Photos by Saikat Mojumder

Discovering JiVitAland (continued)

The tremendous organizational feat that has made JiVitA possible could bear fruit in at least two ways.

First, the project’s findings on infant vitamin A could lead to national policy: widely distributing vitamin A to newborns could cut infant deaths by 20 percent in Bangladesh and elsewhere in the region. Already, senior JiVitA researchers have spread the news about the effects of infant vitamin A at 15 presentations to Bangladeshi government officials and groups of doctors.

The next step is to figure out how to deliver the vitamin A to newborns beyond the study area. This poses huge logistical challenges. In rural areas, most babies are born at home and without a health care professional attending. A survey in the JiVitA Project area, for instance, found that only 8 percent of women gave birth attended by a nurse-midwife or doctor. Half the women had help only from relatives or neighbors, or they gave birth alone.

Bangladesh’s Ministry of Health is close to granting permission to JiVitA to begin operations research into how to broadly distribute the vitamin to newborns, says Rashid.

The second legacy of JiVitA may be the research site itself, providing more opportunities for research in Jivitaland, home to 650,000 people. It’s unclear what might come next, but West, Christian and Labrique all have proposals in the works for further studies in maternal and child health.

Rashid feels confident that scientists will continue to come, whether from Hopkins or elsewhere. “The infrastructure is here,” he says, “so the cost would be minimal to continue research. We have a huge cohort of the population. We have detailed  maps, GIS maps, of this population, and trained manpower—womanpower, human power. ... It’s a diamond mine. We just need some good research questions.”
Christian says, “Our biggest challenge is to continue to sustain the big population site that we have spent so much time and effort developing. Our Bangla staff feels a strong sense of ownership.”

In the village of Sahabaz, in one of the 145,000 households in Jivitaland, a baby boy sleeps aloft: his small bed is suspended from a bamboo rafter by jute ropes and decorated with colorful ribbons.

Interviewer Ripu Rani has come to see the month-old child and his mother, Asiya. Rani will ask Asiya a series of standardized questions about her son’s first month of life and about Asiya’s own health during her final month of pregnancy and the month since the birth. This is one of six or seven interviews that Rani will do today, traveling by bicycle.

Asiya’s child continues to sleep as Rani unpacks bulky bags of equipment, including adult and infant scales and a board for measuring the length of infants, designed and built by the JiVitA Project.

Rani first met Asiya a few days after a field distributor confirmed her pregnancy. At that first meeting, Rani asked Asiya baseline questions about her health, her diet, her work history and her socioeconomic status. She learned then that like many villagers, Asiya’s family owns no land. Her husband earns money as a farm laborer, and Asiya raises poultry: two chickens and four ducks.

Today, Rani weighs the baby, now awake and crying piteously, and she measures his upper arm, chest, head and length.

Sooner or later, field staff like Rani will inevitably face the death of a participant’s child. One of Rani’s colleagues, field distributor Selina, comforts the mother this way: “I try to make her understand that the baby came from Allah. It’s the will of God—that’s why the baby’s dead. Any of us can go at any time.”

Such painful conversations are rare for Selina. “I feel valued,” she says. “I hope JiVitA will continue to run. I can work with it, and I can survive. For physician and epidemiologist Rashid, working for JiVitA not only allows him to earn a living, but also to serve humanity.

“I think this is the motivation for all of JiVitA,” he says. “Doing good for people in need and serving them is a sort of prayer.””