So, How Was Your Trip?

That is the question everyone always asks. And yes, it was good. But that is really incomplete.

It was hard. Traveling for three days straight both ways is disorienting and mentally fatiguing (and would try the patience of a saint, which I am not ;0). Seeing needs all around you that cannot be met by you, those around you, or truthfully by any human weighs on the heart and soul. And now in this airport in the land of plenty the questions demand answers; Father what role would You have me play in meeting those needs?

It was fun. We went swimming at the compound and I went swimming in the ocean.  Josiah helped rescue a family of kittens. The night before we left we played ultimate frisbee, in the dark. At least there were doctors near by :0). Josiah also got to see the safari animal park -- Bengali tigers still live here (especially in the "hill tracts". But I have to some of the best fun was meeting and hanging out with the families there (and eating yummy homemade donuts).

It was intense. Being deposited into largely a non English speaking culture (especially with no sleep) was a bit challenging. This was accentuated in the clinic when I didn't know the trade names of medications (paracetamol is tylenol for example), the doses (a baby aspirin is 75 mg instead of 81 mg which is a forgone conclusion in the US), or how to treat the everyday conditions in the region like typhoid (which isn't covered by the vaccine the states we were told...so we will see if we contact it in the next 7-10 days...fun), thalassemia, club feet or and rickets...which I can now treat nearly in my sleep. Of course, the driving was a heart attack in and of itself. (I was thinking about this and Kenya was crazy but it had a couple of buffers: the roads were dirt, they had comparatively fewer types of conveyance, and, in the city at least, it was so impacted you couldn't get going that fast. The main roads in Bangladesh are paved. There are fewer large vehicles and a larger number of people on foot, in rickshaws, CNGs, tom-toms, and motorcycles, and to top that people weave and squeeze between the slower vehicles. Btw, they have buses, mini-buses, double stacked buses, vans, micro-vans, and any other Toyota manufactured vehicle. And all of them hit people.

It was exciting. We got to see several surgeries which would have done at tertiary hospitals here in the states. On the flip side it was amazing see all that is being accomplished among the various arms of the body! The new hospital, the Heart House for the widows so women can make a living for themselves and their families, multiple different schools (from elementary to nursing) and so on. He is truly at work! And that is encouraging and invigorating!

It was a growing experience. Not only can I now say a few Bangla words (Josiah can say more) and give you a quick history of the country, but I have been a part of "the culture". We ate at their houses, fellowshipped with them, wore their clothes, worked along side them and got to see some of their lives not only of the Bangladeshis but also the Badeshis (the docs, nurses, teachers and their families). For the latter group it was very challenging to me to see all that has been sacrificed in pursuit of the call. Careers have been laid down. Comforts have been forgotten. Marriages have been set aside. Retirements and financial security have been exchanged for trust. Friends have been left behind. All counted as loss to pursue. What have I given in this pursuit?

Oh, and I only got a dozen...okay, two dozen or so bug bites, I first I thought they were mosquito bites but now I think they are likely also ant, spider and other bites as well. And they are healing well. 

But yes, our trip was good. Thank you for asking

Last Day

Last days are always sad in some ways and happy in others. Even though I am truly excited about going home, I see so much more to be done and so much more that will be done in His name.  The fields are ripe.  Did you know that Bangladesh gets three harvests a year!  Me neither 😃

My last day at the clinic was arguably my busiest.  I steadily saw patients all day which was unusual and then as the day was closing out there was a tom-tom accident (a tom-tom is a three wheeled vehicle with a high center of gravity that makes it tip easily), a rickshaw incident, a toddler who was dropped, and a guy who fell off the roof. Oh, and don't forget about the stab wound and the seizure kid.

The tom-tom guy lacerated his forehead, crushed his tibia, fibula (both those were open fractures) and fractured his foot -- he needed surgery and we had no space to keep him so he went to Chittagong.  A four year old had been run over by a rickshaw and had to go to surgery because of bleeding in the abdomen -- we kept him and he seems to be doing well with partial thickness lacerations to the bowel and pancreas. The toddler had a supracondular fracture that was 100% displaced...he needed pediatric orthopedist. When my medic translated to mom what was wrong and that he needed surgery she started crying.  It's is so hard not to be able to offer comfort.

The guy who fell off the roof had a wrist fracture that was open and needed washed out in the OR -- we also kept him and the stab wound (who looks like he will make it).  But we had to send the seizure boy to a pediatric neurologist (very odd seizure, still are not sure of the cause).  So many people in need and only so many beds and so many doctors.

Right now I am sitting in the Dubai airport (seems like I was just here).  I will try and post once from NYC as well.

The End of A Thing

Solomon said the end of thing is more blessed than the beginning but as I realized this morning this will be my last post for a few days (until I get to the airport’s internet) I have very mixed feelings.  So much to think about and consider. Today is (already) my last day in clinic; my last day to struggle through an interpreter; at least for now…who knows what the future holds. But onto funner things.

Yesterday I got to watch a surgery to remove a tumor.  An 18.118 kg tumor (which is about 40 lbs); it was so large one of the doctors would hold it and the other doctor would cut on it and then they would roll it the other was and cut on the other side.  You could tell it was an exciting surgery because every doctor on the compound was in there and the staff were all crowded in the hallway to see the tumor afterward.  It didn’t appear obviously like cancer so we are hoping it is benign and that the patient can recover and live a long wonderful life.  They were working on getting her some information in her own language so hopefully that came to fruition.  Can’t wait to show you pictures.

Last night we had a movie night with all the kids and watched Beauty and the Beast (except the guys who went elsewhere and played games…for obvious reasons) which was a very theatrical remake but enjoyable.  Well, I have to go…or I will be late on my last day!

Adventures in Cooking

Today, June 26th, is Eid in Bangladesh -- the end of Ramadan.  It is a huge holiday here, comparable to Christmas.  People visit family, eat traditional foods, and visit neighbors and friends.  It has mostly been a quiet day for me, which I have greatly enjoyed.  Josiah went to "tea" (which is at about 10 am) with a friend and then they went to the Wild Animal Park.  The price if you are a local is 20 taka (about a quarter) but if you are a visitor make that 400 :0)

But because everyone is off from work, we had to scrounge for ourselves today.  So, I got to try and cook in the kitchen here at the guest house...all I needed to do was boil water for the soup.  That's it, boil water and the soup finally got done 2 hours later.  Why?  Well, there are quirks here.  The outlets have to be turned on for power.  You can't use the water from the tap for cooking.  And the stove tops are difficult to turn on. 

To figure out which burner I was turning on I had to hold my hand over it and even then the electric stove top never got warm enough to boil the water.  The gas range was out of propane (which sits next to it in a large can...made me kinda nervous). Once that was replaced, by someone else :0) who also showed me how to turn it on (no fan allowed because it blows out the flame), it went tolerably quickly.  And the package of tortilla soup was reasonably good -- though nothing like New Mexico's. 

Ps. This is not mine.  This is from the market across the way.

Our Trip in Sound Bites (For the Easily...Squirrel!...Distracted).

A Few Rules for Bangladesh:

1.       If it feels like something is biting you, it probably is.

2.       Always where your orna (this is the scarf) in public.

3.       Fans are your best friend (and they are also why there is a paperweight in every room).

4.       No two clocks are the same so don’t expect them to be.

5.       Plastic bags don’t mean it doesn’t leak or that it is safe from the ants.

(I confess I will not miss: Killing the ants crawling through my toothbrush; killing ants biting me during dinner; killing ants on my food; killing ants I find crawling on my body after removing undergarments.)

Things I Finally Learned

1.       Md. Does not stand for medical doctor it stands for Mohammad.

2.       How an umbrella could be a dangerous weapon.  They are solid wood and so essentially you are carrying around a staff.

3.       What it feels like to worry about having enough money to pay for a child’s medication.  In the middle of our journey being unable to withdraw currency made money tight.

4.       Language barriers make you more direct.  You have to say exactly what you mean if you want to give you patient any chance at understanding what is going on.

5.       How it feels to stand in a woman’s only line… The women’s lines are always longer and not just for the restroom.

6.       For Asia, I am tall and this means that most kamizes (the long shirts) hit me much higher than most woman, near high mid thigh.  (You should have seen the man’s eyes when we told him that Josh was 4 inches taller than Josiah who is also considered tall :0).

7.       It's a good thing I have huge feet – because everyone takes off their shoes before going inside and since no one else can wear my shoes they won't walk away.

When Do You Go To AWANA?

I admit it – I am a purist.  I used to be more so…but I definitely still have those tendencies.  When I was a kid it is was like unto heresy to even think of having AWANA anytime but Wednesday night.  And then we found a church that had AWANA on Sunday nights and that became okay – because who doesn’t want to go to AWANA twice a week, hello!  Then it was Thursdays nights…and now, here in Bangladesh, Friday mornings, after church.

It is so exciting to see AWANA going on over here.  The one we attended was grades 1-8 in one club.  I wish our clubs could play games together!  I really couldn’t understand anything but I still had a rough idea of what was going on.  We sang songs (all with motions!), listened to a lesson, and broke into small groups by age.   Instead of using individual books, the leader has the book and teaches the lesson.  This decreases cost which is paramount here.

So much fun!  The kids are awesome.  Oh, and Blue Team won!  Go blue!

The Ticket System

This morning during a lull our outpatient department (OPD) “house supervisor” Becky (the nurse that helps keep everything flowing), showed me how patients get a ticket to be seen.

Early in the morning people come and line up outside the gate.  Two medics sit in little booths at the head of the line and triage everyone who comes.  They will decide who gets the tickets to see the doctors.  It is not first come first serve.  With only two surgeons (who are amazing), one family practice doctor (who astoundingly also does most of the C-sections -- 400 last year), a part time family practice doctor and myself (both of us are handicapped because we need translators) some patients will simply not be able to be seen.  Though I think this is less of an issue right now because everyone is fasting for Ramadan and fewer people come to be seen.

A green ticket means you get to see a surgeon.  A yellow ticket means you get to see a medic (and not a doctor).  A red ticket is an emergency ticket and that means you get to see me!  A white ticket is the most diverse.  It is a medical ticket – but it also includes OB, pediatrics, chronic disease, and acute medical problems.  An OB patient sees the full time family practice doc.  The young peds patients under 5 months (are supposed) to see the part time family practice doctor.  And we divvy up the others as they appear.

My last patient today was a tribal patient (I can tell because of the way she was dressed).  She is 6 weeks pregnant and has bad typhoid. This is her second pregnancy.  Her first baby was born dead.  I am hoping and asking for a healthy baby this time around.