The River's A'Rising

We looked across the river last night from the deck of our ship and realized that the neighboring Char we had just recently visited (AKA Coney Island) was partially submerged.  The very place we had parked our boat and walked ashore was no longer.  We also noticed,while reading on the deck of our houseboat that, for the first time, it began to rock back and forth.  It seems that a combination of rain and melting glaciers from the North have caused the river to rise over 3 meters in the last month.  Soon the water will be high enough for the hospital to move on from the island where it has been docked for over a year.

There have been quite a few rain showers the last few days.  We managed to squeeze in a short run between storms this morning, after which, Courtney was approached by a couple of local boys outside the houseboat.  Much to their delight she pulled the headphones out of her IPOD and began to play them some music.  What do you play for Bengali 8 year olds who speak no English?  Billy Joel, of course.  'We Didn't Start the Fire' was, as always, a big hit.

US Healthcare, Maybe Not So Bad Afterall

Yesterday we took a trip to the nearest government hospital--about 30 minutes by boat and then 2 hours by car.  And, only one flat tire along the way, par for the course.  It was an eye-opening experience for us both.  When we arrived we were greeted by the chief of anesthesia who offered us some coffee and then ushered us to the pediatric ward.  We like to keep these blogs light, but there was nothing light about what we would see.  First a brief walking tour through the 'wards'.  The ward was a large communal room with high ceilings, dirty floors and foul odors.  It was divided into sections by 4 foot concrete walls.  There was the neonatal unit, a series of filthy cots each occupied by a tiny baby wrapped in dirty blankets, typically a mother and some other 'attendants' as well.  Some babies had feeding tubes in their noses which were manned by the mothers themselves.  Others with tiny IV's.  Most of these babies, we learned, were born at home and then brought to the hospital for problems that are all too common in this country-infection, low birth weight, prematurity.  The young children's ward was another series of dirty cots where kids with pneumonia, sepsis, TB, skin infections, even leukemia, received treatment.  The remainder of the wards for various age groups were more of the same.  On our rounds with the head of the pediatric division we learned just how dire the situation is.  As we walked he explained how the hospital is run.  Although this was a government hospital, almost nothing is provided spare the beds and some blankets.  Once a diagnosis is made the doctor informs the parents what is needed, antibiotics, chemotherapy agents.  And, the parents must go out and buy the medicines to bring back to the hospital... if they can afford them.  We felt terrible for the patients but also for the physician who seemed at his wits end.  Towards the end of rounds we were asked a poignant question, 'if pressed do you think you could work here?' 

We were relieved when rounds ended and it was time for us to leave.  We had been looking forward to our escape to the mainland as an opportunity to buy some bananas and perhaps some other goodies.  Jasim guided us to a local fruit stand where, we not only procured bananans, but a cluster of coconuts.  The shop keeper promptly pulled out a large blade and chopped the top off of one and popped in 2 straws for us to enjoy.  Jasim could not believe that in the US coconut water comes in a box for 4 dollars instead of 25 takas (roughly 40 cents).

We arrived back at our boat.  We were to have another interesting meal...goat.  A few donors to Friendship were visiting from Sweden so it was considered a special treat, no parts were spared.  We had joked about fish and chips the day before and to our surprise a few "french fries" accompanied our meal.  These days, that's enough to make us happy!

Happy Bangladeshi Independence Day

We woke up yesterday morning and wandered over to the main boat for breakfast where we learned that it was Independence Day.  "Celebration?" we asked.  Apparently, there would not be fireworks, but we did manage to convince the boss that this called for a night of  'improved diet'.  We would look forward to it all day.

After dinnner, as we were relaxing enjoying the breeze in the main room, the crew began to close all of the doors and windows, despite our protests.  Apparently we were about to be treated to our first "cyclone."  High speed winds whipped walls of sand around and the current managed to rock our little houseboat.   The whole storm lasted about 30 minutes then blew out just as quickly as it blew in. 

Who Doesn't Love a Bideshi?

Lets go for a walk.  Seemed like an innocent enough idea.  As we made our way across a field of tiny onions we were approached by a 12 year old girl and her two young siblings.  "I am Misthi" she proclaimed, followed by "I am Rufti" and "I am Mulani" as she pointed to her brother and sister.  They deftly began to guide our walk towards their village, prompting us to sing and dance with them along the way.  We entered a maze of chicken coups, cow troughs, and animal families (nursing goats, tiny puppies).  Our guide scurried away and returned with two plastic red chairs which she placed in a clearing between two houses.  She gestured for us to sit and promptly we were surrounded by a herd of children.  Some more dancing ensued as each child tried to be at the center of our picture/video taking.  We attempted to make an escape but the children had other ideas.  It was time for us to visit the adults who were working in the field.  We were less guided but more pushed/prodded by the hoarde of children now in charge of our fate.  We paid a quick visit to "Auntie, Uncle, and Abba" and then decided to return to the boat.  We had plenty of company for our walk back and finally parted ways when we reached the boat entrance.

Making foreigners sing is apparently a national tradition.  On our visit to "Coney Island" the requests came frequently and we ultimately relented.  We gave them a version of the "Star Spangled Banner" that would have made Roseanne Bar proud.  We don't think we will be getting a call from Bangladesh Idol.

7-Up Never Tasted So Good

On Tuesday we completed our training course for the paramedics of the area, teaching them about diarrhea and dehydration and how to manage it.  This was one of our major goals for the trip.  Our trip falls at the tail end of the dry season, when diarrheal illness is rare, however we have learned that during the rainy season it becomes a widespread and potentially life threatening problem.

We inadvertently caused a minor commotion over the last 2 days.  With the help of a microbiologist who is also visiting from Mt Sinai we have discovered 2 cases of malaria.  We at first did not recognize the significance of our diagnoses, however malaria is considered essentially nonexistent in this area and is associated with a major stigma, so everyone was very excited.  Needless to say we continue to take our malaria prophylaxis.  For Tom this is less important as he has discovered a fool-proof bug repellant--  Stand next to Courtney at all times, the bugs love her.

Yesterday the crew was very excited for lunch.  We were told before lunch that today would be a day of "improved diet."  We wondered...what could this possibly mean, red rice instead of white, spicier curry, extra tiny boned fish???  As it turns out it meant...fried rice, peanut sauce chicken, flavored hardboiled eggs and delicious eggplant.  Then, to our surprise, they brought us dessert...SODA!!!  After two weeks of room temperature water, we both agreed it was the best 7-Up we had ever had. 

Still full from our feast we decided to accept an invitation from the 'lab' crew to take a boat trip to a nearby char.  Boat was a generous term, maybe wooden raft with motor would be more appropriate.  A short trip across the river brought us to our closest neighboring char.  As we climbed off the boat our US compratriot proclaimed, 'It's like Coney Island!".  Sure, if coney island is a low lyling sand bar inhabited only by giant crickets and tiny frogs.  We checked, there was no Nathans.

Don't Drop the Soap...

As our fame continues to grow its becoming almost impossible to leave our yacht.  While reading on the sundeck of our lovely home away from home, a group of village children gathered 20 feet away from our boat and yelled "Asalum Walekum Bideshi!" over and over again until we waved.  They were soon after joined by an adult who insisted on some photos.  Later during our evening cricket game the paparazzi multiplied with several camera-phone wielding men documenting our every move. 

Courtney has finally found her demographic.  She has more friends now than ever before, who cares if they are in the 2-10 year old range.  If only they had facebook.

The joys of having a hole in your bathroom floor which doubles as your shower drain and urinal can come crashing to a halt in a mere second.  Courtney finally discovered the appeal of soap on a rope when her bar disappeared into the river after taking a bad bounce.  Luckily we had a spare. 

Finally topping our list of things we would love to bring back with us...the hospital boat's electric fly swatter.  Picture a tennis racket plus 20 volts.  In case you were wondering, flies make a lovely snapping sound while their tiny gnat friends simply disintegrate.

Anybody Got a Light???

With three runs into the village under our belts, we have become a little more daring.  Today, we decided to take a new route and were met by a little girl carrying her baby brother.  As we ran past her she shouted a greeting.  Tom astutely inquired, "did that girl just yell holla at us?"  No Tom, I believe that was hello, I doubt they teach ebonics as a second language here!

We may have underestimated Jasim.  This morning Tom met him in the hallway on the way to the shower.  Jasim explained he wasn't feeling well, he had a fever.  He stated the reason for his fever was the cold shower he took yesterday.  To which we only had one thought...where the hell is he taking hot showers???

After work we were beckoned by Manann to play cricket with the rest of the boat staff.  This quickly turned into a game of futball (soccer you crazy Americas).  The game ended when Courtney's new best friend, a precocious 2 year old deftly crept up to the game and stole the cigarettes out of our goalies shoe and ran off with them.  Fortunately he forgot to take the lighter...

Goodnight!

Its OK...She's from New York

After a brief hiatus we are back to the blog.  The last few days have continued to be interesting.  Mannan, who is the head paramedic here on the boat returned.  In another 2 days the paramedics from the boat and from the surrounding chars (pronounced, chores- which are the islands in the river here) will be coming to hear us give a presentation on diarrhea- cha cha cha.

Yesterday we went for a run around our little char.  Venturing further than we had been before we made our way into a village.  Wherever we go we create a spectacle.  We are especially popular among the bengali children who love to run out and shout "bideshi!" (which means foreigner) as we run by.

Today we were brought to one of the other chars to see their clinic, which is associated with friendship.  This trip required a 2 hour boat ride.  Upon arriving we were faced with the challenge of actually getting onto the island.  Our fearless captain brought us up alongside the char where the sand shore line was approximately ten feet in the air.  He took out a wooden plank and wedged it into the soft sand on a gradual incline about 8 feet up.  The precarious nature of our walkway did not sit well with Jasim who was very concerned about Courtney crossing.  To his protests Monir (our other translator) replied, its OK...she's from new york, which promptly ended the disagreement.  We guess in Bangladesh they believe what they say, if you can make it there you'll make it anywhere!

A short walk later we reached the village.  We were shown a building where women were being taught how to weave, the local clinic, and the surrounding residences.  For the highlight of our tour we stopped in at the island school where we were treated to a rousing rendition of twinkle twinlke little star performed by the school children.

After a little over an hour it was time to head back to the boat.   Obviously, no trip would be complete without some misadventure in transportation and this time would be no exception.  A mere twenty minutes from home (so close!) our propellar sputtered and suddenly we were grounded.  No problem, that's what our trusty bamboo pole is for, it does not, however, fix a propellar that has snapped in two.  Luckily, any trusty captain carries a spare.  Unfortunatlely, by this point we had drifted even further towards shore and our bamboo pole just wasn't cutting it.  In an effort to help, Monir rolled up his pants and jumped in to the dangerous calf deep water only to stumble backwards and land on his back.  Soaked and flustered he tried to pull himself back on to the boat. Five minutes and a hilarious flip video later he scrambled back aboard.  Guess how long it took us to show that video to all of the crew when we finally got back...where we learned 'sold out' translates just fine.
 

Brown Sugar

Two days now completed here on the Friendship Hospital Boat.  We are staying on a house boat that is docked with the hospital.  Sharing the houseboat with us are our translators, a gecko, and a cockroach (may he rest in peace). 

Here we are "expert" in all things medicine.  Forget that we haven't seen anyone above 20 years old in 3 years, our geriatric skills are being dusted off.  We are also seeing plenty of kids as well.  Some of them have put our diagnostic skills to the test.  Fortunately, as experts, whatever we say goes, and when we are faking it, no one is the wiser.  Unfortunately, we have also found that sometimes we do know the answer but knowing the answer and solving the problem are two very different things here.  Yesterday we diagnosed a 4 year old girl with kidney disease, only to realize her father was too poor to get her to a hospital.  Today we saw an 18 year old who has chronic lung disease but had never been diagnosed and now has lungs that hardly work.

On a lighter note we LOVE rice.  We have no idea how we ever had breakfast/lunch/dinner without it.

How's this for lost in translation... Tom was seeing a 6 yo boy who was having some constipation.  Having learned very quickly that low cost solutions are best he went for a tried, true and cheap solution.  He suggested using some brown sugar.  A well timed phone call had pulled tom's translator from the room.  With blank stares all around him tom found help from Jasim (our broken english translator).  With Jasim on the case he led tom directly to the lab where they asked if this brown sugar was a blood or urine test.  When tom explained it was something you eat, Jasim finally nodded in understanding.  Who knew that 'brown sugar' means 'hashish' in bengali.  Apparently, everyone but us.

The Wheels on the Bus Don't Go Round and Round

Yesterday we had the opportunity to visit the main hospital in Dhaka, where we discovered that Courtney's black cloud is transcontinental.  Within an hour of arrival we were running a code in their "ICU".  It was a 40 something year old with HIV and possibly TB.  Luckily we see a lot of that in the NICU.

We were then whisked away on a tour of the rest of the hospital.  Our next stop, the short stay diarrhea unit.  Here the cots were lined up as far as the eye could see with mothers attending to their sick children.  Noticing that all of the heads of the beds were slightly elevated, tom turned to courtney wondering out loud if there could possibly be some neurological benefit.  Courtney astutely pointed out "shit rolls down hill tom."  All of these cots were specially designed for diarrhea - hole right in the middle with bucket below awaiting any deposits.  Then we were off to the ER where they tallied 60+ patients per hour (eat your heart out Adam Vella). 

Today we were scheduled to make our journey to the boat.  Journey may be an understatement.  With two false starts, our third bus was the charm after a wheel replacement and some 'tinkering' with the speedometer.  Thank GOD the horn worked.  Our ride would be one of luxury and comfort, or rather a 10 plus hour ride in a non air conditioned bus as our trusty translator informed us the a/c buses only run at night time.  However, just when even Tom had had enough, horns a blaring we arrived at our destination, Chilmari. 

A short ride brought us to the shore where two tiny men (Tom continues to pride himself on being the tallest man in Bangladesh) threw our suitcases on their heads and carried them to the river boat that brought us through the fog to the Friendship Hospital.  And here we are, time for dinner.

Lanes optional, Horns a must

We have arrived! After a long flight with a stop over in dubai we have made it to Dhaka (the capital of bangladesh). 

Our first task, getting to the office of Friendship.  We were picked up at the airport by our translator Jasim.  He ushered us into a cab who then put all NYC cabbies to shame.  Roadways shared by bikes, cars, buses, and rickshaws (more on them later) where the lanes painted on the ground apparently serve as mere decoration.  When approaching another car/bike/rickshaw who is taking half of your lane while you take up another 2 simply honk and keep on going.  Pedestrians challenge themselves to a human game of frogger to keep things from getting boring.  Against all odds we arrived safely at the office where we were briefly oriented and introduced to our second translator, Monir.

In store for the afternoon, a trip into the village for our first meal in Bangladesh, Pizza.  We were 'not ready' for bangladeshi food yet, one has to acclimate first.  We were, however, apparently ready for our first ride via rickshaw. 

There is no way to really do justice to riding on a wooden carriage (extremely generous) with three people when meant for only one.  With every bump the six inches of wood we were sitting on seemed to laugh at our clinging.  We were now experiencing the lanes optional scene from the rickshaw perspective fortunately our driver was armed with a bicycle bell. 

Exhausted from jet lag and our first bengali language lesson we called it a night.

We're going to Bangladesh and we're bringing an...Apple...

Hey Everyone!
So whether you already knew about our trip or this is the first you are hearing about it, we are heading to Bangladesh!  We were really just looking for an excuse to get out of the city but while we are over there we will be doing some medical work.
We will be staying on a floating hospital and will be teaching Pediatrics to the medics on the floating hospital and in the surround communities.
Here is the link to the organization we will be working with if you are curious... http://friendship-bd.org/

Hopefully we will be able to keep up a somewhat regular posting here to let you know whats going on in Bangladesh.