Chowdhury, Zafrullah

A fear of illness and of the often exorbitant costs of treatment and medicine is shared by all except a few wealthy elites in the developing world. Families frequently are driven into debt by the calamity that illness brings. Tragically, many invest their scant savings in medicines that are worthless and sometimes even harmful. Their predicament is compounded by ignorance and lax professional and government monitoring of the pharmaceutical industry. 

Dr. ZAFRULLAH CHOWDHURY was in surgical training in London when the Bangladesh “war of liberation” erupted in 1971. Hurrying home he, with colleagues, established a field hospital to treat battle casualties. The nearby rural poor, however, soon proved to be his principal patients. After the war a shattered economy and a lack of sanitary and health facilities made apparent the need for a permanent rural health program. His answer was to found at Savar, 40 kilometers north of Dhaka, Gonoshasthaya Kendra, or People’s Health Clinic, as a charitable trust. 

As medical services at Savar expanded to nearby villages, it became evident that medical care was of little worth without programs in general sanitation, nutrition and education, and without training for productive employment. CHOWDHURY organized a low-cost health insurance scheme and launched a Bengali-language consumer magazine with a health bias which now has the second largest distribution of any periodical in Bangladesh. He trained illiterate rural folk to vaccinate and treat common ailments, sending them out on bicycles to teach rudimentary maternal and child care, and family planning, including sterilization and menstrual regulation. In predominantly Muslim Bangladesh two-thirds of the village workers are women and these “barefoot doctors” are now also teaching the villagers handicrafts and improved practical techniques in farming, gardening and poultry raising. 

Because of the high cost of imported medicine, CHOWDHURY founded Gonoshasthaya Pharmaceuticals, Ltd., to manufacture cheaper generic drugs. Although more than 4,000 commercial drugs were for sale in the country, including some that were unnecessary and others that were dangerous, some 150 of the most essential were in short supply. The government responded in April 1982 by establishing a committee of experts, including CHOWDHURY, to seek a countrywide solution. The committee recommended restricting manufacture and import to roughly the 225 essential drugs on the list compiled by the World Health Organization for developing countries. Despite protests from drug manufacturers abroad, this policy has been pursued. The result has been wider availability of essential drugs at lower prices, and less confusion among laymen. 

In an iconoclastic approach to customary bureaucratic practices CHOWDHURY has not spared many of the international agencies whose avowed objectives are to facilitate development. Often, he insists, they are as concerned with the welfare of their frequently highly compensated expatriate staffs as for the programs under their auspices. 

CHOWDHURY, energetic and unconventional at the age of 43, lives the simple life of service he preaches — which is shared by his wife and only child. He is now organizing a new kind of medical school where the emphasis will be upon teaching holistic preventive medicine as an integral part of daily village life. 

In electing ZAFRULLAH CHOWDHURY to receive the 1985 Ramon Magsaysay Award for Community Leadership, the Board of Trustees recognizes his engineering of Bangladesh’s new drug policy, eliminating unnecessary pharmaceuticals, and making comprehensive medical care more available to ordinary citizens.

I am honored to be here. We are all members of an uneven and unjust world, where one class is ruling over another; one expropriates the fruit of another?s labor. Such exploitation leads to ill health of nations, both physical and mental. Ill health is not just a misfortune but largely a product of the social and economic organization of society. 

It is well-known that people with lower incomes tend to have higher morbidity and mortality. Malnutrition is the constant companion of the lower social class. The health and illness of rural people or people in urban slums is neither the act of God nor of their genes, but a measure of the misery caused by present social and economic organization. Every year about five million children under five years of age die of diarrhea. Each year a similar number die from measles, whooping cough, polio, diphtheria and tetanus, all of which are easily preventable through vaccination. One estimate suggests that the cost of providing sufficient Oral Rehydration Salts for treating all cases of diarrhea in the world?s 1,000 million children under five years of age would be $300 million a year. Another $500 million would be needed to vaccinate all such children. This may seem high. But what is the world spending on the military? 

World military spending in 1982-83 exceeded $600 billion a year, in other words, $1 million a minute. The USA spent one trillion dollars ($1,000 billion) between 1981 and 1984 on arms. Next to the USA, the USSR and the United Kingdom are the largest spenders. Under developing countries are no exception. [I do not like the word “developing” as it does not reflect the truth. Most of the Third World countries are not “developing” but rather “under developing: because of the continuation of past colonialism and imperialism in different disguised forms.] Britain spent $9 billion on health in 1981-82, which represents 5.7 percent of its Gross National Product (GNP), while spending $13 billion on defense. Most Third World countries spend between 25 and 40 percent of the GNP on so-called defense. 

One half of one percent of one year’s world military spending would provide agricultural implements to allow food deficient, low income countries to attain self-sufficiency by 1990. 

While developed countries, with a few exceptions, persistently violate the recommendations of the United Nations to give 0.7 percent of their GNP as development aid to underdeveloped nations, civilized (!) developed countries continue to increase their arms exports to Third World nations. While people go hungry in most underdeveloped countries, purchase of arms is the main item in their budgets. And it may be no coincidence that in many of these, the form of government is military dictatorship. 

Where is the world?s conscience? Where is our humanity? Has it gone to sleep? No. People all over the world will definitely rise soon against exploitation and imperialism to end human sufferings. 

We, the workers in Gonoshasthaya Kendra (GK) in Bangladesh, are also trying in our humble way to move in that direction. The workers of GK have asked me to express their gratefulness to the Ramon Magsaysay Award Foundation for giving me the Ramon Magsaysay Award for Community Leadership in 1985. I have come here to receive the Award on their behalf. We consider the Award to be for the collective work of GK workers, not for an individual. You will be pleased to know that the workers of Gonoshasthaya Kendra have decided in a meeting to invest the whole amount of the Award in our endeavor to bring about a change in medical education. The proposed education will not transform the medical students into businessmen; greed will not rule them. These new doctors will be the “Doctors of Health,” not the “Doctors of Disease.” 

They will be the change agents for tomorrow’s healthy, humane and sane world, where exploitation through imperialism and capitalism will not exist. 

Thank you very much for helping us in our efforts for the development of a healthy society in Bangladesh. And probably the endeavors of the late President Ramon Magsaysay were in the same vein.