine, published on November 30, 2007]

Courtesy: The Daily Star

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The doctor with a heart of a warrior

 

Dr Zafrullah Chowdhury: The doctor with a heart of a warrior

Gonoshasthaya Kendra founder and trustee Dr Zafrullah Chowdhury passed away at the age of 81 at the Gonoshasthaya Nagar Hospital in the capital

Photo: Collected

In 1971, Zafrullah Chowdhury was a 30-year-old young man. He was studying FRCS in England when the Independence War broke out. 

Jahanara Imam in her book 'Ekattorer Dinguli' writes that when the war broke out, Zafrullah Chowdhury skipped out on his FRCS exam and boarded a flight to Delhi to take part in the Independence War. He was accompanied by Dr. MA Mobin.

The Syrian Airlines flight they boarded was delayed for five hours in Damascus. Everyone got off the plane, but the two did not get off. Unbeknownst to them, a Pakistani colonel was waiting at the airport to detain the two 'absconding Pakistani citizens'. No one can be arrested inside a plane as it is an international zone, and so the two survived. The Pak colonel had to return disappointed.

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After joining the war, he took part in guerilla warfare in the early stages. Later, along with surgeon Dr Mobin, he established the first field hospital at Melaghar for freedom fighters and refugees. 

The temporary hospital with 480 beds was managed by five Bangladeshi doctors and a large number of female volunteers. None of the volunteers had any previous medical training.

As the people's doctor passes away, he will surely continue to be remembered for his works, especially for his contribution to the country's health sector.

Dr Zafrullah Chowdhury held the position of chief advisor of the expert committee for Bangladesh national medicine policy in 1982. By implementing the recommendations of that committee, it was possible to increase the production of medicines locally and improve the quality of medicines, to eliminate harmful and unnecessary medicines, and to formulate policies regarding the price and import of medicines.

Seventeen hundred dangerous and unnecessary drugs were banned through the Essential Drugs Act. There was a lot of resistance at the time from foreign drug manufacturing companies, but the government eventually accepted the committee's advice. This policy became an example for many countries in the world in terms of market regulation of therapeutic drugs.

Zafrullah Chowdhury had started his work in the health sector of the country immediately after independence. He realised the sorry state of rural healthcare in the war-torn country. The Bangladesh Field Hospital of the Liberation War was converted into Gonoshasthaya Kendra on the last Sunday of 1972.

There is a beautiful story behind the naming of Gonoshasthaya Kendra involving Bangabandhu Sheikh Mujibur Rahman.

A concept paper titled 'Basic Health Care in Rural Area' was first presented in Dhaka in April 1972, which laid the theoretical foundation of the healthcare centre. This report became one of the foundations of subsequent international discussions on primary healthcare. 

The then Bangladesh government objected to the name of the field hospital set to resume operations in the independent country. Frustrated, Zafrullah directly complained to Bangabandhu, "Mujib Bhai, they are not allowing us to build the field hospital."

Bangabandhu advised him to give a beautiful name to the hospital. After much discussion, Bangabandhu proposed that he would give three names, and Zafrullah would give three names. The best would be the name of the hospital. In the next meeting, Zafrullah started reading out names from his list. Number two was Gonoshasthaya Kendra. Bangabandhu stopped him and said, this name is beautiful. This will be the name of the hospital.

Bangabandhu did not stop only with helping with the name, he also allocated 23 acres of land for Gonoshasthaya Kendra. Several other individuals also donated a total of five acres of land from their family property for the Gonoshasthaya Kendra.

Through Gonoshasthaya Kendra, Zafrullah Chowdhury trained the less educated or uneducated rural people on vaccination and treatment of common diseases. These trained volunteers used to roam from village to village with the mantra of service to humanity. Village people used to get basic healthcare for mother and child, family planning advice etc from them.

Bangladesh Government's NGO web portal states that Gonoshasthaya Kendra's journey began with the motto 'Go to village, build village'. The volunteers of the Kendra would go to the village on their own initiative, live in the village, and taking the villagers with them would decide on the necessary programmes.

The functions of Gonoshasthaya Kendra can be roughly divided into two categories: direct services and indirect services. The first phase includes support to agriculture, community schools, primary health care centres and hospitals, technical training for women, nutrition development, disaster and relief management, etc. Gonoshasthaya Pharmaceuticals, Gonoshasthaya Intravenous Fluid Unit, Gonoshasthaya Basic Antibiotics Production Unit, Gonoshasthaya Printing etc. are some sources of income of Gonoshattha Kendras.

Gonoshasthaya Kendra was the first to introduce the concept of paramedics in Bangladesh. Then in 1977, Bangladesh government accepted it. Gonoshasthaya Kendra placed special emphasis on the training of paramedics and their own paramedics provide medical services to common people across the country. Thanks to these paramedics, the maternal and child mortality rates in the areas operated by them have decreased a lot, compared to the overall rate of the country.

Dr Zafrullah Chowdhury co-authored a research paper titled "Tubectomy by Paraprofessional Surgeons in Rural Bangladesh." On September 27, 1975, it was simultaneously published in the world-renowned medical journal Lancet from the United States and the United Kingdom. This was the first cover article published in the Lancet from the Indian subcontinent. During the rest of his life, many articles of Zafrullah were published in national and international journals. 'Research: A Method of Colonisation' published in 1977 was translated into Bangla, French, German, Italian, Dutch, Spanish, and many Indian languages.

Zafrullah Chowdhury started working as a project coordinator of Gonoshasthaya Kendra in 1972. He held that position for 37 years and retired from that position in May 2009.

The contribution of this great man did not go unnoticed or unappreciated.

In 1977, he received the highest civilian honour of the Bangladesh government, the Independence Award. In 1985, he was awarded the Ramon Magsaysay Award from the Philippines. In 1992, he received the Right Livelihood Award from Sweden. He also received the International Health Hero award of the University of Berkeley in the United States, and the Ahmed Sharif Memorial Award of Bangladesh.

Zafrullah Chowdhury was an optimistic person. Expressing his feelings after receiving the Ramon Magsaysay Award, he wrote: 'Where is the conscience of this world today? Where is our humanity? Is humanity asleep? No! People all over the world will rise again very soon against exploitation and imperialism, to end human misery.'

In 2023, Emeritus Professor Sirajul Islam Chowdhury described Dr. Zafrullah's overall contribution to Bangladesh as unique, and added that it is difficult to find another person like Zafrullah in contemporary society.

As a child, Zafrullah wanted to be a banker, but his mother encouraged him to become a doctor. In a speech he said, 'Now I can say, my mother showed me the right path.'

Zafrullah Chowdhury was born on 27 December 1941 in Raujan, in Chattogram district. His father was a student of revolutionary Masterda Surja Sen. Zafrullah passed matriculation from Nabakumar School, Bakshibazar, Dhaka and Intermediate from Dhaka College.

He passed MBBS with Distinction in Surgery from Dhaka Medical College in 1964. Then he studied FRCS from the Royal College of Surgeons, UK, from 1965 to 1971. Then when the war started, he left without taking the final exam. Later in 1990, he received an honorary FCGP from the College of General Practitioners. In May 2009, he was awarded a Doctor of Humanitarian Service by the World Organisation of Natural Medicine of Canada.

Courtesy: The Business Standard

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