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!