Birdem Assigned agency

Preface

Social work education seeks to provide information, knowledge and skills to people who wish to work in the field of Social work. Being  a professional social worker requires theoretical knowledge base as well as skill (that come through practice). These two go side by side.

Fieldwork brings this golden opportunity to an apprentice social worker to use his/her knowledge on social work effectively in execution, to acquire certain skills which are rarely learnt in the classroom and thus to bridge the divide between the classroom and the real world.

For this reason field work has been included in the syllabus of social work education and  i  was sent to an agency named  BIRDEM.

This report has been prepared based on the activities I have done during 60 working days of my field work. My first duty was to know about the agencies history, objectives, programs, its associates which I discussed in  chapter  2. Another  important duty bestowed on me was to study some cases as part the application of social work methods. Information I have collected by studying the cases have been given in the 4^th chapter. In the 5^th chapter I have  tried to highlight my experiences and some recommendation for further improvement of the agency.

In essence, this report is a presentation of what I have seen and what I have done in the course of fieldwork.   

Introduction

The institute of social welfare and research was established in 1958 as a constituent college of the University of Dhaka. It was jointly sponsored by the hen central government of Pakistan and the United Nations Technical Assistance Programme. Subsequently after the emergence of Bangladesh the then College of Social Welfare and Research Centre was emerged with the University of Dhaka as one of its institutes in March 1973.About 100 students get enrolled in the BSS Honours programme of the institute every year. The Institute also offers Masters,M.Phil and PhDs degrees.

The Institute,as part of the academic programme, periodically organizes discussions and seminars. The Institute is physically detached from the main campus of the university but maintains a congenial academic atmosphere for teaching and research activities. The Institute has a rich library equipped with more than thirty thousand books, periodicals and journals of national and international origin. 

Fieldwork consists of supervised practice in problem-solving activities with the recipients of social work services which enables students to learn to apply and test social work skills necessary for professional practice. Education experience in field work is designed to integrate practice with theoretical knowledge. Students assignments are planned to give content sequence and progression  in learning. The minimum required time for fieldwork is 420 hours to be spread over 60 working days.In addition,10 days will be allotted for final report writing.

Each student is required to write a final report  on his/her work which will be examined by the supervisors responsible for field instruction during fieldwork. There will be a viva-voce examination for this course at the end of the session.

Field work

Fieldwork is a very important component for Social work education programme.Supervised fieldwork provides opportunities for students to develop social work skills by applying social work theory to real-life practice in social service agencies.The fieldwork process is where knowledge and experience are intregrated and skills are tested and refined.

Fieldwork progamme is designed to help and guide a student to develop his skill and competence for independent professional functioning and carrying out appropriate responsibilities.The primary emphasis in field work practice is,herefore ,on the development of skills in the application of knowledge and understanding in the solution of specific social problems-of the individual or the group or the community.

The western concept of social work , which underlines in our country too,is clinically oriented.Social workers or students of Socialwork education with in such a conceptual framework deal with ‘cases’ rather than with problems.

The objective of field work programme in social work education is to provide the student with actual experience in applying social work methods and enable him/her to become familiar with the real work of practice,That is ,to develop a sense of professional self and of professional discipline,to gain self confidence and to feel himself/herself a social worker with beginning competence.Fieldwork is an integral and significant part of the student’s total professional education.

The procedure is to structure an assignment through which the student has responsibility for a definite piece of work in agency which he conducts on a relatively self directing basis under the supervision and guidance of the supervisor.it my involve more independent responsibility for a given individual,group or community problem,including a diagnostic study of the problem and a recommended course of action.It is hoped that in connection with his field work experience he student will come to realize that the methods involve ‘working with individual’,’interpersonal’,’group’and ‘intergroup’-and that the practitioner needs to understand and constantly to apply his/her understanding of the dynamics of individual and group behavior as well as of broader community forces.The student may also have a variety of additional incidental assignments of an adhoc nature in order to broaden his/her exposure and experience as well as of more observational assignments for the same purpose.(attending agency staff ,representing the agency before community groups,observing or carrying responsibilityforpublic meetings,consultation,interagency exchange,budgeting,fund raising or other social action activities).

Concept of  field work:

Fieldwork is a dynamic course that challenges students to apply social work practice knowledge, skills and values within an organizational and community context. Fieldwork is a vital dimension of students for undergraduate and graduate social work education.The hours of field practice students to enter the work force as professional social work practitioners.

Fieldwork affords experimental assessment and evaluation of students development in the process of becoming a helping professional.Students are development in the process of becoming  a helping professional.Students are provided opportunities to apply their academic and practical experiences in the reality of the agency client service matrix.Through the supervised field experience,students participate in, and become familiar with, the many components of social work and its varied roles.The ideal field placement offers a focus on the methods of direct practice,policy development and implementation, and other social work special projects and research activities.

Fieldwork provide practice experiences in  continuum of modalities and varying sizes of systems,including work with individuals, families,small groups,nd communities within an organizational and community context.

It is expected that students will experience  diversity of client populations and intervention issues,relying upon a range of theoretical concepts and models to develop breathe of learning and develop a broad base for practice.

In Fieldwork Manual M. A. Momen has said,’The pattern of social work education, of which fieldwork is essential related to the existing conditions t the agency level its policies and programs,its resources,personnel,the supervisory practices.’

International Encyclopaedia of Social Sciences has mentioned-‘Fieldwork is the study of people and their culture in their nature habitat.Fieldwork came to mean learning as far as possible way to speak, see and act as a member of its culture and the same time,as  trained social from a different culture.’

R.R.Singh said in Fieldwork in social work education- Fieldwork is n educationally sponsored attachment of social work students to an institution, agency or a section of community, in which they are helped to extend their knowledge and understanding and experience the impact of human needs.

Social work is a helping profession which aims to help the individuals, groups and communities to cope with their problems through enabling them so that they can solve their problems. The students of social welfare discipline have to acquire theoretical knowledge in practice field. Field work gives the opportunities to the students of social work to apply their acquired knowledge in practical field .In field  training the students have to deal with the clients.Thus they understand how to solve the psycho-social and other problems of the client.They become skilled in interviewing, assessing,recording,reporting,using theories, methods and techniques in practical situation.

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 a supervisor.Field Work provides the students opportunity to realize how social problems are influencing the individuals, group, family, organization, and community. Moreover Field Work enables a student to understand the roles and functions of social policy, law, and social service related organization, network and community resources. In total, practical training gives a chance to a student to observe the role of a social worker in total problem solving process.

Objectives of Field Work

The objectives of Field Work are:

• Making contribution for getting student acquainted comprehensively with all types of social work profession
• Creating a due environment to make students self-consciousness.
• Along with studies the attitude and the skill of the students should have a balanced display in the classroom.
•  Making opportunities available to the students to apply social work    methods and be experienced.
• Taking necessary steps so that students can acquire primary experience of social work profession.

Besides, the above-mentioned objectives these are some other objectives left for practical training of social work:

Practical training in capacity the trainee of practical training to make use of the opportunities available, will enable them to bring about changes in different circumstances, make them acquired them with the elements that influence the administrative process, decision making and realization of those processes and decision; practical training of social work will make them of capable of collecting interviews, reports and other communication related activities.

Mutual relationship between social work education and practice: Modern social work education has two dimensions: theoretical and practical. A social worker gains knowledge about society, social problems, property, social structure, social values, human behavior, social work process when practical training enable them to use this knowledge acquired knowledge in this field for real life purposes. Thus practical training is required for social worker to solve social problems of human beings/society for modern social work. Taking notice of this requirement higher education has been provided with practical training course in its syllabus about social work, through which students can apply theoretical knowledge for solution of problems. On the other hand, acquiring knowledge and practical exercise of this knowledge is extremely necessary for a skilled social worker. And this point of view social work education and practical training is mutually related.

In these days social work is recognized as a helping profession throughout the world. Social problems are inter-related. After the industrial revolution human problems appeared to be such complex a subject that material assistant appeared to be insufficient as a consequence of it education about social problem and the socio-economic, physical, mental causes of these problems gave a real feeling of importance of such education and practical training. For that, the purpose of practical training of social work is to create opportunities for students so that they can apply their acquired knowledge, principle and methods through an organization in a creative manner. A society devoid of deprivation of any class, developed social and economic atmosphere around and a balanced social system is desired by every reasonable member of it and the fundamental and necessary methods of social work’s study and their appropriate application in real life can ensure those desired conditions. Social Work is a practical education, which is learned through theoretical study of society and social work. This is because ‘public good’ can be affected only by applying theoretical knowledge in real life in a scientific way. And practical training helps apprentices to be full-hedged social workers by making arrangements of applying theoretical knowledge in practical life. And these together make social work education and practical training inter-dependent upon each other.

Conceptual analysis of Medical Social Work:

The prevalence of illness and premature death due to lack of awareness, access to good medical care or failure to take advantages of care mental or psycho-social disorder have long made medical care a topic of prime concern to the field of medical social work. We have come to realize that success of medical care or treatment is based as much on the adequacy of the delivery system as it is on the knowledge and skill of the medical personnel and social worker. Medical care is an important field of practice for social workers who play significant roles in facilitating the delivery in social services at the individual groups and community.

By analyzing the previous discussion about medical social work we can identify such criteria of medical social work

• Medical social work is a professional and specialized branch of social work.
• Here the social work method, skill, philosophy is being used for the treatment of a patient.
• Medical social work emphasize not only for treatment but also it attempts to provides training and rehabilitation facilities.
• In medical social work social case work and group therapy are used properly.
• Hospital/medical social work help a patient or problematic person so that they can solve their problem next except the medical diseases. Ex: Drug addiction
• Medical social work is a integrated attempts of spiritual therapy, psycho-social, religious and educational therapy.
• Here poor patient get help and guideline to adjust with the hospital environment.
• After all medical social work provides counseling follow up, treatment, home visit, psycho-social therapy with applying the social work method principle and code of ethics of social work discipline.

Medical social work is a social work practiced in a responsible relationship to medicine and public health within the structure of program of health and medicine.

Now the overall constant of medical social work in Bangladesh are given below:

• Lack of financial constant and extreme poverty
• In sufficient knowledge of social service officer
• Lack of doctors co operation
• Without getting the professional recognition of social work discipline
• Lack of sufficient agency for exercising the field work practice
• Lack of relevant literature

BIEDEM

BIRDEM (Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders)

BIRDEM, the Bangladesh Institute of Research and Rehabilitation for Diabetes, Endocrine and Metabolic Disorders (BIRDEM) at Shahbag, Dhaka, Bangladesh is a 600-bed multidisciplinary hospital complex of the Diabetic Association of Bangladesh.

In the mid seventies, a complex was established at Shahbag area in the name of `Bangladesh Institute of Research and Rehabilitation in Diabetes, Endocrine and Metabolic Disorders’ (BIRDEM). The name implies that it was planned from the very beginning that all facilities for academic and research activities will be available within the Association. It is a 550-beded hospital. BIRDEM is now providing diabetic care to almost 3.5 lakh patients from which about 3500 registered patients are taking health services from BIRDEM OPD every day. In a small surveys it is indicated that the prevalence of diabetes in Bangladesh in populations aged over 15 years is between 2%-5%. This type of similarity is also found in most of the under-developed countries. As diabetes may affect other system of the body, BIRDEM adopted a multidisciplinary approach to its services. Gradually, BIRDEM established specialized disciplines like, Cardiology, Gastro-enterology, Surgery, Gynecology and Obstetrics, Nephrology etc.From 1982 It has been designated as a WHO Collaborating Centre on Diabetes, Endocrine and Metabolic Disorders, as the only on of its kind in Asia. The late National Professor Muhammad Ibrahim is its founder. Associated with the hospital is the Ibrahim Medical College.

BIRDEM, a well-known & tertiary care hospital, has its ICU from 1989. Till 1995, it was an open unit i.e. primary doctors who choose to admit patients, generally make management decisions leaving the responsibility of managing ventilators & doing procedures to the Intensivists. In 1996, the name was changed from “Intensive Care Unit” to “Department of Critical Care Medicine” & it became a closed one i.e. the Intensivists take on the senior role & are the physicians of record for all ICU patients.Cardio-Pulmonary Resuscitation (CPR) training is mandatory for all health service professionals including both medical & paramedical. Unfortunately it is relatively a new concept in our country. Prof. Mohammad Omar Faruq was first to initiate this training in Bangladesh in 1995 in BSMMU. That was soon followed by BIRDEM & the CPR training program was institutionalized here in 1999. Till then it has been going on successfully & more than 70 workshops has been taken place. In July 2007, the department celebrated the 50th workshop program. At the beginning, the number of beds in ICU was only 6. Total number of beds in BIRDEM hospital is 593. Not only indoor patients but also out patients from different hospitals & ICUs are admitted in BIRDEM ICU, so the number of beds was very much insufficient. So in December 2004, the number of beds was increased & now it has 10 beds.There is non availability of sufficient number of medical specialists in intensive care in our country. To overcome this shortage, Department of Critical Care Medicine of BIRDEM initiated MD course in Critical Care Medicine (CCM) in 2007 under DhakaUniversity & has played the role of pioneer.    

Dr Mohammed Ibrahim first thought of diabetic care in the country. He realized that diabetes is such a disease where not only doctors but patients should be involved in the process of diabetic care. He thought the matter as a socio-medical care. Although the real extent of the problem of diabetes in the country was not evident, he could foresee the present picture 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 an adhoc committee was formed to run the organization.

The National Council meets at least once a month and reviews the activities of the Association. It takes decisions on matters policy, budget and finance, planning and development. The executive power of the National Council is vested with the Secretary General who runs the different institutions through respective Board of Management with the help of the Treasurer, BADAS Secretariat and BADAS Project Office. BADAS Vision

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 patients. 
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.

The Diabetic Association of Bangladesh was established on 28 February 1956 in Dhaka at the initiative of the late National Professor Dr M Ibrahim (1911-1989) and a group of social workers, philanthropists, physicians and civil servants. The Association started an out-patient clinic in 1957 in a small semipermanent structure of about 380 sq ft at Segun Bagicha, Dhaka. Over the years, the clinic has turned into a diabetes care and research complex at Shahbag, Dhaka, which, after the demise of Prof M Ibrahim in 1989, has been renamed as the Ibrahim Memorial Diabetes Centre. 
BADAS is a nonprofit voluntary socio-medical service organization registered with the Ministry of Social Welfare under the Society’s Registration Act, 1860. It is run by a 32 member National Council of which 18 members from the life member category and 6 members from the Affiliated Association category are directly elected. One-third of the members (ie 6) from the life member category and 2 from the affiliated association retire every year by rotation and election to those one-third posts is held in every Annual General Meeting of the Association. The elected members elect the office-bearers of the National Council, consisting of a President, 3 Vice-Presidents, a Secretary General, a Treasurer, a Join Secretary General, and a Joinst Treasurer.
The President, so elected, nominates 5 members from amongst the Vice-chancellors and Professor of Universities in Bangladesh,

• In Bangladesh no diabetic should die untreated, unemployed or unfed.
• All people shall be provided with affordable health care service.

BADAS Mission

• Provide total healthcare including rehabilitation for all diabetics irrespective of gender, economic and social status through different institutions of Diabetic Associations of Bangladesh.
• Expand these services to provide affordable BADAS healthcare for all Bangladeshi through self-sustaining centres 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.

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). The Institute has the largest diabetic Out-Patient turnover in the world under a single roof and it has about 650 bed In-Patient hospital with all modern disciplines of medicine. Through its Academy BIRDEM conducts the largest number of postgraduate courses in the private sector. With large umber of international 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 of Europe. The Project Mohila and Shishu Diabetes Endocrine and Metabolic Hospital, Segunbagicha, Dhaka: was approved by the ECNEC. During the period under review, plaster work up to 5th floor with some other finishing works were completed. This Project Liver Transplantation Services of Diabetic Association of Bangladesh was originally approved at a cost of Tk. 1173.00 Lac. The inquiry committee visited the site and recommended to prepare the new DPP dropping all the construction works previously done and reflecting the unfinished construction works and equipment. Accordingly DPP was prepared and submitted to the Department of Social Services.

BADAS – A MAJOR GENERAL HEALTH CARE PROVIDER IN THE COUNTRY

Due to the inherent nature of diabetes mellitus as a generalized disorder(and not a single disease) and due to the great demand in the society for using good quality medical services, the facilities of BADAS are open to non diabetic patients although diabetic persons get priority and certain privileges. With some variation among individual Enterprises/ AAs about 30 to 40% of patients attending BADAS OPD/IPD facilities are non diabetic and the proportion is even higher in case of people seeking diagnostic services. In recent year BADAS has taken a special pilot project named as Health Care Development Project (HCDP) with the aim of transforming the diabetes health care model of BADAS to a sustainable General Health Care Model in the Bangladesh context.

HCDP includes network of hospitals and health centers in an around Dhaka as well as in north-western part of Bangladesh. During FY 2008-09 almost all of the hospitals and health centers of HCDP started functioning only partially in case of the Pabna Swasthoseba Hospital, North Bengal Medical College Hospital in Sirajganj and BIHS hospital in Dhaka

A large poportion of OPD and IPD patients are also receiving general health care in the Ibrahim General Hospitals of NHN and ICHRI

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). The Institute has the largest diabetic Out-Patient turnover in the world under a single roof and it has about 650 bed In-Patient hospital with all modern disciplines of medicine. Through its Academy BIRDEM conducts the largest number of postgraduate courses in the private sector. With large number of international 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 CollaboratingCenter for Research on Prevention and Control of Diabetes. It is the First of its kind outside of Europe. The Project Mohila and Shishu Diabetes Endocrine and MetabolicHospital, Segunbagicha, Dhaka: was approved by the ECNEC. During the period under review, plaster work up to 5th floor with some other finishing works were completed. This Project Liver Transplantation Services of Diabetic Association of Bangladesh was originally approved at a cost of Tk. 1173.00 Lac. The inquiry committee visited the site and recommended to prepare the new DPP dropping all the construction works previously done and reflecting the unfinished construction works and equipment. Accordingly DPP was prepared and submitted to the Department of Social Services.

BIRDEM has the following Departments

Out-Patient Department

• Department of Diet and Nutrition
• Department of Dentistry
• Department of Dermatology
• Department of Physical Medicine and Rehabilitation
• Department of Social Welfare
• Department of Public Relations

In-patient Service Departments

• Department of Medicine, Oncology, Rheumatology and Hematology (I & II) – MU-I
• Department of Gastrointestinal, Hepato Biliary & Pancreatic Disorders (GHPD) – MU-II
• Department of Nephrology Unit I (MU-III)
• Department of Nephrology Unit II (MU-III)
• Department of Neurology Unit I & 2
• Department of Endocrinology and Pulmonoligy (MU-IV)
• Department of Endocrinology
• Department of Internal Medicine and Neurology (I & II) MU -V
• Department of Critical Care Medicine (ICU)
• Department of Cardiology
• Department of Pediatrics and Neonatology
• Department of Gynecology and Obstetrics
• Centre for Assisted Reproduction
• Department of Surgery
• Department of General Surgery & MIS (Unit I)
• Department of General & Colorectal Surgery (Unit II)
• Department of Surgery (Unit III)
• Department of Surgery (Unit IV)
• Department of Hepato Biliary & Pancreatic Surgery (HBP)
• Surgery Emergency
• Department of Urology (Unit I & II)
• Department of ENT and Head & Neck Surgery (ENT)
• Department of Orthopedics and Traumatology
• Department of Ophthalmology
• Department of Anesthesiology
• Department of Transfusion Medicine
• Emergency Unit
• Hemodialysis Unit
• Logistic Services Division
• Nursing Department
• Equipment Maintenance Department
• Building Maintenance
• Kitchen Section
• Laundry-Linen and Apparel Section
• Material Management Department (Store)
• Local Procurement Section, BIRDEM
• Printing and Publication Unit
• Department of Clinical Biochemistry, Clinical Pathology & Hematology
• Department of Endocrinology
• Department of Microbiology
• Department of Histopathology & Cytology
• Department of Immunology
• CRF Project
• Department of Clinical Biochemistry, Clinical Pathology & Hematology
• BIRDEMAcademy
• Library
• Department of Radiology & Imaging
• Department of Biochemistry and Cell Biology
• Department of Pharmacology
• Department of Physiology and Molecular Biology
• Biomedical Research Group (BMRG)
• Department of Epidemiology and Biostatistics
• Department of Health EducationPrevention is the only feasible way to combat the present epidemic of diabetes and it is particularly important for low resource societies like Bangladesh. Studies in various parts of the world have shown that simple intervention in life style (nutrition and exercise/physical work habit) may reduce the incidence of diabetes by about 60%. The Projects and AAs of BADAS always had some arrangement for education of the patients, but in the recent years BADAS has given special emphasis on the preventive aspects of diabetes. The preventive campaigns in FY 2008-09 were conducted in the form of observance of Special Days in various places of the country, media programs, publication of awareness materials, and diabetes/health magazines, educational classes, discussion programmes and dissemination seminars.

Diabetes Awareness Day (28 February 2009), Death Anniversary of Prof (Dr) M Ibrahim, Diabetes Service day (06 September 2009) and World Diabetes Day (14 November 2009) were observed in Dhaka as well as in the other districts through

• Rally
• Discussion Programs
• Radio and TV Programs
• Seminar
• Distribution of Awareness Materials and Diabetes Health Magazine PICTURE (special Kanti, leaflet)
• Children Art Competition
• Screening of diabetes in various centers and in the community

Secondary and Tertiary Care Services at BADAS Facilities

• Medical and Surgical facilities in almost all disciplines at BIRDEM, BIHS, NHN and selective AAs.
• Basic and advanced diagnostic facilities including laboratory and radiology & imaging services.
• ICU and CCU in BIRDEM and ICHRI
• Advanced medical and surgical care including ICU and CCU services for cardiovascular patients in BIRDEM and ICHRI
• Hemodialysis and kidney transplant in BIRDEM
• Special Care Baby Unit at BIRDEM
• Surgical foot care in BIRDEM and NHN

At the end of FY 2009-2010 the total bed capacity of BADAS facilities is around 2450

What is diabetes? What causes diabetes?

Diabetes (diabetes mellitus) is classed as a metabolism disorder. Metabolism refers to the way our bodies use digested food for energy and growth. Most of what we eat is broken down into glucose. Glucose is a form of sugar in the blood – it is the principal source of fuel for our bodies.When our food is digested the glucose makes its way into our bloodstream. Our cells use the glucose for energy and growth. However, glucose cannot enter our cells without insulin being present – insulin makes it possible for our cells to take in the glucose.
Insulin is a hormone that is produced by the pancreas. After eating, the pancreas automatically releases an adequate quantity of insulin to move the glucose present in our blood into the cells, and lowers the blood sugar level.
A person with diabetes has a condition in which the quantity of glucose in the blood is too elevated (hyperglycemia). This is because the body either does not produce enough insulin, produces no insulin, or has cells that do not respond properly to the insulin the pancreas produces. This results in too much glucose building up in the blood. This excess blood glucose eventually passes out of the body in urine. So, even though the blood has plenty of glucose, the cells are not getting it for their essential energy and growth requirements.

There are three main types of diabetes:

Diabetes Type 1 –  Produce no insulin at all.
Diabetes Type 2 – Don’t produce enough insulin, or your insulin is not working properly.
Gestational Diabetes -Develop diabetes just during your pregnancy.

Diabetes Types 1 & 2 are chronic medical conditions – this means that they are persistent and perpetual. Gestational Diabetes usually resolves itself after the birth of the child.All types of diabetes are treatable, but Type 1 and Type 2 diabetes last a lifetime; there is no known cure. The patient receives regular insulin, which became medically available in 1921. The treatment for a patient with Type 1 is mainly injected insulin, plus some dietary and exercise adherence.Patients with Type 2 are usually treated with tablets, exercise and a special diet, but sometimes insulin injections are also required.If diabetes is not adequately controlled the patient has a significantly higher risk of developing complications, such as hypoglycemia, ketoacidosis, and nonketotic hypersosmolar coma. Longer term complications could be cardiovascular disease, retinal damage, chronic kidney failure, nerve damage, poor healing of wounds, gangrene on the feet which may lead to amputation, and erectile dysfunction.

Type 1 diabetes:

Type 1 diabetes mellitus is characterized by loss of the insulin-producing beta cells of the islets of Langerhans in the pancreas leading to insulin deficiency. This type of diabetes can be further classified as immune-mediated or idiopathic. The majority of type 1 diabetes is of the immune-mediated nature, where beta cell loss is a T-cell mediated autoimmune attack. There is no known preventive measure against type 1 diabetes, which causes approximately 10% of diabetes mellitus cases in North America and Europe. Most affected people are otherwise healthy and of a healthy weight when onset occurs. Sensitivity and responsiveness to insulin are usually normal, especially in the early stages. Type 1 diabetes can affect children or adults but was traditionally termed “juvenile diabetes” because it represents a majority of the diabetes cases in children.

“Brittle” diabetes, also known as unstable diabetes or labile diabetes, is a term that was traditionally used to describe to dramatic and recurrent swings in glucose levels, often occurring for no apparent reason in insulin-dependent diabetes. This term, however, has no biologic basis and should not be used. There are many different reasons for type 1 diabetes to be accompanied by irregular and unpredictable hyperglycemias, frequently with ketosis, and sometimes serious hypoglycemias, including an impaired counterregulatory response to hypoglycemia, occult infection, gastroparesis (which leads to erratic absorption of dietary carbohydrates), and endocrinopathies (eg, Addison’s disease). These phenomena are believed to occur no more frequently than in 1% to 2% of persons with type 1 diabetes.

Type 2 diabetes:

Type 2 diabetes mellitus is characterized by insulin resistance which may be combined with relatively reduced insulin secretion. The defective responsiveness of body tissues to insulin is believed to involve the insulin receptor. However, the specific defects are not known. Diabetes mellitus due to a known defect are classified separately. Type 2 diabetes is the most common type.In the early stage of type 2 diabetes, the predominant abnormality is reduced insulin sensitivity. At this stage hyperglycemia can be reversed by a variety of measures and medications that improve insulin sensitivity or reduce glucose production by the liver.

Gestational diabetes:

Gestational diabetes mellitus (GDM) resembles type 2 diabetes in several respects, involving a combination of relatively inadequate insulin secretion and responsiveness. It occurs in about 2%–5% of allpregnancies and may improve or disappear after delivery. Gestational diabetes is fully treatable but requires careful medical supervision throughout the pregnancy. About 20%–50% of affected women develop type 2 diabetes later in life.

Even though it may be transient, untreated gestational diabetes can damage the health of the fetus or mother. Risks to the baby include macrosomia (high birth weight), congenital cardiac and central nervous system anomalies, and skeletal muscle malformations. Increased fetal insulin may inhibit fetal surfactant production and cause respiratory distress syndrome. Hyperbilirubinemia may result from red blood cell destruction. In severe cases, perinatal death may occur, most commonly as a result of poor placental perfusion due to vascular impairment. Labor induction may be indicated with decreased placental function. A cesarean section may be performed if there is marked fetal distress or an increased risk of injury associated with macrosomia, such as shoulder dystocia.

A 2008 study completed in the U.S. found that the number of American women entering pregnancy with preexisting diabetes is increasing. In fact the rate of diabetes in expectant mothers has more than doubled in the past 6 years. This is particularly problematic as diabetes raises the risk of complications during pregnancy, as well as increasing the potential that the children of diabetic mothers will also become diabetic in the future.

Other types:

Pre-diabetes indicates a condition that occurs when a person’s blood glucose levels are higher than normal but not high enough for a diagnosis of type 2 diabetes. Many people destined to develop type 2 diabetes spend many years in a state of pre-diabetes which has been termed “America’s largest healthcare epidemic.”

Latent autoimmune diabetes of adults is a condition in which Type 1 diabetes develops in adults. Adults with LADA are frequently initially misdiagnosed as having Type 2 diabetes, based on age rather than etiology.

Some cases of diabetes are caused by the body’s tissue receptors not responding to insulin (even when insulin levels are normal, which is what separates it from type 2 diabetes); this form is very uncommon. Genetic mutations (autosomal or mitochondrial) can lead to defects in beta cell function. Abnormal insulin action may also have been genetically determined in some cases. Any disease that causes extensive damage to the pancreas may lead to diabetes (for example, chronic pancreatitis and cystic fibrosis). Diseases associated with excessive secretion of insulin-antagonistichormones can cause diabetes (which is typically resolved once the hormone excess is removed). Many drugs impair insulin secretion and some toxins damage pancreatic beta cells. The ICD-10 (1992) diagnostic entity, malnutrition-related diabetes mellitus (MRDM or MMDM, ICD-10 code E12), was deprecated by the World Health Organization when the current taxonomy was introduced in 1999.

The cause of diabetes depends on the type.

Type 1 diabetes is partly inherited and then triggered by certain infections, with some evidence pointing at Coxsackie B4 virus. There is a genetic element in individual susceptibility to some of these triggers which has been traced to particular HLA genotypes (i.e., the genetic “self” identifiers relied upon by the immune system). However, even in those who have inherited the susceptibility, type 1 diabetes mellitus seems to require an environmental trigger.

Type 2 diabetes is due primarily to lifestyle factors and genetics.

Diabetes Symptoms:

Hyperglycemia and osmosis:

The classical symptoms of diabetes are polyuria (frequent urination), polydipsia (increased thirst) and polyphagia (increased hunger).Symptoms may develop rapidly (weeks or months) in type 1 diabetes while in type 2 diabetes they usually develop much more slowly and may be subtle or absent.Prolonged high blood glucose causes glucose absorption, which leads to changes in the shape of the lenses of the eyes, resulting in vision changes; sustained sensible glucose control usually returns the lens to its original shape. Blurred vision is a common complaint leading to a diabetes diagnosis; type 1 should always be suspected in cases of rapid vision change, whereas with type 2 change is generally more gradual, but should still be suspected.

Diabetic emergencies:

People (usually with type 1 diabetes) may also present with diabetic ketoacidosis, a state of metabolic dysregulation characterized by the smell of acetone; a rapid, deep breathing known as Kussmaul breathing; nausea; vomiting and abdominal pain; and altered states of consciousness.A rarer but equally severe possibility is hyperosmolar nonketotic state, which is more common in type 2 diabetes and is mainly the result of dehydration. Often, the patient has been drinking extreme amounts of sugar-containing drinks, leading to a vicious circle in regard to the water to loss. 

Complications:

All forms of diabetes increase the risk of long-term complications. These typically develop after many years (10–20), but may be the first symptom in those who have otherwise not received a diagnosis before that time. The major long-term complications relate to damage to blood vesselsDiabetes doubles the risk of cardiovascular disease. The main “macrovascular” diseases (related to atherosclerosis of larger arteries) are ischemic heart disease (angina and myocardial infarction),stroke and peripheral vascular disease.Diabetes also causes “microvascular” complications—damage to the small blood vessels.^[16] Diabetic retinopathy, which affects blood vessel formation in the retina of the eye, can lead to visual symptoms, reduced vision, and potentially blindness. Diabetic nephropathy, the impact of diabetes on the kidneys, can lead to scarring changes in the kidney tissue, loss of small or progressivelylarger amounts of protein in the urine, and eventually chronic kidney disease requiring dialysis. Diabetic neuropathy is the impact of diabetes on the nervous system, most commonly causing numbness, tingling and pain in the feet and also increasing the risk of skin damage due to altered sensation. Together with vascular disease in the legs, neuropathy contributes to the risk of diabetes-related foot problems (such as diabetic foot ulcers) that can be difficult to treat and occasionally require amputatio

Diabetes mellitus is characterized by recurrent or persistent hyperglycemia, and is diagnosed by demonstrating any one of the following

• Fasting plasma glucose level ≥ 7.0 mmol/L (126 mg/dL).
• Plasma glucose ≥ 11.1 mmol/L (200 mg/dL) two hours after a 75 g oral glucose load as in a glucose tolerance test.
• Symptoms of hyperglycemia and casual plasma glucose ≥ 11.1 mmol/L (200 mg/dL).
• Glycated hemoglobin (Hb A1C) ≥ 6.5%.

A positive result, in the absence of unequivocal hyperglycemia, should be confirmed by a repeat of any of the above-listed methods on a different day. It is preferable to measure a fasting glucose level because of the ease of measurement and the considerable time commitment of formal glucose tolerance testing, which takes two hours to complete and offers no prognostic advantage over the fasting test.According to the current definition, two fasting glucose measurements above 126 mg/dL (7.0 mmol/L) is considered diagnostic for diabetes mellitus.People with fasting glucose levels from 100 to 125 mg/dL (5.6 to 6.9 mmol/L) are considered to have impaired fasting glucose. Patients with plasma glucose at or above 140 mg/dL (7.8 mmol/L), but not over 200 mg/dL (11.1 mmol/L), two hours after a 75 g oral glucose load are considered to have impaired glucose tolerance. Of these two pre-diabetic states, the latter in particular is a major risk factor for progression to full-blown diabetes mellitus as well as cardiovascular disease.Glycated hemoglobin is better than fasting glucose for determining risks of cardiovascular disease and death from any cause.

Treatment and management:

Diabetes mellitus is a chronic disease which cannot be cured except in very specific situations. Management concentrates on keeping blood sugar levels as close to normal (“euglycemia”) as possible, without causing hypoglycemia. This can usually be accomplished with diet, exercise, and use of appropriate medications (insulin in the case of type 1 diabetes, oral medications as well as possibly insulin in type 2 diabetes).Patient education, understanding, and participation is vital since the complications of diabetes are far less common and less severe in people who have well-managed blood sugar levels. The goal of treatment is an HbA1C level of 6.5%, but should not be lower than that, and may be set higher.^[  Attention is also paid to other health problems that may accelerate the deleterious effects of diabetes. These include smoking, elevated cholesterol levels, obesity, high blood pressure, and lack of regular exercise.

Self-Care at Home :If you or someone you know has diabetes, they would be wise to make healthful lifestyle choices in diet, exercise, and other health habits. These will help to improve glycemic (blood sugar) control and prevent or minimize complications of diabetes.

Diet: A healthy diet is key to controlling blood sugar levels and preventing diabetes complications.If the patient is obese and has had difficulty losing weight on their own, talk to a healthcare provider. He or she can recommend a dietitian or a weight modification program to help the patient reach a goal.Eat a consistent, well-balanced diet that is high in fiber, low in saturated fat, and low in concentrated sweets.A consistent diet that includes roughly the same number of calories at about the same times of day helps the healthcare provider prescribe the correct dose of medication or insulin.It will also help to keep blood sugar at a relatively even level and avoid excessively low or high blood sugar levels, which can be dangerous and even life-threatening.

Exercise: Regular exercise, in any form, can help reduce the risk of developing diabetes. Activity can also reduce the risk of developing complications of diabetes such as heart disease, stroke, kidney failure, blindness, and leg ulcers. As little as 20 minutes of walking three times a week has a proven beneficial effect. Any exercise is beneficial; no matter how light or how long, some exercise is better than no exercise.If the patient has complications of diabetes (eye, kidney, or nerve problems), they may be limited both in type of exercise and amount of exercise they can safely do without worsening their condition. Consult with your health care provider before starting any exercise program.

Alcohol use: Moderate or eliminate consumption of alcohol. Try to have no more than seven alcoholic drinks in a week and never more than two or three in an evening. One drink is considered 1.5 ounces of liquor, 6 ounces of wine, or 12 ounces of beer. Excessive alcohol use is a known risk factor for type 2 diabetes. Alcohol consumption can cause low or high blood sugar levels, nerve pain called neuritis, and increase in triglycerides, which is a type of fat in our blood.

Smoking: If the patient has diabetes, and you smoke cigarettes or use any other form of tobacco, they are raising the risks markedly for nearly all of the complications of diabetes. Smoking damages blood vessels and contributes to heart disease, stroke, and poor circulation in the limbs. If someone needs help quitting, talk to a healthcare provider.

Self-monitored blood glucose: Check blood sugar levels frequently, at least before meals and at bedtime, and record the results in a logbook.This log should also include insulin or oral medication doses and times, when and what the patient ate, when and for how long they exercised, and any significant events of the day such as high or low blood sugar levels and how they treated the problem.Better equipment now available makes testing blood sugar levels less painful and less complicated than ever. A daily blood sugar diary is invaluable to the healthcare provider in seeing how the patient is responding to medications, diet, and exercise in the treatment of diabetes.Medicare now pays for diabetic testing supplies, as do many private insurers and Medicaid.

Medications:

Oral medications

Metformin is generally recommended as a first line treatment for type 2 diabetes as there is good evidence that it decreases mortality. Routine use of aspirin however has not been found to improve outcomes in uncomplicated diabetes.

Insulin

Type 1 diabetes is typically treated with a combinations of regular and NPH insulin, or synthetic insulin analogs. When insulin is used in type 2 diabetes, a long-acting formulation is usually added initially, while continuing oral medications. Doses of insulin are then increased to effect.

My Assigned Duties as an Apprentice Social Work:

Field work is an integral part of the total social work education. As an apprentice social worker we have to face to field work every year. So I was sent to BIRDEM from Institute of Social Welfare & Research. I was to maintain some rules and regulations both of institute & agency supervisor. Firstly, they directed me, which work should be performed. Such as:

 Duties from the Institute Supervisor:

• Students should have all basic social work knowledge including social work objectives, principals, code of ethics, social work methods, and social work theories and approaches.
• Apply all basic social work knowledge through fieldwork.
• Learn about case recording processes, consult a number of cases and prepare case/group/community work reports.
• To maintain rules & regulations of agency.
• To be oriented with Officers and Staffs of BIRDEM.
• To be oriented about background, structure, aims & objectives, goals, principles, nature & programs of  BIRDEM and specially work with the social welfare division of the BIRDEM .
• Showing the process recording paper.
• Prepare a field report.

Duties from the Agency Supervisor:

• To maintain rules & regulations of agency.

• To be oriented officers & staffs of BIRDEM social welfare division.
• To be oriented about background, structure, aims & objectives, goals, principles, nature & programs of BIRDEM social welfare division.
• To know about socio-economic condition of patients.

• Ensuring the service to patients specially in Diabetic and related diseases, providing health , education and training,ensuring social welfare service,Problem identification of patients and follow up the patients.
• Contact with staff and related department
•  Follow up the old case histories and collecting current information.
•   Home visit
•  Case record and presentation
•  Seminar
•  Library work

Duties that are performed During Field Work:

• Collecting the information about the assigned Organization.
• Admitting the patients in hospital: Many people don’t know the procedure of admitting in hospital, somebody even doesn’t know where he should admit. Social Worker helps them to admit in the necessary hospital.
• Creating format for information collection.
• Keeping process recording paper.
• Participate in weekly supervisory conference.
• Maintaining rules & regulation of organization.
• Library works.
• Dealing with cases.
• Practicing social work knowledge.
• Conduct a Action Research.
• Preparing a final report.

My performed activities in agency

I have started field work in BIRDEM at21^th September, 2011.First of all I introduced with various department of BIRDEM. Then I start my work as social welfare worker. At first I started to write case histories of poor people who comes to get the help of welfare department. To gather information I built up rapport with the poor people which is very much necessary. In this case I gather information about Physical condition, socio economic condition which is related to their problem. To solve their problem is the main responsibility of mine in the agency. For this I have perform the following responsibilities-

To do case study of diabetes patient the following subject is referred:

• Introduction: patient no, reference no, age, Social welfare no, education , occupation.
• Marital status
• Present address, permanent address,
• Treatment related information
• Family structure of patient
• Patient’s occupational information
• Descriptions of financial condition of patients
• Identified problem.
• Recommendation.

Home visit

To observe the financial and physical condition of the patient home visit is very much necessary. The objectives of these-to get accurate information about patient,to maintain consistency among information they the patient gave in case study,to know surrounding environment of patient ,to inform the patient and family member about diabetes at all, to know if the patient is eligible to get help from social welfare department home visit is done.

A description of a home visit is given below

1.Home visit

Patient name: Hamida Begom

Reference no: 270070

Social welfare no. 57139

Age.60

Address: 4/1,Nilambar saha road,P.O-Newmarket,Hazaribug,Dhaka-1200.

Objectives: to verify the information.

Diabetic related information:

Height:148 cm

Weight:58 kg

Problem:DM+HTN

Prescribed Inj Act HM(U-40)

Family structure:Patient have three daughter and two son. His two sons are not able helping her mother financially. Elder daughter and middle daughter bear her all responsibility         .Patients worked as a maid servant.

Socio economic condition:

The patient is residing in his daughter’s house. Her son’s are married and they live separately.Her daughter and her relatives helps her to bearing initial expenditure,we visited the place where she lives now.They lived in two –roomed house.She is widow and have no physical condition to working as a maid.

Neighbors’ comment: At last I talked with neighbor  and the shopkeeper next to her living place,who inform me the patient is actually struggling  with life.          

Comment: I recommended to continue the help which is she getting from the social welfare division of BIRDEM Hospital,now its totally up to the higher authorities to take the decision.

2.Home visit-      Patient name: Asa Begom

Reference no: 398757

Social welfare no. 57676

Age.47

Address:House no-20,Kulaimohol,P.O-Newmarket,Hazaribug,Dhaka-1200.

Objectives: to verify the information.

Diabetic related information:

Height:160 cm

Weight:66 kg

Problem:DM

Prescribed Inj Maxsulin HM(U-100)

Family structure:Patient have one daughter and one son. His husband is paralised patients also and totally unable to do work.Her son donot want to continue his studies,so the patients put him in to a bakery shop as a learner. Her daughter reads in class 3 in a government school.

Socio economic condition: The patient is residing in their own house.But it consist only one room.They donot have any gas supply and water supply facilities there.Their social condition is really bad.Patients is the only earning person of his family and he makes shopping bag by the using of newspaper.Her relatives helps her to bearing initial expenditure.

Neighbors’ comment: At last I talked with some of her relatives who are living next to her room, who inform me the patient is actually struggling  with life.    

Comment: I recommended to continue the help which is she getting from the social welfare division of BIRDEM Hospital, now its totally up to the higher authorities to take the decision.

3.Home visit-

Patient name: Yasmin Islam

Reference no: 296110

Social welfare no. 40473

Age.47

Address: W-17,Nurjahan Road,Mohammadpur,Dhaka.

Objectives: to verify the information.

Diabetic related information:

Height:146 cm

Weight:57 kg

Problem:DM+HTN

Prescribed Inj Act HM(U-40)

Family structure and Socio economic condition:

Patient have only  one daughter,and she is married.She lives separately in her in laws house with her husband.Patient have no relative here because she is Pakistani,her husband was in abroad ,they have everything and economically sound but recently 3-4 years their economical condition became poorer day by day because of the loss of his husbands business. Her husband is suffering from heart diseases,they donot have the financial condition of bearing this treatment cost,so they need to have much more help from this social welfare division.

Neighbors’ comment: At last I talked with  the neighbor  who inform me the patient is  doing sitching and this way they struggling  with life,her husband had a shop but now he is unemployed.         

Comment: I recommended to continue the help which is she getting from the social welfare division of BIRDEM Hospital,now its totally up to the higher authorities to take the decision.

4.Home visit-

Patient name: Dilip Kumar Roy

Reference no: 439255

Social welfare no. 57890

Age.49

Address:13 no Kathalbagan bazaar,Dhanmondi,Dhaka.

Objectives: to verify the information.

Diabetic related information:

Height:156 cm

Weight:61 kg

Problem:DM+HTN

Prescribed Inj Mixtard(U-100)

Family structure:Patient have only one son,his wife and his son who read in class 3 are living here in a rental house. They said in case history that they live with their brother but I found it is a false statement.

Socio economic condition:

The patient is the only earing person of this family but recently he lose his work and became unemployed,now they bear all expenditure with their savings and with the help of their relatives.They hide some information for getting sympathy from the authority but their present condition is really bad.

Neighbors’ comment: At last I talked with the gate man of patient’s rented house,who inform me the patient is living here last one and half year.      

Comment: I recommended to continue the help which is she getting from the social welfare division of BIRDEM Hospital,now its totally up to the higher authorities to take the decision.

Problematic case

Description of  two cases are given below:

Case 1

Patient name: Md.Ibrahim

Reference no. 351313

Social welfare no. 57721

Ward no-51

Bed No-517

Personal information:

Father’s name:Late Siddique Ullah

Mother’s name:Safia Khatun

Wife’s Name:Jannatul Ferdous

Address- Lokhinarayanpur,Maijdicourt,Noakhali.

Patient have diabetes from 2007,his glucose level in fasting period is 14.8 and after 2 hour it is 18.7.He admitted here this time for operating her finger in left leg because of gangrain.Last time he had another operation in his leg but this time he have severe infection,so that doctors operate the infectious finger.

After treatment the patient is requested to abide the rules and regulation imposed by doctor. The  leg follow up date of the patient is 29-11-2011.For this follow up I have gone 51 no. ward. I talked with the patient about her physical condition and give her some advice to control diabetes.

Case 2

Name: Irin Khatun

Reference no: 438019

Social welfare no: 57517

Bed no. 1218

Ward no. 121

Date of admission: 19.11.2011

Address :Horikesh,Kurigram

Personal information:

Father’s name:Late Aataur Rahman

Mother’s name:Sufia Bewa

Age of the patient:17

Patient have diabetes from 2008,her glucose level in fasting period is 19.3 and after 2 hour it is 30.0.She admitted here this time for DM+FCPD+Choletithiasis+UTI.Last time she was in hypo in sleep and she is loosing weight very rapidly ,now she cannot sit alone because of her weakness.Her mother work as a maid and they have no one to maintain their expenditure.Her diabetes level is very high.

After treatment the patient is requested to abide the rules and regulation imposed by doctor. The follow up date of the patient is 9-12-2011.For this follow up I have gone 121 no. ward. I talked with the patient about her physical condition and give her some advice to control diabetes.

Experiences:

I was sent to BIRDEM-Social welfare division.Basically I have gathered lot of experience within 60 working days that will help my professional life in future. Before going to BIRDEM neither I have knowledge about the organization. I have been able to do something in this practical field by my theoretical knowledge. My gathering skills & experience are mentioned below:

• Idea of  the services provided by BIRDEM.
• Importance of practical social work in Hospital services.
• Management system of a social welfare division of a hospital.
• Knowledge about the socio-economic conditions of  the help seeker.
• Information collection.
• Rapport building.
•  Recording & reporting.
•  Case report writing.
• Follow –up and homevisit.
•  Growing more confidence.
•  Dealing cases.
•  Removing some unexpected situation.

Recommendations:

• First few days the agency authority was not cordial and cooperative enough to work with them effectively; but when our agency supervisor introduced us with them formally, they accepted us and helped us to work with them effectively.
• In some cases some staffs behavior is very rough and rude towards patients. Psychologically the patients could not accept it.
• There is no specific budget for the novice social worker. So for the lack of finance social worker can not work with the patients. They only recording case history.
• There is no separate room for the novice social workers.
•  Lack of coordination and cooperation between the hospital authority and social service department is also mentionable.

Conclusion:

In the concluding moment of preparing this final report I can better say that the theoretical knowledge of social work becomes fruitful when this knowledge is implemented in real to solve the problems. The impact of fieldwork plays a vital role in expanding and enriching the theoretical knowledge of fieldwork standing on little bookish knowledge I tried my best to overcome my assigned duties. In some cases I have achieved success and in some cases I have failed to achieve it due to some problems. I apologize for my unintentional mistakes. If my report is helpful and useful to others for any work, then my labor and efforts will be fruitful.

As an apprentice social worker, the success of my social activity, as measured in terms of helping patients, is dependent on the helpful personnel of BIRDEM and nice organizational environment in which the work is carried out. In this respect BIRDEM is a leading hospital, providing organized service, would be a pioneer in this field. I am grateful to my teachers and agency supervisor to give me the opportunity for such a rich experience.The experiences I have gathered from field work will greatly help for my future.

Last of all, I want to say my hearty thanks and devoted reverence to my respective teacher and institute supervisor Mr. Golam Rabbani and my Agency supervisor Mrs.Daulutunnesa for their cordial guidance and inspiration, which I have received from the very beginning to the end of my field work practice. I pray and bless that the help of Social welfare division of BIRDEM may live long and the program would be more effective, helpful and development oriented for the patient to make them self-reliant.