A little closer to home...

To my faithful blog followers,

I would like to apologize for the brief hiatus in blogging. I checked into a Bangla 5 star hotel yesterday and have been lounging in luxury ever since! I was like a kid in a candy store yesterday. I spent time in the gym, the steam room, took the best shower of my life, and had the most comfortable nights sleep in a long time! I woke up this morning and had a somewhat normal breakfast with my first cup of coffee in almost 3 weeks. It wasn't the best but I have to have something to look forward to! Tonight I had french fries and ice cream for dinner (partly because why not?, and partly because you get used to spending 75 cents - 2 dollars a meal and it just seems really wrong to spend $25 on a buffet dinner!).

This morning I visited a local government hospital and got to see what their protocol is in treating malnutrition from start to finish. It was very enlightening and actually very rewarding to see that what I have spent the last 3 weeks on is a very important issue here.

It is a large referral center for diarrhea and I was shocked to see the patients lined up on cots with holes in the beds draining into buckets. (no pictures necessary, it is just as you might imagine)

I plan to spend some final time in Dhaka tomorrow visiting their large market prior to flying out. I start my 24 hr journey home tomorrow night.

I cannot believe I am less than 24 hrs from flying out!

If this is my final post (I plan on posting some additional pictures after tomorrow), I truly appreciate those of you that took this journey with me. Your emails were more enjoyed than you will ever know, and the only way I made it was knowing that you were all there supporting me.

Thank you!

Poor Rangpur...

This morning, I visited Rangpur Medical College and I don't even know how to relay the shock I was in when I first walked through the door. I was not even aware that hospitals like this still exist in 2011. However, I met with some very nice, educated, dedicated, and passionate doctors that made me realize that medicine is the same all over the world, despite the aesthetics. I am constantly reminded that no matter how corrupt and ridiculous we feel our government/country/healthcare system is, we are so lucky to be Americans!

We toured the pediatric ward which is a large room with rows of beds. If the babys were small enough, there were two to a bed. The NICU consisted of a room with isolettes lining the walls (not much less aesthetically pleasing than our NICU at Mount Sinai honestly). Some neonates were under white lights and I didn't get the chance to ask if they were onto something there that we aren't, or if they just weren't able to get actual bili lights. There was a special room for kids with diarrhea...I won't go any further about that room. Then, there was a large room with a sign above the door that said "isolation" where about 30 beds were full of patients all together...no gowns, masks, gloves, fancy signs, Mona walking around. It was one of the most enlightening experiences I have had this entire trip.

Then, the day went downhill as we boarded our "sitting bus" as Jasim calls it which means that we pay to actually have a seat, vs standing, vs riding on the top of the bus. Seriously! You can pay a certain amount for a seat, less if you are willing to stand, and even less if you are willing to ride on the top of the bus. If you knew how these people drive, I would equate riding on the top to sky diving! I will hear honking in my sleep tonight!

So long Chilmari...

Our work in Chilmari is done! We left the guesthouse at 5:40 am to catch a boat to Gaibandha. As we piled all of our stuff and somehow ourselves onto a Rickshaw down to the river, the sun was rising. It was so nice and peaceful without hundreds of eyes staring at me, horns honking, bicycle bells ringing, people crowding the streets, naked children running around, cows pulling trailers trodding by, and large trucks stirring up sand. It was just us, the red sun rising, the cool 70 degree weather, rice paddies, and a river. I was glad to see this side of Chilmari before I left.

The three hour boat ride was uneventful and our training session went well. We then took a van to Rangpur where I will be visiting the medical college tomorrow. After almost checking into possibly the worst hotel room I can ever even imagine, we found a new state of the art place! I mean to tell you that I currently have air conditioning, fast internet, television with a movie channel in English (that is currently showing Twilight), and possibly even warm water to shower with!!! If only I had a "tall toilet" then I would be in paradise.

Just a side note to relay the difference in what things cost here. When we received our bill for 7 nights and 16 meals at our guesthouse, it came out to.....$89 for me!!!!! Jasim and I just had dinner complete with tea for two for...89 taka (let me remind you its 70 taka to the dollar)! Apparently when its potato season and they are in great supply, you can get about 35 lbs of potatoes for a dollar!! I can't even imagine how cheap rice must be.

I almost forgot to mention before that I found a profession here that would be quite successful in NYC...a umbrella technician. Seriously! There was a guy on a char we visited a few days ago that drives a bicycle full of parts and makes house calls to come and fix your umbrella! When I told Jasim of the hundreds of broken umbrellas that litter the city with each storm we have, he was shocked that we don't have an umbrella technician.

bugs...

We are sitting outside, its 930 pm and we are delighted that our internet is working. And, in true Bangladesh fashion, the electricity goes out. The bugs begin to swarm at the computer screen, then they swarm to my face. We cannot figure out why they like my face and not Jasim's until we realize that my light skin must reflect he light and look like a light to them...this doesn't happen to Jasim since he is so dark.

We laugh so hard that I almost lose my rice...these bugs have never seen a white person either!!

Then, the generator starts up and the bugs go back to the neon light.

(I realize that you may not find this as funny as we just did...sorry)

I am taking advantage of this opportunity, while I have it, to upload some more pictures

working to dry the hay and the rice

tea time...always my favorite time of the day

bringing bags of dum dums was the best decision I made!

a mother and child looking into the home where we were holding clinic

a happy baby after club foot repair. the best age...before they know to be afraid of doctors

This kid decided to go for a dip in the mud. I got better pictures of him, but seeing as he was naked (as most kids are) I felt it was inappropriate to include on the blog...but he was so freaking cute I felt he deserved an appearance!

My work on the chars has come to an end. What seemed at one time like a never ending process has finished. I will never forget the awe I felt each day as we stepped off of our boat and onto the sand. I was fortunate enough to get back on a boat and leave at the end of the day, but this is the constant life of these people. However, they are so carefree (notice the proud look of the father above as his son comes home filthy...we would have been in so much trouble!). The kids spend each day playing outside, only coming in to eat (most don't attend school at all which is sad). They are unfortunately content with the simple lives that they have. I will spend the next few days visiting surrounding hospitals to see what they have to offer in the way of malnutrition and general pediatric care. As amazing and irreplaceable as this experience has been, I must admit that I am looking forward to coming back home. But, each time I am feeling like I cannot wait to leave here, I see a cute little kid smiling at me and it makes it all worth it.

mass transportation in Bangladesh

Is that ___? No, its just a white person

This rickshaw picture has nothing to do with this post...I just liked it :)

I have talked quite often about the reaction I get here. However, tonight was a true experience. When you are on the boat/hospital or out in the chars, people stare, but they know that you are a doctor and work with Friendship and it is a somewhat tolerable stare. However, when we go out in the village just to walk around, it is a bit different. The kids are always really cute and stare in awe of someone that looks so different. Sometimes at night, we just go for a walk through the town and as we walk, the crowd behind us just grows and grows. People come out of their houses and line the streets...you would think I am the president or something. Little girls wave, little boys smile shyly, the women stare, rickshawallas (that is the rickshaw drivers) sometimes nearly crash into each other, I sometimes even think that the cows stare at me funny. However, it is the grown men that I am always most surprised by their lack of attempt to hide their staring.

Since I am doing a project on malnutrition, we took a rickshaw into the market that comes twice a week to take some pictures of local foods that they can use to teach parents in the future. These people were so flabbergasted by my presence that I am sure they all forgot what they came to buy (I bet there were some angry wives when they got home). We quickly had a mob of grown men following us (and I don't mean from a distance, they want to get as close as possible!). However, I was able to get some great pictures of some crazy local vegetables, colorful lentils, etc. Then, we decided to really throw these people off guard and stop to have some tea. No one drinks here (it is a religious thing), so the closest thing to a bar are these tea shops. The picture below isn't the greatest but you get the idea.

the tea kettles on the bottom left, the tea maker with canisters of different biscuits/cookies, and me at the edge of the bar that extends into a narrow shop. (don't mind all of the stuff floating in the air...it's what I have been breathing the past 9 days!)

We enjoyed our tea (it was actually made with cow's milk (I am sure straight from the cow...they haven't heard of Luis Pastuer (sp?) here either as he was also white) and made it safely back to our guesthouse

Two dramatically different chars...however, the people are always the same

locals waiting for a boat

Unfortunately I haven't been able to blog in a couple of days and I seem to forget all the things I plan on blogging about. Yesterday we visited a char that has only been there 1-2 years. It is crazy to see a small village in the middle of what is basically a huge sand dune. The best thing I can compare it to is that scene from Pirates of the Caribbean where the ship is sitting on salt (I guess the ocean has evaporated?) and that is all you see for miles. When our boat pulls up to the edge of the char and we climb up from the water, it is just sand as far as you can see with a village faintly present in the far distance. The people are very poor. The men go onto the mainland for a month at a time to work and earn money to buy food. The women invite you into their homes, though and are willing to do anything to help. I am always immediately offered a chair and made to sit. They almost always ask how old I am and if I am married (the wedding ring isn't recognized here as a sign of marriage, I need a nose ring and a dot on my forehead) as they are into arranged marriages here and I am flattered that they wish to have me stay and marry into their families.

In contrast, today we visited a char that has been there for an estimated 15 years (however I often wonder where Jasim gets his estimations from). It was covered in bamboo trees, established buildings, and even has a market. Word quickly spreads that there is a white person that has candy and as always, the kids come running. There was some downtime after our work was done and we were waiting for the boat to come and pick us up. Jasim was busy, so I was sitting outside reading a book but there is only so long that you can sit and try to read with 20 children literally staring at you. The few kids with cell phones take pictures of me, they all want to know my name and show of what little English they know. To kill some time, we got a game going. It was very similar to the game "sorry" that we play in the states. It is amazing how games like this can bring people that don't even speak the same language together.

Sand storms, and other things we take for granted...

Jasim and I on a boat, headed out to a char

Remember that dust/wind storm that I talked about earlier? Well, there was another one today that I got to truly experience! We were on out a char, minding our business, screening some children for malnutrition when we noticed some storm clouds rolling in. We took shelter in a lady's house while a brief rain passed, then headed out to do more work. On our way back to the river to wait for a boat to come by and take us back to the mainland (we just stand and wait for the next boat to come. Jasim always tells me that the boat will come as soon as he has picked people up from the mainland that want to come over to this char. When I ask him how long that will be, he just laughs and tells me "anytime, it could be five minutes, it could be 2 hours"...I never find this as funny as he does) the wind picked up, and when I say "picked up" I mean we looked like the cows in that picture below!

We made it across on the boat to find it even worse on that side of the river. We ran and ducked into a "restaurant" which is a small little hut until we could run for the road to catch an "auto" to take us to our guesthouse.

Then, we make it back windblown, dusty, and a little wet to find that there is no electricity. This is no big surprise as we only have it a few hours a day, but it leaves you to sit outside in the storm as it is pitch black inside your room.

This takes me to the things that I have realized that I take for granted everyday:

1. electricity

2. warm showers

3. unlimited cell phone minutes

4. reliable internet access

5. the ability to drink water from the tap

6. variety of food

7. mattresses (vs the mat on top of my wooden bed frame)

8. being able to go outside without feeling like a celebrity and everyone staring

Oh, and I forgot to mention something when I was blogging about food earlier. I just learned this today, after eating mutton a few times. In the states, we refer to lamb as mutton (as in Keen's infamous mutton chop) however in Bangladesh mutton is either lamb or goat. Goat being the more expensive of the two which makes me think that thankfully when I have eaten mutton here, it is probably lamb!!!

Oh, and they eat pigeon, too.

Bangladeshi Fare...

I have had some queries about the food here, and it unlike me to have gone this long without commenting on the food. Luckily I like "indian" food, because it is all that we have for every meal. Breakfast is usually my favorite meal, mostly because of the ruti (no Sandy, we do not have cereal here :)). It is in the picture below. I would describe it as a hybrid of naan and tortillas (Paul would LOVE it). Their bananas are also very good, small, sweet, and delicious. Give me "milk tea" (it is the equivalent of the "crack coffee" that everyone drinks at Elmhurst Hospital), ruti, and bananas and I am happy!

It is usually served with an egg (on the left) and some curried, spicy potatoes.

Lunch and dinner ALWAYS involve a huge portion of white rice. I mean, this portion puts the Chinese takeout box to shame! There is usually some curried vegetable, some sort of protein. The protein will be egg, chicken (on the bone...poor, skinny, no steroids used chicken), beef (I can not figure out where on the cow this comes from because every piece involves bone, and if you see how skinny the poor cows are here you feel bad for eating it), fish (on the boat we had really good stewed fish, however here in Chilmari we have fried fish for every meal. It is a small fish and is entirely fried...head, tail, bones and all. Jasim loves them and eats the WHOLE thing, so I leave those to him).

They are big believers in tea here. This will be one thing that I plan to take home with me. I have thoroughly enjoyed my tea time. Back in the days where we were on the boat (and spoiled...Tom and Courtney have no idea!) we would have breakfast which involved tea, noontime tea, option of tea after lunch (lunch doesn't happen until 2pm), 5'ish tea, and tea after dinner (which happens around 8pm). I haven't had a single cup of coffee since being here, but have made up for it in tea!

Satellite clinic...

Yesterday was my first trip out onto a char to their satellite clinic. The way things work here: there are theoretically hospitals around but the closest one from here (besides the 10 bed hospital in Chilmari) is a University hospital that I will be visiting that is 75km away. So, on each char there is at least one woman, FCM (Friendship Community Medic) that makes her house available for people to come and be seen. She has a few medications such as paracetamol (tylenol). Then 1-2 times per month, the paramedics come out to her house and hold a clinic (=satellite clinic). Not to belittle or disrespect anyone here (these people work harder than we ever could imagine working), just to give you a good idea the houses are mostly built out of galvanized metal. The floor is dirt and there are usually 1 or 2 beds that the family shares. There is another building where they cook, another "bathroom", and usually another where the animals live (cows, ducks, chickens, pigeons, goats, lamb, etc). So, we set up a clinic in the bedroom portion by hanging a sheet in front of one of the beds to make an exam table and set up a pharmacy on a table. There is a blood pressure cuff and a scale.

I think word got out that there was a pediatric doctor from America and the children came pouring in! Then, word got out that the doctor had candy, and they started coming out from everywhere!!

We saw lots of children! We even diagnosed ear infections with a cellphone flashlight!

It is pretty amazing to be welcomed into the homes of these families and get to really experience what it is like to live the way that they do.

Regrets...

I have always had a problem saying no if I am afraid that I may hurt someone's feelings. It is something I really should work on and is surprising given my usual brutal honesty. However, I have done it again.

All of the women here dye their nails with a natural dye made from certain leaves. I was working with a paramedic yesterday that had her hands dyed and was telling her I liked it and inquiring, out of curiosity, about the process. Well, next thing I know Jasim and I were on a rickshaw to her house. I thought we were just going over to say hello, but when we arrived she had fingernail polish remover (to take off my beautiful manicure that had lasted over a week) and everthing ready to go. She was so excited that I just went with it. Now, the tips of my fingers are bright orange as are my palms. What have I done!? It may last MONTHS!!!

I can only imagine what everyone at Cornell with think if it is still there in July!!!

(the picture above is me with the dye on my hands waiting for it to dry)

Off of the boat and onto the mainland...

We left the hospital this morning and traveled by boat to Chilmari which is a village on the river bank of the mainland. We had a training session with some of the local paramedics. They are very nice women and eager to learn. Then, Jasim and I found our way to the guest house where we plan to stay for the next 6 days or so. It is a nice place (in Bangladeshi terms). I upgraded for an extra ~200 taka a night (a little less than 3 dollars) so that I could have an actual toilet...I am in the VIP room!!

We are currently sitting outside at a table where they feed us because there is no electricity right now and it is really dark in our rooms. However, the sun is quickly setting and I am not sure what we will do. There is electricity at times we are just not sure when those times are. The plan is to have dinner tonight, get some rest, and leave in the morning to go out to a nearby char and visit a satellite clinic there. We will be seeing children and screening them for malnutrition.

Today, after all the patients had been seen we made a trip into the village to see where these people were coming from. We obviously stuck out and were immediately surrounded by and followed by a gang of children and wherever we went the crowd kept growing. We were warmly welcomed and invited into the homes of many, offering seats for us to sit down and stay for a while. I got some really great pictures but unfortunately cannot spare the hours it takes to upload them, so I pick and choose.

I am amazed at how hard these people work all day long and how happy and content they seem to be in their lives. We could all learn a thing or two from them.

It is good that I got to take the trip into this village because I will be leaving the boat in the morning for Chilmari (a char continuous with the mainland) to train their paramedics and local healthcare workers. I will be staying there for a few days to collect data on their rates of malnutrition to get a better idea of what is going on there.

It has yet to be determined whether or not I will be returning to the boat but my time here has been really great!

Practicing without modern medicine

Another day on EFH (Emirates Floating Hospital). We casually start our morning with breakfast from 8-9, then mosey over to the hospital and wait for patients to arrive. Then, the flood gates open and there is no holding them back. I saw ~30 patients this morning from 10:30 to 12:45. That puts Peds Associates to shame! And by "I saw these patients", I mean that I saw and treated things I only remember seeing in medical school. There was a fair share of kids with the "common cold" which I am more than comfortable with but it was all of those adult issues that made you go into Pediatrics that were a bit challenging. However, we saved the lives of many today with paracetamol, metronidazole, and fluconazole. The saddest were a family with three children, a 5 yr old boy and 11 yr old girl twins who had never sat up, rolled over, talked, etc. It makes you feel rather helpless when you cannot just print out a referral to the nearest Pediatric Neurologist. You can tell them to go to the closest medical college which is 75 km away and hope that they can go, but even if they can afford the trip who knows what help they will receive. There was also a 20 yr old with some sort of peripheral neuropathy of his right leg likely secondary to polio that we weren't able to do anything for. It is quite challenging without the luxuries of modern medicine. However, everyone is so thankful and it is quite rewarding to be able to help at all. We are having our afternoon tea and then off for my first venture into the village...stay tuned!

Happy Bangladeshi New Year!

There is an orthopaedic camp here on the boat now (made up of a surgeon, nurse, anesthesiologist, and physiotherapist all from France) and a crowd of people are camped outside waiting to be seen each day. We have spent the morning preparing for my upcoming journey to go out in the chars (islands) and train the paramedics. In the afternoon, I saw patients with the Ortho guys and some kids with Manaan (the paramedic that is trained in pediatrics). We diagnosed one little girl with Ricketts and another two children with pneumonia. The bulk of the surgeries are club foot repairs and there are children everywhere with casts on their legs.

I experienced my first Bengali dust storm today. 4 years in Lubbock, surviving many a dust storm and you would think I would learn to close my windows! However, it came from nowhere.

We ended the night with some fish fresh caught from the river today and some tea out on the boat deck while watching the lightning...so luxurious!

A very long day in Dhaka...

As most of you know, I have arrived! The trip was rather uneventful and painless. I spent the first two days in Dhaka and finally we arrived at the Emirates Floating Hospital last night. It was a long, 10 hour, bus ride from Dhaka with unnecessary amounts of honking and swerving to avoid other buses, rickshaws, people, cows, chickens, etc. I wanted to wait to bog about Dhaka after I was gone...hoping that absence does make the heart grow fonder! Needless to say, it was quite an experience. I feel that I am a pretty adventurous person. I began crossing 7th avenue (the busiest street in Corsicana, TX) at an early age with my father to run across from the rental store and buy snacks for our breaks. I am considered by most of my friends in NY to be rather brave and even a little crazy at times when it comes to crossing the street. However, I felt that if I even blinked for a second in Dhaka that I might be killed by some sort of transportation buzzing by in any direction. I have never seen such mass chaos. When questioning Jasim if there are many accidents his response was, "it is much better now with the new system." I cannot even imagine it before, nor am I sure what this new system is! Somehow we made it on a tour of the city and saw the Liberation museum (it is amazing to think what these people went through just 40 yrs ago!), Parliament, strolled through the park, and had some authentic Biriani for dinner. I was exhausted! Another night of trying to sleep with constant horns honking made me yearn for the peacefulness of New York City!