The development of oral rehydration saline is just one example of the cutting edge research and innovation that ICCDDR,B has engaged in during its decades of operation. Shamsher Chowdhury traces the history and achievements of this internationally renowned institution.



"The most important medical advancement of the 20th century" -- Lancet

In an underdeveloped country like Bangladesh, research and development, be it in the field of medical sciences or otherwise, is often considered a low priority. Many of us in the third world countries have little or no concept of the comprehen-sive benefits of medical research having a positive impact on the overall socio-economic lives of the entire nation and its impact on the future generations. Millions in most of the third world countries to this day continue to suffer and die from innumerable diseases, which are a rarity in the countries of the developed world. The poor state of healthcare services in Bangladesh is but too well known. It is dominated by indifference and inefficiency, and devoid of minimum levels of human compassion and concerns. One has to only look at the growing culture of high profiled diagnostic clinics and other hospital facilities, which are essentially focused as business enterprises. Most importantly, the qualitative aspects of these service providers have often been questioned. Not only that, but most of the clinics and hospitals, by default or otherwise, are tailored towards serving the affluent and not the people of lesser consequence and the poorer section of the population.

Brief history
Against the backdrop of the above ICCDR,B today can rightfully claim itself as unique and the only one of its kind in the country. It began its glorious and yet humble journey in 1960 as the Pakistan SEATO Cholera Research Laboratory, with most of its financial support being provided by a handful of international donor countries with USA (USAID) and the United Kingdom leading the way. The Laboratory began functioning in earnest by setting up a small patient care facility in Dhaka in 1962 for the treatment of cholera cases as part of a larger goal aimed at carrying out research into the causes and effects of cholera with a view to provide better and more effective treatment. The SEATO Cholera Research Laboratory thereafter continued in vigorous pursuit of its objectives right through early 1971.

Beginning March 1971 and well beyond post-independ-ence Bangladesh, the centre witnessed and had passed through turbulent times, which intermittently threatened the very existence of the centre due to prevailing uncertainties in the newly-born country. However, due to the selfless and dedicated services of a handful of Bangladeshis and expatriate professionals, and their unflinching faith and commitment to the cause, the laboratory not only survived but continued with its operations unabated, when in 1978, it emerged as ICDDR,B -- an international institution with 26 countries and international agencies signing a Memorandum of Understanding endorsing the centre as an international entity. The centre was thus established by Ordinance no. 51 of 1978 as successor to the Cholera Research Laboratory, created in 1960.

Legacy and heritage
So long we have dwelt on the unique feature and the brief history of the centre. We shall now focus on the various achievements and its current functions. ICCDR,B has indeed a long and creditable heritage, but its forte has been in building up and maintaining a performance culture of continued excellence.

Since 1960, this centre has earned a well-deserved reputation of excellence. Its work is often cited as the authority for important health and population related decisions by multi-lateral, government, and development agencies throughout the world. Its accomplishments in research have led to broad improvements in health for people worldwide.

In the 1970s scientists at ICDDR,B developed a simple mixture of salts and water, called oral rehydration solution (ORS), which revolutionised the management of patients suffering from life-threatening diarrhea. Since its discovery, the use of the ORS has spread over the entire globe. With the rapid increase in the use of ORS and the resulting decrease in diarrhea deaths, 40 million lives have been saved worldwide. The prestigious medical journal Lancet described the development of ORS as "the most important medical advancement of the twentieth century." ORS has been hailed as one of the most outstanding medical discoveries of the last century and responsible for saving the lives of millions of children with diarrhea during the last two decades. In recognition of this particular discovery alongside others, the centre was awarded the first ever Gates Award for Global Health in May 2001 with a prize of $1 million, with the government of Bangladesh providing an equivalent grant. In 1987 it received USAID's Science and Technology for Development Award. This year ICDDR,B received the prestigious national Independence Day Award. In 1984 the centre also received Unicef's Maurice Pate Award.

Areas of interventions and impact
The most important feature of ICDDR,B's operational strategies and subsequent interventions is that these are directed not only to the overall health concerns of the poor of Bangladesh, but also elsewhere in the world. While most third world countries usually stagnate after a few years of success or so, ICDDR,B chose not to, and continued to move forward. It went on with its diversified programs working on other strategic issues, problems and interventions of public health concerns for the poor of Bangladesh and elsewhere, driven by its success triggered by ORS.

The development of appropriate and successful family planning strategies has made Bangladesh a family planning success story and resulted in a current population that is 50 million fewer than it would have been but for the centre's unique MCH-FP program. The strategies that evolved from the program interventions are now used around the world. On the other hand, immunisation research at the centre has also shown conclusively that routine and new vaccines can decrease illness and death rates in developing countries.

The centre's combined programs in child health and family planning have contributed to 75 per cent reduction in the annual number of childhood deaths in the last 25 years, particularly in around its main field research areas of Matlab.

In 2003 the centre celebrated its 25th anniversary and launched its programs on HIV/ Aids and poverty with a commemorative stamp on ICDDR,B unveiled by the Honourable President of Bangladesh.

Clinical laboratory services
The other unique feature of the centre today is its diversified clinical laboratory services available for people at Dhaka, Matlab, and Chakoria, including others from all over the country desirous of availing its services. At the same time it carries out its own research and supports research protocols of scientists of the centre, including providing training to national and international fellows and mentor students of national and overseas universities and medical research centres. Of significance also is that, keeping in view of the need for quality diagnostic services of people vis-a-vis the capacity of gaining access to such services by the majority who belong to the lower middle class and fixed income groups, the centre since 1990 has been running a most modern pathological diagnostic unit on cost re-imbursement. The services provided by the clinical and pathology diagnostic unit is extremely efficient backed by a technology of laboratory information and management information systems making the unit of an all round international standards.

The diagnostic and clinical laboratory of the centre has most automated advanced technologies and does maintain the highest standards of services. The laboratory performs almost all biochemical tests such as blood chemistry for diabetics, liver functions, renal/kidney functions, thyroid panel, reproductive functions, cardiac markers, and biochemical analyses etc. The unit is also equipped with highly sensitive automated analysers hematological test profiles, blood cell morphology for all types of anemia, leukemia and other forms of blood cancers.

It has the capacity to carry out various sero-diagnostic test markers of sexually transmitted diseases like Syphilis and HIV, markers for various types of Hepatitis A, B, C and E Cancer markers for liver, intestine, prostrate, breast, ovary etc including such old and recently emerging diseases like dengue, Japanese encephalitis, Typhoid and triple antigens. Normal and high sensitive CRP tests can also be carried out for cardiac patients.

Of late the centre's clinical and diagnostic laboratory facilities have been further strengthened, making it capable of carrying out the estimation of Hepatitis B viral load (HBV) and Hepatitis C (HCV) and its genotyping. Nowhere else in the country has the capability of performing this test. Formerly patients used to travel to Singapore for the test particularly for genotyping, which would cost each individual patient $400 for the test alone in addition to travel and other related costs. It can now be carried out at the centre's facilities at a cost of $40 only.

The unit maintains the highest standards in collection of specimens of each individual specimen from the collection time up to its submission to the respective points at the laboratory for actual tests, ensuring accuracy in test results, an aspect many diagnostic centers in the capital city and else where tend to overlook.

Some critical facts on patient care
The goodwill and the reputation the centre's hospital built over the years have resulted in the steady rise in patients exceeding one hundred thousand annually. In 1993, during one of the worst outbreaks of cholera, the hospital treated over 139,750 patients followed by a record 157,500 in 1998.

Of the 100,000 patients attending the hospital each year, 60 per cent are less than five years of age and more than half of these have moderate to severe malnutrition, about 60 percent of their mothers are illiterate and earn less than $50 a month. Most patients come from slums and represent the poorest urban classes. The majority of whom are infant and children who come to the general ward are malnourished and often do suffer from illnesses such as pneumonia, meningitis, etc. Because of the serious nature of their illnesses, many of the children remain under the hospital's care for 7 to 10 days with medications and other intensive treatment provided by the centre.

Many of the mothers and children who visit the hospital for treatment of diarrhoeal diseases have not received any routine preventive health services. The ICDDR,B hospital offers both curative and preventive services, usually not available in the developing world, free of charge. In addition health education is provided to patients and their attendants through group discussions and all kinds of modern day visual aids.

Once India's celebrated Prime Minster Jawaharlal Nehru while referring to the unique character of his country said: "Unity in Diversity." ICDDR,B can also be proud of having some of those unique characteristics in a different context. The centre's operations are funded by as many as 55 governments and agencies, with as many diversified accounting procedures and accountability requirements, which in turn are reflective of the faith, the donor agencies have in the centre's mission and its noble objectives.

It has braved the many rigors and onslaughts during the turbulent times of our liberation struggle. Many of the centre's employees who was with the centre at that time will also tell you how extraordinary moral and ethical support were provided by the centre's staff (both local and expatriate) to the cause and spirit of our liberation struggle.

Let us also pay tribute to the team of dedicated professionals both local and expatriates without whose efforts and commitment, ICDDR,B could never have achieved what it has today. ICDDR,B is too dear an institution, too close to our hearts, and too valuable an institution for our country and hence it is our collective responsibility to provide all out support to this unique institution in its efforts to save lives particularly the poor and the disadvantaged in South Asia and elsewhere.

Shamsher Chowdhury is a freelance contributor to The Daily Star.

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