Professor Georgia Guldan, an expert in nutrition and health at Tufts University in Boston, tells me about the nutrients lacking from the diets of slum dwellers.  “A roti weighing 125 grams contains 12.9 grams of protein and 95.4 grams of carbohydrates.  This is a meagre amount of protein and provides very little energy,” she says, noting that such a roti would be a special treat for slum dwellers in the first place.  “Cooked rice, the staple food in the slum residents’ diet, does not do any better.”   Malnutrition, the most common result of this bland and bare diet, impairs the development of children and decreases their overall health and increases mortality rate.

Families from the slums find it difficult to get adequate care for health problems associated with malnutrition. At the Chittagong Medical College (CMC), the government provides free treatment for everyone, but they do not treat every patient equally.  Slum dwellers are scorned and their children are not made to feel comfortable or welcome.  When I visited the clinic, I found the environment to be not only unclean, but also not conducive to the curing of disease. The CMC rarely has visiting doctors or nurses and patients often wait for hours before receiving any treatment.  “Today at six in the morning, I brought my child’s diagnostic test reports; now it is three in the afternoon, and not a single nurse or doctor came to see the reports,” says one father waiting at the clinic.

Slum children are afflicted by many diseases – some due to malnutrition, others due to the filthy conditions in which they live.  There is insufficient medical equipment and few doctors in clinics.  In a slum near Chittagong, for example, people are treated by a doctor who has no education whatsoever in medical science, or public health. When I asked about the quality of treatment at this clinic, the slum dwellers told me, “There is a doctor, so you buy a ticket with 20 taka and you get treatment. They provide a medicinal potion, and they take 20 taka for any problem.”  There have been cases of medical practitioners misusing resources or providing faulty advice to slum-dwelling patients.  “I heard the doctor is educated, but how would I know?” says one outspoken slum dweller waiting for treatment.  “We only believe what people tell us.”

Among all the wards of the CMC, the paediatrics ward provides the worst care for patients, many of whom are too young to be aware of the seriousness of their conditions. On the day that I visited, more than 500 young patients were waiting for medial attention in the paediatrics ward.  After searching throughout the entire clinic for a doctor to interview, it was clear that there was not a single doctor in the whole ward, except for two partly-trained interns. Most of the children waiting for treatment exhibited symptoms of diseases that are caused by malnutrition. I met a few slum children with enormous bellies but very skinny figures. Their hands, legs and other parts of their bodies were frighteningly thin.  When I talked to the mothers of these children, they mistakenly believed that the condition was due to drinking too much tainted water.  Without a doctor around to correct them, they had no way of knowing how to help their children recover.

“That’s edema,” says Guldan about the condition causing the children to have swollen bellies but small limbs.  She tells me that it almost always occurs due to malnutrition. “There is a disease called kushioko. If edema develops from this disease, it is called protein energy malnutrition.”  According to medical literature, this condition is common in families where mothers have too many children to breast feed individually, but cannot afford nutritional supplements to aid the development of their offspring.  “When the first child comes along, it has to be removed from the mother’s breast because the second child comes along,” explains Guldan.  “The children need protein, and protein comes from breast milk, which the mother can’t provide to all the children she has.”

“A one-year-old child should be eating food containing half of their energy calories other than the breast milk,” says Guldan. “A one-year-old child also has a very small stomach. Foods like daal do not have a lot of calories or energy. So quickly the energy finishes, and no one feeds the children again. The body of a child really needs snacks between meals.”   But without the ability to regularly eat meals, it is very unlikely that slum children would ever be able to acquire snacks.  Too often, adds Guldan, families are unable to afford staple foods that add energy to basic foods.  “Is there much oil in their daal or rice?” she asks rhetorically.  “As they can’t afford it, it means no oil.”

According to the Bangladesh Bureau of Statistics, the country has the highest prevalence of underweight children and malnutrition in Southeast Asia.  Pakistan ranks a close second, as it relies on imported food and its populace is poor.  However, some have argued that despite the fact that Bangladesh produces an enormous amount of food, Bangladeshi policies requiring that staples be exported, leaving residents of slums and other poor people without access to even the cheapest goods, like rice and lentils.

To remedy this situation, the government of Bangladesh has taken some steps to make food accessible to even the poorest citizens. For example, regional governments offer “Education for Food” programs in both urban and rural areas.  Through these programs, a few meals each day are provided to children who regularly attend school.  When I asked some slum dwellers if they knew about these steps being taken by the government, they were highly critical.  “We heard about the Bangladesh Government School,” they say.  “But only the children of garment employees or government employees can get admitted.”