Dhaka’s ugly, ruthless side
It was a piece of news in late July that tugged at the heart and left a nagging unease long after the first read. Jewel Mia, a day labourer, and his wife Nasrin, a domestic worker, had hanged themselves from the ceiling fan of their tin-shed room in Rampura, Dhaka. They were 28 and 22, respectively – in other words, "in the prime of their youth." Eight months ago, they had lost their first child. Nasrin had given birth to a stillborn baby despite the couple raising Tk 63,000 for the delivery in a private hospital in Kishoreganj. According to the news report, relatives said it was both the tragedy and the financial hardship that led them to take such an extreme decision.
They had a Tk 30,000 loan on their heads as well as Tk 3,500 unpaid rent for their one-room tin-shed home, not to mention daily expenses like food. Jewel's job as a day labourer was irregular, and Nasrin could not go to work for the last few days as she had a fever. From the couple's point of view, the future, clouded by their child's death and riddled with unpaid bills and loans, looked so bleak that death seemed the only escape.
The story would resonate with many young couples starting out in this ruthless city, where what you earn is nowhere near what you spend, just for the bare minimum. It is a bizarre scenario where the cost of food, housing, and healthcare – basic needs for any human – keep soaring while incomes stay relatively the same.
On the day I read the news of Jewel Mia and Nasrin, 14 people had died of dengue in 24 hours. Diseases spread easily in a city that has 23,234 people inhabiting each square kilometre. For the working class, getting tested for a fever and flu-like symptoms hardly warrants a costly visit to the doctor or huge fees for tests. But sometimes they get sicker and cannot afford not to go to work, so they are forced to seek healthcare. Yet, where will they go? The public hospitals are overcrowded and, for many, too far to drag the sick to. So they go to nearby private clinics and doctors' chambers where a long list of expensive tests and medicine are prescribed. Thus, a huge chunk of their income just disappears into the doctors' chambers, diagnostic centres and pharmacies. If hospitalisation and surgery are required, the costs are bound to soar to impossible heights. So, they sell assets or jewelleries, and if they don't have that, borrowing is the only answer. For others, even a serious illness may have to be waited out with practically no treatment apart from over-the-counter pills. Sometimes they live, sometimes they die: being fatalistic helps to justify perishing without any medical attention.
Perhaps this painful story struck a chord with me because of Minara, a highly efficient home worker. Two weeks ago, her husband and seven-year-old son had fallen sick and tested positive for dengue. There was no government hospital near her house, and the far-away ones would have turned them away, being overwhelmed with patients. The tests, cost of saline drips, and doctors' fees reached well over Minara's means and she could only cover them with help from her employers. But even then, she had to buy food on credit; the bill had already reached Tk 6,000, weeks before her next paycheque. I was shocked to know she and her family had been having just daal, potatoes, and rice for all the time her husband had been sick, as he could not drive the rickshaw and earn money for daily groceries. I thought of how anxious those days must have been for her and her husband, agonising over how they would make ends meet in the following days. I wondered what would have happened if her husband and son hadn't had follow-up tests done, or received treatment. What if her husband or her son had not survived? What desperate thoughts would have engulfed her?
I know I should not have such morbid thoughts, but I cannot help feeling defeated, realising that I don't know even a fraction of the struggles that Minara and her husband face on a daily basis.
What I do know is that there is something obscenely absurd that Minara has to pay the same amount for tests that I do when I am sick. A recent study by the World Bank has found that out-of-pocket spending in Bangladesh accounts for 73.9 percent of health expenditure – the highest in South Asia. In the absence of a universal health insurance scheme, people in Minara's income bracket just cannot afford proper healthcare, no matter how serious the illness. Essential surgeries, medication, and other forms of treatment are postponed or abandoned because of a lack of funds. Otherwise, borrowing from loan sharks who charge high interest rates is the only answer. There are no statistics on the informal debt burden of the poor – not just in the cities but in the villages too. Often, another loan is taken to pay off the first loan, and so the burden just gets bigger and bigger and the debtor becomes poorer and poorer.
People come to Dhaka from all parts of the country with the belief that they will earn enough to survive and feed their families. But soon enough, they become trapped in the vicious cycle of working and spending every penny on just living costs. For the majority of its residents, Dhaka is the most expensive city where even a shabby tin-shed room like Jewel and Nasrin's costs Tk 3,500 a month. Dhaka is also an uncaring, brutal city where no one really cares if a young couple decides to hang themselves from the ceiling fan when they feel they have no way out.
Aasha Mehreen Amin is joint editor at The Daily Star.