Hariban, a mother of Þve, was always worried about visiting the doctor. Language and cultural barriers aggravated her fear of interacting with anyone outside her Bangladeshi community. But a chance health education session with a local pharmacist led Hariban to reveal her condition. She was advised to see a GP - and she tested positive for diabetes. Hariban was helped by the Bengali Bridge Project, a pilot scheme that has helped dozens of men and women from the 10,000-strong Bangladeshi community in Camden, north London. Many have not accessed health services because they cannot speak English and feel that healthcare professionals do not understand their needs or beliefs.
This has been frustrating for health professionals who are alarmed at the high levels of diabetes and coronary heart disease in the community.
Four years ago, pharmacist John Foreman, who runs the Green Light pharmacy near Euston station, developed a plan to run classroom-style education sessions looking at chronic health conditions among the Bengali-speaking community. The focus of the project, funded initially by the former Camden and Islington health authority, was organising seminars, employing translators and distributing literature and posters. Later, the project was accepted as a three-year pharmaceutical services pilot. It has been funded by the Department of Health since April.
"The results are very encouraging," says Foreman, whose Bengali-speaking staff act as translators for the sessions. "The community has responded well to the effort because it is very convenient and open for them. They always Þnd someone here who can talk to them in their language."
The focus of the project has been carefully delineated to provide basic advice about health misconceptions. Sessions are organised regularly - about every six weeks - to educate the community about diabetes, asthma, coronary health disease and travel health. A nurse from Camden primary care trust (PCT) and two translators ease the process.
The Þrst sessions, however,did not attract many people. Foreman eventually realised this was because they were mixed, with both men and women present at the same time. A subsequent switch to single-sex classes led to many more female attendees. About 20-25 people are present at each session.
Some of the early sessions were held at the local health centre, which did not prove popular. Now the pharmacy itself acts as a makeshift conference room and patients with a diagnosis of, say, coronary heart disease, hypertension or diabetes can attend at any time for on-the-spot care.
"John's sessions have been extremely helpful," says 67-year-old diabetic Munazir Ahmed. "We feel comfortable talking to him. I can come here any time to monitor my blood sugar and blood pressure."
Foreman says that diabetes and coronary diseases are the most common illnesses. "We also have to regularly educate them about travel health, as they go to Bangladesh and return with allergies and infections due to lack of awareness." This may mean tropical sores, dehydration and diarrhoea. Often, travellers who have taken no precautions are so sick on their return to Britain they are admitted in hospital.
The pilot is due for its Þrst annual appraisal next month, but Foreman is satisÞed with his results, particularly on smoking cessation. The incidence of smoking is as high as 49% among men in Britain's Bengali community - more than double the national Þgure of 21%. "Up to 30-40% of smokers quit after attending the sessions," says Foreman.
Foreman admits to playing on the deep religious beliefs of his patients. He roped in the imams of local mosques, thinking their status in the community would help him to get his message across. Two sessions were held last year exclusively for the imams and staff of mosques at Islington and Camden. What followed was a diktat from the imams that men should quit smoking during the month of Ramadan, when Muslims fast.
"It was initially very hard to communicate with the Bengali community because of religious and cultural barriers. Faith has been an advantage for us," says Foreman. "Imams helped us overcome these barriers. We have good relations with them and it has helped galvanise the Bengali community towards the need for health, hygiene and care."
Ahmed, an Arabic chef who prefers not to give his full name, speaks English but is not conÞdent doing so - even after living in Britain for 20 years. "Though I can speak and understand a bit of English, I take my university-student daughter along when I have to visit the hospital. It is difÞcult for me to understand the medical terminology of doctors," he says.
The communication problem is more acute among women, some of whom have not learnt English in two decades or more. Hariban, who has been in Britain since 1979, says she used to regularly attend English classes, but stopped after having children. "It was only after I attended one of the sessions at the pharmacy that I was encouraged to see a GP - where my diabetes was diagnosed," she says. Another woman, Shobum, who came to Britain with her husband in 1982, also suffers from diabetes. "The sessions helped me to understand dietary control and proper medication," she says. "We feel comfortable since we can interact in our language."
Suhas Khanderia, the commissioning lead for the Camden pilot, helped Foreman to secure the government funding. She is enthusiastic about the results. "The project has shown how pharmacies can be involved to deliver successful health interventions for local communities," Khanderia says. "It is unique in its concept and it is a good model for other parts of the UK."
For more on the Camden primary care trust: www.camdenpct.nhs.uk
