May 2009

The flight to Bangladesh was incredibly long, with a stop first in New York City, then in Doha, Qatar, and finally to Dhaka, Bangladesh.

We then took a flight down from Dhaka to Chittagong, where we were picked up by our friends Stephen and Stephanie Kelley.
 
After a brief stop for lunch in Chittagong, we were on our way to Malumghat Hospital, with a first stop at Moonshine, the equivalent of Costco in Chittagong.

Because we were doped out on sleeping pills to reset our clocks, we remember only a few aspects of this part of our venture. The weather was warm but only mildly muggy. Here are some views of our guest house and the scenes immediately around it.

Betsy and I were soon jumping into helping at the hospital. It is totally amazing to see the variety and intensity of cases occurring. The general surgeons are performing all of the Urology and Orthopedic cases, including rodding femur fractures, doing TURPs, etc., etc. They are also doing some chemotherapy, and I will be working with the nursing staff at establishing a serious chemotherapy program while helping them to decide what the best and safest cases for chemotherapy would be. I am quite happy for the training that I received in Chicago and never thought that my moments writing chemotherapy orders with Linda Wild would ever come useful in the future. Well, it is.
 
Betsy and I are both having a daily language lesson. I love Bengali! Nomoskar! Kaemon achen? Ami bhalo achi. Eckon jay. Pore dekha hObe. The natives are friendly, and while very poor as compared to Amerikans, are rich in spirit. Betsy and I have so far not had too much time to get out into the neighboring villages. Last Saturday 21.MAR2009, I took a motorcycle ride up into the Chittagong Hills Tract. This is just east of the hospital, and sitting between us and Myanmar. It is a very rugged country, with lots of rubber tree plantations, and banana plantations.

You are not allowed to go far into the Hills without passing checkpoints. Fortunately, the lead person we were with (Dr. Kelley) was able to explain that we were only going in for tea. This we did, stopping in a cafeteria, that by Western standards would be described as filthy beyond belief. Yet, when you order tea, it is boiled and thus safe. They drink a hot milk tea, which I have not gotten used to, and so usually will drink lal cha (red tea) with a teen-kon-shomasa, which is a small triangular pastry, with a very spicy curry filling in the middle. Again, since these are baked, they are safe, even though they are from restaurants beyond belief in filth.
 
The weeks are a bit unusual. Friday is the Muslim holy day, so, Friday and Saturday are the weekend. Friday is the usual day for Muslim and Christian church services, and Saturday is a day like our Saturday. We would attend the Friday AM church in Chittagong, which was all in Bangla.

Notice how sandals are taken off outside a building. Sunday is a work day. The clinic is on Sunday and Thursday, and Monday, Tuesday, and Wednesday are operative days. The ORs are nicer than what we had in Jamaica, but still a touch below average standards in the USA. It is common to lose electricity at least 3-5 times a day, usually while operating, which is one of the only reasons we typically wear battery-powered head-lamps. The lights go off. The work goes on.
 
26MAR2009 Today is Bangladesh Independence Day. I worked in the hospital, and then went on a motorcycle ride with Stephen Kelley up into the Chittagong Hills. Afterward, the hospital threw a large feast for the hospital employees, about 300 people showing up. This was a mixture of expatriate nurses, doctors, and other missionaries, along with a large component of natives. Goat curry, fish, and rice were served. It was excellent. Traditional meals are not eaten with a fork or spoon, but with your hands. It is just a little too odd, eating curried rice with your fingers–it’s exactly what we were taught not to do.

 
31MAR2009 Today, we went to a Bangladeshi funeral. One of the beloved orthopedic techs, Lawrence Halder passed away unexpectedly early in life, possibly due to mismanagement in Dhaka of a simple eye problem. He had a son and daughter. Funerals occur within 1-2 days of the death, as they have no embalming or means of corpse preservation. Lawrence was buried in his backyard, next to his brother and father. The funeral was late at night since they were waiting for various people to first arrive in town. He was laid in a simple pine box and placed six feet under. It was quite emotional, with family showing a great amount of wailing.

Unfortunately, in this culture, there is no welfare or social security, and the death of a father can be a serious tragedy in life, his children in college, and a wife with limited earning potential. There was recently one young pregnant lady brought in by her Muslim husband in eclampsia, seizing, and required a c-section for infant delivery. A girl was delivered. The husband promptly abandoned her and was nowhere to be found. The reasons? 1) A c-section means that all other children will require c-sections, which is expensive in Bangladesh. 2) There will be a large hospital bill. 3) An infant girl has absolutely no economic value since a dowry must be paid to marry her off, and she will have no means of supporting the family. When people speak of how wonderful the Muslim religion is, I just consider the terrible absence of value held for the females in that society, where cows or goats are of more value than females.
 
03APRIL2009 Friday is the equivalent to Sunday in America, which is the day where people either go to church or to Mosque. Saturday is the free day, and Sunday is the usual workday. This coming Sunday is Palm Sunday, and next Sunday is Easter, which are also taken off by Christians as holidays in Bangladesh. Today, we went to the Bengali church, and then afterward went over to the house Dhirjidon, our language teacher.

He had invited us in for tea and rice pudding, both of which are very good, though I don’t really care for the milk-tea that they drink. They live in a mud-house but is fairly nice by Bengali standards. They have gardens outside their house and are attempting to grow some banana trees and mango trees. Dhirjidon has two young daughters and a fairly young wife (long story, but not typical for Bangladesh). They are all very proper, for instance, when you enter their house, they bow and then touch both your feet. The house kitchen and toilet are out behind the house. It makes sense to do that. Their life is very hard, and family life is completely dependent on the male being able to work. This is why they wish for sons, who could support the family when the parents get too old to work.
 
04APRIL2009 – Boat trip – I wish it was a boat trip down the Rhein, but such was not to be. No Lorelei, no castles, no good German beer. Oh well! We had a great time all the same. Uttam was our connection to some native fishermen. We went out in their wooden boat, powered by a diesel motor, built in Shanghai.

We had to wait for the tide to come in, then walked the plank onto the boat. We saw some people doing a boat repair onshore- the Bangladeshi version of the Krupp-Thiessen Boatworks in Hamburg. We then puttered down the river to the farm of a friend of Uttams’. He had multiple shrimp ponds, as well as a salt refinery. We watched them catching shrimp, and one of the men went off for some bird hunting with his shotgun. We had some drinks in the raised hut, which was actually very cool and comfortable. Baba (father) lived out on the farm, keeping an eye out for poachers, which are many. Finally, we climbed back on the boat and headed back home as the sun was setting.
02MAY09 Several days ago I performed a c-section with Dr. John, and everything went well. Post-operatively, the patient would not stop vaginal bleeding. We took her back to the OR and found an atonic uterus filled with clots. After multiple attempts to stop the bleeding, I finally ended up doing a supracervical hysterectomy. She did well, though she lost quite a bit of blood. Tonight, at 1 am, I was again called to do a c-section on a breech delivery. It went well, but with the anxiety of the complication of my last c-section.
 
Please proceed to Bangladesh -2 & -3. This blog was broken down into three sections to facilitate easier downloading.

06APRIL2009 – Market visit – Today, Dirjidhon took us on a walk through the market. It was market day, and all the vendors had their vegetables, fruit, chal (uncooked rice), and halud (a yellow spice) out for sale. The only thing that really grossed me out was the fish, some live, and some smoked. These markets are fairly popular and do provide fresh produce on a regular basis. It also allows the poorest of folk to market their goods.

10APRIL2009 – Today, Dr. Kelley and I were working in the OR, and we discovered that some of our instruments were stripped. We desperately needed several bolt drivers reground, and so-called up the maintenance man, Les C, who is spending two years with his wife in Malumghat. We had him scrub in and identify the exact problem, while I scrubbed out to snap photos.

12APRIL2009 –  Easter Sunday, we went to church. The church in Chabigong (where Memorial Christian Hospital is located) is the second or first largest Christian church in the nation of Bangladesh. It was packed. The choir sang first. The service started at 6:30AM, though half the people didn’t show up until 7:00. This is typical of Bangladesh. I had to leave 1/2 way through the service to go round at the hospital. That evening, the mission workers all had a potluck and easter service. It is of note that though Bangladesh is very strongly Muslim, the hospital has been effective at reaching out to the Muslims and Hindus in this area, as well as the tribal people in the hills, offering them joy and hope that is missing in the prevailing religions of the land. There is a sense of absence of joy, of death, of gloom, seen on every street corner and in every Mosque and Hindu temple. Then you go into the Christian church, where many young people and elderly alike are happy, joyful, praising God with a giant smile on their faces. It was contagious.  We brought with us one of our patients, a Hindu diabetic female, whose husband left her and required a below-knee amputation by me. It was her first glimpse of hope. Many of these ladies would tend to go home and commit suicide, as life outside of Christ had nothing to offer. The Hindu teacher would not criticize the husband and agree with the wife. The Christian is able to find meaning and community even in tragedy and suffering.
 
14APRIL2009 – Shubho Nobo Borsho (Happy New Year) – today was a regular day at the hospital, but they held a special lunch and other celebrations since today was the Bengali New Year. For morning tea, someone brought us in a Bengali treat, which was the rice equivalent of popcorn. It was a little like puffed rice but tasted much better. Then there was another type of popped rice, made by heating sand up to very high temperatures, and then throwing chal (uncooked rice) onto the sand and letting it pop. I have seen so many incredible new foods, that are also reasonably healthy for you, that I suggested that a Bengali restaurant open up in the Northwest. Unfortunately, I’m not sure it would sell well.
 
16-18APRIL2009 – It’s raining. Reportedly, a cyclone is coming through. Cool. It will be our first cyclone. We shouldn’t be hit with the brunt of the storm, so nobody is evacuating, but it is raining quite hard. Today, Dr. Kelley was working on advancing the renewal project and was out running a chainsaw in order to remove trees, so that ground preparations could begin for the new hospital. Surgeon Lumberjack Steve worked feverishly with “Doc” Collins to take a number of trees down. As he was sawing through one trunk, he realized that somebody had climbed the tree and that he was still up in the tree! Wild. 17APR – on call, doing massive amounts of Ob. I’m learning how to manage a 22-week pregnancy with vaginal bleeding, which we presume is either placenta previa or abruptio placenta. Suddenly, I need to read massive amounts of basic obstetric literature. It continues to rain cats and dogs. This evening, we have started to get very forceful winds. The cell phone connections no longer work, and power lines are down. We drove into the hospital to board up all the windows, and to check on the sicker patients. On the way back to the guest house, power lines were across the road, causing us to have to walk the rest of the way back home. Unfortunately, photographs were impossible. Maybe tomorrow…   18APR – The brunt of the storm was expected to hit us today, but actually ended up hitting us last night. Today, there was no rain, but debris and power lines everywhere. By noon, almost everything was cleaned up. The cattle were eating the downed leaves, and villagers gathered the downed wood to sell as firewood. Unfortunately, the internet remains down for now. I’m on call for the hospital for the last few days. Saturday is a usual day off, so only emergencies come in. I had to start a central line on a 4 yo child (actually, older, but the size of a 4 yo) and then calculate out chemotherapy doses, as he is being treated for Burkitt’s lymphoma, and the first doses weren’t quite right.

Rounds on 30+ patients. Rice poisoning patient came in this afternoon, oxygen sats. of 70%. He died. Two Ob patients bleeding, demanding me to relearn Ob. I recheck the child getting chemo, and all the hospital patients. It’s quiet. All the hospital missionaries were invited over to Lucky’s house for dinner. Just awesome. Bhat ar dhal (rice and dhal), quite spicy, with vegetables, chicken, and shrimp. Khub tasty (very tasty). Also, quite spicy. We ate it with our hands (no spoons or forks). It would be almost an insult to ask for an eating utensil. Back home, we hear a motorcycle drive up. It’s another rice poisoning. Rice poisoning is quite common here. They are not poisoned by rice. They eat the insecticides, which are organophosphates, and come in with dilated pupils and a racing pulse. Supposedly, it is usually a suicide attempt. We do our best. I think this person will make it. Much of the hospital is run by techs that are trained in highly specific things. We are now training a young male tech to give chemo. Other techs in the outpatient department are very good at managing rice poisoning, and many of the problems that come in. Usually, there isn’t much that us doc’s need to do except to check the techs and make sure they aren’t messing up when something unusual comes in. There is a diabetic with heart disease, and her blood sugar is 57. I tell the tech to give her some sugar by mouth, and he brings in a vial of Calcium. Remember, many of these techs have never seen college, and I have no idea if they’ve even made it through high school. It’s now 11:20 at night. I was called in to see a 52 yo tribal lady (which means she’s come many miles to see us). She fell off of a baby taxi this morning, landing on her head. She was okay until she went in to get a forehead laceration sewn up. They used large silk to repair the wound (a no-no), and also gave her an injection of who-knows-what. She became semi-conscious since then. I can’t find anything on her that suggests a bleed or serious brain injury, so admitted her for observation. This lady is an example of how there is a moderate amount of health care in Bangladesh, some of it in very nice facilities, but the care is very often detrimental to health. I thought American health care was bad! When brother Dennis tells me how terrible the American Health care system is, I’ll tell him to go to Bangladesh to get treated there the next time he needs a doctor! We spend much of our time rescuing people from injuries induced by the local “professional” or local alternative care providers. Unfortunately, even though care is much better in Dhaka or Kolkota (Calcutta), mortality rates are still prohibitively high as compared to the US and other western countries. It’s now raining out, and I have only my bicycle and a climbing headlamp to ride 1/2 mile home in the dark. All I could think about is how I wished I had a CT scanner. Does anybody care to donate for a used CT machine?
 
 
19APR09 – Today was a busy clinic, seeing many unusual cases. The worst was a 7 yo child from southwest Bangladesh who was flown in by a charity organization for care. She had phocomelia, with absolutely no arms. Her right leg was also just a stump. She was able to write by picking up a pen with her toes and writing. Both her hips showed hip dislocation, not being treated right at birth. We needed to explore options with her. I had never seen a case of phocomelia and had never seen an old case of bilateral hip dislocation from birth since they are always treated in the US before the problem becomes irreversible. She was the most cheerful child. Some charitable institution in the US apparently heard of this poor girl, and (correctly) realized that Dr. Kelley was probably the best surgeon in Bangladesh to handle this problem. Result? An e-mail to the world’s expert in unusual orthopedics, Dr. Bullock, who was the orthopedist at Malumghat Hospital for many years. There may not be much that we could do, and the charitable institution will have spent a whole lot of money for little gain. I am learning that indiscrete altruism may placate a conscience, but result in mostly wasted sweat and funds.
 
20APR09 – Thomas Kühn – I was running through the clinic yesterday, and here comes a white guy. Strange. He was bringing a child to the hospital for repair of contractures of a burnt hand. Thomas grew up in East Germany, migrated to the west before the downfall of the Wall, and developed a heart for missions. He met his wife from Rapid City, South Dakota in Germany, was married, and moved to Chittagong to run an orphanage. They have 3 children, and about 62 kids in their orphanage. I will save a lengthy discussion of Thomas but felt a strong kinship from our first encounters. Please visit his website athttp://www.holbangladesh.com to see what he is doing in Bangladesh. He brought in one of his orphan children, who received an insect bite to his hand many years ago, and through a series of serious mishaps using local medical lore techniques, the hand went from bad to worse. He lost three and 1/2 fingers, and the wrist went 180 degrees extended. We started a two-stage reconstruction, today releasing the skin, and flexing the hand as far as it would go, with the transfer of unused third digit extensor tendon to a taught second digit extensor tendon. We will now weight out the hand in order to get it straight, and then go back and skin graft a large vacant area.

21APR09 – I did a 40 yo male with a large left retroperitoneal tumor. It was about 18 cm diameter, and highly vascular, thus, a very tedious dissection. We needed to transfuse blood. In order to do that, relatives come in with the same blood type and donate at the moment the blood is needed. It is then given straight to the patient as whole blood. It works well, and you don’t need the units and units of blood that you might require if you were giving component blood. The patient did well, with 1500 cc blood loss, but with 2 units of transfusion.
 
23APR09 – Today, we ran up to Chokoria to go shopping. Dr. Lattin, Dr. Welch, and I purchased our first lungis. What is a lungi? It’s what all the natives wear, and virtually everybody in Bangladesh owns at least one lungi. It looks a little bit like a dress but is the most versatile piece of cloth that a person could ever wear. Lungis would typically be considered by the elite as casual wear so that we would never wear our lungi into the hospital. But sitting around the house, or working in the back yard, it’s the most comfortable thing one could ever own.

I also wanted a Fotua, which is like a Neru shirt but couldn’t find a short sleeve one that I liked. So, oh well, Uttam said that I could get one in Cox’s Bazar this Saturday. The Mayor of Cox’s Bazar was at the hospital today, and he invited me to come to visit him. His wife was in the pregnancy care. He is Muslim, and there are large hospitals in Cox’s Bazar, but people from all over Bangladesh that have the money prefer the care at Malumghat Christian Hospital. So, we are often operating on somewhat wealthy people coming down from Dhaka. The mayor was running around on his Honda motorcycle, with his father-in-law and brother-in-law sitting behind him. I wish I could have gotten a picture.
 
24-25APR09 – Uttam Mollick, Cox’s Bazar. The 24th was Friday, which is the day they have off from the hospital, and is celebrated like western Christians would celebrate Sunday, with the church, and going over to people’s houses, etc. We went over to Uttam’s house and was served a meal that was like top Ramen with an egg in, but very spicy. It was quite good. Uttam will be taking us on our trip to Cox’s Bazar tomorrow.  So, we meet Uttam at 7 in the morning, and hop on one of the public busses. This is a bus with people on the roof and hanging out the door. We go to Ramu, to visit a friend of Uttam, whom he calls the professor. She teaches biology lab in the college, and her husband is an IT man in Dhaka.

They serve us breakfast. She has a newborn baby. Even though she is Buddhist, and Malumghat Christian Hospital is many miles away, many of the elite (like the Cox’s mayor above) with go to MCH for their delivery, since it is the only place around where doctors actually make an appearance, and things are to be trusted. We then visited several Buddhist temples, including a very large temple, where Buddha actually lived and some of his bones are buried there.

Every day they placed out food for a very hungry Buddha, who refused to eat it. The tree is where Buddha used to meditate. The monk on the left is actually taking Bible classes at MCH.  Next to the temple was an orphanage that was built by the Italians. The children were all girls, and very polite and cute, all of them knowing a moderate amount of English. After that, we went back to the professor where they served us lunch and then hopped a bus to Cox’s Bazar. I bought several more lungis, as well as several fatuas, and Betsy bought some gifts, so, we are set to return home. We stopped to walk the beach, which is the longest sandy beach in the world, 70 miles long.

The ride home was in darkness on the public bus. Though I don’t have photos, we stopped on the way for someone to load several crates of chickens onto the roof, then climbed on top to hold them down for the trip to Chittagong. It was a tremendous time with Uttam, especially since he is able to give us a real Bangladesh experience, and not just a tourist view of the country.
 
07MAY09 The Mangos and Lychees were ripening on the trees. I had no interest in either of those fruits in the US, as they both tasted rather disgusting. But, tree-ripened mangos and lychees are the most incredibly tasty, delightful fruit you could ever savor. We finished clinic a touch early, so Jason (Dr. Lattin) suggest we grab the bucket truck and go lychee picking. The problem is, the ripe lychees and mangos are quite high up in the tree, as they ripen from the top down. The natives simply run up to trees with their bare feet and lungis pulled up, and pick the top fruit. That, by the way, creates many of the fractures we see at the hospital. The bucket truck, like you, would see being used by the electric companies to repair power lines, was our perfect solution. We found a ripening lychee tree in from of the Archibalds’ house, so pulled the truck off under the tree.

We did have a problem starting the truck, requiring a jump. I went up first and got a large bucket of lychees. We then moved the truck, and Jason went up with his young 3-year-old son, Nathan. Once he got halfway up, two events occurred. First, the motor to the bucket stopped. Minutes later, a belt on the truck motor disintegrates. Then, we discover there is no safety release to the bucket hydraulics. So, we grab a rope, and Jason lets Nathan down, followed by him climbing down the rope hand over hand. The lychees were awesome, sweet, succulent, slightly tarty.
 
 
Please proceed to Bangladesh -3!

Please also read Bangladesh -1 & -2 first…
 
08MAY09- Medical Trip into the Chittagong Hills Tract. I was invited to go along for a medical trip into one of the trips deep into the Chittagong Hills. My ID doc warned me to absolutely do not go into the Chittagong Hills, as there are dangerous diseases. So, off we go. The plan was to go to a tribe that was completely removed from civilization, and truly, they ended up at the literal end of the road. We drove for four hours. First, we went through a checkpoint that most westerners are not allowed to pass. Since our group was favorable to the government and going for medical reasons, they let us through.

We then had to stop in the town of Lama to obtain the presence of armed escorts–the Bengalis are always afraid of insurgency. We proceeded on, first on paved road, then very bad, very narrow paved road, then dirt road beyond comprehension, and then we arrived at a river, across which the village of our destination stood. Almost nobody spoke Bangla, so we had to use two translators, the first to go from English to Bangla, and the second to go from Bangla to their tribal tongue.

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We set up several stations to examine patients and saw over 110 patients. We did stop for lunch. Most to patients had vague symptoms, such as abdominal pain for years, or knee pain, but we did see some real pathology. Almost all the kids have helminthic diseases, and so lots of anti-worm medicine was given. The main economic revenue was from growing tobacco, which we could see in various stages of processing. The photos also show us having lunch (quite tasty), and an important crop, tobacco, that the Brits are pushing on the Bengalis. Nancie also gave mid-wife lessons, and a little kid demonstrated that the birth-control pundits had already come through (those were not balloons). Also, note what the ladies have in their ears … large bells, plus flowers, plus, rolled up taka notes. This was a sign of affluence. All in all, this was a once-in-a-lifetime experience that few Westerners could ever imagine experiencing.
 
09MAY09- Safari Park  There is a “zoo” about 2 km south of Chabigang, which is a large open Safari that animals are kept in mostly natural surroundings. A relative of the head of the OR at MCH (Satindra, or Shoti) is an assistant to the veterinarian at the Park, so, we are able to get in for free and ride on the roof of our vehicle around the park. The Bengal tigers could be seen, but we moderately concealed, and thus could not be photographed. Also, there were numerous monkeys all over the park, some in cages, and some outside.

The top attraction was the ability to ride an elephant. They aren’t very comfortable, bareback. In the end, the zookeeper had a refreshment prepared for us, which is a coconut with a small square cut in it, and a straw inserted for drinking the coconut water. Coconut water grows on you and is totally perfect when you are extremely thirsty for quenching your thirst.

By the way, this sign was NOT in the zoo. Elephant crossings can be quite damaging to automobiles, especially on the main interstate, as this road is.
11MAY09 – A ferocious windstorm occurred this morning, requiring maintenance to turn off all the generators. This meant doing rounds at the hospital with backpacking headlamps, and in total darkness. The electricity goes off quite frequently, about 10-12 times a day, usually only for 15-90 seconds, though it could occasionally last longer. It is quite often to be operating and the electricity goes off, because not only do the lights go off, but the electrocautery and everything else goes off.
 
13MAY09- I did my first c-section under local and ketamine, with Dr. John. Kind of a freaky experience. We couldn’t give the mom a spinal as she was being a bit too theatrical. She had cervical-pelvic disproportion (the nurse mid-wives figure that out), and we needed to get the baby out. The baby boy had a bit of meconium but did well. It’s a nice technique to know how to do, as you must get the baby out before the ketamine gets to it.
 
15-17MAY09- The evening of 15MAY, Uttam invited me to speak with a group of young men and women who get together regularly at church. The topic was unity. I spoke to them mostly about the need for love, moral purity, and delight in getting together with fellow believers. The next day, Les and Deb Collins headed out with me and Betsy to Chittagong. We flew into Chittagong, but we were so dopy, we didn’t remember much of it. On the 16th, I went shopping to get a few more lungis for all the people who asked me for one, including Onkel Herbert and Hannes. I also picked up a load of spices. This area (BD) of greater India was the source for most of the spices of Europe, and we were able to take home many bags of the best spices, as well as one of our favorite treats, Chanachur, which is this hot, spicy finger treat you eat, sort of like the Pub Mix that you would get at Costco, but much tastier, and less fattening. We settled in at the Chittagong Guest House, then, Betsy and I had the honor of meeting Jim and MaryLou Long. Jim is the general director of ABWE in our area, and MaryLou was the director of the William Carey Academy. Both of them had the sweetest and most attractive personalities.

The next day, Betsy and I toured the William Carey Academy. It is a grade K-12 school, and probably among the top several best schools in BD. Thus, many of the wealthier families send their children to this academy. It has a mix of Muslim and Christian students and provides an avenue for the missionaries to approach the Muslims in Chittagong. Next to the school is the free academy, also run by the ABWE, but for the hopelessly poor children in Chittagong. It is with the deepest regret that Peni H. was gone and that we could not tour the free school. Lunch is served every day, and children are given an education they would otherwise never get in BD. After this, we did some more shopping, stopped at Moonshine for groceries, where a local beggar girl always gets a nutritious piece of candy from one of us.

Driving to and from Chittagong is another matter. The map shows no towns. That is because it is practically a continuous town. It was ceaseless mayhem. If one didn’t have a strong constitution, they would get a heart attack in 5 minutes on the road. It is 10 times worse than Jamaica, and 100 times worse than NYC. Chittagong has about 5 million people, yet we saw only one traffic light, which everybody ignored. Combine that with innumerable rickshaws and baby taxis, and you end up with pure mayhem. It is surprising we were able to get anywhere. For food, on the 16th, we had lunch at Bonanza, which serves BD national food. It is distinct from Thai, Chinese or Indian food, and unbelievably good. Why BD food hasn’t made it in the USA is a mystery to me. The next day, we had lunch at Pizza Hut. The pizza was not greasy and tasted quite good. We were pleasantly surprised by the quality of food in Chittagong. Then, there is Chanachur. It is the most awesome snack in the world; sweet, devilishly hot, low fat, wonderful to eat. Pick some up, if you find it anywhere.
 
18MAY09- The Operating room threw a good-bye party for us. We smiled a lot, but our hearts were in tears. Betsy and I will truly miss the many people, ex-pat and national, that we have met here. Many people have asked us if they could pray for us, as we return to America. We ask now, that you would specifically ask God to bring us back to Bangladesh.

19-20MAY09- The Trip Home. We actually left the night of 18MAY on the night bus, Green Line. It was a top-class bus, but a bottom-class road. The inability to sleep on busses and the insane way people drive in Bangladesh led to a very restless night. It was only by God’s grace that we arrived in Dhaka, now so tired, that when we got to the Baptist guest house, we had breakfast and collapsed, sleeping all day. For devotional reading that day, our Psalm was 65. Please read it. It was a perfect description of Bangladesh. First, it suggested that our only hope was in the Lord, which is true though rejected by most Bengalis. Then, it spoke about how the Lord makes the earth bring forth massive abundance for us. This was true in every small village, and in the large cities. Everywhere you looked, you would see rickshaws to large trucks laden with fruits, vegetables, and other edible produce, or animal for the market. The fruit variety was tremendous, including things I’ve never heard of, but the mangos, papaya, bananas, watermelon, Jackfruit, cucumbers, coconuts, and many other products were quite abundant. We will always remember Psalm 65 as our Bengali Psalm. That evening, we had an even more insane drive to the airport, with the driver acting as though he was possessed of the devil. The airport was rather quiet. I found another Bengali cookbook that also had English and purchased it. It was a reflection of the superb food we had gotten in Bangladesh. I would have thought that the food would have been rather unremarkable, but it was everything but that. Even when we ate in the distant tribal village, the food was quite excellent. It is very spicy, again, reflective that Bangladesh was the area of India where most of the spices in the past centuries originated. It is no wonder that Bangladeshi cooking demands multiple complex spices. I purchased a number of packages of spice but realized from the cookbook that there were many others that I could have picked up, in order to make an original meal. The cookbook also calls for many types of rice. In Bangladesh, as Dr. Kelley tells me, there are at least thirty types of rice, each a bit different from the others. I have never seen the type of rice that we typically ate in Bangladesh here in the US. Even the way they cook it is slightly different as there are flecks of spice seen in the rice (I hope that they weren’t actually insects that got into the rice!) There was even black rice, which is often used for dessert. There is a type of rice that smells (and tastes?) like excrement. Most of the rice types we had were quite good but were of a non-sticky variety. They would never eat the rice plain but mix in the halud (yellow) seasoning sauce with their hand, making a sticky ball that they then could eat with their fingers. I’d really like a copy of the recipes but could not find them. Meanwhile, back at the airport… There were a huge number of young men in the airport, together with large groups all wearing a similar piece of clothing. These were men going to Arabic countries for work. We forget that the largest export of Bangladesh is human workers. The flight to Doha went well, and we arrived in Doha at 11:30 pm, and due back at the airport at 6:00 am, so we canceled our hotel and slept a few hours in the airport. It felt good getting on the airplane, at last, to set foot on US soil. Except for a minor hassle where a female angry official at the baggage screen confiscated some of my AA batteries (Gottlosen Schwein!), we got on ok.
 
Trip People that we have met… I especially am overwhelmed by my friend Steve, a man who has earned the favor of God and man and blessed beyond measure. He is the most multi-talented person I have ever met, skilled in broad aspects of surgery and medicine, deft in the Bengali language, brilliant as an administrator, and single-minded in his Christian faith. I have never met a more brilliant, multi-tasking, an innovative person in my life. As an example, one of our patients had the port catheter break off and lodge in the right atrium. There was not a single procedural radiologist in the country that had ever retrieved such a catheter. So Steve did it in the OR. The snare would not grasp it properly, so he sterilized a colonoscopic grasper, ran it up the vein, and successfully retrieved the catheter. I was amazed. He and his family will remain forever in our fondest memories of an example of true giants.

Nancie is one of the most faithful nurses I have ever met, blessed with multi-talented skills as a nurse, but also a sense of honesty of encounter and practical saintliness that would offer any of the greatest saints a hard run for first in the kingdom. She would never fit the Hollywood image of a saint. She is the opposite of Mother Theresa. Dynamic, spunky, speaks her mind, no display of fake religiosity. Yet, as you get to know her, you realize that every drop of blood in her is of the sincerest Christian love. She oozes Christ. I’d vote for Nancy over Mother Theresa any day for “sainthood”. Yet, she can do anything and everything, including run anesthesia, pass chemotherapy, resuscitate babies and run a neonatal ICU, organize field medical clinics, and I’m sure I’m missing many other things. I have never met a nurse ever as competent as her in so many things, and yet so sweet and loving as a person. Equal with Nancy are the other nurses with whom I have developed the deepest appreciation, including Mary, Ruth, and Gail. Mary was the quiet but competent counterpart to Nancy. They lived (sort of) together, and richly complemented each other in personality, talent, and sweetness. Also, hyper-competent beyond any nurse I’ve ever met in the US, Mary never seemed to complain, but always maintained a delightful joyful countenance that exuded genuine concern for everybody she interacted with. All the nurses deserve a similar commendation for their selfless devotion to the mission, yet I realize that whatever I say will be matched infinitely greater by the God whom we give ourselves.

Nathan the holy man – I first met Nathan, when I was trying to resolve Mac connection problems. I have encountered one other MAC user besides Nathan, leaving only three Mac users in the entire country of Bangladesh. Real men use Macs. (Actually, real women also use Macs). Nathan finished a year of language study in Chittagong and is now honing his language skills, especially the Chittagonian dialect, by living with the natives in the village, in one their mud houses. He is a very bright but soft-spoken character. Last Good Friday he preached his first sermon to a small church south of here, said entirely in Bengali, and yet stirring a number of Muslims to ask him for a Bible to learn more about the Christian faith. His dedication and concern for the Bengali people are monumental.

As time went on, there were many others that we had gotten to know. Need I mention Frank and Alvis, quiet, honest, truly caring people, faithfully giving of themselves for the mission here, leaving a successful practice in Nebraska to serve Christ in Bangladesh.

Or Harold and Shaun, who we see jogging by the guest house every morning, always reflecting a tremendous joy, and infectious enthusiasm for working with the people of Bangladesh.

Bob and Chrissy had lived and studied in Tacoma, and happened to know friends of ours at the Tacoma Baptist School system; they had two children, and Bob had returned to Malumghat where he grew up. Oddly, their home church was in central Illinois, and they were quite acquainted with the people from the denomination of our youth. We were reminded of what a small world it was.

Bob and Chrissy were wonderful, in that their demeanor immediately put you at ease – none of this “hey we are lifetime missionaries and holier than thou” attitude, but people that had a genuine love for the Bengali people and willing the sacrifice most of the conveniences of Amerika to serve here. There are a number of other people I could mention with similar acclaim. A close “soul-mate” was Jason, whose presence made our entire stay a great joy. He was like Onkel Herbert in providing a wonderful stimulus for thought, he and his wife have thought processes that leave me wondering if we were not brothers separated early in life. Clinically, I’ve not seen a better surgeon than him who is just a few years out of practice, competent, cautious, making excellent decisions, yet quite skilled in the OR.  A quote from his ex-professor and a dear friend of mine, JV, stated  “Jason-he was my favorite Chief resident last year (yes, he just graduated a year ago). A very mature guy and he and his wife are committed to third-world surgery. Wow.””

There was Steve and Monika, arriving after we did, and here for a two-year stent, yet always cheerful and enthusiastic in the work at the hospital. Steve and Monika and their kids were a total pleasure to get to know. I wish that we could have had more time getting to know this couple.

It is with trepidation that I stop here since virtually every ex-pat Missionary that I met at Malumghat deserves a lengthy comment, and the ones mentioned had all been served an injustice by the brevity of my comments. Among all these people,, it would trivialize matters to say that they are giving their time for the gospel and for the people of Bangladesh. They are not giving their time. They are giving up their lives.  It is a different spirit that I could see driving them, a Spirit far greater than our own personal spirit. May God richly bless them in this life and the life to come. We came to Bangladesh hoping to bring a small blessing to those working out here, and instead, Betsy and I received the greater blessing from them.
 
I should comment on a few of the Nationals that Betsy and I go to know.  Many times, one of the Nationals employed in the hospital would drop me a small note thanking us for coming out, with no mention of any desire for something in return. There was Dr. John, a tribal native of the Tripura tribe (!), now a surgery resident at MCH. John was a total joy to work with, offering a wonderful educational exchange, both of us learning off of each other as we cared and instructed each other on the wards, in the clinics, and in surgery.

Then there was the administrative assistant Uttam, a bit younger, always happy, grateful for his position, always wanting to chat about America or about the Christian faith. Here he is with Betsy, singing on the beach.

There was Lucky, an older single tribal person, who one day had all the ex-pats over for dinner. He works in the hospital store, being “lucky” since he gets an air conditioner in his office. He is a total joy to see every day. The people of Bangladesh tend to be very relaxed, and definitely not time watchers. That can be a touch frustrating, as an 8:00 o’clock meeting typically means 8:30 or so. They have been a joy to serve in spite of the nuances of their character.
 
I hope that in the upcoming month, I will be able to touch base with my American (and German) friends to show the photos of our trip. Photos are woefully inadequate to convey the actual character of our trip. It misses the smells, the tastes, the touch, the breadth and depth of the real experience of Bangladesh.

It was not easy for me to decide exactly how to do the reports on the trip to Bangladesh. It was impossible to publish a webpage update while in Bangladesh, unlike while I was in Germany. Thus, I created a large Bangladesh report in the “Travel” section. Here, I offer an overall assessment and reflections on the trip. First, you may be wondering about the title. It means you all are our friends. After such a long episode of silence and absence of correspondence, many of you felt that we had abandoned you as friends. That is simply not true. There was a combination of 1) poor internet connections, 2) mac incompatibility, 3) inability to download appropriate programs to connect my mac, owing to large program size and slow internet connections, and 4) suspicion that the Bangladeshi government was keeping an eye on correspondence. It was not that we felt that we might say something that offends our Bengali friends, but only that we wished to avoid even a remote suggestion of wrong-saying or wrong-doing. Thus, our silence.

So, reflections on our trip. Many of you have written to us, acknowledging the sacrifice that we have made to serve the Bangladeshi people. I guess that Betsy and I don’t really view it as a sacrifice. What were our motives? I hope they were genuine, in having a love for the people we served. I certainly have a much deeper compassion for reaching out as a Christian to the Bangladeshi people and other unfortunates in this world. Perhaps there was also this curiosity, or spirit of adventure. Perhaps Betsy and I were “absolving sins”. I hope not. I leave with two thoughts. 1) I have the most extreme respect for Memorial Christian Hospital, and their ability to not only provide medical care to the mostly Muslim community that we served but that they were also able to deliver the message of salvation only through Christ, in a consistent and honest fashion. 2) I have acquired the utmost respect for the long-termers, who faithfully work year after year, mostly unthanked, mostly unregarded, yet they serve without grumbling or complaining, delivering medical care and spiritual hope with joy and gladness. For this reason, I have listed a few people in the trip section that have especially been an influence to me.

But, what about Bangladesh? My biggest surprise was the number of people in this country. When you look at a map of our area of stay in Bangladesh, you see only two cities, Chittagong and Cox’s Bazar. Yet, except for a few rice paddies and rivers, it is almost wall-to-wall people between those two towns, with many large villages between. And, Chittagong has a population of about 4-5 million, Cox’s Bazar of a million. Dhaka itself is roughly 15 million people. The country has about 160 million people, in a state the size of Wisconsin. It is the equivalent of moving everybody east of the Mississippi into the state of Illinois. If you look on a map, you will not even see the town of Chabigong where our hospital sets, yet the 30-mile radius around the hospital has approximately 6 million people. Except for the Chittagong hills, which are not terribly high, it is essentially flatland and a giant vacuum for typhoons. In spite of the crowdedness, they grow 95% of their food, and unfortunately, also grow a poor quality of tobacco, and poor quality rubber (the rubber starts out okay, but poor standardization of processing ruins the quality of the product).
 
There are four main religious groups in Bangladesh, being Muslim (approx. 90%), Hindu/Buddhist (10%), Animists mostly found in the Chittagong Hills (?%),  and Christian (less than 1%). Buddhists are mostly located in the strip of land south of where we are. Hindus live sporadically throughout the country but tend to stick to their own sections of town, living together. Wealthier Hindus will also own land in India, owing to a serious lack of trust of Hindus for their more dominant Muslim neighbors. Muslims seem to dominate the scene. Many mornings, they will wake us up at 5 am with prayers roaring over the loudspeakers (their god is now slightly deaf), or late at night on Thursday. They tend to be reasonably pleasant folk as a whole, and we have found many of the Muslims to be quite enjoyable.
 
But, we also see the problems of the Muslim religion. It is definitely a man’s religion, and the wives are often treated no better than dogs. Besides an obliteration of their personality through the Burkha, they are expected at all times to remain at home, while their husband socializes at the local tea shop or town square. We have seen many instances of husbands dumping their wives when they fail to deliver the desired boy child. Joy seems to be totally absent from their religion.  It’s hard to not imagine that religion maybe play some role in the prevailing morals of this country. When one venture to the wealthier Muslim countries, one doesn’t see the situation any better. Indonesia, Saudi Arabia, United Arab Emirates, and many others have no freedom of religion, and Muslim converts are usually put immediately to death. The situation is only slightly better in Bangladesh. We get many patients in our hospital from Saudi Arabia. Bengali workers will go to the Middle East with the lure of money. It is not uncommon for serious injuries to occur to these migrant workers, since the Bengalis are given the worst and most dangerous jobs. If they have any life left in them at all after an injury, they are usually thrown on the next airplane back to Bangladesh. If you think that the Saudis have any value for human life, think twice. The appeal of their religion remains a mystery to me. Muslim is the only religion that teaches their children to hate at birth. The more religious the Muslim is, the greater the scowl you get from them on the streets. Yet, even the most radical bitter Muslim will soften after a time in our hospital, seeing that we truly care for them, and have no intention of shoving religion down their throat. The less religious will often return a smile once they realize that you are looking upon them as a person and not just as a “Muslim”. It is certain that unloving Christians have done more harm than good.
 
Again I am NOT saying that all or that even the majority of Muslims are mean and nasty because we have become friends with many kindly Muslims, such as the Mayor of CB, though they often tend to go unnoticed sitting quietly on the side.
 
Hindus tend to not exhibit the passivity that would be expected from their religion. They can be violent when they are in the majority. Sadly, we have seen this behavior even in Christian countries. All in all, there seems to be a common behavior of man, in spite of their religion. This confirms the Christian doctrine of the total depravity of man. Man cannot escape their “mannishness” through religion. It is sad to see that as the west escapes from its Christian base, we are reverted more and more to the prevailing behavior and moral base of the rest of the world.
 
The tribal people are hated by all, especially the Muslims, which leads to the tribals having a very poor image of the religion that dominates the country. This leads to serious unnecessary oppression of the tribal people by the Muslims, increasing the hate factor between the two peoples. I find the tribal people to be the most friendly folk, and there are many tribals at the hospital that we’ve gotten to interact with.
 
I suspect that there will be a day when white ex-pats will be asked to leave the country of Bangladesh. That day is possibly soon, as economic jealousies and racial tensions, as well as Muslim fundamentalism, intensifies in the country. I pray that the Christian Nationals in the country have the fortitude to stand for Christ, even when it means persecution or death.
 
What have we accomplished personally by the trip? I was able to catch up a little on my reading, going through 33 books on the trip. We (Betsy and I) had our first real experience with third-world medical missions. We had much time together in devotions, and in really thinking about our plans for the future. It was a great time to escape our culture and see the world through the eyes of a non-European. It was a time that we hope to repeat. We will probably keep our trips a little bit shorter, but hopefully, will be able to do at least one trip somewhere each year. And, hopefully, that will mean returning to Malumghat more times in the years to come. We have new friends on the complete another side of the globe, that are dearer than most of our acquaintances (friends) at home. I’m not sure we will ever be the same, once we return home.
 
Coming home has had minor challenges. It’s called foggy brain syndrome (jet lag). I’ve never been hit worse with it. It has disoriented cay and night for me and Betsy to the extreme degree so that we are getting barely nothing done. We’ll have to try to figure out a solution.
 
I should be posting additional thoughts and reflections on our trip in blogs to come. This whirlwind trip left us with many questions and thoughts that we will need to explore in the coming months. Our next medical mission in coming up in late September through November, and hopefully, a restful summer will provide more time to meditate and prepare ourselves for the work ahead.
 
For a blow-by-blow account of our trip to Bangladesh, please turn to the section on “TravelBlog”. I have tried to be discrete in my discussions and to not leave anybody out. Considering the technical difficulties that I had, I may have inadvertently said something too strongly or offensively or failed to mention somebody. Please graciously drop me an e-mail if you feel that have noted a website problem, and I’ll do my best to immediately correct the issue.  Note that I have divided the Bangladesh account into three sections to allow for easier editing and downloading.
 
I will be giving slide shows of various other aspects of this trip, such as the work at the hospital. I would normally include it on the webpage, except that it would be photo-heavy and quite laborious to download. Also, I am using iWeb, which is acting upon me and behaving unbearably slow. It took me about 36 frustrating hours to accomplish what usually takes me about two in making up this website. I’ve figured out pretty much what I’ve been doing wrong, and will be re-designing this site for more speed. In the meantime, it is forcing me to do a smart move, which is to reorganize my website with a “blog” style for all my entries. This will allow you to comment on particular book reviews, trips, etc. You should see this organization on my next post.