With a population of 156 million jammed onto a land mass not much bigger than New York state, Bangladesh is known for crowding, dire poverty and routine floods, as well as widespread government corruption.
Still, a group of British Columbia volunteers and a Bangladeshi college have over the past six years managed to develop an innovative nurse-education program that matches Canadian instructors with Bangladeshi students. The Bangladesh Health Project recently turned out its first batch of graduates and is now focused on nurturing home-grown instructors.
"These students will be able to change the way nursing is seen and how it does its work in Bangladesh," says Melodie Hull, a nursing instructor at B.C.'s College of the Rockies who volunteered with the program this past summer. "They will really be able to change the profession."
The seeds for the project were sown about six years ago when John Richards - a Simon Fraser University professor and director of Vancouver's Mid-Main Community Health Clinic - met the head of a private Dhaka university who was visiting SFU.
That encounter led to Mid-Main and the International University of Business Agriculture and Technology, based in Dhaka, teaming up on a nurse-education program.
Through the program, volunteer instructors teach a curriculum approved by the Bangladesh Nursing Council. Graduates - the first five completed their courses this past September - receive a bachelor of science in nursing. Volunteer instructors typically spend six weeks to six months in teaching positions in Dhaka, where the program keeps a guest house and one Canadian administrator lives year-round.
Funds for the program, which costs about $55,000 a year to run, are raised through Mid-Main, a registered non-profit group in Canada.
Bangladesh has training programs for nurses, but the quality of instruction tends to be poor. New, private hospitals springing up in the country often hire foreign-trained nurses. The profession also has an image problem: nursing in Bangladesh has been perceived as "dirty work" and even linked to prostitution. There are fewer than 0.125 nurses for every thousand people in the country, compared with an average of eight nurses per thousand people in Organization for Economic Co-operation and Development countries.
Against that backdrop, there was an opening for a program that educates nurses in English and according to international standards, says Alex Berland, a B.C. health consultant who's been involved in the program since it was launched in 2004.
"We're really there because they asked us to go there," Mr. Berland says. "Our philosophy is it's their problem, we'll try to help."
As of June, 2009, 75 students were enrolled in the program. By 2012, administrators want to recruit and train 10 Bangladeshi nurse educators to fill faculty positions. There are also hopes of using variations of the program for other developing countries that lack qualified nursing staff.
The program's biggest challenge has come in helping students who are accustomed to a rote, memory style of learning adapt to a system based on critical thinking and problem solving, says Karen Lund, a Canadian who's been with the program full-time in Dhaka since it began.
The knowledge flows both ways.
Ms. Hull, a psychiatric nurse who's also an expert in English as a second language in the medical profession, just finished writing a 135-page report based on her experience with the program.
Lynn Buhler, director of community health with Vancouver Coastal Health, was struck by the students' drive and commitment to the profession during her six-week rotation this past summer. Faculty volunteers pay their own way to Dhaka; housing is provided.
"It was exciting for me to be able to teach novice nurses," says Ms. Buhler, who taught community health courses to students in their final year, drawing on her own two decades of experience in the field.
"That's where the foundation gets laid and I'm quite passionate about that work," she says. "So it was a wonderful experience for me to teach those students and to collaborate with them."