Literacy has often been defined as those aged 15 and older who can read and write. According to Wikipedia (2011), the overall literacy rate for Bangladesh is 56.5%. This is a significant rise from 29.2% in 1981 (Bangladesh Literacy Rate, 2011). A 2008 UNICEF estimate of gender disparity indicates that the literacy rate for men is 62% and 51% for women (Wikipedia, 2011). The Bangladesh Government and various NGOs have invested significantly in education and literacy. According to a UNESCO report in 2000, there were more than 450 NGOs working in the field of literacy. These NGOs represented nearly 163,000 ongoing literacy centers (UNESCO Institute for Statistics, 2002).
Free education for all children aged six to ten is technically a constitutional right (Wikipedia, 2011 and Asia Info Bangladesh Education, 2011). However, many children are unable to afford school supplies, uniforms, or the necessary tuition for coaching classes that will help them pass their courses and move on to the next grade.
Some studies done by UNICEF (2000-2004) indicated that access to education for girls in the Chittagong Hill Tracts is significantly lower than most other regions in Bangladesh. The distance from home to school is often prohibitive for girls. Socio-economic factors as well as prevailing attitudes toward girls’ education discourage girls from attending school (World Food Programme, 2011).
“There is a clear relationship between household socio-economic status and literacy. Almost three out of every four heads of vulnerable households are illiterate, compared to 22 percent of non-vulnerable household heads” (World Food Programme, 2011). Low levels of female education mean a lack of female presence in community decision-making processes. This, in turn, relates to community issues involving poor health and hygiene practices, a high incidence of preventable diseases, child malnutrition, and low family income (World Food Programme, 2011).
What does all of this really mean for Memorial Christian Hospital and College of Health Sciences? It means that each year we will probably treat a significant number of patients and family members who cannot read or write. The literature we give them on health teaching must be reviewed many times and simplified. Pictures and stories may need to replace charts, diagrams, and lists of “do’s and don’ts.” Low literacy levels are linked to poverty, meaning many of our patients may be very poor.
Low literacy rates in our area contribute to the fact that we continue to see a large number of patients with malnutrition and preventable diseases. Illiteracy means that we just can’t “take anything for granted.” Basic assumptions regarding hygiene and nutrition may be totally foreign concepts to many of our patient population. For those of us making a rapid transition from the “developed world of litigation in medicine” to complete “health illiteracy”…this represents a radical shift in thinking about how we go about communicating with patients. Obtaining “informed consent” takes on a whole new dimension.
Since women and girls face disadvantages in pursuing an education, young male relatives and even children may be called upon to assist in the care of female family members (i.e. assisting in answering sensitive questions during the medical examination process). Lower literacy and education rates for girls in our region mean that we may face significant challenges in recruiting qualified girls and women to train in our medical programs. Our local girls may not meet the education pre-requisites for our nursing program. This is a tragedy as we are in desperate need to have native Chittagonian speakers as our nurses, aides, and caregivers.
Literacy affects our lives and projects in every dimension. It is clear that literacy transforms lives, not just physically and economically but also spiritually. These are challenging but exciting days to work in Bangladesh.