Chaotic and Selfless (Day 5)

Today, I saw my life flash before my eyes. Yes kind of dramatic for an opener but today was intense (definite understatement). We marched for National Language Day with the World Solidarity Movement. As foreigners and people here to support GK we wanted to march alongside the Bangladeshis to show our understanding - that we knew the work and pain that went into gaining their freedom and keeping their national language. And even if we didn't complete understand all that it has taken we wanted to offer this small symbol of support. So we drove to Dhaka at 5am, put on our funny looking hats with words written on them I couldn't understand, and started walking towards the National Language Monument. We weren't the only ones with the idea. Soon I met up with Nazmul Nahar and her good friend. The three of us somewhat parted ways with the World Solidarity Movement group since Nazmul was quicker at weaving in and out of the crowd. After walking for 2 miles or more we stopped in the crowd and waited our turn. I was told we were only a few minute walk away from the monument and we would only have to wait a little while before getting the chance to pay our respects at the memorial. We stood in the crowd and waited an hour. Then a bit more. It didn't seem we were moving at all. Luckily I am not claustrophobic either. Imagine thousands of people marching in from multiple streets and all converging on one main street maybe the width of four cars. We were right in the middle and I couldn't see any glimpse of the memorial up ahead. Nazmul, her friend, and I passed the time by making jokes, they told me about their culture and the importance of the day, I snapped photos and filled them in on my life. Then all of a sudden Nazmul brought us back to the present. Out of nowhere I looked up and the thousands of people in the street ahead of me were facing the opposite way, facing towards us instead of towards the supposed monument. And they were moving, they were running straight at us. I froze. Deer in the headlights, panicked, I just stared at the crowd running. Nazmul pushed me to the side and forcefully yelled at me to run... and to run to the side. With the encouraging push I followed the flow of the crowd to prevent getting run over. As I was pushed and collided with people my heart was racing. It wasn't the power of a pushing crowd that scared me, but the fact that this scene looked exactly like the ones on the news. The ones where riots in the Middle East go bad and people are running through the streets... running away from very real, and very serious threats. I had no idea what or who I was running from, where Nazmul, her friend, or the rest of the World Solidarity Movement was, and I was pretty sure I was going to pee myself. I managed to make it up on a side walk as I saw people jumping the high fences that lined the street. I looked at the height and debated scaling the wall myself for safety, when just like that it was over. The crowd had stopped running, people were standing in the street again searching for family and friends. Injured people were being tended to, and the large white World Solidarity Movement flag acted like a beacon for me to find my group. I later heard that all of the commotion was indeed caused by a simple scare. The prime minister had showed up to pay respects at the memorial and apparently when the police shoved the crowd back as a protective action they did so a little forcefully. The front of the crowd became scared with the forceful pushing and turned and started running in the opposite direction. The wave effect took over and by the time it reached us 5 or so blocks back, the intimidating level had escalated. While I was fine, only a bit shaken, I found out that Nazmul had gotten pushed down and broke her knee cap. When I found her being tended to by medical students while she waited for the Red Crescent emergency van to pick her up and take her back to GK she looked to be in a lot of pain. I felt horrible. I know she could have easily been pushed no matter what, but her selfless act of standing still a second or two longer to push me out of the way and give helpful advice of running towards the street edge to get out of the crowd I will never forget. She had been looking out for me since day 1 (helping me to carry my belongings to my room when I first arrived) and was there making sure my every need was met. I have been shown good hospitality before, but the selflessness Nazmul has showed throughout the week is incomparable. She is going to make one hell of a paramedic if she shows her future patients even half of the kindness she showed me this week.

Fertile & Itchy (Day 4)

Again, unique descriptions for today's title, but right now as my feet lay swollen and covered in red dots at the end of the bed (I literally look like a small pox victim) and I look through my pictures of the village I went to today, its the best I could come up with. While Maureen was off in Dhaka today trying to secure an emergency passport from the embassy (since hers was stolen) I got to hang out with a group of medical students Dr. Chowdry introduced me to. They took me to a small village located outside of the compound. In order to get there the medical students insisted we take a rickshaw. Imagine a horse and carriage contraption where the horse is replaced by a man half my size bicycling and the carriage feels like a few boards held together with super glue. Then ride it down roads that seem like one big pothole. The fact that neither the med students nor I fell out or toppled over and the fact that the man was able to pedal us all the way to the village was a miracle. Needless to say I was quite relieved when the med students accepted my suggestion of walking back to the compound after our afternoon visiting the village was over.
I learned so much about health needs and daily life in Bangladesh from the medical students and the villagers today, but will just try to hit a few of the main points. The first woman we met was cooking lunch for her family over an open fire. While her cooking area seemed well ventilated the medical students confirmed my suspicion that sure enough a lot of women here suffer from high levels of carbon monoxide exposure (looks like Haitian women aren't the only ones who suffer from headaches and dizziness... it comes with the developing nation territory). One of the medical students used her water pump to rinse her hands... when questioned if it was clean water she responded: "Of course!" When I asked where the water came from she told me a local lake, stream, pond, etc she wasn't exactly sure. Judging the pollution situation here thus far I decided to hold my thirst until we got back to the compound... hopefully the woman didn't notice/ wasn't offended.I wondered how many villagers here suffer from water borne illness... I am guessing from the look of some of the ponds quite a few. We made our way to the next part of the village by crossing rice patty fields. Seeing the tough work of planting and harvesting rice was very eye opening. The people stand in the hot sun all day long, in ankle deep water, bent over at the waist (looks the medical students can add melanoma, foot fungus, and lumbar pain to their list of village health concerns). Just walking through the fields made sweat start rolling down my back... I can't even imagine the strength it takes to get up and complete this work day after day. If you're a woman add to burden you have to be fully clothed no matter what the temperature. If you're a pregnant woman, you still are out there working... like I said these women have to be some of the strongest, most resilient people I have ever met.
As I stopped along our trip to take pictures, the medical students would stop too and check the camera to see the points I found the most interesting. They didn't question me up until I stopped to squat down and get a good picture of an empty birth control pill package I saw along the road. This package was one of many I saw strewn throughout the village on our walk today. Yes, Bangladeshi med students we do have birth control pills in the US - although unconvinced at first they tried to make sure I knew what they were and why people would take them... that lead to a very interesting discussion. I wanted to know why, if I saw so many empty packages lying around on the streets we traveled today, the average woman in this village had at least seven children (and that's estimating on the low end and not taking into account infant/ child mortality). They too sat puzzled for a second because two of the three girls were from small families in the city. The one who was from a village spoke up with a "they just do." Based on this and many other roundabout ways of asking the same question I have come to a few conclusions: while the community health workers are very good at distributing medicines to the village, there aren't always enough health care workers or enough time invested in public education (so the women don't take the pills properly). The other key point was made apparent when I asked about maternal health and maternal mortality in general. Women still die in the villages attempting to give complicated child birth without medical assistance because their husbands don't want them to go to the hospital (reasons for a villager here avoiding the hospital could be another blog by itself). So if a husband and a culture expects you to have 9 children that's what you do... no objections. This made me realize that family planning measures are great, but it takes more than these interventions to change the maternal health outcomes and to control the population growth (Bangladesh is projected to rank in the top 10 in the world for largest populations by 2050 even though it's roughly the size of the state of New York). If cultural norms of a strong patriarchal society persist I don't foresee the population growth suddenly leveling off just because community health workers are handing out a bunch of combined oral contraceptive packs.
Speaking of fertility we met the cutest baby and his mom at the final house stop. The baby was crawling around outside the house jingling away when we arrived. The noise apparently was coming from a bell tied around the baby boy's belly with a string. After a lot of questioning the reasoning behind why the baby was wearing the bell was sort of lost in translation. I learned two things culturally: many people here (for religious reasons) tie a string or something of the sort around them so they are never completely naked. It took seeing a lot of patients on the operating table with the same string to finally put this together. The reason for the bell in addition to the string though was for safety I think. The bell acted as the Bangladeshi version of a baby monitor... so if your young child is crawling away from home or towards something dangerous - the cooking fire, an edge of a drop-off to a rice patty field, etc. you hear the bell becoming more distant and you  run after him/ her. Very logical and a lot cheaper than the battery powered walkie talkies we use in the states I guess. Whether or not the bell held superstitious cultural value was hard to tell (again translation issues). But when it rang when I bounced the little boy in my arms it sure did make him happy so I would say it was an all around successful invention (way to go Bangladeshi mom!)
Before departing the final house we thanked them for answering all of our questions and gave them a unique gift. None of us had any physical gifts on us to give away so the one medical student got creative and sang a classical Hindi song to the family while I danced with the baby. While it cost nothing, seeing the joy the family got from getting to dance along to the music with us showed me how easy and important it can be to give of ourselves apart from the normal way of buying people stuff. The young med student stepped outside of her comfort zone to sing along with only the snapping of my fingers and a group of strangers starring at her. The message of gratitude it sent to the village family was well understood.
So while I slab on a bit more hydro-cortisone cream and pop another benadryl I am ending my day with the recognition that the mosquitoes aren't the only relentless thing here in Bangladesh. The trend of giving of yourself (your time, your abilities, your stuff, whatever it may be) is also constant and can be seen just about anywhere here when you take the time to look.

Collaborative & Sweet (Day 3)

"No big achievement was ever accomplished by one man." - Zafrula (founder of GK)
During an awards presentation today I got to hear from many who have done influential work with GK. From the founders, to the leader of the French committee, to a humorous man named Steve who has spent much of his last 40 years living in Bangladesh. Each one opened my eyes to the changes that still need to be made here in Bangladesh and worldwide. GK has improved health care status in Bangladesh by leaps and bounds but as with any place there is always room for improvement. GK was born out of field hospital in the war for Bangladesh's freedom. It now has a hospital, medical school, paramedic school, community health worker program, over 100 elementary schools it runs, its own pharmaceutical plant that produces medicines cheap so the villagers can actually afford them, dormitories, a conference center, a cafe, the list goes on and on. It is an impressive feat that is for sure. But the important thing I realized is it was built by a group of caring, hard-working individuals over a 40 year time span. A group that was committed to improving the lives of the Bangladeshi's and who understood that a good health status is a basic human right everyone should be able to obtain. The speakers opened my eyes to the importance of working as a team. While their might be visionaries like Paul Farmer in Global Health, nothing great is done over night and no global health dream is completed by the work of one single person.
After hearing from all the presentations, Dr. Chowdry (a professor of Community Medicine) gave me a tour of the medical school today. We went into town, got to experience the local market, and he even bought me my first Bangladeshi dessert (chum chum - a mistee (the Bangla word for sweet)). It was a ball of milk solids that looked like a miniature skinned potato & had soaked in simple sugar syrup all day (straight shot down the road to diabetes, but totally worth it! It was delicious!) So my assumptions were proved wrong. Bangladesh has lots of sweet options to pick from other than rice and vegetables each meal... that is if you can afford it. Speaking of sweet, their medical campus also took me by surprise! The facility was brand new and beautiful!

I learned a lot by getting to read through Dr. Chowdry's students' end research projects. At first glance the students seemed just like medical students in the US (dressed in short white coats and noses deep in their textbooks during our entire tour). However, after getting to read their insights in their research theses I realized these students get it, on a much larger scale health care wise - they get it. Unlike a lot of students I have seen studying in the US they care about more than just getting through the stressful week, more than acing their Friday morning exam - they care. That's it. Period. End of Story. Final projects ranged from the importance and longevity of breastfeeding in poor, rural populations, to which type of medical care access Bangladeshi villagers utilized. But the woven thread in each project was the time commitment and the level of caring. They took a lot of their time to go out to the villages and meet with their research populations. Not just to collect accurate data but to listen. To hear these rural villagers out. To see how they accessed health care and if they didn't have access to a good health status, what health determinants kept them from achieving it. You could hear it in their writing - they sat down with all of the villagers not because they wanted thorough data for a good grade but because they truly cared about these people and the future of their country's health.
One of the opening speaker's today stated: "I have fallen in love a few times in my life... one of those times was when I first visited Bangladesh." This trip and my trips to Haiti have given me a similar feeling. I have fallen in love with this type of world travel. But more specifically I have a deep appreciation for the type of medicine they teach over here. The kind that emphasizes a close relationship with one's patient. The kind that teaches medical students and paramedics to go out of their way just to listen to their patients and their communities. The kind that teaches them to be collaborative. The kind that teaches them to care.

Empowering (Day 2)

Today started with a 6:30am run. I was very happy that my running suggestion was well received by Sally (a fellow American woman who has spent a lot of time in Bangladesh off and on since the founding of the country and GK in 1972). She gave me a route through the compound. It allowed me to run around the beautiful lake and by GK workers' homes. Running ahead of Sally and Maureen gave me a serene time to think while exploring the compound. My favorite part was the quick gathering of Bangladeshi children I attracted. This of course turned my morning jog into a fartlek workout (for those non-runners out there just know that my jog was interrupted by short sprint races the children found very entertaining). The boys would wait for me each time I circled around the giant campus loop with sly beaming faces, a thumbs up by me and the sprints would begin. The boys only lasted a minute or so before tiring out. This was probably due to many reasons: they were younger than me, they don't get as much protein or a daily multivitamin like I do, they don't have loads of free time to spend hours training, etc. Plus there isn't a very big running culture here in Bangladesh overall - but with the smog, dust, not too mention 200% humidity year-round can you blame them? I steam like my own personal sauna after finishing a 5 mile run and it takes a lot of little pep talks to myself each morning to keep following the  full body covering if you're a woman rule.
However, despite the humidity and uncomfortable clothes, each lap the kids' enthusiasm energizes me. My pride also gets a little boost (yes they're only 5-10 year olds and so yes I should have probably let them win). But the favorite part of my run today was towards the end when a little girl joined me. She didn't make me sprint like the group of young boys. Instead, with a beautiful smile spread from ear to ear she happily kept pace with me all the way back to the compound. Whenever she would start to tire a bit and slow down, all it would take is an encouraging smile and thumbs up from me for her to pick back up again. With this encouragement and good pace she lasted a lot longer and withstood the humidity a lot more stoically than the young boys (clearly girls are tougher/ stronger).

This 10 minutes of a morning jog with this girl was a very small piece of my eventful second day here - my professor had her purse stolen (my wallet was in it - so I lost some cash, credit cards, identity, etc). In addition, I met a Nobel Peace Prize winner, and sat through sessions on how to improve primary health care in Bangladesh and worldwide. Yet, this girl sticks in my mind more than my stolen wallet. More than the wonderful people who run GK (they contacted a past advocate/ current lawyer to do an investigation, gave us gifts and money to apologize, and made sure our every need was tended to). I think its because this girl gives me hope for developing nations as a whole. She represents the strength of the women who I have met here and during my trips to Haiti too. She lasted longer than the boys and did so with a stoic smile - more than I can say for a lot of runners and she was only a kid.
It gives me hope knowing how much GK stresses the empowerment of women. They train illiterate village girls to become Community Health Workers. They give shy young women the education to become paramedics (the equivalent to America's PA's). In an area of the world where women do not hold as many rights as I am blessed with in the US, it helps me sleep better at night knowing GK is working to change it all. These girls get an education, are told to speak their mind, and given the independence to go into villages by themselves to provide the health care these people need. It gives me hope that the CHI group I go to Haiti with might be as successful with its CHW program. A hope that someday a bunch of foreign white people won't have to go around the world to provide medical care to people of developing nations. That someday I might visit these places and just sit back and watch as the strong empowered women of the area provide all the medical care that is needed. It's not going to happen overnight, but in the meantime I can sleep better knowing the future of the GK medical care system lies in the hands of strong, stoic, beaming, runner girls like the one I met this morning.

Frustrating (Day 1 Part 2)

I originally intended on doing one journal entry/ blog per day. However, unlike my trips to Haiti, I don't have a lot of people my age, from my culture, or even that can speak my language to talk to. So for tonight my journal and blog will be my outlet for a very frustrating encounter I had today.
This entry's title is a complete understatement really of how I truly feel about the situation: disgusted, so upset I felt sick enough to vomit, the list could go on and on.
This afternoon/ evening we were given the opportunity to visit the war memorial monument and garden in Savar. The whole area was very beautiful at first glance. We were able to take lots of pictures. We had even more Bangladeshi's taking pictures of us. Apparently our white skin stands out and its very popular to pretend that an American or European is your good friend by having a picture of them on your phone. (At least this means I will feel less bad about taking random pictures of all the Bangladeshi's I meet). It was quite a refreshing and odd experience to be the person on the other side of the camera during a trip like this one.
After successfully chasing off the slowly gathering mob of picture takers we began being followed by a little girl begging. She was just too adorable to say no to so my professor did finally cave and give her 2 taka (the equivalent to about 3 cents American). The little girl turned out to be only one of many children begging in the park. So quickly we had to assume our authoritative, stoic faces and with our hands held in a stop manner kept implying "No! Leave us alone!" As we left the garden we saw a boy, probably no older than 8 (although with prominent stunting here due to malnutrition it is very difficult to guess ages) lying on the ground begging for money. This beggar was unique and much more difficult to see than the rest. His legs were covered in burns and what appeared to be very serious contractures. Realizing that this boy needed and deserved medical attention I tried to stop Maureen (who too at first was very concerned), Maxine (the Belgian college student who had been living here for 4 months already), and Jeremy (the young french photographer). Maxine explained to Maureen (who relayed to me as Maxine quickly searched for a bus for all of us) that there was nothing we could do. In a not exactly polite tone I inquired "Well aren't we staying at a medical compound?!?" However, the underlying social issues surrounding this case were much more difficult to face than the nasty burns themselves. It turns out many of these children are not begging for themselves but are controlled and used as ploys to make more money to give to the adults that keep them enslaved in a hellish life of begging and poverty. The boy did not crawl to that spot and start begging after a freak moto or fire accident. No, he was purposefully (if one can even use that word for such horrible action) put there after being burned, injured, and scared on both his legs and head. He was placed on the main path leading into the monument's garden where many would see him and give him money out of pity. I was informed that even if we helped him this week it was very likely he would wind up getting re-injured and placed back in his exact same spot/ role.
I couldn't accept this child's fate passively. I was furious. A series of questions laden with some not so polite words were projected at Maureen (wonder if this will count as "speaking up" towards my class participation grade for my global health class... oh well I will suffer the consequences later). How could we just let him lay there and do NOTHING for him?!? The calm response about health disparities and the need for long term work/ change was the last thing I wanted to hear. I wanted to do something now. I felt like a hypocrite coming to Bangladesh for a celebration on public health and human rights and then passing over this boy. Deeming his situation too challenging and the social inequalities that created this horrible health outcome for an innocent child too deep. Looks like Slumdog Millionaire stories hold some truth to them.
What I hated most about the situation was that after some time pondering I realized in a way that Maureen was right. This was yet another acute on chronic problem (to use the words of Paul Farmer). And the acute issues would never be settled if the chronic part remains ignored.
The issues of child abuse are problematic in the US where we have extensive medical, social, and governmental services dedicated to trying to prevent and cure this filthy social disease. Gonoshathaya Kendra is an amazing facility that produces talented physicians, paramedics (the equivalent to our PA's), and community health workers. However, other NGO's quickly snag them because they can pay them more. Or some leave for more developed countries (known in the public health realm as the brain drain). So GK remains understaffed and underfunded to tackle all the problems of Bangladesh. The chronic problem does not receive enough resources. The acute problems remain left alone by foreigners only visiting for a week because they understand that long-term investment is needed to ensure these children don't wind back on the streets.
It breaks my heart to know that I did nothing for this boy. And that he is surrounded by a corrupt system that prevents me from doing so. I know I shouldn't blame myself because it's not my fault he was placed on that sidewalk but sometimes guilt is a hard emotion to push away. Some may blame my first sleepless night here on jet lag, others on the relentless mosquitoes. All I know is after a day like today I won't be getting much shut-eye tonight...

Crazy (Day 1)

Possibly an odd first adjective to choose when describing the trip experience or Bangladesh in general. However, this word has passed through my mind quite a few times both leading up to the trip and during our travels and first day in Bangladesh.
A woman working in my lab used the word crazy to first describe me in fact when she heard I was coming here to Bangladesh only a month after traveling to Haiti. Yes, as an undergrad student trying to plan out where she will begin med school this fall, possibly I had too much going on in my busy American student style life to hit pause and escape for a week and a half to Bangladesh. I am sure for a woman who likes a routine work 9-5 Monday - Friday lifestyle a love for global health and a willingness to set aside a week and a half of one's "regular" "normal" life would seem a bit crazy.
Last night in the Abu Dhabi airport the word came up again. My professor (and only travel mate) made me pause and look around. She questioned: "Kristen, what do you notice that seems odd about this situation?" I couldn't put my finger on it at first. The security line ahead of us was rather short and the security guards didn't make us take off our shoes going through the screening (perhaps more a relief to them - who knows how bad our feet smelled at hour 20 of travel). Then the stares provided a helpful hint. The Bangladeshi men waiting in line with us weren't staring at us because we were the only Americans in the terminal. They were staring because we were the only women in the line. In fact, we were among only a handful of women on the entire flight (a very large international one). And we were most certainly the only women traveling without male accompaniment. This was due to our flight from Abu Dhabi to Dhaka being an overnight one. Women in this part of the world are not allowed to travel by themselves at night. The male dominated culture continued to grow more apparent as we filled out our customs forms. Directly below my name I had to list my father or husband's name. So once again - to the males sharing our flight and to probably most people in this region - my professor and I seemed crazy (or at least culturally very, very! different).
In the mad rush outside the airport my professor and I luckily found a cab driver who spoke English and knew somewhat where the GK medical center was in Savar. Or at least for 1,000 taka he pretended to (we only got lost twice). The horn-honking, accident-inevitable traffic that surrounded me on the ride to Gonoshasthaya Kendra was strangely calming. It gave me flashbacks to riding through the streets of Porte au Prince and served as a happy reminder that I was indeed far from the states and in an underdeveloped country - exactly where I wanted to be. The craziness of dodging Bangladeshi versions of tap taps, people darting across the street, people pedaling with enough wood on their rick shaws to practically build a small house - all of this seemed much more exciting and less stressful than the typical bumper to bumper traffic found in the states. (A word of advice to the Bangladeshi's though - No constantly honking your horn will not magically make the cars and trucks ahead of you suddenly disappear out of your way. And why spend money on traffic lights when nobody follows them anyways? Perhaps that money could be better spent on seat belts?) Sorry, back to my original thought process:
Finally after 45 minutes of well-embraced crazy driving and only getting lost twice (due to some translation error of course) we finally arrived to the beautiful GK compound. For my friends who have traveled to Haiti, GK compound is to Mahalia's compound and the Haitian countryside as Dhaka is to Porte au Prince. Needless to say my professor and I (especially our lungs) were quite excited to escape the burning garbage and crammed together buildings to come to this beautiful compound surrounded by tropical trees, rice paddy fields, and much easier to breathe air.
What's crazy about this compound is as I toured it this morning I couldn't help but think how such a large, organized infrastructure surrounded by beautiful land built to supply the group with the food they needed could exist just outside one of the most densely populated (and in my mind one of the most highly polluted) cities. Especially a compound partially run and founded by women in a region where women are typically seen as inferior and not allowed to travel by themselves.
So as I begin my little adventure in Bangladesh I am embracing the so-called "crazy." I feel very blessed to be able to go on these crazy global health adventures, and even more blessed to come from a place that allows me to travel half way across the world as a woman traveling with just one other woman. Already I have seen some of the same public health needs in Bangladesh that I saw on my trips to Haiti. I know in my heart that far fewer of these needs would exist if more people embraced the "craziness" of a passion for global health (or at least if more people understood that the right to health should be seen as a basic human right). So I hope that I never stop being "crazy." And I hope that the amazing Bangladeshi women who I have met at the GK compound never stop being "crazy" either. The world of public health and the world in general would thrive much better if there were just a few more "crazy" people willing to join us.