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.