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.

Medicine is Hard & I Chose It

My first patient this morning was dying of gastric cancer.  The surgeon didn’t feel removing his stomach would extend his life.  Chemotherapy is limited in this country anyway but especially for the poor since everything must be paid for either by the patient or the hospital.  There was nothing to be done except have him see the social worker. 

Then just as my day was ending two young men came in from a motorcycle accident. Riding a motorcycle is very dangerous here; no one wears full clothing let alone helmet, leathers or closed toed shoes.  It is more dangerous with a passenger, in the rain, and it is worse if the driver his holding an umbrella in front of his face to avoid being pelted with rain (this came out later). 

The 16-year-old had a broken femur it was open but otherwise was okay.  He came through surgery fine after a few touch and go moments.  The driver was not okay.  He came in unresponsive pale and flailing.  Large abrasions to the trunk and legs, his oxygen was low, his blood pressure was low – initially normal heart rate then it got fast.  He had a flail chest.  The ultrasound show showed blood in the abdomen.  We rushed him to surgery and he died on the way.

We had no blood to give him – because blood has to be given on scene by a family member or staff and this takes time to match and draw.  Everything needed to be faster.  Only One knows if he could have been saved.  But I heard his wife crying.

The People Who Walk in Darkness

Over the last 2 days, Josiah and I have 2 very kind invites to meals at Bengali homes.  The first gentleman, Bemal, works with Josiah as a day laborer.   He is a skilled decorative welder who had owned his own successful business.  But now, as he repeated multiple times during dinner, he is poor.  His fortune stolen and his business pushed out by his neighbors who didn’t want a Hindu to be successful. His is a sad story but a generous spirit.

I watched him borrow the money for our dinner from another co-worker.  He led us to the edge of the market where he lives with his wife and 2 daughters. The floor was dirt.  One electric wire…that didn’t work the whole time we were there.  The roof was corrugated tin (which basically all roofs are in this area -- so much rain).  No windows beyond the holes in the wall and ceiling.  Dinner was by the light of a camping lantern, mango, grapes, and a Ramadan mix of specialty foods.  Gratefully, we did not get sick…though I fear we may have offended him trying to explain that we would get sick if we drank the water. 

Our second invitation was from a medic I work with.  His family was well established here until his three brothers emigrated to Michigan with his mother.  Now, the only family left in this country, he, his wife, and their 2 boys care for her father (which is a very important responsibility here).  She is an English teacher and we had a very nice visit over noodles, snack mix, cookies and coke. Since he had just gotten off of an overnight shift, I thought we should cut out visit short (only 2 1/2 hours).