Field Practicum report

Social Welfare Department

BIRDEM General Hospital and Ibrahim Memorial Diabetes Centre
Shahbag, Dhaka-1100

Course Code-MSW 5203

Presented By
Ummey Romman
MSS 2nd Semester
Roll- M 160403045
Session 2016-2017
Department of Social Work
Jagannath University

Department of Social Work

Jagannath University
Published on August, 2018
 Field Practicum report
Social Welfare Department
BIRDEM General Hospital and Ibrahim Memorial Diabetes
Centre
Shahbag, Dhaka-1100
Course Code-MSW 5203

Presented By

Ummey Romman
MSS 2nd Semester
Roll- M 160403045
Session 2016-2017
Department of Social Work
Jagannath University

Department of Social Work

Jagannath University
 Field Practicum report
Social Welfare Department
BIRDEM General Hospital and Ibrahim Memorial Diabetes Centre

Shahbag, Dhaka-1100
Duration: 16 April, 2018 to July, 2018
Course Code-MSW 5203

Institute Supervisor Hospital Supervisor

Md. Shahidul Haque Kazi Rashedul Haque

Lecturer, Social Work Assistant Director & Head of

Department the Department
Social Welfare Department
Jagannath University

BIRDEM General Hospital &

Ibrahim Memorial Diabetes
Centre

Social Work Department

Jagannath University
 Declaration
I hereby declare that the project work entitled ‘Field Practicum Report’ submitted
to the Jagannath University, Department of Social Work, is a record of original
work done by me under the guidance of my Institute supervisor Md. Shahidul
Haque and Hospital supervisor Md. Kazi Rashedul Haque. And this report
(course no : MSW-5203 ) is submitted to the Department of Social Work ,
Jagannath University as a partial fulfilment of the requirement for the Degree of
Master of Social Work (MSW) .The results embodied in this report have not been
submitted to any other university or institute for the award of any type of work.

i
 Acknowledgement
I, Ummey Romman, first of all, I would like to express my gratitude to almighty
Allah for keeping me sound physically and mentally sound to prepare this report.
The theoretical knowledge that is gathered from the educational institution is not
sufficient to aware the subject matter rather the practical knowledge is a must.
To apply the professional Social Work knowledge in the field, a social worker
can apply it through Field Work Practicum. I would like to show my open-armed
respect & gratitude to those respected people who give inspiration,
encouragement, suggestion & direction in various way before the publishing of
the report during my field work practicum session.

I am sent to BIRDEM General Hospital from university as an apprentice of Social

Work. I would like to show my earnest gratitude to the authority of the university
for giving me a grand scope to work in this institution.

I am apprising my sincere gratitude reverently to the Chairman of Social Work

Department of Jagannath University, Professor Dr. Md. Anwar Hossain to send
me to BIRDEM General Hospital for field work practicum.

I would also like to impart gratefulness with respect to my mentor Md. Shahidul
Haque. Without his expert knowledge, skill, earnest behavior, wise opinion, well
thought& direction, it won’t be possible for me to write this report in outstanding
manner. Truly speaking, it would not have been plausible for me to accomplish
the successful compilation of the Field Practicum without his supervision.

I am apprising my sincere gratitude to my Hospital Supervisor Md. Kazi

Rashedul Haque of Social Welfare Department of BIRDEM General Hospital.

ii
I would like to express my heartiest gratitude to the staffs of different sectors of
BIRDEM General Hospital who have helped me by providing different
informations specially Mrs. Papri, Mrs Gillian, Mrs. Tahmina, Mr. Alamgir, Mr.
Aziz, Mrs. Borna.

Concededly, I would also like to thank all of my friends, either in my field

practicum group or out of group for supporting me morally and mentally to
complete this field practicum, would like to thank my all respondents who
cordially share their views and answers to complete my report.

Sincerely Yours

(Ummey Romman)

MSS 2nd Semester

Roll- M 160403045
Session 2016-2017
Department of Social Work
Jagannath University

iii
 Preface

On the view of field work in social work education is a dynamic and updated
discipline than the other discipline of arts and social science faculty. But field
work is not a ready-made product of present time. It shows an aged history like
social work education initial stages of field work was not systematic and
organized. Fieldwork practice is indispensable part of social work education. In
1893, Ana L. Dayes at first brought forth the importance of field work in Social
Work Education to understand the surroundings besides the knowing of an
individual. Consequently, in 1898, the professional Social Work had started out
with field work. As Hepworth and Rooney and Larsen (2002) observe, fieldwork
engages the student in supervised social work practice and provides opportunities
to marry theory and practice. Field Work is also denominated as field practicum
or internship. Since, the students have to participate directly in different activities,
on that regard, the term ‘internship’ is deeming as very much applicable. Here,
an internal supervisor and an external supervisor provide guidelines to the
students.

In this dynamic society, the social worker has great scope to solve various
induced problems from positive and negative changes and to learn this with
gaining theoretical knowledge, the social work students have to be trained about
social consequences through field practicum.

Social work is an international profession and similarly social work education

internationally has always embraced both academic and practical components.
Social work education comprises of a theoretical component taught in the
classroom and field- based education involving integration of the academic
aspect and practice.

iv
The purpose of the field education is to provide students within the MSW
program an opportunity to learn hands-on through an internship work
experience. Field practicum provides the student with an opportunity to gain
first-hand knowledge of social service systems in urban& rural settings, apply
theoretical knowledge to urban& rural problems such as poverty, and to
determine how to access appropriate community resources. In addition, students
learn to communicate oral, written, and technological information reflecting
professional social work skills. Field Practicum provides practice experiences in
a continuum of modalities and varying sizes of systems, including work with
individuals, families, small groups, and communities within an organizational
and community context. It is expected that students will experience a diversity of
client populations and intervention issues, relying upon a range of theoretical
concepts and models to develop breadth of learning and establish a broad base
for practice.

As a student of Department of Social Work, Jagannath University, I have been

sent to the Department of Social Welfare of BIRDEM General Hospital for Field
work with 60 working days. I am very much blessed to get a great chance for
field practicum in BIRDEM General Hospital. I am propounded my performed
activities, experience, success, failure, institute acquaintance by this final report
on field practicum. Though I am not gaining exhaustive success in field work as
an apprentice, I have tried my best to accomplish assigned duties with purity and
devotion. Through this I have gained new knowledge on society and it will help
me in every footpaces of proper activities in my life. Overall, it is an earthlings
to bring forth my different experiences consequently during field education
through the field work practicum report.

v
Acronyms

BIRDEM- Bangladesh Institute for Research and Rehabilitation in Diabetes,

Endocrine& Metabolic Disorders

MSW- Masters in Social Work

SWE- Social Work Education

DAB- Diabetic Association of Bangladesh

JNU- Jagannath University

IFSW- International Federation of Social Workers

IASSW- International Association of Schools of Social Work

NASW- National Association of Social Workers

CSWE- Council on Social Work Education

ISWD- International Social Work in Development

EASSW- European Association of Schools of Social Work

vi
 Contents

SL No CONTENT PAGE NO

Acknowledgement ii-iii

Preface iv-v

Acronyms vi

Chapter 1: Field Practicum in Social Work Education

1.1 Preamble 2

1.2 Concept of social Work 3-4

1.3 Concept of Social Work Education 4-7

1.4 Concept of Field Practicum 7-8

1.4.1 Characteristics of Field Practicum 8

1.4.2 Components of Field Practicum 8

1.4.3 Functions of Field Practicum 8-9

vii
 1.4.4 Historical Development of Field Practicum in Social 9-11
Work Education

1.4.5 Aims& Objectives of Field Practicum 11-14

1.4.6 Importance of Field Practicum 14-16

1.5 Field Practicum as Link Between Theory and Practice 17

1.6 Conceptual Analysis of Medical Social Work 17-19

1.6.1 Medical Social Work Practice in Bangladesh 19

1.6.2 Objectives of Medical Social Work 20

1.6.3 Role and Responsibilities of Medical Social Worker 20-21

Chapter 2: Introducing Field Practicum Agency

2.1 Name& location of the Agency 23

2.2 Introduction to DAB 24

2.3 Formation of DAB 25

2.4 Objectives of DAB 25-26

viii
 2.5 Historical Background of BIRDEM 26-27

2.6 Acquaintances of BIRDEM 2 28

2.7 Mission& vision of BIRDEM 28-29

2.8 Organogram of BIRDEM 29

2.9 Functions of BIRDEM 30-32

2.10 Department of BIRDEM 32-35

2.10.1 Social Welfare Department of BIRDEM 35-36

2.10.2 Staffs of Social Welfare Department of BIRDEM 36-37

2.10.3 Functions of Social Welfare Department of BIRDEM 38

2.10.4 Programs of Social Welfare Department of BIRDEM 38-39

Chapter 3: Acquaintances of Diabetes& Diabetes in Bangladesh

3.1 Introduction 41

3.1.1 Diabetes Mellitus 41

3.1.2 Symptoms of Diabetes 41-44

ix
3.1.3 Types of Diabetes 44-45

3.1.4 Diagnosis& Treatment of Diabetes 45-47

3.2 Concept of Insulin& Pancreas 47

3.3 Diabetes in Bangladesh 48-49

3.4 Necessity of Controlling Diabetes in Bangladesh 49

Chapter 4: My Participation in Field Practicum as an Apprentice

Social Worker

4.1 Introduction 51

4.2 My Assigned Duties as an Intern Social Worker 51

4.2.1 Duties& Responsibilities from Internal Supervisor 51-52

4.2.2 Duties& Responsibilities from Field Practicum 52

Agency

4.3 Duties Performed by Me 52

4.3.1 Duties from Internal Supervisor 52-53

4.3.2 Duties from External Supervisor 53

4.4 My Taken Cases 54-55

x
Chapter 5: My Performed Cases

5.1 Introduction 57

5.2 Performed Cases 57

5.2.1 Case 1 57-64

5.2.2 Case 2 65-72

5.2.3 Case 3 72-79

5.2.4 Case 4 80-86

5.2.5 Case 5 86-92

Chapter 6: Evaluations, Recommendations& Conclusions

6.1 My Experiences as an Intern Social Worker 94-96

6.2 Applied Social Work Methods, Principles& 96-97

Techniques

6.3 Strengths & Weaknesses 98

6.3.1 Strengths & Weaknesses of Field Practicum Agency 98-99

xi
6.3.2 Strengths & Weaknesses of Department of Social 99-100
Work of JNU

6.4 Recommendations 101

6.4.1 Recommendations to Department of Social Work of 101

JNU

6.4.2 Recommendations to Department of Social Welfare 101-102

of BIRDEM

6.5 Conclusions 102

References

Appendixes

xii
 Chapter One

Field Practicum in Social Work Education

1.1 Preamble
1.2 Concept of social Work
1.3 Concept of Social Work Education

1.4 Concept of Field Practicum

1.4.1 Characteristics of Field Practicum

1.4.2 Components of Field Practicum

1.4.3 Functions of Field Practicum

1.4.4 Historical Development of Field Practicum in Social Work Education

1.4.5 Aims& Objectives of Field Practicum

1.4.6 Importance of Field Practicum

1.5 Field Practicum as Link between Theory and Practice
1.6 Conceptual Analysis of Medical Social Work
1.6.1 Medical Social Work Practice in Bangladesh
1.6.2 Objectives of Medical Social Work

1.6.3 Role and Responsibilities of Medical Social Worker

1
 Chapter One
Field Practicum in Social Work Education
1.1 Preamble

Field Practicum offers experiential assessment and evaluation of students’

development in the process of becoming a helping professional. Students are
provided opportunities to apply their academic and practice experiences in the
reality of the agency-client-service matrix. Social work in practice is called field
work. Through the supervised field experience, students participate in, and
become familiar with, the many components of the social work profession& its
varied roles. In this field new scholar become skilled interviewing, using theories,
methods, techniques in practical arena assuring recording, responding, reporting
etc.

The ideal field placement offers students a focus on the methods of direct
practice, policy development and implementation, and other social work special
projects and research activities. Therefore field work is a rare combination of
theoretical and practical knowledge and it makes a bridge among the people to
solve the psycho-social and other complex problem.

Social work fundamentally and radically aims to assist the individuals, groups
and community to cope with their complex socio-economic psychological
problems enabling them so that they can solve their problem by helping
themselves. Field work is the way of getting social work students used to with
the diverse fields of social work interventions. Field work may to build a bridge
between community and academic education.

2
1.2 Concept of Social Work

Social Work is a modern scientific problem solving process. Its main target is to
able people of all sectors to play their role in the society and create societal
conditions to favorable to that goal. Social work is mainly method based practical
science. The profession of social work is uniquely founded on altruistic values
respecting the inherent dignity of every individual and the obligation of societal
systems to provide equitable structural resources for all members of the society.

The following definition of Social Work was approved in the IFSW General
Meeting and the IASSW General Assembly in July 2014:

“Social work is a practice-based profession and an academic discipline that

promotes social change and development, social cohesion, and the empowerment
and liberation of people. Principles of social justice, human rights, collective
responsibility and respect for diversities are central to social work. Underpinned
by theories of social work, social sciences, humanities and indigenous
knowledge, social work engages people and structures to address life challenges
and enhance wellbeing.”

According to W.W. Boehm “Social work seeks to enhance the social functioning
of individuals singly and in groups, by activities focused upon their social
relationships which constitute the interaction between man and his environment.
These activities can be grouped into three functions: restoration of impaired
capacity, provision of individual and social resources and prevention of social
dysfunction.”

From this definition it is clear that social workers follow a formal procedure in
helping clients to cope with their life tasks and to realise their aspirations. This

3
involves developing their ability to deal with their problems more effectively at
any given point in time and also in the future. Furthermore, social work
intervention helps people connect with needed resources and to negotiate
problematic situations which might also involve changes to existing structures
where these present blocks to human growth and development.

Social work grew out of humanitarian and democratic ideals, and its values are
based on respect for the equality, worth, and dignity of all people. Since its
beginnings over a century ago, social work practice has focused on meeting
human needs and developing human potential.

1.2 Concept of Social Work Education

Social work is at a crossroad of assuming a world-wide and environmental focus

to address social problems based on an inter-dependent economy that is globally
driven. Social workers use education as a key tool in client and community
interactions. These educational exchanges are not always explicit but are the
foundation of how social workers learn from their service participants and how
social workers can assist with information delivery and skill development. Social
Work Education is an educational process comprises of a theoretical component
taught in the classroom and field- based education involving integration of the
academic aspect and practice. It is a professional discipline anchored on a unified
curriculum consisting of both theory and fieldwork components. As shall be
noted, social work education started in Europe and North America in the last
quarter of the 19th century. Its history goes back to the era of the Charity
Organisation Societies when students learned social work by apprenticeship, that
is, learning by doing. As Royse, Dhooper and Rompf (2007) observe, students
obtained first-hand knowledge of poverty and adverse conditions through

4
“applied philanthropy”. They also noted that the apprenticeship model
emphasised learning by doing and “deriving knowledge from that activity”.

Theory
Social Work
Education

Practice

Figure: Social Work Education

By the end of the 19th century, social work gradually evolved from the
apprenticeship method with the launching of the first social work training in
1898. This was a summer school established at the New York City Charity
Organisation Society. Six years later, in 1904, the Society established the New
York School of Philanthropy, which offered eight months training in social work.
Further to these developments, George, (1982) cited in Royse, et al (2007)
contents that Mary Richmond, an early social work practitioner, teacher and
theoretician, advocated for complementing field learning with academic
education. Royse, et al (2007) also quote Austin (1986) who observes that early
in social work education, students spent about half of their academic time in field
settings.

5
During the first part of the 20th century, psychoanalytic theory dominated social
work education. This influence tended to focus the attention of students and
social work educators on a client’s personality rather than on the social
environment.

Initiatives through the NASW and the EASSW as well as the existence of the
IFSW, ISWD, and IASSW as well as international initiatives by the Council on
Europe and the United States CSWE demonstrates a growing interest in
international commitment to humanitarian efforts. As early as 1992, a
cooperative effort between NASW and CSWE resulted in the creation of a
curriculum manual entitled “Introducing International Development Content in
Social Work Curriculum”. This manual contained teaching modules for use by
social work education programs internationally (Healy, 1992).

In Bangladesh, the journey of Social Work Education was set forth through V-
AID program. In 1953, V-AID program and urban community development
program were expanding quickly by the government and voluntary organizations.
As a result concerned authority felt the need of starting higher education on social
work. And in 1959 Dhaka University started MA course on social work and also
established social work college and research center which was inaugurated by Lt.
Colonel Azam khan on 19th March 1963 for its own building. In 1958-59 Social
welfare College & Research, in 1965-65. Rajshahi University & in 1992-93
Shahajalal University & under National University started Hon's & Master’s
Degree with compulsory Field work.

The profession of social work places emphasis on cooperation through mutual

interaction amongst individuals and communities. An increase in international
cooperation in social work education has expanded through research, mutual

6
exchanges and discussion. The profession’s growing international commitment
is evident through initiatives from NASW, ISWD, IFSW, IASSW, and CSWE.

1.4 Concept of Field Practicum

Field work is a peer supervises of learning process a qualitative study qualitative,

quantitative data or information. Knowledge synthesizes and integrates what is
learnt in the class room or in laboratory (human services). Fieldwork, which is
also known as field instruction, field placement, field education, practicum or
internship is therefore an integral component of social work education.

Field Practicum is an integral part of the social work education. Historically the
profession of social work has considered field work a primary means of providing
student opportunity to acquire knowledge value and skills. Simply we can say
field work refers the process or approach in which social knowledge, value,
principles and other social work related discipline are exercised in the arena of
social service welfare and sustainable development.
According to M.A. Momen- “Field work program is designed to help and guide
a student to develop his skill and competence for his independent professional
functioning and carrying out appropriate responsibilities.” (1970)

In the words of R.R. Sing- “Field work is an educationally sponsored attachment

of social work students to an agency, or a section of community in which they
are helped to extent their knowledge and understanding and experience the
impact of human needs.”

In the words of W.A. Friedlander- “Field work is designed to integrate the

academic knowledge, practical understanding and personal skills of the student
by personal contact and to direct the clients”. (1963)

7
In the field of social work, Field Work is such a way through which the apprentice
social workers get the opportunity to apply their theoretical knowledge acquired
in the class. For this, an apprentice social worker has to apply his knowledge and
skills of social work in real sphere under two supervisors. One supervisor is from
institute and one is from agency.

1.4.1 Characteristics

 It is integral part of social work.

 Students apply classroom knowledge in field.
 It tries to solve problem of real world.

Students enhance their knowledge skill on field practice and that will enhance
their skill and experience.
1.4.2 Components of Field Practicum

other
students
practitioners

social external
supervi
agency
sor
internal
supervi
sor

1.4.3 Functions
The functions for which field work must prepare students are:
 Rendering direct service
 Planning, policy development and administration related to service
delivery.

8
  Engaging in evaluative research in order to improve, change and develop
knowledge and skills in the delivery of services
 Supervision, training and education of personnel required for manning the
programmes and services.
1.4.4 Historical Development of Field Practicum in Social Work
Education
Field instruction has always been a major part of social work training. Its journey
began in the days of the Charity Organization Societies in the last quarter of the
19th century when students learned social work by apprenticeship. With this
apprenticeship model, training emphasized doing and deriving knowledge from
that activity. By the end of the 19th century, social work was moving away from
the apprenticeship model. The first training school for social work was a summer
program that opened in 1898 at the New York City Charity Organization Society.
In 1904, the Society established the New York School of Philanthropy, which
offered an eight-month instructional program. Mary Richmond, an early social
work practitioner, teacher, and theoretician, argued that although many learned
by doing, this type of learning must be supplemented by theory.
At the 1915 National Conference of Charities and Corrections, presenters
emphasized the value of an educationally based field-practice experience, with
schools of social work having control over students’ learning assignments. This
idea put schools in the position of exercising authority over the selection of
agencies for field training and thus control over the quality of social work practice
to which students were exposed.
Early in social work education, a pattern was established whereby students spent
roughly half of their academic time in field settings (Austin, 1986).
This paradigm was made possible by the networking that emerged from the early
organizational efforts of social work educators. The American Association of

9
Schools of Social Work, in its curriculum standards of 1932, formally recognized
field instruction as an essential part of social work education (Mesbur, 1991).
From about 1940 until 1960, an academic approach dominated social work
education. This approach emphasized students’ cognitive development and
knowledge-directed practice. Professors expected students to deduce practice
approaches from classroom learning and translate theories into functional
behaviors in the field (Tolson & Kopp, 1988).
Educational standards for field instruction were refined in the 1940s and the
1950s, and field work became known as field instruction. The American
Association of Schools of Social Work took the position that field teaching was
as important as classroom teaching and demanded equally qualified teachers and
definite criteria for the selection of field agencies. In 1951, the Hollis-Taylor
report on the state of social work education in the United States asserted that
“education for social work is a responsibility not only of educators but equally of
organized practitioners, employing agencies, and the interested public. Widely
accepted by the profession, this assertion became the cornerstone of all
subsequent developments” (Kendall, 2002).
In 1952 the Council on Social Work Education was established and began
creating standards for institutions granting degrees in social work. These
standards required a clear plan for the organization, implementation, and
evaluation of both in-class work and the field practicum. Interestingly, it was not
until 1970 that field work was made a requirement for undergraduate programs
affiliated with council.
When social work programs were housed in other disciplines, academically
minded social scientists sometimes argued that the function of field instruction
was to allow students to observe and collect data on poverty and social conditions
first hand. The emphasis was often on the study of social problems. Students were

10
not expected to provide services or assist clients. Agencies, of course, wanted
students to roll up their sleeves and pitch in and help with the work that they were
doing. As social work has matured as a unique discipline, a view of field
education has emerged that blends both the academic and experiential
perspectives.

1.4.5 Aims& Objectives of Field Practicum

The purpose of the field education department is to provide students an

opportunity to learn hands-on through an internship work experience. Field
practicum which focuses on generalist social work practice with a solid
knowledge of theoretical frameworks with an understanding and acceptance of
social work values and ethics, and with well-developed skills related to beginning
social work practice.

R.R Sing (1985, 44-45) in “Field work in Social Work Education” has
mentioned the following objectives:

o To offer purposeful learning experience to students through interaction with life

situations under supervisory guidance for professional growth in terms of
knowledge, skills, and attitudes.
o To foster attitudes in the student towards professional self-development,
increasing self-awareness appreciation of both capacities and limitations.
o To develop in the student the required skills in helping the needy through
organizational work, use of social work methods, that is, listening, participating
communication and so on.
o To enable the student to develop and deepen capacity to relate theory to practice
and also to relate experience to theory.

11
One of the objectives of fieldwork is integration of theory and practice.
According to Moti Ram Maurya,

“Not only does field work illuminate theory but, because of the many facets
of specific cases it brings to light, or emphasizes new aspects of theory that in
the classroom have been postponed or touched upon only in a passing manner.
It will be . . . unwise to think that theory is taught in classes and practice in
the field only. Both are complementary and interdependent parts of the social
work-whole. Theory without cases is empty and cases without theory are
meaningless on the scientific level (1962: 11)”.

The Committee on Social Work Education in India has mentioned the

following objectives:

o Development of skills in problem solving at the mean and macro

mentioned;
o Integration of classroom learning with field practices;
o Development of skills for professionals practice at the particular level of
learning;
o Development of professional attitudes , values and commitments;
o Development of self-awareness and professional ideas;
To help students develop their professional selves, including some ability to
evaluate their own capacities to help people. This is seen as including
identification with profession and is understood in terms of progress the students
make in identifying with the school and with his field work agency.

12
The field objectives are designed to enable students:

 To gain first-hand knowledge of social welfare and agency policies, programs,

procedures and services and the manner in which they impact upon client
systems in an urban setting;
 To integrate social work theory with social work practice and to apply
theoretical knowledge to urban practice situations;
 To carry out basic generalist practice skills as they relate to the profession and
practice of social work in urban settings;
 To understand the issues of poverty, socioeconomic disadvantage,
interpersonal and community violence, substance abuse, and mental health
problems, social injustice and discrimination, and how these impact the urban
client system, as demonstrated by the ability to identify problems, determine
solutions and access appropriate community resources;
 To demonstrate an awareness of self in the professional context, accept the
value of diversity and differences, and is sensitive to and accepting of the
inherent dignity and worth of each individual client and their rights to self-
discrimination and decision making;
 To be able to perform culturally appropriate client interviews and assessments
as demonstrated by the identification of problems/needs and strengths, and the
determination of interventions, plans, goals, and evaluations;
 To analyze and demonstrate the various roles used by the social worker as an
advocate, a mobilizer of services to meet unmet community needs, and a
mediator in helping clients to negotiate larger systems.
 To facilitate skill development in analyzing social issues and utilizing social
work practice principles in intervening with organizations and community
systems.

13
 To provide opportunity for learning linkages with content in other courses.
 To be able to identify different models of macro terminology and techniques
used in contemporary macro practice through the service learning project.
 To demonstrate an awareness of self and willingness to be reflective of one’s
practice style related to working in groups, in new environments, and in
situations of change and collaboration.

1.4.6 Importance of Field Practicum

Fieldwork gives a reality-check to the students. It is important to read about

theories, but it is equally (if not more) important to use the understanding of
theories with the reality outside of the institution of Social Work. The field does
not always turn in the way students expect it to; field is contextual and contingent.

Educators from different institutions of Social Work expressed that fieldwork

practicum helps the students to draw learning at all the levels of social work
practice.

 At the micro-level, the students develop an understanding of the client

system.
 At the mezzo-level, they learn to assess the needs of a community and,
accordingly, learn to develop intervention strategies to fulfill them.
 At the macro-level, they understand the various tactics of dealing with the
establishment, and to advocate the rights of people.

Senior educator Mr. Khan of the Jamia Milia Islamia, New Delhi was of the
opinion that fieldwork involves learning by doing; it exposes the students to
different social realities, and makes them learn about the diversity and the needs
of the Indian population.

14
Students from different institutions of Social Work said that fieldwork helps them
to internalize their learning from the classroom and to identify the gaps in the
pedagogy of Social Work education and the real life situation. Fieldwork
practicum highlights the difference in education between Social Work and the
Social Sciences. The students from Karnatak University, Dharwad deliberated
that through fieldwork new ideas are generated. The fieldwork supervisor gives
a concrete shape to these ideas and incorporates them into the pedagogy of Social
Work through examples. These examples can generate practice theories for future
through research.

According to United Nations report “It is important that students should be

helped to develop the attitude of mind which leads them to make connections
between study and relief ……it is needed vital that this should be done if students
are to become professional practitioners in the field rather good natural amateurs
of technicians applying narrow skills by rule of thumbs methods.”

The considering importance of field practicum are-

 The student will learn to apply the values and ethics of the profession and

develop the capacity to tolerate and work constructively with the value
dilemmas, conflicts, and ambiguities inherent in the practice of social work.
 The student will develop a varied repertoire of practice skills fundamentals

to social work and relevant to a wide range of clients, modalities and types
of setting.
 Field practicum gives opportunity for the students to learn to work with other

professional and voluntary workers.

 Fieldwork is helpful to build up theory. When we practice field work we can

test the social work methods, principle, values, and ethics.

15
  The student will actively engage in the learning process and develop the

capacity to reflect on the work and make active use of supervision and other
feedback.
 Field work is the greatest strategy to evaluate the social work.

 The student will develop a self-reflective and reflexive stance, which

includes a growing awareness of self with clients, staff and larger systems
in relation to practice.
 The student will develop a knowledge base and the related skills needed to

work for social justice on behalf of population at risk.

 The students can understand how to work under administrative and

organizational structure and they can learn how an office is governed and
what kind of routine needs to be established.
 The student will develop the ability to work collaboratively with other

professional and the community at large in his /her role as a professional

social workers.
 The student will develop and demonstrate the skills of critical thinking.

 Social worker must need clear concept about human behavior, attitude,

values etc. Field practicum students have chance to go near the general
people. So they can gain knowledge about human behavior.

As stated earlier, owing to the understanding that Social Work is practice-

oriented, fieldwork carries a lot of importance. At last, we can say that field
practicum develops the students’ skills that will enable them to respond
appropriately to the needs of clients.

16
1.5 Field practicum as Link between Theory and Practice:

This provides an opportunity to apply theoretical knowledge that we achieved by

class room learning and by reading literature of social work is a practice and
knowledge based professional services. Filed practicum is called as link between
theory and practice. There have some special aspects of this issue such as-

 To make linkage between welfare and development needs, problems and

resources;
 Acquisition of knowledge of practice oriented approaches and integrated
method of social intervention;
 Acquisition of professional action and skills;
 Integration of classroom learning with field practices;
 Developments of professional attitudes value and communities;
 Students develop their problem solving skills and methods;
 Students can learn how to face ethical dilemma;
 Students can learn how to apply social work methods, principles, values,
and skills to solve problems;

1.6 Conceptual Analysis of Medical Social Work

Medical social work is a sub-discipline of social work, also known as hospital

social work. Medical social workers typically work in a hospital, outpatient
clinic, community health agency, skilled nursing facility, long-term care facility
or hospice. They work with patients and their families in need of psychosocial
help. Medical social workers assess the psychosocial functioning of patients and
families and intervene as necessary. Interventions may include-

17
  connecting patients and families to necessary resources and supports in
the community;
 providing psychotherapy, supportive counseling, or grief counseling;
 or providing help to a patient to expand and strengthen their network of
social supports.

According to Robert L. Barker "The medical social work practice that occurs
in hospitals and other health care settings to facilitate good health, prevent illness
and aid physically ill patients and their families to resolve the social and
psychological problems related to the illness. Medical Social Work also sensitize
other health care providers about the Social psychological aspects of illness"

Medical Social Work is the branch of social work and it deals with the social,
physical and psychological aspects of patients.

According to Skidmore and Thackeray, “Medical Social Work is the

application of social work knowledge, skill, attitudes and values to the field to
health and medicine” (1964:73).

According to Russell H. Kurtz "Medical social work is a social work practiced

in responsible relationship to medicine and public health within the structure and
programs of health and medical care."

According to Clarkson, “ Medical Social Work is a specialized branch of social

work practiced in hospitals, clinics, community health centers and sometime in
general practice” (1974).

18
 Medical Social Work

Characterized by
(Emphasize on the solution
of the problems of the
patient

social emotional other

problems problems
problems

Figure: Characteristics of Medical Social Work

Hospital social service is a service based on social work knowledge and skills
where the psycho social factors behind the diseases are studied and helps the
client to improve his mental state and necessary steps are taken for his recovery
and rehabilitation besides giving emphasis on preventive care.

1.6.1 Medical Social Work Practice in Bangladesh

Medical Social Work practice in developed and underdeveloped country is quite

different due to the variation in socio-economic condition. In developed society,
patients need the psychosocial support, whereas financial support in developing
countries. The concept of Medical social work was introduced in the western
countries of the world in the nineteenth century. In Bangladesh, modern medical
social work was developed in 1958. At first, it was started at Dhaka Medical
College Hospital with the it initiative of Red Cross in 1955 National council of
Social Welfare started to supervise medical social work in 1958. Then in 1961,
it was taken as a government program and other four projects were started at
Chittagong, Rajshahi, and T.B hospital. In 1984, it was renamed as -Hospital
Social Work' in place of 'Medical Social Work'. Now the program is going on
in 84 hospitals throughout the country (Husna Ara. 1994).

19
1.6.2 Objectives of Medical Social Work

Objectives of medical social work-

- Helping people enlarge problem solving and coping abilities.

- Facilitating interaction between individuals and others in their
environment.
- Helping people obtain resources.
- Making organizations responsive to people influencing interactions
between organizations and institutions.
- Influencing social environment policy (Minahan 1981).
Medical Social Workers must have patience, compassion, empathy and
excellent people and communication skills.

1.6.3 Role and Responsibilities of Medical Social Worker

According to Robert L. Barker "Medical Social Workers are professional

social workers employed in health care settings primarily to provide for the
psycho social needs of patients and alert other health care providers to the social
needs of the patients."

Russell H. Kurtz said a medical social worker play the following role....
 Authoritative definition of the social situation of the patient;
 Identification of the social forces and factors which are exerting influence
upon the etiology and treatment of the patients health problems;

 Selection of appropriate measures of intervention directed toward the

modification of factors which may have adverse consequences for the
patients care and recovery;

20
  Participation in joint treatment planning and evaluation of treatment
outcomes;

 And finally the execution of social treatment within the goals and
structure of a jointly development treatment plan;

According to A. R. Sadia the other main functions of the medical social worker
are the following:

 Participation in program planning and policy formulation of the agency

 Participation in community organization

 Participation in educational program

 Participation in social research and Consultation

Overall:

• Establishing •Documentation and

relationship to record keeping
doctors and nurses
Rapport
Collaboration
Build Up

Screening Post
and case Discharge
finding Follow Up
• The medical social • The medical social
worker as a teacher worker as consultant

Figure: Role of Medical Social Worker

21
 Chapter Two
Introducing Field Practicum Agency

2.1 Name& location of the Agency

2.2 Formation of DAB
2.3 Objectives of DAB
2.4 Historical Background of BIRDEM
2.5 Mission& vision of BIRDEM
2.6 Organogram of BIRDEM
2.7 Functions of BIRDEM
2.8 Department of BIRDEM
2.8.2 Social Welfare Department of BIRDEM
2.8.2 Staffs of Social Welfare Department of BIRDEM
2.8.3 Functions of Social Welfare Department of BIRDEM
2.8.4 Mission& Vision of Social Welfare Department of BIRDEM
2.8.5 Programs of Social Welfare Department of BIRDEM

22
 Chapter Two
Introducing Field Practicum Agency

2.1 Name& location of the Agency

I have sent to the Department of Social Welfare of BIRDEM General Hospital

and Ibrahim Memorial Diabetes Center as a social work apprentice from the
Department of Social Work of Jagannath University for 60 working days.

Field Practicum Agency: Bangladesh Institute for Rehabilitation in Diabetes,

Endocrine and Metabolic Disorders General Hospital and Ibrahim Memorial
Diabetes Center

Location: 122, Kazi Nazrul Islam Avenue, Dhaka-1000

Working Days: 60 (From April 16 to July16)

BIRDEM
Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and
Metabolic Disorders
122, Kazi Nazrul Islam Avenue, Dhaka-1000
Phone: 00 880 2 8616641-50, Fax: 00 880 2 9667812
Email: dg [email protected];[email protected]
Web: www.birdem-bd.org

23
2.2 Introduction of DAB (Diabetic Association of Bangladesh)

Dr. Mohammed Ibrahim is the foremost who was concerned about diabetic care
in the country. He thought the care as a socio-medical care. He cognized that
diabetes is such a disease where not only doctors but also patients should be
involved in the process of diabetic care. Although the real latitude of the problem
of diabetes in the country was not obvious, he could foresee the present situation
at that time and organized a group of social workers, philanthropists and
professionals. With the help of them he established Diabetic Association of
Bangladesh (then Pakistan) on February 28, 1956. Primarily a committee was
formed to run the organization. Later, on May 21, 1956 the first office bearers of
the association has been formed with the following members:

Name Designation
Major Dabiruddin President
Dr. Md. Ibrahim Vice President
Mrs. Nurjahan Morshed Vice President
Mr. A M Salimullah Fahami Secretary
Miss. Tahera Karim Joint Secretary
Dr. M A Mannan Joint Secretary
Mrs. F Dosani Treasurer

24
2.3 The Formation of DAB

Diabetic care was started in a tin-shed building at Segun Bagicha. The motto of
Dr. Ibrahim was “No diabetic patients should die untreated, unfed or
unemployed even if she/he is poor”. So, he committed to give primary care to
the diabetic patients free of cost irrespective of socio-economic, racial or
religious status. Even rich patients were not allowed to buy the primary diabetic
care, but they could donate money to the association. The resources and fund was
raised through motivation programs.

It is to be noted that, there were no indoor facilities initially at Segun Bagicha.

Patients in need of hospitalization were sent to other hospitals. In the beginning
of 70's few short-stay beds were established to take care of the serious patient.
Dr. M Ibrahim was very much aware about the quality of the service provided to
the patients. He used to address the patients by saying that “We are grateful to
you for giving us the opportunity to serve”. He also motivated other doctors to
serve the patients with empathy. He included social welfare, health education,
nutritional education and rehabilitation in the diabetes healthcare delivery
system.

2.4 Mission and Vision of DAB

Vision
 In Bangladesh no diabetic should die untreated, unemployed or unfed.

 All people shall be provided with affordable health care service.

Mission

 Provide total healthcare including rehabilitation for all diabetics

irrespective of gender, economic and social status through different
institutions of Diabetic Associations of Bangladesh;

25
  Expand these services to provide affordable BADAS healthcare for all
Bangladeshi through self-sustaining centers of excellences;

 For human resources development create requisite specialized quality

manpower (Physician, Technicians, Nurses and other related) of high
ethical standards for manning these institutions and for the country;

 Develop leadership in healthcare through dedicated and transparent

management system;

 Develop industries for diabetic, and other health food and manufacturing
medicines;

2.5 Historical Background of BIRDEM

The clinical services of BIRDEM provide comprehensive diabetic care free of

charge to all the registered diabetic patients. The fund collected by 'Cross
financing' system through medical care and diagnostic service to other patients,
is spent for imparting free medical service to the Diabetic patients. The patients
are entitled to get medical supervision, consultations, diabetic education (which
includes basic knowledge on overall health), advice on nutrition, social support
and rehabilitation, if necessary insulin, oral hypoglycemic agents, and medicines
are supplied free or at subsidized cost. The comprehensive health care delivery
to a vast number of diabetic all over the country is well recognized as a unique
program of the Diabetic Association of Bangladesh (BADAS).The Association
executes this program primarily through its central institute called the
Bangladesh Institute of Research& Rehabilitation in Diabetes, Endocrine and
Metabolic Disorders (BIRDEM).

Through its Academy BIRDEM conducts the largest number of postgraduate

medical courses in the private sector. With large number of international

26
collaborations the institute is now widely acclaimed as one of the most advanced
research center in the world. This is reflected in the recognition of BIRDEM by
the World Health Organization (WHO) as a Collaborating Center for Research
on Prevention and Control of Diabetes. It is the first of its kind outside Europe.

Here is few steps which will describe the history of Bangladesh diabetic
association-
The first meeting of the diabetic association was held on the 28 th February of
1956, and the place of that meeting was, the resident of the Dr. Md. Ibrahim.
 Establishment of the medical research center in 1957;
 In 1959 the diabetic association got the membership of the
“INTERNATIONAL DIABETIC FEDARATION”;
 During the month of March of 1967 diabetic hospital opened its emergency
unit;
 The month of January in 1968 the first rehabilitation center opened;
 April of 1968, the applied nutrition training and research institute
established;
 In 1975 the association got assistance from WHO;
 In 1977 BIRDEM started building its own structure at Shahbag in Dhaka;
 For the first time the WHO organize a post-graduation course titled
“diabetic endocrine and metabolic disorder”;
 The national council in its 178th meeting took decision to create a fund for
the diabetic federation;
 Bangladesh diabetic association got elected in the presidential council of
international diabetic association;
 At last in 1980 BIRDEM got established;

27
2.6 Acquaintance of BIRDEM 2

The Project has been added the existing establishment of BIRDEM as BIRDEM-
2. Mohila and Shishu Diabetes Endocrine and Metabolic Hospital,
Segunbagicha, Dhaka started on 7th February 2012 along the Gynae and Obs
and Pediatrics OPD facilities on Diabetes Endocrine& Metabolic disease, GHPD,
Eye, Skin care facilities and modern laboratories facilities for both Diabetic and
non-diabetic subjects. Some Departments of BIRDEM 2 are-SCABU, Pediatric
Board, Obs Ward, Gynae ward, Operation Theater.

Two Projects of BIRDEM 2:

 Changing Diabetes In Children (CDIC)

 Life For a Children (LFC)

Services of LFC-

 Laboratory Service
 Follow-up Service
 Education Service
 Counselling Service

2.7 Mission& vision of BIRDEM

Vision

 In Bangladesh no diabetic should die untreated, unemployed or unfed.

 All people shall be provided with affordable health care service.

Mission
 Provide total healthcare including rehabilitation for all diabetics
irrespective of gender, economic and social status through BIRDEM;

28
  Expand these services to provide affordable BIRDEM healthcare for all
Bangladeshi through self-sustaining centers of excellences;
 For human resources development create requisite specialized quality
manpower (Physician, Technicians, Nurses and other related) of high
ethical standards for manning these institutions and for the country;
 Develop leadership in healthcare through dedicated and transparent
management system;
 Develop industries for diabetic and other health food and manufacturing
medicines;

2.8 Organogram of BIRDEM

Present Board of Management of BIRDEM General Hospital:

Chairman

 Dr. Sarwar Ali- Member, NC, BADAS

Members

Name Designation
Professor Rashid-E-Mahbub Joint Secretary General, BADAS
Professor Dr. A H Syedur Rahman Member, NC, BADAS

Professor Harun-Ur Rashid Member, NC, BADAS Nominated

Member NC, BADAS (Ministry of
Health & Family Welfare)
Professor Nazmun Nahar Director General, BIRDEM

Professor Kishwar Azad Project Director, PCP, BADAS

29
2.9 Programs of BIRDEM

There are 4 important programs of BIRDEM, such as…

 Diabetes Education Program:

Diabetic patients are directly educated by the diabetes educators from NHN,
HCDP and Affiliated Associations. Development of Flip chart is completed and
has been disseminated among the diabetes educators. Educators are using the
tools and efforts are appreciated by the patients. Development of leaflet and
poster is complete. The materials were distributed for the diabetes educators and
other Health Professionals. Development of other training tools like video
programs, Animation films is under process.

 Education team: Diabetic Education Program is conducted by Honorary

Physicians (Dialectologist). They give the scientific lecture for effective
lifestyle modification for primary prevention of diabetes to modifying the
modifiable risk factors through simple intervention of life style modification
specially.

A colorful diabetes guide book for primary prevention of Diabetes and NCDs in
Bengali was published and distributed to each participant which is helpful for
them to adopt life style modification and to reduce the prevalent of Type-2 DM
& NCDs. There is question & answer session between Physician (Dialectologist)

30
and the Participants of different organization to assess the primary knowledge
about diabetes in education program.

 Clinical service: DCCS project-1650 patients were followed up.

800 students/Medical personnel of various Medical College/Institutes visited
in 19 visit events. Eleven students from Japan visited twice. 12 officers from
Armed Forces Medical Institute visited BIRDEM through Health Education
Department. 375 patients received training on glucometer operation and
56160 tests were done with glucometer by the patients. Insulin injection
training was conducted (Syringe 7035: Pen device3844).

 Young Diabetic Society: Here, the members of society are the patients who
are suffering from diabetes since childhood and they, then, were unable to
bear the cost of treatment because of poverty or they were orphan. This
members are provided work in the Social Welfare Department
 Mass Awareness Program through Various Events Links
 Free Services: Various department of BIRDEM General Hospital gives free
services. The patients are entitled to get medical supervision, consultations,
diabetic education (which includes basic knowledge on overall health),
advice on nutrition, social support and rehabilitation, if necessary insulin,
oral hypoglycemic agents, and medicines are supplied free or at subsidized
cost.

31
 Diet Discipl
ine

Drug

Figure: Slogan of BIRDEM General Hospital

3D Maintaining By a Diabetic Patient

2.9 Department of BIRDEM

Right now BIRDEM has following departments-

(a) Clinical Services Division: This division includes-

Out-Patient Department:

Department of Diet and Department of Physical Department of Public

Nutrition Medicine and Relations
Rehabilitation

Department of Dentistry Department of Department of Social

Dermatology Welfare

In-patient Service Departments:

Department of Department of Internal Department of

Medicine, Oncology, Medicine and Neurology Gastrointestinal, Hepato
Rheumatology and (I and II) MU –V Biliary & Pancreatic

32
Hematology (I & II) - Disorders (GHPD) –
MU-I MU-II
Department of Department of Department of
Nephrology Unit I (MU- Endocrinology Endocrinology and
III) Pulmonology (MU-IV)

Department of Department of Department of

Neurology Unit I and 2 Nephrology Unit II Anesthesiology
(MU-III)
Department of Critical Department of Department of Pediatrics
Care Medicine (ICU) Cardiology and Neonatology
Department of General Department of Surgery Centre for Assisted
Surgery and MIS (Unit I) Reproduction
Department of Department of General Department of Surgery
Gynecology& Obstetrics and Colorectal Surgery (Unit IV)
(Unit II)

Department of ENT and Department of Urology Surgery Emergency

Head and Neck Surgery (Unit I and II
(ENT)
Department of Hepato Department of Department of
Biliary and Pancreatic Orthopedics and Ophthalmology
Surgery (HBP) Traumatology

Department of Surgery Hemodialysis Unit Department of

(Unit III) Transfusion Medicine &
Emergency Unit
(b) Finance and Accounts Division
(c) Administration Division
(d) Logistic Services Division: It includes-
Logistic Services Nursing Department Material Management
Division Department (Store)

33
Equipment Maintenance Building Maintenance Kitchen Section
Department

Laundry-Linen and Local Procurement Printing and Publication

Apparel Section Section, BIRDEM Unit

(e) Division of Laboratory Services

Department of Clinical Department of Department of

Biochemistry, Clinical Histopathology and Immunology
Pathology and Cytology
Hematology

Department of Department of CRF Project.

Microbiology Endocrinology

(f) Research and Academy Division: This division includes-

Department of Clinical Department of Department of

Biochemistry, Clinical Biochemistry and Cell Physiology and
Pathology& Biology Molecular Biology
Hematology
BIRDEM Academy and Department of Department of
Library Epidemiology& Pharmacology
Biostatistics
Department of Biomedical Research Department of Health
Radiology and Imaging Group (BMRG) Education

34
Some Important Counters& Room

No of Counter& Room Acquaintance

1 no counter Blood Test for Male
15 no counter Blood Test for Female
14 no counter Registration& Guide Book Collection of New
Patients
10 no counter Collection of Report of Blood Test
4 no counter Insulin Collection
24 no counter Information counter
102-116 no Room Doctor’s Chamber
144 no Room Emergency Department
160 no Room Radiology Department
190 no Room Surgery Department
210 no Room Specialist Chamber

2.10.1 Social Welfare Department of BIRDEM

The Department was established since the inception of DAB. Free treatment of
diabetic is available here to poor and helpless patient. Socio-economic, psycho-
social counseling are provided for diabetics’ patients at free of cost and diagnosis
reports are carefully recorded here.

Gender Ward no of Surgeory Ward No of Medicine

(No of Bed) (No of Bed)
Male 63 113
(22) (24)
Female 62 133
(12) (24)

Figure: Ward and No of Bed under Social Welfare Department of

BIREDM General Hospital

35
 Counters& Room No of Social Acquaintance
Welfare
Department
2 no counter Doing blood Tests ,collecting receipts
of free investigation and collecting
report of blood test
5 no counter Money Pay in for insulin, collecting
insulin
227 no room Social Welfare Department
Figure: Different Counters and Room no of Social Welfare Department of
BIRDEM General Hospital

2.10.2 Staffs of Social Welfare Department of BIRDEM

Director Clinical Services

Deputy-Director

BIRDEM-1 INDOOR BIRDEM-2

(Hospital)
Outdoor Social Welfare Officer
Assistant Director

Assistant Director Social Welfare Asst./UDA

Social Welfare MLSS

MLSS
Junior Social Welfare Officer

Social Welfare
Assistant/ UDA

MLSS

Figure: Administrative Structure of Social Welfare Department

36
Following is the present staff list of Social Welfare Department of BIRDEM
General Hospital:

Md. Kazi Rashedul Haque Asst. Director and Head of the

Department
Halima Shireen Barna Asst. Director
Mrs. Gilian Guda Asst. Director
Mrs. Jesmina Haque Asst. Director
Md. Mazharul Islam Social Welfare Officer
Md. Shariful Islam Junior Social Welfare Officer
Sultana Yesmin Papry Junior Social Welfare Officer
Mrs. Hosne Ara Junior Social Welfare Officer
Md. Abu Bakar Siddique Junior Social Welfare Officer
Md. Azizul Haque Mia Junior Social Welfare Officer
Md. Alamgir Sheikh Junior Social Welfare Officer
Mrs. Renuara Ferdous Upper Divisional Asst
Md. Mobinur Rahman Upper Divisional Asst
Mrs. Samchun Nahar Upper Divisional Asst
Mrs. Jebun Nahar Social Welfare Asst
Mrs. Laiju Begum Social Welfare Asst
Mrs. Noor Tahmina Social Welfare Asst
Md. Abdul Hannan Upper Divisional Asst
Sahajuddin Chawdhury Asst. MLSS Supervisor
Md. Manju Mia Asst. MLSS Supervisor
They all are working together in the Social Welfare Department of BIRDEM
General Hospital and BIRDEM 2 to ensure quality services for all poor diabetes
patients all over the country following the motto of Dr. M. Ibrahim.

37
2.10.3 Functions and Programs of Social Welfare Department of BIRDEM

Ongoing Activities: On-going activities of Social Welfare Department of

BIRDEM General Hospital includes following welfare activities-

 Serving free/ 25%/50%/75%cost for insulin, investigation and hospital

services to patients;
 Assisting getting admission of urgent patients;
 Seeking treatment in hospital for all;
 Keeping patient’s information and registration;
 Conducting patients’ follow up;
 Providing poor patient’s blood, lance and wheel chair;
 Issus new book and advise to control diabetics;
 Rehabilitation Program for poor, unemployed and unable people;
 Showing sympathy;

2.10.4 Programs of Social Welfare Department of BIRDEM

Type of Services

 The Social Welfare Department has been rendering services to the diabetic
patients to uphold and improve their life-level, especially to help them to
lead a normal self-dependent and useful socio-economic life;

 Again to improvise and standardize their compliance of health care, our

educational-emotional support, motivational and follow-up activities of
this Dept. are being carried out regularly;

 In order to facilitate care and treatment of poor, under privileged patients

living outside Dhaka are being referred and insulin injections are being
sent to their nearest Branch Associations and Thana Health Complexes;

38
 During the period under review the diversified services rendered in terms of
need of the patients are as follows:

Major Services Provided

 Out Patient's Department (OPD), In Patient's Department (Indoor),

Affiliated Association, District Sadar Hospital and Thana Health Complex.

 Social history, Assessment & follow-up for poor patients.

 Insulin supplied for poor diabetic patients.

 Including investigation (Outdoor & Indoor) for poor diabetic patients.

 Blood, Wheel Chair & Black glass supplied for poor admitted patients.

 Basic Socio-economic information of new diabetic registered patients.

 Letter issued to treatment and health care providers of affiliated

association, District Sadar Hospital and Thana Health Complex for poor
patients.

 Education care, interpretation of medicine advice, motivation and mental

support.

39
 Chapter Three

Acquaintances of Diabetes

3.1 Introduction
3.2.1 Diabetes Mellitus
3.2.2 Causes of Diabetes
3.2.3 Types of Diabetes
3.2.4 Symptoms of diabetes Mellitus
3.2.5 Diagnosis& Treatment of Diabetes
3.3 Concept of Insulin& Pancreas
3.4 Diabetes in Bangladesh
3.5 Necessity of Controlling Diabetes in Bangladesh

40
 Chapter Three
Acquaintances of Diabetes
3.1 Introduction

Diabetes comes from Greek, and it means a "Siphon". Arêtes the Cappadocia, a
Greek physician during the second century A.D., named the condition diabainein.
He described patients who were passing too much water (polyuria) - like a siphon.
The word became "diabetes" from the English adoption of the mediaeval Latin
diabetes.

In 1675, Thomas Willis added mellitus to the term, although it is commonly

referred to simply as diabetes. Mel in Latin means "honey"; the urine and blood
of people with diabetes has excess glucose, and glucose is sweet like honey.

3.2 Diabetes Mellitus

Diabetes mellitus, disorder of carbohydrate metabolism characterized by

impaired ability of the Body to produce or respond to insulin and there by
maintain proper levels of sugar (glucose) in the blood. Diabetes is a major cause
of morbidity and mortality, though these out comes are not due to the immediate
effects of the disorder. They are instead related to the diseases that develop as a
result of chronic diabetes mellitus. These include diseases of large blood vessels
(macro vascular disease, including coronary heart disease and peripheral arterial
disease) and small blood vessels (micro vascular disease, including retinal and
renal vascular disease), as well as diseases of the nerves.

3.2.1 Types of Diabetes

There are three types of Diabetes. They are:

41
 - Type 1 Diabetes Mellitus,
- Type 2 Diabetes Mellitus and
- Gestational Diabetes Mellitus
 Type 1 Diabetes Mellitus

Type 1 diabetes is usually caused by auto-immune destruction of the islets of

Langerhans of the pancreas. Patients with type 1 diabetes have serum antibodies
to several components of the islets of Langerhans, including antibodies to insulin
itself. The antibodies are often present for several years before the onset of
diabetes, and their presence may be associated with a decrease in insulin
secretion. Some patients with type 1 diabetes have genetic variations associated
with the human leukocyte antigen (HLA) complex, which is involved in
presenting antigens to immune cells and initiating the production of antibodies
that attack the body’s own cells (autoantibodies). However, the actual destruction
of the islets of Langerhans is thought to be caused by immune cells sensitized in
some way to components of islet tissue rather than to the production of
autoantibodies.

 Type 2 Diabetes Mellitus

Type 2 diabetes is strongly associated with obesity and is a result of insulin

resistance and insulin deficiency. Insulin resistance is a very common
characteristic of type 2 diabetes in patients who are obese, and thus patients often
have serum insulin concentrations that are higher than normal. However, some
obese persons are unable to produce sufficient amounts of insulin, and thus the
compensatory increase in response to increased blood glucose concentrations is
inadequate, resulting in hyperglycemia. If blood glucose concentration is
increased to a similar level in a healthy person and in an obese person, the healthy

42
person will secrete more insulin than the obese person. Type 2 diabetes is far
more common than type 1 diabetes, accounting for about 90 percent of all cases.

People with type 2 diabetes can control blood glucose levels through diet and
exercise and, if necessary, by taking insulin injections or oral medications.
Despite their former classifications as juvenile or adult, either type of diabetes
can occur at any age.

 Gestational Diabetes Mellitus

Gestational diabetes is a temporary condition associated with pregnancy. In this

situation, blood glucose levels increase during pregnancy but usually return to
normal after delivery. However, gestational diabetes is recognized as a risk for
type 2 diabetes later in life. Gestational diabetes is diagnosed when blood glucose
concentrations measure between 92 and 125 mg per 100 ml (5.1 and 6.9
millimoles [mmol] per litre) after fasting or when blood glucose concentrations
equal or exceed 180 mg per 100 ml (10 mmol per litre) one hour after ingesting
a glucose-rich solution.

This type affects females during pregnancy. Some women have very high levels
of glucose in their blood, and their bodies are unable to produce enough insulin
to transport all of the glucose into their cells, resulting in progressively rising
levels of glucose. The majority of gestational diabetes patients can control their
diabetes with exercise and diet.

Two very important concepts are related to the diabetes patients. These are,

 Hypoglycemia and ,

 Hyperglycemia.

43
Hypoglycemia

Levels which are significantly above or below this range are problematic and can
in some cases be dangerous. A level of <3.8 mmol/L (<70 mg/dL) is usually
described as a hypoglycemic attack (low blood sugar). Most diabetics know when
they’re going to “go hypo” and usually are able to eat some food or drink
something sweet to raise levels. A patient who is hyperglycemic (high glucose)
can also become temporarily hypoglycemic, under certain conditions.

Hyperglycemia

Hyperglycemia, or high blood sugar, is a condition in which an excessive amount

of glucose circulates in the blood plasma. This is generally a glucose level higher
than 10 mmol/l (180 mg/dl), but symptoms may not start to become noticeable
until even higher values such as 15-20 mmol/l (270-360 mg/dl). However,
chronic levels exceeding 7 mmol/l (125 mg/dl) can produce organ damage.

3.2.2 Symptoms of Diabetes Mellitus

People with type 2 diabetes often do not have any symptoms. When symptoms
do occur, they are often ignored because they may not seem serious. Symptoms
in type 1diabetes usually come on much more suddenly and are often severe.

Common symptoms of diabetes include:

 Excessive thirst and appetite

 Increased urination (sometimes as often as every hour)
 Unusual weight loss or gain
 Fatigue
 Nausea, perhaps vomiting

44
  In women, frequent vaginal infections
 In men and women, yeast infections
 Dry mouth
 Slow-healing sores or cuts
 Itching skin, especially in the groin or vaginal area

Figure: The Result after Affecting of Diabetes

3.2.3 Diagnosis& Treatment of Diabetes Mellitus

Universally, Diabetes is one of the fastest growing and deadliest diseases. The
disease is usually discovered when there are typical symptoms of increased thirst
and urination and a clearly elevated blood sugar level.

 Diagnosis of Diabetes Mellitus

45
The diagnosis of diabetes is based on the presence of blood glucose
concentrations equal to or greater than 126 mg per 100 ml (7.0 mmol per litre)
after an overnight fast or on the presence of blood glucose concentrations greater
than 200 mg per 100 ml (11.1 mmol per litre) in general. People with fasting
blood glucose values between 100 and 125 mg per 100 ml (6.1 to 6.9 mmol per
litre) are diagnosed with a condition called impaired fasting glucose
(prediabetes). Normal fasting blood glucose concentrations are less than 100 mg
per 100 ml (6.1 mmol per litre).

Oral glucose tolerance tests, in which blood glucose is measured hourly for
several hours after ingestion of a large quantity of glucose (usually 75 or 100
grams), are used in pregnant women to test for gestational diabetes. The criteria
for diagnosing gestational diabetes are more stringent than the criteria for
diagnosing other types of diabetes, which is a reflection of the presence of
decreased blood glucose concentrations in healthy pregnant women as compared
with non-pregnant women and with men.

Treatment of Diabetes Mellitus

Treatment for diabetes mellitus is aimed at reducing blood glucose concentrations

to normal levels. Achieving this is important in promoting well-being and in
minimizing the development and progression of the long-term complications of
diabetes.

 Diet and exercise All diabetes patients are put on diets designed to help them
reach and maintain normal body weight, and they often are encouraged to
exercise regularly, which enhance the movement of glucose into muscle cells
and blunts the rise in blood glucose that follows carbohydrate ingestion.

46
 Insulin therapies Diabetics who are unable to produce insulin in their bodies
require insulin therapy. Traditional insulin therapy entails regular injections
of the hormone, which are often customized according to individual and
variable requirements. Human insulin may be given as a form that is identical
to the natural form found in the body, which acts quickly but transiently
(short-acting insulin), or as a form that has been biochemically modified so as
to prolong its action for up to 24 hours (long-acting insulin). Another type of
insulin acts rapidly, with the hormone beginning to lower blood glucose
within 10 to 30 minutes of administration; such rapid-acting insulin was made
available in an inhalable form in 2014.

 Drugs used to control blood glucose levels

There are several classes of oral drugs used to control blood glucose levels,
including sulfonylureas, biguanides, and thiazolidinediones.

 Glucometer monitoring

All patients with diabetes mellitus, particularly those taking insulin, should
measure blood glucose concentrations periodically at home, especially when they
have symptoms of hypoglycemia. Using this technology, many patients become
skilled at evaluating their diabetes and making appropriate adjustments in therapy
on their own initiative.

3.2.4 Concept of Insulin and Pancreas

 Insulin-Insulin is a hormone. Human body's cells absorb glucose from the

blood. The glucose is stored in the liver and muscle as glycogen and stops

47
 the body from using fat as a source of energy. When there is very little insulin
in the blood, or none at all, glucose is not taken up by most body cells. When
this happens human body uses fat as a source of energy. Insulin is also a
control signal to other body systems, such as amino acid uptake by body cells.

 Pancreas-The pancreas is part of the digestive system. It is located high up

in human abdomen and lies across human body where the ribs meet at the
bottom. It is shaped like a leaf and is about six inches long. The wide end is
called the head while the narrower end is called the tail, the mid-part is called
the body.

3.3 Diabetes Mellitus in Bangladesh

Bangladesh has a disproportionately high diabetes population with more than 7.1
million, 8.4% or 10 million according to research published in WHO bulletin in
2013, of the adult population affected by the disease. The number will be 13.6
million in 2040. Nearly half of the population with diabetes, 51.2%, don’t know
that they have diabetes and don’t receive any treatment.

Bangladesh is home to a 161 million population, according to the latest census

report. During 90s, the country has a relatively low diabetes affected population.
In 1995 is was only 4% which grew to 5% in 2000 and 9% in 2006 to 2010.
According to the International Diabetes Federation, the prevalence will be
13% by 2030.

According to a report published in WHO Bulletin in November 2013, there is a

quite significant correlation between age and diabetes. Older people were more
likely to have diabetes. A greater number of affected population were educated
and working and more likely to come from affluent family with 40.7% came from

48
the richest quintile, whereas 12.7% came from the poorest quintile. The report
also said that, urban people are slightly more prone to diabetes than the rural
people and that 56.0% of affected people did not know they were carrying the
disease and only 39.5% were receiving treatment regularly.

3.4 Recommendations to Control Diabetes in Bangladesh

It is important for us to understand the state of diabetes in Bangladesh in order to

tackle this deadly health challenge.

Some recommendations are given below for the improvement of the condition of
the diabetic patient and the service providing system. These are-

o To arrange regular meetings and seminars, symposiums, round table

discussion with the diabetic patient to inform the latest information about
diabetes and inspired them to follow the rules and regulations;
o To arrange training programs for the assigned employees about diabetes;
o Proper management should be taken to lessen the diabetic cost;
o Different therapies such as behavior therapy, psychotherapy should be
applied to remove the psychological problems of the diabetic patients;
o To create public awareness about diabetes, its causes, symptoms, treatment
diet, discipline, form of taking drug etc. ;
o To increase publicity about diabetic through print and electric media;
o To make effective measurement to remove the anxiety of the family
members of the diabetic patients family members;

49
 Chapter Four
My Participation in Field Practicum as an Apprentice Social
Worker

4.1 Introduction
4.2 My Assigned Duties as an Intern Social Worker
4.2.1 Duties& Responsibilities from Internal Supervisor
4.2.2 Duties& Responsibilities from Field Practicum Agency
4.3 Duties Performed by Me
4.3.1 Duties from Internal Supervisor
4.3.2 Duties from External Supervisor
4.4 My Taken Cases

50
 Chapter Four
My Participation in Field Practicum as an Apprentice Social
Worker
4.1 Introduction

I started working at Social Welfare Department of BIRDEM at 16 April, 2016.

From the starting I have to be introduced to the officials of agency. Firstly I and
my group member met to Kazi Rashedul Haque, Assistant Director of the
Department. He delivered a brief introduction on the social welfare department
and its activities. He also interpreted what tasks would be done by us.

Stage by stage we introduced all the officials and staffs of the agency. 3 days I
attended to the lecture of BIRDEM’s doctors on diabetes that are given for the
consciousness of diabetic patients. Then Sultana Yeasmin Papri, Social Welfare
officer taught us to write case history. Thus I launched to perform my work.
Mainly I performed three types of activities.

4.2 My Assigned Duties as an Intern Social Worker

During my field work in BIRDEM I had some duties on me from my institute

supervisor and my agency supervisor. The kind of duties I tried to completed,
those are;

4.2.1 Duties& Responsibilities from Internal Supervisor

 To go to the agency in time and obey the agency supervisor;

 Keep the daily record in the process recording book;
 Listen and attend the supervisory conference;
 Take at least 5 cases for the finale field work report;

51
  Prepare a finale field work report;
 Use the social work and skills effectively in the knowledge problem
solving process;

4.2.2 Duties& Responsibilities from Field Practicum Agency

 Sign the attendance register regularly;

 Create a good relation among the working stuff, and make rapport with
the client;
 Learn about the different unit and department of agency;
 Learn the structure, objectives, goals and programs of the agency;
 Help the client to have their service, by taking their interview;
 Collect data about the social, economic condition;
 Take the case history effectively;
 Make follow up with full attention to the client;
 Visit the Social Welfare wards;
 Attend the library to know about hospital service& history;
 Provide information to the newly patients;

4.3 Duties Performed by Me

I have accomplished some duties which are assigned by my institute supervisor

and hospital supervisor. Now the performed duties of mine are referred here:

4.3.1 Duties from Internal Supervisor

 Writing process record note on daily basis;

 Taking signature on process record of Institute Supervisor on supervisory
conference after assessing by him;

52
  Assisted in the activities of Social Welfare Department of BIRDEM
General Hospital on the instruction of Institute Supervisor;
 Attending the institute supervisory conference;
 Taking cases of admitted patients in the wards of Social Welfare
Department of BIRDEM General Hospital;
 Providing counselling to the patients;
 Doing follow up of the taken cases;
 Doing assignments on the topics of Field Work Report;

4.3.2 Duties from External Supervisor

 Signing on the Attendance Note Book;

 Accomplishing Social History of the patients;
 Assisting Junior Social Welfare Officer in the process of assessment&
review of the patients;
 Providing Social History Date and Assessment Date on the instruction of
Junior Social Welfare Officer;
 Keeping record of the assessed patients;
 Keeping record of patients whose social history have been done;
 Visiting the wards of the Social Welfare Department;
 Doing library Works;
 Attending Diabetes Guide Classes;
 Performed duties in BIRDEM 2 for 7 working days;
 Assisting in keeping record of newly hospitalized patients of Social
Welfare;
 Attending hospital supervisor conferences;

53
4.4 My Taken Cases

Name Age Reference no Social Welfare no Occupation Address

1 Jayda 55 581763 70366 Housewife Dhaka

2 MST. Sharifa Begum 55 575446 70374 Home maid Norshingdi
3 MST. Roma 37 563885 70376 Housewife Cumilla
4 Nasima Begum 46 561041 70377 Housewife Munshiganj
5 Raziya Begum 60 490738 70379 Housewife Dhaka
6 Anjuma Begum 42 582673 70385 Housewife Tangail
7 Agnes Chinu 41 580526 70388 Housewife Gazipur
8 Hasina Begum 55 579379 70401 Housewife Dhaka
9 Parboti Roy 52 580761 70414 Housewife Dhaka
11 Nazma Begum 23 568582 70418 Housewife Gopalgonj
12 Mst Julekha Begum 54 577033 70421 Dependent Gazipur
13 Monowara Begum 52 573867 70422 Dependent Barishal
14 Ohab Shikdar 81 539852 70427 Dependent Barishal
15 Shurjo Begum 48 579043 70428 Housewife Dhaka
16 Rehana Begum 36 548376 70430 Retail Dhaka
Merchant
17 Parboti Rani 48 500155 70437 Housewife Munshiganj
18 Mir Jahidul islam 50 324373 70440 Dependent Munshiganj
19 Md. Musaraf Dewan 40 582583 70442 Salesman Dhaka
20 Sufiya Begum 48 542010 70449 Housewife Dhaka
21 Mst. Aleya 51 581590 70451 Housewife Gazipur
22 Mst. Tahmina 34 582209 70456 Housewife Gazipur
23 Nasrin 41 584870 70465 Housewife Mymensingh
24 Latifan 70 232341 70474 Dependent Dhaka

54
25 Nurjahan Begum 69 584384 70479 Dependent Chadpur
26 Sabina Yeasmin 46 509179 70484 Housewife Dhaka
27 Mst. Anowara 46 581965 70535 Housewife Dhaka
28 Shirana Begum 51 586160 70537 Housewife Tangail
29 Maya Begum 59 286191 70542 Dependent Dhaka
30 Rahima Begum 40 586595 70554 Housewife Chadpur
31 Shahnaz Begum 48 432142 70558 Housewife Munshiganj
32 Rashida Begum 35 586649 70560 Dependent Manikganj
33 Sahera Khatun 78 585874 70563 Dependent Dhaka
34 Md. Alauddin 56 429677 70566 Dependent Narayanganj
35 Selina Akter 34 586815 70570 Housewife Jashore
36 Amena Begum 50 457690 70576 Housewife Dhaka
37 Sahera Begum 40 493933 70584 Housewife Dhaka
38 Ujjol Molla 29 587084 70585 Day Faridpur
Laborer
39 Salma Begum 51 586826 70586 Housewife Dhaka
40 Tabrej Alam 53 574642 70587 Shop Dhaka
assistant
41 A. Razzak Mondol 36 587282 70598 Dependent Kushtia
42 Taslim Uddin 58 217253 70599 Security Dhaka
Guard

55
 Chapter Five
My Performed Cases

5.1 Introduction
5.2 Performed Cases
5.2.1 Case 1
5.2.2 Case 2
5.2.3 Case 3
5.2.4 Case 4
5.2.5 Case 5

56
 Chapter Five
My Performed Cases

5.1 Introduction

I am assigned to take 5 cases from hospitalized patients in free wards. As I

referred before the free wards of BIRDEM General Hospital under the Social
Welfare Departments. The free wards are-62, 63, 113, 133.

5.2 Performed Cases

My performed cases are-

Case No Patient Name Reference No Social Age

Welfare No
Case 1 Monowara 237388 24425 55
Begum
Case 2 Tahmina 557658 69187 24
Akter
Case 3 Nasrin Begum 310914 36040 23
Case 4 Saleha Begum 377159 54400 50
Case 5 Md. Billal 540790 68465 55
Hossain

5.2.1 Case 1

 Background of the Case

For taking a case, I select a patient named ‘Monowara Begum’. She is an illiterate
person. She is physically and mentally so much weak. She becomes dependent at
her 55 years of age. Her Daughter was with her and she said that her mother is so
much physically ill that her mother has to admit in the hospital for six months of
a year and this is going on for 10 years. And the Patient is victim of 3rd time heart
attack. She is admitted in BIRDEM General Hospital at 04-05-18.

57
 Patient’s Profile

Name Monowara Begum

Reference No 237388
Social Welfare no 24425
Age 55 years
Sex Female
Marital Status Married
Father’s Name Md. Kalu Mia
Mother’s name Karimunnessa
Education Illiterate
Profession Dependent
Address Keraniganj, Dhaka

Treatment Related Information

Problem Diagnosis DM, TB, HTN, Kidney Disease, Heart
Disease, Gall Bag Stone
Bed No 1352
Ward No 133
Admission Date 04/05/18
Case Recording Date 28/05/18
Supervisory Doctor Dr. Zakera Sultana

Family Related Information

SL No Name Age Education Profession Relation
1 Md. Siddique 65 Illiterate Dependent Husband
2 Md. Hanif 27 Class 6 Garments 1st Child
Worker
3 Md. Hossain 25 Class 6 Garments 2nd Child
Worker
4 Miss Morium 20 SSC Student 3rd Child
5 Miss Mina 18 Illiterate Mentally 4th Child
Handicapped

58
 History of Illness

When Monowara Begum was 40 years old, she was suffering from hyper tension
so much and she frequently became physically weak. Then she consulted with a
doctor. Doctor prescribed her to do some tests and after observing the report, he
said that Monowara Begum is a diabetic patient. Doctor referred her to BIRDEM
General Hospital.

 Rationale of Taking Case

At first, with taking permission of Social Welfare Department, I went to the free
ward, 133. I take this case because Monowara Begum is-

 Along with daughter and laying on the bed, looking distressed;

 Suffering from many diseases in her body and no one is there for helping
her;
 Able to give me information about new disease;
 Not able to do everything by herself like talking to the doctors, nurses,
bringing medicines etc;
 There is a scope to apply social work knowledge, methods& techniques;

 Rapport buildup

Rapport build up is a so much important before commencing planned treatment

because collecting deep information and giving effective problem solution to
client are impossible without establishing rapport so as an apprentice social
worker. I used the following techniques for establishing rapport.

 Acceptance-I accepted Monowara Begum giving full dignity and respect. I

gave assurance to solve her problem. As a result she also accepted the giving
importance.

59
 Communication-I maintained regular communication with Monowara
Begum and tried to understand her needs and information about problem.
 Participation-Establishing rapport is impossible without ensuring
participation of client is problem solving process. So I ensured participation
of Monowara Begum is every steps in problem solving process.
 Confidentiality-I assured Monowara Begum to hide her all information as a
result he believed me fully and she promised that she didn’t hide any
information in her life.
 Individuality-I knew all clients are individual. Their problem, patterns of
problems, cases of problem, solution process, expectation etc. are iterant
from other. So I applied individuality principle for establishing rapport with
Monowara Begum. I tried to solve her problem on according to real findings
and her needs.
 Self-confidentiality-Every client has own view and want to ensure of those
needs. So I tried to ensure Monowara Begum helps me to establish rapport.

 Psycho-social Study

In social case work psycho-social study is a very important phase. As an

apprentice social worker to know details information about Monowara Begum. I
complete Psycho-social study.

In this stage I can apply some techniques. This techniques are given below-
Interview-Interview is the main way to collect client’s information. To complete
interview I went to my patient Monowara begum’s ward and follow some steps
for fruitful interview-

During staying time of Monowara Begum in BIRDEM made for his 6 interview
of my working day.

60
1st interview-This was first day of Monowara Begum and my interview. Today
her physical and mental condition was not normal. I had to talk with her daughter
and I talked with her for few minutes. I tried to give mental support.

2nd interview-In this day, I saw physical condition of Monowara Begum was not
so much improved and mental condition also. So I helped to remove her mental
depression and gave some advices.

3rd interview-In this day, physical and mental condition of Monowara Begum
was improved. But she was very much tensed about her daughter. Because her
daughter had to drop out from education for her situation. So, I tried my best to
counsel her.

4th interview-In this day, I saw mental condition of Monowara Begum was good
but physical condition was not good because her sugar level is so high and for
that she was not prepare for surgery. I gave some advice to follow Doctor's advice
and taking regular medicine.

5th interview-In this day, Monowara Begum's physical and mental condition was
fine. I provided her different kind of information related to his treatment. I
advised her to follow the rules and regulations which were given by the assigned
doctor.

6th interview-In this day, Monowara Begum was almost well. I arranged all
necessary things to helping for Monowara Begum. At last, she gave me thanks
for helping her and she promised me to take all of her medicines regularly.

 Observation-It is very important techniques at interview stage. I observe my

clients personality, behavior, body language, mental condition with carefully.

61
 Listening-As an apprentice social worker I listen my client Monowara
Begum physical and mental problem and also social, financial and family
related problem with deep concentration
 Questioning-Continuing interview stage I question my client with simple
language.
 Answering-When my client ask me any questions, I answer her with
logically.
 Case Record-I reviewed the previous and present files of Monowara Begum
that was so helpful for knowing Monowara Begum.

 Socio-Economic Condition:
o Economic condition-Monowara Begum’s economical condition is not so
good. Her two sons are the earning persons of his family. Her economic status
are given- Profession : Dependent

Monthly Income : 10,000/-

Personal Property : Poor

Family property : Poor

Ability of Treatment : Disabled

Helping Relatives : Absent

o Social Condition: My client’s social status is good. He is totally devoid of

political impasse. And his neighbor does good behavior with his family. His
social status are given below-

Education : Illiterate
Resident : Rural
Household Composition: Tin Shed House

62
o Psycho-social Information-Client belongs to an insolvent family. But he and
his family has good relationship with neighbors, relatives and often visited
them. So, considering patient’s overall conditions, it can be said that his social
status was good. My patient was very upset and worried about his present
problems. As usual as her economic condition too, was upset for her daughters
also.

 Problem identification-From my interview as well as hospital’s documents,

I got some problems of my client. I also talked to the duty doctor, she told me
the whole problems and I noted down that problems. Such as-
Diagnosis
 Dynamic Diagnosis-Dynamic diagnosis process involves examining the part
of a psychosocial problem for their particular nature and organization, for the
interrelationships among “them, for the relation between them and the means
to their solution. I observe my cliental present problem and how to remove
this problem.

a. She is an old and dependent person but suffering from critical diseases.

b. She doesn’t know about her future barring.

c. The family is economically insolvent because the cost of treatment is very high.

d. Her husband is also a dependent person.

 Clinical diagnosis-Clinical diagnosis means fault and inconsistency in

behavior and causes of social malfunctioning. We find out the problem of
clinical diagnosis about Monowara Begum. Such as-
o High blood pressure;
o Breakdown mentally;
o Hopelessness;

63
 o Sleeping disorder;
o Physical illness (kidney, Heart& Uterine disease related);
 Etiological diagnosis-It is psycho related problem without clinical problem.
It is happened after disease. Such as-
o Frustration
o Mental depression
o Financial crisis etc.

 Treatment-In the light of supportive treatment and motivate treatment. The

activities are-
 Supportive treatment
o Helping her to get medicine from the hospital social welfare
department.
o Free supplying of medicine and cloths.

 Modifying treatment-Building professional relationship and become

reliable to her and collect information.
o Inspire her how to cope up with society.
o Inspire her to follow the guidebook and doctor’s suggestion regularly
o Motivate her daughter to start her study again and also provide some
education related information;

 Evaluation/ Follow-Up

I am an apprentice social worker so basically I tried to apply my class room

knowledge to solve Monowara Begum mental problem. She contacted with me
cordially. So it was possible to look after her to come round quickly. It was also
possible within few days. I tried to help her form myself with the help of my
agency as such as possible. So they were grateful to me for my assistance.

64
5.2.2 Case 2

 Background of the Case

For taking a case study, I select a client named Tahmina Akter (24). Her home
district is Noakhali. Her educational quality is class nine. She is married. From
2012 Tahmina Akter feeling hypogondaisemia. Then she with her elder sister
after some days came to Dhaka and visited a doctor. This doctor referred to
BIRDEM Hospital. When I go in the 13th floor, I see a very young age
problematic patient and I accept her as my 2nd case.

Patient’s Information
Name Tahmina Akter
Reference No 557658
Social Welfare no 69187
Age 24 years
Sex Female
Marital Status Married
Father’s Name Abdus Sattar (Late)
Mother’s name Monowara Begum (Late)
Education Class 9
Profession House Wife
Home District Noakhali

Hospital Related Information

Problem Diagnosis DM, Serious Kidney Disease
Bed No 1350
Ward No 133
Admission Date 20/05/18
Case Recording Date 28/05/18
Supervisory Doctor Dr. Zakera Sultana

65
 Family Related Information-Patient Tahmina Akter lives alone as her
husband is an immigrant. Her husband name is Md. Saleh Ahmed. Patient’s
all responsibilities are taken by her elder sister named Amena Akter and who
is also married.

 History of illness-From 2012, she was very deep pain in her abdomen and
she felt Hypogondhisemia so frequently. And after some days she goes to a
village doctor and doctor treat her but her problem is stable. Then she came
to Dhaka along with her elder sister Amena Akter and visited a doctor. This
doctor referred to BIRDEM Hospital. Tahmina Akter needs Regular Kidney
Dialysis.

 Rationale of Taking Case-When I went into indoor and I saw her first she
was laying in the bed. The rationality
o So young in age;
o Suffering from serious pain;
o Facing very much financial problem;
o Always need blood for kidney Dialysis;
o To observe the overall physical and socio-economic condition of the
patent;
o Getting no support from her husband or husband’s family;

 Rapport buildup-Rapport build up is a so much important before

commencing planned treatment because collecting deep information. At first
I met with her and tried to build up a friendly relationship with her. Then I
followed her for five days and help her to get services and provide her
information and motivated her to reduce frustration. By this way I build up a
professional relationship with the client. I used the following techniques for
establishing rapport.

66
 Acceptance-I accepted Tahmina Akter giving full dignity and respect. I gave
assurance to solve her problem. As a result she also accepted the giving
importance.
 Communication-I maintained regular communication with Tahmina Akter
and tried to understand her need and information about problem.
 Participation-Establishing rapport is impossible without ensuring
participation of client is problem solving process. So I ensured participation
of Tahmina Akter is every step in problem solving process.
 Confidentiality-I assured Tahmina Akter to hide her all information as a
result she believed me fully and she promised that she didn’t hide any
information in her life.
 Individuality-I knew all clients are individual. Their problem, patterns of
problems, cases of problem, solution process, expectation etc. are iterant from
other. So I applied individuality principle for establishing rapport with
Tahmina Akter. I tried to solve her problem on according to real findings and
her needs.
 Self-confidentiality-Every client has own view and want to ensure of those
needs. So I tried to ensure Tahmina Akter helps me to establish rapport.

 Psycho-social Study

In social case work psycho-social study is a very important phase. As an

apprentice social worker to know details information about Tahmina Akter. I
completed Psycho-social study. In this stage I can apply some techniques. This
techniques are given below-

 Interview-Interview is the main way to collect client’s information. In my

case I met Tahmina Akter five times and take interview from her. These are
include in below:

67
1st interview-After receiving the case, first day I met with Tahmina Akter. I
wanted to know about her, her family, personal information and so on. I also
asked the nurse about her illness. I find out the background of her illness and
mental stress. I talked with her elder sister too as patient is feeling very much
pain and her body is swelling.

2nd interview-Second day I saw physical condition of Tahmina Akter was not
improved. She is feeling so pain and her body is swelling too. And I tried to give
her courage.

3rd interview-3rd day I wanted to know about her background and observed her.
I wanted to know about if she got proper treatment or if she felts any problem.
Then I came to know that she needed 2 bags blood after her kidney dialysis but
blood was not available in Hospital’s blood bank. I discussed with Social Welfare
Department and my class mates for collecting blood.

4th interview-On fourth day I followed her. This day I want to know about her
husband’s family. 1st time she refused then she agreed. Then I came to know that
her husband is not so caring and he did not believe about her illness. And patient
also did not share about serious disease if her value became low to her husband.
I inspired her to talk freely with her husband about her problem to get potential
support.

5th interview-I met her and wanted to know her update of her physical condition.
She informed me that she was feeling much better than before and now she got
proper treatment. She thanked me and become pleased at me. Today her husband
also contacted with her by telephone and she shared her problem to him.

68
 o Observation-It is very important techniques at interview stage. I observe
my clients personality, behavior, body language, mental condition with
carefully.
o Listening-As an apprentice social worker I listen my client Tahmina Akter’s
physical and mental problem and also social, financial and family related
problem with deep concentration.
o Questioning-Continuing interview stage I question my client with simple
language.
o Answering-When my client Tahmina Akter asks me any questions, I answer
her with logically.
o Case Record-I reviewed the previous and present files of Tahmina Akter
that was so helpful for knowing about the disease of Tahmina Akter.
 Socio-Economic Condition
o Economical condition: Tahmina Akter’s economic condition is not so good
as she needs a great amount for her medical treatment. Her husband is the
earning person of her family. Her family’s economic status are given below-
Profession : House Wife

Monthly Income : 6,000/-

Personal Property : Poor

Family property : Poor

Ability of Treatment : Unable

Helping Relatives : Present

o Social Condition: My client’s social status is not so good. Her Husband’s

family members ignore her as my patient has done love marriage. Her social
status are given below-

69
Education : Secondary

Resident : Rural

Household Composition: Semi Brick Built House

Friendship : Present

 Psycho-social information

My patient was very upset and worried about her present problems. As usual as
her economic condition too, was upset about her husband also.

 Problem identification-From my interview as well as hospital’s documents,

I got some problems of my client. I also talked to the duty doctor, she told me
the whole problems and I noted down that problems. Such as-
Diagnosis
 Dynamic Diagnosis-

Dynamic diagnosis process involves examining the part of a psychosocial

problem for their particular nature and organization. I observe my cliental present
problem and how to remove this problem.

a. She is a 24 years young person but suffering from critical diseases.

b. She doesn’t know about her future barring.

c. The family is economically insolvent because the cost of treatment is very high.

d. Her husband is an immigrant and has no care about his wife.

 Clinical Diagnosis

70
Clinical diagnosis means fault and inconsistency in behavior and causes of social
malfunctioning. We find out the problem of clinical diagnosis about Tahmina
Akter. Such as-

o Serious Abdominal pain

o Body Swelling.
o Anemia
o Breakdown mentally
o Hopelessness
 Etiological Diagnosis

It is psycho related problem without clinical problem. It is happened after disease.

Such as-
o Frustration
o Mental depression
o Financial crisis
o Anxiety

 Treatment

In the light of supportive treatment and motivate treatment. The activities are-

 Supportive treatment
o Helping her to get medicine from the hospital social welfare
department;
o Free supplying of medicine;
o Providing correct information about disease and treatment;
o Establishing regular communication and counseling;
o Arranging recreational activates, such as –gossiping with historical
moment, listening previous lovely moments in her life etc.

71
 o Purchasing medicine, injections and blood-beg;
o Arranging free test related to treatment;
 Modifying treatment
o Building professional relationship and become reliable to her and collect
information.
o Inspire her how to cope up with society.
o Helping her to take medicine regularly.
o Motivate her to freely talk with her husband and husband’s family
member;
o Inspire her elder sister to help her sister;

 Follow-Up/Evaluation:

I am an apprentice social worker so basically I tried to apply my class room

knowledge to solve Tahmina Akter’s mental problem. She contacted with me
cordially. So it was possible to look after her to come round quickly. It was also
possible within few days. I tried to help her form myself with the help of my
agency as such as possible. So they were grateful to me for my assistance.

5.2.3 Case 3

 Background of the Case

For taking a case, I select a client named Nasrin Begum (23). Her home district
is Norshingdi. Her education qualification is class 8. In her very early age, the
problem has arisen and she frequently became senseless. As a result, that client
was admitted in the hospital in Norshingdi. Then, those doctors suggested them
to admit in the BIRDEM. She is a registered patient of BIRDEM for some years.
At present she is admitted in Surgeon ward under free bed of BIRDEM.

72
 Patient’s Profile
Name Nasrin Begum
Reference No 310914
Social Welfare no 36040
Age 23 years
Sex Female
Marital Status Married
Father’s Name Sirajul Islam (late)
Mother’s name Sufia Khatun
Education Class 8
Profession House Wife
Address Hafijpur, Norshingdi

Treatment Related Information

Problem Diagnosis DM, Fibro Calculus Panereatic

Diabetes
Bed No 624
Ward No 62
Admission Date 03/05/18
Case Recording Date 28/05/18
Supervisory Doctor Prof. A. Md. Mamunur Rashid

Family Related Information

SL No Name Age Education Profession Relation

1 Ataur Rahman 34 Signature Van Driver Husband
Knowledge
2 Sathi Begum 8 Class 1 Student 1st Child
3 Md. Hamim 6 - - 2nd Child

73
 History of illness

In Nasrin Begum’s very early age, the problem was arisen and she frequently
became senseless. As a result, that client was admitted in the hospital in
Norshingdi. Doctor said that she is a diabetic patient. Then, that doctor suggested
them to admit in the BIRDEM. At present she is admitted under the Social
Welfare Department of BIRDEM.

 Rationale of Taking Case-With the permission of the Social Welfare

Assistant (SWD) of BIRDEM I visited the wards. I went to him, and start
talking. After some time, I understand he is a problematic patient. I may have
some scope of using my social work knowledge, and skill to solve his
problem. After talking to the nurses I decide to take him as my client.

 Rapport buildup-Rapport build up is a so much important before

commencing planned treatment because collecting deep information and
giving effective problem solution to client are impossible without establishing
rapport so as an apprentice social worker.

I used the following techniques for establishing rapport.

 Acceptance-I accepted Nasrin Begum giving full dignity and respect. I

gave assurance to solve her problem. As a result she also accepted with
importance.
 Communication-I maintained regular communication with Nasrin Begum
and tried to understand her needs and information about her problem.
 Participation-Establishing rapport is impossible without ensuring
participation of client is problem solving process. So I ensured
participation of Nasrin Begum is every step in problem solving process.

74
  Confidentiality-I assured Nasrin Begum to hide her all information as a
result he believed me fully and she promised that she didn’t hide any
information in his life.
 Individuality-I knew all clients are individual. Their problem, patterns of
problems, cases of problem, solution process, expectation etc. are iterant
from other. So I applied individuality principle for establishing rapport
with Nasrin Begum. I tried to solve her problem on according to real
findings and her needs.
 Self-confidentiality-Every client has own view and want to ensure of
those needs. So I tried to ensure Nasrin Begum helps me to establish
rapport.

 Psycho-social Study

In social case work psycho-social study is a very important phase. As an

apprentice social worker to know details information about Nasrin Begum, I
completed Psycho-social study. In this stage I can apply some techniques. This
techniques are given below-

 Interview-Interview is the main way to collect client’s information. To

complete interview I go to my clients M Nasrin Begum’s ward and follow
some step for fruitful interview. During staying time of Nasrin Begum in
BIRDEM I made for his 6 interview of my working day.

1st interview-This was first day of Nasrin Begum and my follow-up. Today her
physical and mental condition was not normal as few days ago her surgery of
Gall bag stone was done. She was crying. I tried to give mental support.
2nd interview-In this day, I saw physical condition of Nasrin Begum was
improved but mental condition was not improved. So I helped to remove her
mental depression and gave some advices.

75
3rd interview-In this day, physical condition of Nasrin Begum was fine but she
was very much worried about physical illness like hearing problem, baldness,
sight problem. I explained her that why she was facing these. I came to know that
she was not very much serious about her diet chart. So, I cleared her that why the
diet chart is so important for physical healthiness.

4th interview-In this day, I saw mental condition of Nasrin Begum was good but
physical condition was not good. I gave some advice to follow Doctor's advice
and taking regular medicine. But she said that she was facing serious financial
problem to buy medicine as she did not get free medicine service from Social
Welfare Department. She asked me to help her. But it is impossible for me to
provide free medicine services from Social Welfare Department. Because, here
is a system that every free patient’s services identified on assessment date will be
remain for 3 years. And it can’t be changed before 3 years. Her next review date
is after one year. So, I clear her that she has to explain her financial problem on
that day to get free medicine service.

5th interview-In this day, Nasrin Begum’s physical and mental condition was
fine. I provided her different kind of information related to her treatment. I
advised her to follow the rules and regulations which were given by the assigned
doctor.

6th interview-In this day, Nasrin Begum was almost well. So Doctor gave release
from the Hospital in this day. I arranged all necessary helping for Nasrin Begum.
At last, she gave me thanks for helping his and he promised me to take all of his
medicine regularly.

 Observation-It is very important techniques at interview stage. I observe my

clients personality, behavior, body language, mental condition with carefully.

76
 Listening-As an apprentice social worker I listen my client Nasrin Begum’s
physical and mental problem and also social, financial and family related
problem with deep concentration
 Questioning-Continuing interview stage I question my client with simple
language.
 Answering-When my client ask me any questions, I answer him with
logically.
 Case Record I reviewed the previous and present files of Nasrin Begum’s
that was so helpful for knowing about Nasrin Begum.

 Socio-Economic Condition
o Economical condition-Nasrin Begum’s economical condition is not so good.

She is the only earning person of her family. Her economic status are given
below- Profession : House Wife

Monthly Income : 6,000/-

Personal Property : Poor

Family Property : Poor

Ability of Treatment: Unable

Helping Relatives : Absent

o Social Condition-My client’s social status is good. She is totally devoid of

political impasse. And her neighbor does good behavior with her family. Her
social status are given below-

Education : Class 8
Resident : Rural
Household Composition: Ten shed House

77
o Psycho-social information-My patient was very upset and worried about her
present problems. As usual as her economic condition too, was upset her
husband and children also.

 Problem identification-From my interview as well as hospital’s documents,

I got some problems of my client. I also talked to the duty doctor, she told me
the whole problems and I noted down that problems. Such as-
 Dynamic Diagnosis

Dynamic diagnosis process involves examining the part of a psychosocial

problem for their particular nature and organization, for the interrelationships
among “them, for the relation between them and the means to their solution. I
observe my cliental present problem and how to remove this problem.

a. She is a 23 years young persons but suffering from various disease;

b. She needed to test some skin, eye and hearing related and pathological test;

c. She doesn’t know about her future barring;

d. The family is economically insolvent because the cost of treatment is very

high;

e. Her husband is a van driver and has no educational qualification;

 Clinical Diagnosis Clinical diagnosis means fault and inconsistency in

behavior and causes of social malfunctioning. We find out the problem of
clinical diagnosis about Nasrin Begum. Such as-
o Serious hearing problem
o Facing baldness
o Breakdown mentally
o Hopelessness

78
  Etiological Diagnosis

It is psycho related problem without clinical problem. It is happened after disease.

Such as-

o Frustration
o Mental depression
o Financial crisis etc.

 Treatment

In the light of supportive treatment and motivate treatment. The activities are-

 Supportive treatment
o Helping her to get medicine from the hospital social welfare
department;
o Providing correct information about disease and treatment;
o Establishing regular communication and counseling;
 Modifying treatment-Building professional relationship and become reliable
to her and collect information
o Inspire her how to cope up with society;
o Helping her to take medicine regularly;
o Inspire her to follow diet chart on daily basis;

 Follow-Up/Evaluation-I am an apprentice social worker so basically I tried

to apply my class room knowledge to solve Nasrin Begum’s mental problem.
She contacted with me cordially. So it was possible to look after her to come
round quickly. It was also possible within few days. I tried to help her with
the help of my agency as such as possible. So they were grateful to me for my
assistance.

79
5.2.4 Case 4

 Background of The Case

For taking a case, I select a patient named ‘Saleha Begum’. She is an illiterate
person. She is physically and mentally so much weak. She becomes dependent at
her 50 years of age. Her Daughter was with her. And the Patient is victim of brain
stroke. She is admitted in BIRDEM General Hospital at 24-05-18. When I see
her physically and mentally disturbed, I have taken this patient as my Case 4.

Patient’s Profile
Name Saleha Begum
Reference No 377159
Social Welfare no 54400
Age 50 years
Sex Female
Marital Status Widow
Father’s Name Md. A Kader Khan (late)
Mother’s name Mst. Rokeya Begum
Education Illiterate
Profession House Wife
Address Kamrangichar, Dhaka

Treatment Related Information

Problem Diagnosis DM, HTN, Chronic Calculus
Choleystitis
Bed No 631
Ward No 62
Admission Date 24/05/18
Case Recording Date 28/05/18
Supervisory Doctor Prof. Taposh Kumar

80
 Family Related Information
SL No Name Age Education Profession Relation
1 Nilufa Yesmin 27 Class 9 House Wife 1st Child
2 Shahinur Sonia 25 Class 7 House Wife 2nd Child
3 Rumana 22 B.A House Wife 3rd Child
4 Rubi 20 Class 6 House Wife 4th Child
5 Sharifa Islam 18 HSC House Wife 5th Child
6 Umme Kulsum 16 SSC Student 6th Child

 History of illness-During 2007, the problem was arisen and she felt
hypogondisemia. As a result, that client was admitted into another hospital.
Then, doctor suggested them to admit in the BIRDEM.

 Rationale of Taking Case -During the case follow-up, I used to visit my

client Saleha Begum and talked to about her psychological and social aspects.
I observed her hospital’s documents and found that she is suffering from DM
and others. I achieved my client’s reliability through my conducts and
establish rapport. When I saw her first, she was lying in the bed. The main
objective of taking long case is to observe the overall physical and socio-
economic condition of the patient for long time. It’s the main goal is to arrange
a proper solution and taking rehabilitation steps for the patient/client.

 Rapport buildup-Rapport build up is a so much important before

commencing planned treatment because collecting deep information and
giving effective problem solution to client are impossible without establishing
rapport so as an apprentice social worker. I used the following techniques for
establishing rapport.

81
 Acceptance-I accepted Saleha Begum giving full dignity and respect. I gave
assurance to solve his problem. As a result he also accepted the giving
importance.
 Communication-I maintained regular communication with Saleha Begum
and tried to understand her needs and information about problem.
 Participation-Establishing rapport is impossible without ensuring
participation of client is problem solving process. So I ensured participation
of Saleha Begum is every step in problem solving process.
 Confidentiality-I assured Saleha Begum to hide her all information as a result
she believed me fully and she promised that he didn’t hide any information in
his life.
 Individuality-I knew all clients are individual. Their problem, patterns of
problems, cases of problem, solution process, expectation etc. are iterant from
other. So I applied individuality principle for establishing rapport with Saleha
Begum. I tried to solve her problem on according to real findings and her
needs.
 Self-confidentiality-Every client has own view and want to ensure of those
needs. So I tried to ensure Saleha Begum helps me to establish rapport.

 Psycho-social Study

In social case work psycho-social study is a very important phase. As an

apprentice social worker to know details information about Saleha Begum, I
complete Psycho-social study. In this stage I can apply some techniques. This
techniques are given below-

 Interview-Interview is the main way to collect client’s information.

During staying time of Saleha Begum in BIRDEM I conducted 5 interview
with her of my working day.

82
1st interview-This was first day of Saleha Begum and my interview. Today her
physical and mental condition was not normal. She was afraid for her surgery. I
tried to give mental support.

2nd interview-In this day, I saw physical condition of Saleha Begum& also
mental condition were not improved as her sugar level is so high which is barrier
for her surgery. So I helped to remove her mental depression and gave some
advice.

3rd interview-In this day, mental condition of Saleha Begum was fine and her
sugar level is normal. I explain her the necessity of keep controlling of blood
sugar and what are the doings for that.

4th interview-In this day, I saw mental condition of Saleha Begum was good but
physical condition was not good. I gave some advice to follow Doctor's advice
and taking regular medicine.

5th interview-In this day, Saleha Begum’s physical and mental condition was
fine. And she was ready for surgery. I provided her different kind of information
related to her treatment. I advised her to follow the rules and regulations which
were given by the assigned doctor.

 Observation-It is very important techniques at interview stage. I observe my

clients personality, behavior, body language, mental condition with carefully.
 Listening-As an apprentice social worker I listen my client Saleha Begum’s
physical and mental problem and also social, financial and family related
problem with deep concentration.
 Questioning-Continuing interview stage I question my client with simple
language.

83
 Answering-When my client Saleha Begum asks me any questions, I answer
her with logically.
 Case Record-I reviewed the previous and present files of Saleha Begum that
was so helpful for knowing about her Disease.
o Socio-Economic Condition-Economic condition: Saleha Begum’s economic
condition is not so good. She and her little daughter are dependent on her
married daughters’ help. Her economic status is given below:

Profession : House Wife

Monthly Income : 6,000/-

Personal Property : Poor

Family property : Poor

Ability of Treatment: Unable

Helping Relatives : Absent

o Social Condition-My client’s social status is good. She is totally devoid of

political impasse. And her neighbor does good behavior with her family. Her
social status are given below-

Education : Illiterate

Resident : Urban

Household Composition: Tin Shed House

Friendship : Present

o Psycho-social information-My patient was very upset and worried about her
surgery. As usual as her economic condition too, was upset his little daughter
also.

84
 Problem identification-From my interview as well as hospital’s documents,
I got some problems of my client. I also talked to the duty doctor, he told me
the whole problems and I noted down that problems. Such as-
 Dynamic Diagnosis-

Dynamic diagnosis process involves examining the part of a psychosocial

problem for their particular nature and organization, for the interrelationships
among “them, for the relation between them and the means to their solution. I
observe my cliental present problem and how to remove this problem.

a. She is a 50 years old women and widow.

b. She doesn’t know about his future barring

c. The family is economically insolvent because there is no earning

member in the family.

d. She is unaware about her disease.

 Clinical diagnosis-Clinical diagnosis means fault and inconsistency in

behavior and causes of social malfunctioning. We find out the problem of
clinical diagnosis about Saleha Begum. Such as-
o The lips skin become fade and come out.
o The clients is physically weak and have some fever.
o Breakdown mentally
o Physical illness
 Etiological diagnosis-It is psycho related problem without clinical problem.

It is happened after disease. Such as-

o Frustration
o Mental depression
o Financial crisis etc

85
 Treatment-In the light of supportive treatment and modifying treatment. The
activities are-
 Supportive treatment
o Helping her to get medicine from the hospital social welfare
department;
o Free supplying of medicine;
 Modifying treatment
o Inspire her how to cope up with society;
o Helping her to take medicine regularly;
o Inspire her to reduce hyper tension;
o Motivate her little daughter about self-supporting and try to link
with educational information;

 Follow-Up/Evaluation: During the case study week, I used to visit the client.
Every day, I took the information about my client’s physical and mental
condition. I talked to my client’s mother, relatives and especially with her.
And I helped her as an apprentice social worker, as much as possible with the
help of my agency.
5.6 Case 5

 Background of the case

For taking a case study, I select a client named Md. Billal Hossain (55). His home
district is Shariyatpur. His educational quality is Secondary .He is married. He
has been suffering from diabetic for last eight years. At first he take tablet but
when sugar level increased doctor advised him to take insulin. But he is a lower
class people and can’t afford the cost. So, he seek help from social welfare dept.
in BIRDEM General Hospital. Few days ago he felt pain in right side and was

86
suffering from fever for 20 days and went into nearest hospital but his condition
didn’t improve. So he admitted into BIRDEM for better treatment.

Patient’s Profile
Name Md. Billal Hossain
Reference No 540790
Social Welfare no 68465
Age 55 years
Sex Male
Marital Status Married
Father’s Name Wajuddin (late)
Mother’s name Safia
Education Class 8
Profession Salesman
Address Shariyatpur

Treatment Related Information

Problem Diagnosis DM, Liver Absence, Neurofibronatosis
Bed No 1140
Ward No 113
Admission Date 28/05/18
Case Recording Date 03/06/18
Supervisory Doctor Asso. Prof. Golam Azam

Family Related Information

SL No Name Age Education Profession Relation
1 Rahima 38 Class 5 House Wife Wife
2 Dalia 25 Class 7 House Wife 1st Child
3 Sonia 21 Class 7 House Wife 2nd Child
4 Tania 18 Class 10 House Wife 3rd Child
5 Riyana 16 Class 10 Student 4th Child

87
 History of illness-He face some problems before 8 years ago, then he meet
nearby doctor. The doctor told him he is a diabetic patient.

 Rationale of taking case-When I went into indoor and investigate the

condition of the client then I saw his first, she was lying in the bed. I knew
about Md. Billal Hossain. Nobody comes to inform him and he has no one
here to take care him. I also knew his socio economic condition is not well
and his wife refute his because of his illness. His body is also circulated with
water. He became frustrated, so I took him as a case.

 Rapport buildup-Rapport build up is a so much important before

commencing planned treatment because collecting deep information and
giving effective problem solution to client are impossible without establishing
rapport. So at first I met with him and tried to build up a friendly relationship
with him. Then I followed him after four or five days and help him to get
services and provide him information and motivated him to reduce his
frustration. By this way I build up a professional relationship with the client.
I used the following techniques for establishing rapport.
o Acceptance-I accepted giving full dignity and respect. I gave assurance to
solve his problem. As a result he also accepted the giving importance.
o Communication-I maintained regular communication with Md. Billal
Hossain and tried to understand her need and information about problem.
o Participation-Establishing rapport is impossible without ensuring
participation of client is problem solving process. So I ensured participation
of Md. Billal Hossain is every step in problem solving process.
o Confidentiality-I assured Md. Billal Hossain to hide his all information as a
result he believed me fully and he promised that he didn’t hide any
information in his life.

88
o Individuality-I knew all clients are individual. Their problem, patterns of
problems, cases of problem, solution process, expectation etc. are iterant from
other. So I applied individuality principle for establishing rapport with Md.
Billal Hossain. I tried to solve his problem on according to real findings and
his needs.
o Self-confidentiality-Every client has own view and want to ensure of those
needs. So I tried to ensure Md. Billal Hossain helps me to establish rapport.
 Psycho-social Study

In social case work psycho-social study is a very important phase. As an

apprentice social worker to know details information about Md. Billal Hossain. I
complete Psycho-social study. In this stage I can apply some techniques. This
techniques are given below-

o Interview-Interview is the main way to collect client’s information. In my

case I met him five times and take interview from him. These are include
in below:

1st interview-After receiving the case, first day I met with him. I wanted to know
about him, his family, personal information and so on. I also asked the nurse
about his illness. I find out the background of his illness and mental stress.

2nd interview-Second day I observed his physical and mental condition. And I
tried to provide him counseling.

3rd interview-3rd day I wanted to know about his background and observed him.
I wanted to know if he got proper treatment or is he any problem. I discussed a
nurse for his better treatment.

4th interview-On fourth day I followed him. I talked with his wife I motivated
him so that he feel more relaxed.

89
5th interview-In this day, Md. Billal Hossain’s physical and mental condition
was fine. I provided his different kind of information related to his treatment. I
advised his to follow the rules and regulations which were given by the assigned
doctor.

6th interview-In this day, Md. Billal Hossain was almost well. I arranged all
necessary helping for his. At last, he gave me thanks for helping his and he
promised me to take all of his medicine regularly.

o Observation-It is very important techniques at interview stage. I observe my

clients personality, behavior, body language, mental condition with carefully.
o Listening-As an apprentice social worker I listen my client Md. Billal
Hossain’s physical and mental problem and also social, financial and family
related problem with deep concentration.
o Questioning-Continuing interview stage I question my client with simple
language.
o Answering-When my client ask me any questions, I answer his with logically.
o Case Record-I reviewed the previous and present files of Md. Billal Hossain
that was so helpful for knowing his.
 Socio-Economic Condition:
o Economic condition-Md. Billal Hossain family’s economic condition is not
so good. He is the only earning person of his family. His economic status are
given below- Profession : Salesman

Monthly Income : 8,000/-

Personal Property : Poor

Ability of Treatment : Unable

Helping Relatives : Absent

90
o Social Condition-My client’s social status is good. He and his family is
totally devoid of political impasse. And his neighbor does good behavior with
his family. His social status are given below-

Education : Secondary
Resident : Rural
Household Composition: Tin Shed House
o Psycho-social information-My patient was very mentally upset and worried
about his present problems. As usual as his economic condition too, because
his family member depend on his.

 Problem identification-From my interview as well as hospital’s documents.

I got some problems of my client. I also talked to the duty doctor, she told me
the whole problems and I noted down that problems. Such as-
 Dynamic Diagnosis-Dynamic diagnosis process involves examining the part

of a psychosocial problem for their particular nature and organization, for the
interrelationships among “them, for the relation between them and the means
to their solution. I observe my cliental present problem and how to remove
this problem.

a. He is a 50 years old persons and suffering from various diseases.

b. He needed to test some pathological test.

c. The family is economically insolvent because the cost of treatment is very high.

 Clinical diagnosis-Clinical diagnosis means fault and inconsistency in

behavior and causes of social malfunctioning. We find out the problem of

clinical diagnosis about Md. Billal Hossain Such as-
o High blood pressure
o Fever

91
 o Illness
o High sugar
o Can’t/didn’t get treatment proper time
o Can’t take medicine and test report
 Etiological diagnosis-It is psycho related problem without clinical problem.

It is happened after disease. Such as-

o Frustration
o Mental depression
o Financial crisis etc.

 Treatment-In the light of supportive treatment and motivate treatment. The

activities are-
 Supportive treatment

o Helping her to get medicine from the hospital social welfare

department
o Free supplying of medicine.
o Providing correct information about disease and treatment
o Establishing regular communication and counseling
 Modifying treatment
o Building professional relationship and become reliable to him and
collect information.
o Inspire him how to cope up with society.
o Helping him to take medicine regularly.

 Follow-Up/Evaluation:

Every day, I took the information about my client’s physical and mental
condition. And I helped him as an apprentice social worker, as much as possible
with the help of my agency.

92
 Chapter Six
Evaluations, Recommendations& Conclusions

6.1 My Experiences as an Intern Social Worker

6.2 Applied Social Work Theories, Methods& Techniques
6.3 Strengths & Weaknesses
6.3.1 Strengths & Weaknesses of Field Practicum Agency
6.3.2 Strengths & Weaknesses of Department of Social Work of JNU
6.4 Recommendations
6.4.1 Recommendations to Department of Social Work of JNU
6.4.2 Recommendations to Department of Social Welfare of BIRDEM
6.5 Conclusions

93
 Chapter Six
Evaluations, Recommendations& Conclusions

6.1 Evaluations

My Experiences as an Intern Social Worker

Social work is a profession. So a social worker has to acquire knowledge from

real environment on subjects like the nature of human behaviors, social relation,
cultural values, environments etc. Only field work practice gives this opportunity
to trainee social worker. It helps to correct between theoretical knowledge and
practical knowledge. This short period of time sixty (60) working days. I worked
under Md. Kazi Rashedul Haque.
Shahidul Haque as my Institute supervisor and Md. Kazi Rashedul Haque as
Hospital supervisor in the Social Welfare Department, BIRDEM General
Hospital and Ibrahim Memorial Diabetes Center as my agency. I learned and
obtained lot of experiences and developed my skill in certain fields of social
worker.
Only the theory inside the classroom or in library cannot provide the worker this
type of knowledge. It requires practical experience besides the theory to perform
his duty perfectly.
I used my theoretical knowledge and gathered the following experiences:
 I observe that various types of patients come to BIRDEM General Hospital
from many place round the country, talking to them, I gathered experience
on their social status, acceptance, beliefs, power, rights, duties, ideals,
values, ethics, language, culture, lifestyle, religion, family, conception about
others, prejudice, roams, philosophy, accountability etc.

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 I had misconception on hospital social service before my field work practice.
I came to know the necessity of hospital social service by field work
practice. Consulting with doctors and dealing with patients, I came to know
the names of many diseases, their characteristics, the way of prevention and
cure or getting relief etc. which I think could not be possible from my part
elaborately.
 I got an excellent opportunity of providing flawless service to the clients not
deviating from the code of ethics of social welfare in any complicate and
emotional moments.

 Social work believes in individual secrecy I used this principle and grows
the confidence in the mind of my client and has found out various sensitive
information regarding their disease.
 I have acquired the mentality to face any adverse situation.
 Rapport build-up is an important part and parcel of social case work. In the
field work practice at BIRDEM General Hospital gained necessary
knowledge on the methods of rapport building and how to develop it.
 I came to know how to take a compete interview of clients and gained
practical knowledge on the techniques, terms and conditions of an interview.
I realized the importance of the principle of acceptance.
 I learnt the way of specifying the aims and objectives of institutions or
agency, how to achieve these during my field work practice. I have acquired
knowledge on every side of a proper planning from formulation to
implementation.
 I have got practical experience on conducting follow- up for knowing the
matters like the development of patient’s condition their demands and needs
etc.

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  I got the opportunity to develop intricacy with people of every level of the
society by serving them. I could realize especially the real picture of majority
of the people of how much they are poor ignorant, illiterates, helpless and
disdained.

6.2 Applied Social Work Theories, Methods& Techniques

I have tried to do all my assigned duties during the field practicum. I have handled
the cases with the help of the basic methods of social work, social work helping
process that means psycho-social study, diagnosis, treatment& follow-up. Beside
these I have practiced the basic and auxiliary methods of social work.

The total methods, principles and techniques I have practiced from the beginning
to the end in my field work practicum are in the following-

 Social case work-Economic, social& psychological factors of individuals-in-

problem is the core attention of social case work as a method of professional
social case work.
 Principles of case work-As a trainee social worker I have used principles of

social case work in the problem solving process.

o Acceptance
o Communication
o Participation
o Confidentiality
o Individuality
o Self-confidentiality
 I use the Principles of Acceptance in the level of first impression with the
client every time. I tried to welcome them with a smile and friendly behavior.

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 Using the Principle of Communication I was able to communicate with the
client and I gave them chance to Communicate with me, so that their problems
could come out with a bloom.
 I encourage the client to participate in their problem solving process, and
ensure their decisions in their solving process.
 Ensuring them that their personal information is completely safe and remain
untold and will only be used in the departmental use, I had to use the principle
of confidentiality.
 I use the Principle individualization to recognize and understand the unique
qualities of each clients’ toward a better adjustment.

 Techniques used in Psycho-social study of Social Case Work-

o Observation
o Listening
o Questioning
o Answering
o Case Record
 Social Welfare Administration-Actually social welfare administration is a
process of transforming social policy into social services, involving the
concomitant use of experience to modify policy or method.
o Techniques used in Social Welfare Administration-
 Communication
 Collaboration
 Co-ordination
 Co-operation

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6.3 Strengths & Weaknesses
6.3.1 Strengths & Weaknesses of Field Practicum Agency
I am a student of social work in Jagannath University. I come for my field work
practice in BIRDEM General Hospital. It is completely new experience for me.
I faced some problem during my work.

 Strengths of Field Practicum Agency

 Here I get opportunity to apply the values and ethics of the profession and
to develop the capacity to work constructively with the value dilemmas,
conflicts, and ambiguities inherent in the practice of social work.
 I get chance to develop a varied repertoire of practice skills fundamentals to
social work and relevant to a wide range of clients.
 I also get opportunity to work with other professional and voluntary workers.
 I get scope to test the social work methods, principle, values, and ethics.
 Field work is the greatest strategy to evaluate the social work.
 I get scope of growing awareness of self with clients, staff and larger systems
in relation to practice.
 I work under administrative and organizational structure and learn how an
office is governed and what kind of routine needs to be established.
 I get the chance to develop the ability to work collaboratively with other
professional as a professional social workers.
 I get the scope to develop and demonstrate the skills of critical thinking
through social history of patients’.
 I get the clear concept about human behavior, attitude, values etc.
 Weaknesses of Field Practicum Agency-The doctors and other hospital

stuffs are not introduced with the working style of a social worker. Here are

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 lack of scope. Several time we faced that the doctor visit the rooms or the on
duty doctors are not co-operating with us or feel disturb by us.
 I have been failed to build up rapport in some cases because of having
ignorance, illiteracy and fear about treatment process.
 My limitation goes on maintaining the principle of confidentiality as
interviews were taken in front of other.
 I could not ensure sustainable material help to my client.
 The working environment of the social welfare department is noisy and
caucus.
 Sometimes clients express indifference in giving information.
 Sometime we don’t fulfill the patients’ expectations. The patient’s
expectation is not in our control then we need to handle the patient
diplomatically.
 Here are lack of knowledge and scope of counseling. Sometimes the doctors
felt disturbed and they thought we are against of their treatment.
 Sometimes we faced lack of actual knowledge about the management of
psychiatric patient. They don’t like share the actual information about the
psychological problem.

6.3.2 Strengths & Weaknesses of Department of Social Work of JNU

 Strengths of Department of Social Work of JNU

By the scope of Field Practicum, Students of Social Work are getting many
facilities. Now the strengths of Department of Social Work of JNU referred
below:

- Students can learn to apply social work methods in the solution of given
individual ground or community problems.

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 - The student are getting scope to develop facility in the use of
organizational structure; particularly the committee.
- The student are achieving self-awareness and disciplined use of self as a
helper and group situations.
- The students can learn the organizational framework of services.
- The student becomes familiar with administrative procedures and
processes.
- The student can acquire knowledge regarding community structure and
procures.
- The student can acquire significant substantive knowledge in the specific
field of practice characterized by the agency in which he/ she in placed.
- The student can acquire competence in recording and reporting (process
records minutes, monthly reports, administrative correspondence, etc.).
- The student can acquire and try out a variety of social work methods, skills
and techniques,
- Field work helps the students to realize the theory, methods and principles
of social work in practice which facilitates them to develop professional
self.
 Weaknesses of Department of Social Work of JNU
There I can’t see any such serious weaknesses of Department of Social Work of
JNU. But if -

o There is a scope of a joint orientation program of Institute Supervisor and

Agency Supervisor, it will be great for the apprentice social worker;
o And if apprentice social worker gets chance to choice the agency for field
practicum by own, then student can do great job in the field practicum;

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6.4 Recommendations

6.4.1 Recommendations to Department of Social Work of JNU

o Organize a joint orientation program of Institute Supervisor and Agency
Supervisor
o Create a scope that students can choice the agency by own

6.4.2 Recommendations to Department of Social Welfare of BIRDEM

There are some following steps to combat the existing barriers and to make more
the programs.

Every day, I took the information about my client’s physical and mental
condition. And I helped him as an apprentice social worker, as much as possible
with the help of my agency.

• The doctors, nurses, & authority BIRDEM General Hospital should be

more heart-felt and cooperative.

• More discipline should be maintained at the time of medicine distribution

• Emphasis should be given on the publicity about diabetes at the root level.

• At the district and thana levels, the structures of the sub-departments of

BIRDEM should be established that will lessen the pressure on BIRDEM beside
the patients.

• Beside case work, group work and community work can be practiced.

• Rehabilitation programs can be extended to rehabilitate the poor and

destitute, helpless patients.

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• Provision of seminar, symposium and conference with joint venture of
doctors, social workers, donors, and NGO’s to know the importance of hospital
social work service.

• More skilled manpower should be involved to fertilize the services.

• Hospital social work should be included in the medical syllabus.

• Conference needs to be effective to enhance students’ skill in problem

solving and being professional social workers.

6.5 Conclusions

Social work is a professional subject. It discusses not only theoretically but also
practically or professionally. It is a successful application of theoretical
knowledge highly depends on field work practice. Social workers have to study
the scientific principles of human behavior and the structure and organization of
social institutions. They have to develop, on their own, knowledge and skill in
working with people under specific social, economic, and emotional conditions.
During my field work I have worked social services officer, doctor, nurses and
with some cases. I have gathered a lot of valuable and precious experience and
knowledge from them. In some cases I have achieved success and sometimes
failed due to some problems related my limitation and the fault of agency. I am
apologizing for my unintentional mistakes and limitation. I tried with my best
effort to do my duties and take my responsibilities properly. Finally I pray and
bless that the social welfare department, BIRDEM General Hospital may be live
long and all activities would be more effective and progress and development
oriented for the diabetes to run a general and joyful life on the basis of these
improvement social work must get the professional recognition in the upcoming
future.

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References

 Akbar, Dr. Md. Ali, 1965, Elements of Social Welfare, Khan Art Press,
Dhaka.
 Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine
and Metabolic Disorder (BIRDEM), Social Welfare Department.
 Barker, R. L. (1995), The Social Work Dictionary, 3rd edition, (Washington
D.C., NASW press)
 Barker, Robert, L., (ed.), 1995, The Social Work Dictionary, Washington
D.C., NASW Press.
 Birdem.org 2014 BIRDEM Official Website [ONLINE] Retrieved from
www.birdem-bd.org
 Clarkson, Elizabeth M.R., 1974, Medical Social Work, Visiting Professor of
Social Work, University of Rajshahi.
 Daily bd-protidin, Daily jugantor, Daily Star
 Freidlander, 1997, Introduction to Social Welfare, Prentice Hall, Englewood
Cliffs: New Jersey.
 Husna Ara, 1994, An Introduction to Hospital Social Work Program,
Department of Social Services, GOB.
 Hossain, Ismail, 2005, Pakistan Journal of Social Sciences 3(3): 503-509,
Grace Publication.
 Islam, M.N. & Ahmed, M., 2008, Fieldwork Practice in Medical Setting: An
analysis in Bangladesh Context.
 Islam, Md. Nurul and Ahmed, Mostafiz, Field Work Practice in Medical
setting: An analysis in Bangladesh context, December, 2008, The Journal of
Social Development. Vol-20, No-1
 Momen, M. A., 1970, Field Work Manual, Institute of Social Welfare and
Research, University of Dhaka.
 National Association of Social worker, 1997, Encyclopedia of Social Work,
NASW Press, Washington, DC.
 Roshan, Dartur, 1974, Quarter Century of medical Social Welfare; Legend
& Legacy, Silver Jubilee Commemoration volume of Indian Council of
Social Welfare, Bombay Popular Prokashan.
 R. R. Singh, 1984, Field Work in Social Work Education: A Prospective for
Human Service Profession.

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Appendixes

Figure: BIRDEM General Hospital

Figure: Mohila and Shishu Diabetes Endocrine and Metabolic Hospital

Figure: Insulin

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Figure: Measuring the glucose level in blood

Figure: The Pancreas

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