The project is the initiative of two Portuguese family doctors, Dr Cristiano Figueiredo and Dr José Lima, who realised that access to healthcare services by recent immigrants from South Asia was a challenging issue. Consulting with Margarida Martins, President of the Arroios Civil Parish Council, the doctors determined that the Bangladeshi community stood out in the Asian population due to the perception of an increased cultural and linguistic barrier, with negative consequences for the community’s knowledge on rights and entitlements while residing in Portugal, especially in the area of healthcare.

The main objective of Bengalisboa is to reduce health inequalities of the Bangladeshi and other immigrant communities in Lisbon (compared to the non-immigrant population). The project bridges the gap between the Bangladeshi community and healthcare professionals by easing cultural and linguistic barriers and by fostering a cross-cultural care environment of empathy, curiosity, and mutual respect. The project also works to improve the intercultural competences of health professionals working with migrant populations.

The main target population are immigrants from Bangladesh who are living in the city of Lisbon. The project also targets healthcare professionals working with multicultural populations. However, the activities are open to all patients who go to USF Baixa for healthcare services and to all professionals interested in participating.

This project is implemented at the Baixa area Family Health Unit (USF Baixa) in Lisbon. Data from the Portuguese Immigration and Borders Service show that 66.5% of the 3,450 documented Bangladeshi nationals in Portugal live in the city of Lisbon, especially in the areas served by USF Baixa. The project works primarily with the immigrant population and with health professionals, developing specific activities directed to these two groups.

The project has developed community activities in Portuguese, English, and Bengali, in collaboration with the Bangladesh Islamic Centre (Baitul Mukarram Mosque) and the Portugal Bangladesh Friendship Association to disseminate the information. Overall, the project is modelled after the Lambeth Portuguese Wellbeing Partnership, a community health project founded in 2015 in the city of London by Doctors Vikesh Sharma and Cristiano Figueiredo.

The project organises community health education sessions on a quarterly basis, addressing health issues relevant to the Bangladeshi community. Some of the previous activities aimed at the Bangladeshi community include:

• Meetings with members of the Bangladeshi immigrant community to inform the population about local health services and the health entitlements of foreign citizens in Portugal (including undocumented residents). At the beginning of the project in August 2016, two focus groups were held to hear community members’ views on access to and quality of health services. In all community activities, these topics are addressed in order to continue to empower participants with respect to local health services and healthcare rights.
• Ramadan & Diabetes (May 2018) - Health education session for Muslim immigrants with diabetes, with the aim of raising awareness about the care a person with diabetes should have during the fasting period of Ramadan. This session was held in a neighbourhood Bangladeshi restaurant with the collaboration of USF Baixa physicians and nurses. The session was open to the community, regardless of nationality or legal status, and approximately 20 immigrants from Bangladesh and Pakistan took part. The ‘Diabetes & Ramadan’ patient brochure was presented at the event and on the Bengalisboa website and Facebook. Its translation into Bengali and other languages is underway.
• Depression, Let's talk (September 2018) - Health education session on depression and suicide. This educational session included showing two educational videos from the World Health Organization and a discussion with participants. Approximately 30 people participated, including migrants, healthcare professionals, and members from local associations. The patients’ brochure ‘Depression: Let's talk’ was also presented, with translation into Bengali and other languages underway. Participants completed an evaluation questionnaire about the event with a focus on topics to be addressed in the next sessions. The session was an official activity of World Suicide Prevention Day.

Activities aimed at health professionals:

• A focus group was held at the beginning of the project with health professionals. The focus group dealt with the professionals’ experiences and opinions concerning the migrant communities they worked with and the barriers and facilitators in the delivery of care to these populations.
• Safe Ramadan - Guide for Doctors and Family Nurses (May 2018). The project published this guide to inform healthcare professionals about Ramadan practices and how healthcare professionals can contribute to the spiritual experience of their Muslim patients without medical complications, especially for patients with diabetes and other chronic diseases.
• The project has held several workshops and presentations for professionals
  • Providing Primary Care to Multicultural Communities – the challenge of overcoming health inequalities among migrant populations (January 2018). This training was tested first internally at the USF Baixa area, benefiting 22 professionals working in the health unit. It was later presented at a conference for young European family doctors. The Family Health Unit Travessa da Saúde area (municipality of Loures) also requested the workshop for its healthcare professionals in July 2018.
  • Presentation for the Vasco da Gama Movement’s (VdGM) Special Interest Group on Migrant Care, International Health & Travel Medicine. The project presented their first joint workshop at VdGM's Preconference in Krakow (May 2018) with the theme Improving Migrant Care in Europe - Learning from each other now and in the future.
  • Suicide, a multicultural approach (September 2018) - Training for health professionals on a culturally sensitive response to the mental health problem of suicide. The session was opened to other healthcare professionals from ACES Lisboa Central (Group of Health Centres of Central Lisbon).
  • Social sciences meeting (September 2018) - Meeting between USF Baixa health professionals and social sciences specialists to share knowledge and discuss topics of common interest. These meetings are expected to take place twice a year.
  • Bangladeshi Community in Portugal: Challenges for health care (October 2018). This workshop was organised by the Hospital Centre of Central Lisbon (CHLC) for its employees in all professional groups. Presentations included: Major health problems in the community of Bangladesh - Bengalisboa Project by Dr Figueiredo and Response to the needs of women and children who resort to USF in Baixa area by Nurse Tânia Meneses.

Activities aimed at academics: Participation in the NOVA Health Discovery Experience Primary Health Care (November 2017), with the aim of presenting the research ideas of the Bengalisboa Project to a jury of academics working at the New University of Lisbon and professionals from ACES Lisboa Central. Following this event, the project developed a partnership with Professor Sónia Dias, from the National School of Public Health.

Ramadan & Diabetes: This initiative contributed to direct awareness-raising among approximately 20 immigrants from Bangladesh and Pakistan during the session that took place in a local restaurant, as well as dozens of people attending the Baitul Mukarram Mosque and Benformoso Street commercial establishments through the distribution of project leaflets for diabetes patients.

Depression, Let's talk: This initiative contributed to direct awareness-raising among approximately 30 migrants, health professionals, and members of local associations during the event. The project also distributed dozens of leaflets for patients in person during the session, in the community, and online.

Bengalisboa’s Facebook page, which is also used to distribute leaflets and information on health, has 304 likes, reaching 2,900 users in the last 28 days (as of 26 October 2018).

Evaluation of the ‘Depression, Let's talk’ activity was conducted through an individual and anonymous Assessment Questionnaire in Portuguese or English. The questionnaire was completed by 24 participants (19 male, 5 female). Among the respondents, 16 came from Bangladesh, 6 from Portugal, 1 from Italy, and 1 from Brazil. Among the questions posed to the 24 participants, the following results can be highlighted:

• 92% agreed that their knowledge concerning the issue of depression increased
• 87.5% agreed they were motivated to change their attitude pertaining to depression
• 87.5% were satisfied or very satisfied with the activity
• 83.3% would recommend this activity to a friend
• 91.7% agreed that this activity improves migrants’ integration in Portugal

Human Resources: The project has one main coordinator (Dr Figueiredo). Physicians and nurses working at USF Baixa collaborate actively in planning and carrying out activities for the community and for healthcare professionals. For both the coordinator and the USF Baixa staff, most of the activities of the Bengalisboa Project are carried out on a voluntary basis. The ACES Lisbon Central allocates four non-attendance hours per week to the coordinator for Bengalisboa and two other outreach projects of USF Baixa.

Financing: The Bengalisboa Project does not have any independent financing. It seeks funding to improve the quality of service, pay for translations, and build a network of community navigators (community health agents) comprised of community members from Bangladesh. Patient leaflets and publicity posters of outreach activities were printed in black and white at USF Baixa, using the resources of ACES Lisboa Central.