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.
