Christmas in Bangladesh

Walking through through the small but crowded market on the other side of the street from the hospital, our presence invited stares from young and old alike. Cell phones came out to take pictures and videos of the strange white visitors on this morning of December 25th. For the majority it was just another Thursday, but for a minutely small percentage of this country it is the day to celebrate Christmas. Finding ourselves among that group, we made our way through the market and then the rice fields, some green with life and others brown with the leftovers from the most recent harvest. We then walked through the brick road that goes through the town, a crowded area with brick, mud, and bamboo houses all mixed together. Arriving at the church, we found a crowd of people mostly in brightly colored saris, newly bought for the occasion. With the women seated on the left and the men seated on the right, the left quickly filled up and overflowed into the half-empty right side. The significantly larger number of women was an indication of who has responded to the invitation to Truth. We enjoyed the service, although agreed that it will be infinitely more enjoyable when we can understand some of what is being said.

After a two hour worship service, we left in order to particapate in a common Bengali custom, visiting friends. A community affair, Bengalis celebrate Chhristmas by visiting one anothers' homes. Ducking down to avoid hitting our heads on the low doorway, we entered the home of a hospital employee. We were shown around the modest two-room mud brick home and it's accompanying outdoor cooking area. When it was time to eat, we were served a spicy chickpea dish with Bengali sweets. As the next group of visitors were waiting, we were served Bengali spiced tea to finish the meal. With snacks eaten, the next group waiting, and a child who had swallowed a pin waiting at the hospital for the doctors to see, it was time to go. Offering the Bengali Christmas greeting, Shuvo Boro Din (literally "happy good day"), we thanked our hosts and left.

Bekah

Salwar Kamiz

Grace proudly modeling her new salwar kamiz that Bekah bought in the bazaar.

A Few Pictures...again

Grace enjoying cake at a Christmas tea party

Tea time with the OR staff

Fishing boats that fish the Bay of Bengal (taken from the hospital property)

Life and Death at Malumghat

I'm on call this weekend, which afforded me the opportunity to get involved with aspects of medicine that I'm not exactly used to. Pediatric diarrheal illnesses are straightforward enough, but malaria, OB, seriously? With C-sections, I'm following the see one, do one, teach one model. After assisting with a section on Friday, tonight it was my turn. I did one skin to skin as they say. Anyone need a lesson now that I'm ready?

This week we also lost a child. A 6 year old with 3rd degree burns covering 25% of his body. His story is sad enough to break even the hardest heart. His family's village burned to the ground last year, leaving his family without anything at all. A couple of weeks ago, his twin younger brothers were killed in a freak accident. After the funeral, it is tradition that the family serve a meal to all those that attended the service. As his mother was bring out the meal, she stumbled and spilled the boiling water onto him. His clothes, soaking with boiling water, were difficult to remove and got caught around his neck, resulting in very deep burns to his face. As we excised the burns early this week, we found that an invasive infection had caused all of the soft tissue to become necrotic down to the bone. We proceeded with radical debridement but the next day it was apparent that we were fighting a losing battle as all of the tissue surrounding the excision was dead. He died the next night and joined his brothers were there is no more suffering. For his parents, the suffering continues.

A Few Pictures...will have to wait

I've been trying to upload some pictures for the last hour and a half, but we are at peak internet usage times and to say its been slow would be charitable. I'll post some pictures when I can.

A note from Grace

There have been a few questions about my experience on our big trip. I've mostly had a really good time. I've been tired and less agreeable than usual but that's getting better as I get over jetlag and adjust to the new time zone. It's like having one huge yard to play in, with a great sandbox and swingset that I've already spent hours playing in. It's a good thing mom brought a bunch of clothes for me. I'm having so much fun and get so dirty that I get to wear 2-3 different outfits each day! There are so many things to explore here! Unfortunately I've had a few time outs because Mommy doesn't seem to think I should explore out of her sight. Silly Mommy, doesn't she know that I'm just checking things out?

The most frustrating this here is that everyone wants to touch my face or pet my hair. And most of them don't look at all like Mommy and Daddy. I find this extremely annoying and either bury my face in mommy's shoulder or try to slap or kick them away. Mommy doesn't seem to approve of this, but it's the only way I know how to get them to leave me alone. I'm used to a lot of attention, but not this kind.

Grace

Mashi

For the sake of honesty and I feel compelled to share a bit of the negative. Desiring to actually contribute to something here and find a bit of relief from running after an incredibly curious and active two-year-old, a long-term worker tried to help me find an ayah (nanny). The first day was to be a trial run and what a trial it was. The day began with Grace becoming agitated as soon as she saw Mashi (kids here call their caretakers "auntie"), running from her and back to me. With advice from another long-term worker I decided that I would need to stick around for the first part of the morning, so I, along with the lady I was paying, watched as Grace played in the sandbox. Mashi even tried to push Grace on the swing, but she would not allow this and became angry. Mashi and I soon amused ourselves by hiding behind the swing and seeing how long she could push Grace before Grace realized it was her and not me!

I attempted to redeem the time by asking Mashi to teach me the colors in Bangla, but the rest of the day ended up consisting of more of the same, with Grace becoming increasingly more agitated as time went by. I did get a small break when, after I put her down for a nap, the poor lady sat and walked around, listening for Grace to wake up. Fortunately for Grace, I returned before she woke up from her nap.

Feeling horrible about it because Mashi had done nothing wrong, the first day was to be the last. I couldn't justify making Grace this uncomfortable in order to fulfill my desire for myself. I will add this to the list of "cultural experiences," realizing that not all will be positive.

On a more positive note, after two meetings with a Bengali tutor, I am well on my way to speaking Bangla. I can now pick out the subject pronouns and words such as child, son, daughter, good, and . Grace is constantly asking, "What his name be, mommy?" Therefore, the first phrase I asked to be taught was, "What is your name?" "Apnar nam ki?" in transliterated Bangla. I have been encouraged by realizing that the setup of this particular hospital and it's related activities should allow for me to learn to communicate even while taking care of Grace, a particular challenge that I have feared.

My next challenge is to practice ordering at the cantina (hospital cafeteria). I've tried twice so far with varying lack of success although the food has been good both times.

By the way, for our non-medical readers, Jon's lists translate to many basic general surgery cases, a few heart wrenching stories, a bunch of new things not seen in the U.S., and a few really crazy things, all of which he finds fascinating and every one a dark situation in which he feels drawn to bring the light of Truth.

Bekah

Victory Day

Happy Victory Day! Tuesday marks the 37th anniversary of victory in the war for independence in Bangladesh. A time for great celebration in this country. It normally means a day off for everyone, however, we had a full day of operating.

Monday we did 5 cases

• modified radical mastectomy on a man with breast cancer
• hernia repair
• open cholecystectomy (removing gallbladder) with drainage of half a liter of pus from above the liver
• burn debridement and grafting
• cholecystectomy with common bile duct exploration

Tuesday was a day for emergency cases only because of Victory day.

We started out with an a patient with a perforated esophagus from Boerhaave's syndrome followed by a burn debridement, a C-section, and a fasciotomy of foot (!) compartment syndrome.

Rounds, Clinic, and a Wedding Feast

Rounds at 7:30. We saw only 6 patients. Its been slow because of the holidays. The patients include an electrical burn, a scald burn, resolving acute cholangitis, resolving acute cholecystitis, diabetic foot infection and a femur fracture.

In clinic patients come fast and furious. A small sampling of cases seen

• depressed skull fracture


• locally advanced breast cancer


• inguinal and incisional hernias


• tonsilitis


• parotid tumor


• malignant fibrous histocytoma

In the afternoon, we had ortho clinic - wide range of cases from perinatal elbow dislocation resulting from birth trauma to nonunion of midshaft femur fractures.

Finally, this evening a wedding. The groom is a former patient of Dr. Kelley's who was quadraplegic after a c-spine fracture who regained complete neurologic function after reduction and fixation. He now works at the hospital as a janitor and is a very happy groom.

The Fog

During a moment of down time I can't read, something I'm normally deperately trying to do, because once I start I will no longer be reading. Instead, I will be sleeping. The fog of jetlag is heavy, granting relief early in the day (today at 3:30 am) but settling over one's mind and body by early afternoon. As the day progresses, the fog thickens, impairing one's ability to comprehend and remember. There is so much to see, smell, taste, hear, touch, and sense but full appreciation of these experiences must wait for a later time.



Jon, in an opportunistic manner, took advantage of the situation to share, gently and unaccusingly of course, that this is the post-call feeling that leads to occasional inattentiveness and unresponsiveness at home. Ok, so he may have a point; but I'll have to think about that.

Bekah

We made it!

4 flights, 36 hours, 3 countries, 1 tired girl.

more information soon