Abar dekha hobe

"See you again"

We are leaving LAMB tomorrow, so for now, "Abar dehka hobe."

Evening

"Kids asleep?"
"Yes"
"Ready?"
"Yup"
"OK...Go!"

The commute home

As a parent of four, you can easily imagine that peace and quiet are long sought and seldom found.  The two are linked in both our language and common experience: sometimes the quietest and most peaceful moment of my day is the commute home.  It is often a time for reflection.

If I feel restless, have difficulty doing the simplest tasks, or can't collect my thoughts, it is often because I have not bookended my day with quiet time.  Making margin in my life necessary to do this usually requires making decisions, but seeking quiet time makes a difference.

Simplicity is closely related: mental quietness.  I admire the simplicity of action following belief.  What do you believe?  Look at your actions.  What kind of tree is it?  Look at its fruit.  It's a simple principle, but suggests hard decisions.  That's probably what it takes to walk peacefully home.

A precious gift

One of my dear ayahs came in the door with a bowl of small green leaves yesterday.  When I asked her what it was for, she replied that she had no money to buy me a birthday gift, and so putting the henna-like stain of the leaves on my hand in the traditional Bangladeshi village style (not the fancy swirls we have seen before) would be her gift to me.

The leaves were ground with a rolling pin on a rough stone slab.

She then applied the green paste to the ends of the fingers of my left hand and a big circle on my palm.  Both the ayahs did the same to their own left hands.

An hour later, when the leaf paste was washed off, their fingertips and palms were a lovely red.  Mine were a vivid ORANGE!

Apparently, even after the color fades from my skin, my fingernails will remain stained.  They assured me that it looks quite beautiful as it grows out.  I have to wonder what people in the States will think!

Dear friends and I have remarked in the past that it can be a delight to give the gift of an experience, rather than a material thing, to mark an occasion.  Our ayahs have shared their lives and culture with us and worked like crazy to keep us clothed, fed, and in a tidy home.  But this one heartfelt gesture is sealed in my heart forever as a mark of true affection.
  

Marconi

  A medical assistant here is more akin to a nurse practitioner in the  States: very capable, and often quite experienced, especially in local problems.    Marconi, one of the M.A.s, is slim, dark, about my age, and sharply dressed: every crease is crisp, each cuff perfectly in place.  His father is a tailor.

  He invited me to his family home for lunch and I accepted, not realizing this involved a 14 km sojourn by electric taxi, vangari, and foot that took an hour each way.  I passed a very pleasant afternoon today, out in the fields and paddies, listening to the wind in the rice and palms as we walked to his village.  Along the way he told a bit of his story.


When he was young, his mother worked as a day laborer and his father taught in a school for tailors.  They were very poor, owning no fields with which to feed themselves (each field about the size of my living room).  However, his parents worked hard and his father saved for 9 years to purchase two small paddies for the family - a minor fortune.

Marconi studied and excelled in primary school, earning the opportunity to attend upper grades 30 km away in Dinajpur for free.  Placing second in his class there, he was sponsored for university in Dhaka.  Finishing, he applied to LAMB for the (then free) MA training.  Finishing that, he has worked here 6 days a week for 11 years, earning a respectable $157/month.

In that time he has: bought his father a small space (6'x8') in nearby Joshi to open a tailor shop, put his brother through MA school (no longer free), and been the primary breadwinner for his extended family.  He is now married, has two daughters, one of which attends school at LAMB (expensive) and they spend the work week living near LAMB.  They rent a single room here for $17.14/month: any more than that and his daughter would have to attend the local primary school, about which he says, "That is not good".

Here's an image for Bangladesh today:  A slim young man in a tattersall shirt that could be L.L. Bean, sharp slacks, small briefcase, talking quietly on his mobile phone as he threads his way between lush rice paddies, past goats and chickens, and up to his home village of mud daub and wattle houses.  

Birthday!

This March 26th is both Mary's 4th birthday and Bangladesh Independence Day.

She thought that all the festivities, activities and cultural events were for her.

We are deeply grateful for her.

A gratuitous photo of Annie in a Sari (or re-purposed orna).

Practice for reentry

We are less than a week out from leaving LAMB and experienced folk have warned us that it will take more than just recovering from jetlag to reacclimate to the West.  We've discussed what that might look like.  Here's one idea:

"I'd like a tall skim latte"

"Tall skim latte, OK, that'll be eight dollars and fifteen cents at the first window"

"For that coffee? Are you kidding? I'll offer you 50 cents"

"Huh? It's $8.15, sir"

"Give me a break. OK, how about 85 cents?"

or this:

"Laura, what's wrong with this food - does it taste funny to you?"

"I don't know - just doesn't look right...wait, it's not yellow!"

So the occasion of receiving a package from Maine (more than 3 weeks in transit!) seemed a fitting one to begin the process gently.

Mac 'n cheese

It might have been too much of a shock if it weren't yellow.  

And this speaks for itself.   

Shopping for bags

Have I ever told you that I hate shopping?  I think the only thing worse than shopping for bags is shopping for pants.  In Saidpur, 18km away, we ran errands on a chuti day, and everyone told us we must stop in at the bag store.  Even the driver said, "You go next action bags?".  I sighed.

I'm not sure what I was expecting - I had an idea of a dim, cavernous building, the smell of incense and a vaguely bohemian decor: a mental echo from college?  Instead, our driver pulled up to a nondescript door in a residential area, where a small sign next to the door read, "action bag, fair-trade project, Saidpur, Nilphimari dist.".  We let ourselves in unannounced to a small atrium, walked across to an open door and looked inquisitive (something we've perfected).  A fiftyish woman behind a business desk looked over her glasses and smiled, closing a ledger.  "I am manager of action bags, you are from LAMB? "

"Yes" How could you tell?

"We get many people from LAMB."  Ah, you read minds.  And also we're bideshi. 

"You wait one minute".  She found the assistant production manager who let us into a room about the size of a bedroom, stacked to the ceiling with bags in no order I could discern.  I have a suspicion some piles may not have seen daylight for a decade.  The assistant manager reached into a pile and pulled out precisely the right kind of bag first try.  The right kind?  Yes - exactly what Laura was looking for.  We dragged it out, and still it took all of six minutes.

The Assistant Manager

Out back in another atrium, several people were cutting fabric to take home and a few women were sewing in an open courtyard.  Maybe 15 people in all.  A whiteboard had orders listed, due dates, and destinations, ranging from Japan to the USA.  Each person either looked curious or smiled at us.

Back in the manager's office we were served hot ginger tea with fresh bits of ginger in the bottom of the cup, while the manager explained about the project.  We sat and chatted for five more minutes and then excused ourselves, each placing our right hand over our chest and thanking her for the tea.  And yes, after this, I might even go shopping for pants in Bangladesh.

Decision

S died two days ago.  I could not write yesterday.
She was well known here at LAMB, like family to some of the staff.  Most people were subdued yesterday: Dr. Hassan said to me, "I am not very well today" by way of explanation.

I had a decision to make.  A nurse came, said, "The condition is very serious now".  I stood up, walked 7 meters and as I arrived, her heart stopped beating.  I could have coded her: CPR, life support, special medications.  I have coded several people here.  But I knew we could not win this one.  I made the decision to let her go.

What makes it especially difficult was that she was 29 with an underlying treatable illness.  It was TB, though she died of sepsis.  I made the correct decision but it is always difficult.  Thank you for praying.

SURRENDER!

It's 3 p.m. on the LAMB compound in late March.  Where IS everyone?!?

Warning: PG-rated post.

We've enjoyed some of the brand names here.  This one is peanut butter.

You'll have to look carefully at this matchbox car.

And...sorry, but this one's kind of racey.

Friends

  Mostly, my children have been very happy here.

  Do you remember hanging out with your best friends when you were eight?  It happened in that idyllic neighborhood we all shared in our collective unconscious.  You just ran next door to see if they were home, and they always were.  It was the coolest thing - you could hang out in your fort, making the rules of your secret society, planning world domination, or planning how you would build a robot suit with real working arms for halloween, or what you would do when you had earned a million dollars.

  Do you also remember when your only friend was a pet?  There was a little girl who lived next door, but she didn't want to play with you.  Your older brothers had been mean to you all morning, and even though your father told you he thought you were wonderful, it didn't matter.  Well, at least the cat seemed to appreciate you.

  One of the challenges we face as parents is living vicariously through our children - we do it all too easily.  It's easy when things are wonderful, but I, at least, always want to cushion the hard landings a little too much.  Childhood can be idyllic, but it can also be very, very hard.  Were you a 7th grade girl?  Did the kid you thought was your friend ever turn and belt you in the gut?

Each of my children has had idyllic moments and hard ones here.
Will has been made fun of by kids he wanted to be friends with.  He also found the friends above.
Jack got punched in the eye, but also has been included with the older kids.
Mary had the day I described above, but on another day she played dolls with an older girl.
Annie - well, she got put to bed when she didn't want to go.  Talk about betrayal!

  I know that these experiences are part of what shapes them into real people - what will give them understanding and compassion when they are older - but it is hard to watch them suffer the 'slings and arrows of outrageous fortune'.  They will survive.  And they will have those scars we all feel, and the memories we all savor.

Chuti

A day off from work and a holiday, are the same word: chuti

Some of the chuti celebrated while we were here have included the deshi version of president's day, and a day celebrating Bangla, the language, which is a big deal.

A day off is a really nice thing.  I've seldom been so pleased to do nothing at all.

The Bird and 50 years

Today we saw this bird; it is black with a blue-green sheen.  If someone has a "birds of the world" book and would be willing to look it up, we'd love to know what it is!

The first ventilator (breathing life-support machine) was invented by a Dr. Bird, and, especially on "Dr. Kildare" (the 1960's television show), it came to be known as "The Bird".

Medicine here is very interesting - you must have your wits about you.  We have Xray, but there is no CT scanner.  There is no MRI. We have only very basic blood tests.  The only ventilator we have is for the operating theatre and is of the same vintage as the 'bird'.   Granted, we have an ultrasound, but today was a good example of why clinical judgment outweighs scans and tests - just as it did in medicine 50 years ago.

A young woman was admitted to my service with minimally abnormal blood tests, an essentially normal ultrasound of the abdomen, and an exam that just wasn't quite right for appendicitis, though it certainly could have been.  There was a potential alternative diagnosis for which she'd been previously treated with some relief, and we could easily have decided to pursue that.  In the States, the next step would've been a CT scan, and that would have revealed no more than the ultrasound.

In Dr. Bob's judgment (the surgeon, who is also of the same vintage as the 'bird'), something just wasn't right.  50 years ago, the right answer was to 'open the belly' and have a look - surgery -  so that's what he did.  She had peritoneal 'studding' - small white bumps all over her intestinal lining that are invisible on scans.  This is either TB of the intestines, ovarian cancer, or rarely a fungal infection.  We'll find out in 2 - 4 weeks.

Please pray for 'S'.  Two of the above options are far preferable to the third.  We've started treatment for TB, hoping.

linens and concrete

   There are many cultural differences, but it's interesting which ones trip you up as a bideshi.  This is how the hospital linens are dried:

My first thought was, "What? They don't have a clothes dryer?".  It's a lot of work to hang an entire hospital's linens on the line and then remove them. 

Next, we marvel daily at the construction site immediately next to our flat. The foundation holes were dug by hand with mattocks by about 30 manual laborers.  The dirt was carried by hand in woven jute baskets about the size of large salad bowls to piles beside the site.  Rebar was cut by chisel.  The concrete, mixed in small batches, was carried in the same baskets (as above) by a continuous line of workers to the foundation holes.

We've watched and thought, "A construction company doesn't have a backhoe?" and, "One cement mixer would make short work of this."

Then it was explained to us that this would put 30 deshi families out of work (and into hunger); labor is inexpensive. 

In America, efficiency is an idol.  Here, family and friends are the measure.  You can only imagine some of the cultural differences this causes.

So, what's Bangladesh like?

How could I begin to answer this question?  When asked, I just shake my head and laugh.

Here are a few responses:

The bananas are marvelously flavorful.
To turn on a light, you flip the switch DOWN.
Traffic moves on the left side of the road.
Food is yellow.
Ayahs do all the cooking, cleaning, laundry, shopping, and some childcare.
The lizard chirping INSIDE my room every night is a comforting sound.
There are an average of 1,000 people per square kilometer.
We think twice before spending the equivalent of one dollar.
Living in a house with 5 flats = it is pretty much NEVER quiet.
There are NO rocks in Bangladesh.
The kids pretty much come and go at will.

So, what's Bangladesh like?  It's GREAT!   : )

Bideshi

   As a 'bideshi', or foreigner, you are treated differently.  It is unavoidable.  In a very status-conscious society, you automatically have status.  People step out of your way, open gates for you, serve you tea unexpectedly, bow their heads as they greet you, and even scold others who aren't looking and are blocking your path.  It is uncomfortable, but there's nothing you can do about it.  

   Of course, the flip side is that you will be offered starting prices in the market three times the starting price for a 'deshi'.  But when a rickshaw driver smiles slyly and offers you twice the going rate for a ride, being able to say, "Are you kidding? These kids are small, I'm not paying that!" is kind of fun.

Words, words, words...

Here are 4 kids acting like goofballs.  3 of them mine.

Here are some things we've heard from them this trip:

(after feeding me a bunch of "cookies" made of wooden blocks, sung to a pleasant tune and utterly absentmindedly) "Daddy will be fat. Daddy will be fat. Daddy will be fat. Daaaaadddy will be fat."

"May I go to school? I want to play battle."  (played in the woods next to the schoolyard)

"I'm a panda, and he's a horse - I'm his pet." said in matter-of -fact tones: what could be more natural?

"I love Bangladesh! I wish we lived here."  and less than an hour later...  "I can't wait to go home to Maine"

"What was that?!?"  "A lizard."  "Inside? Cool!"

"Mommy, may I have some more Dal bhat?"  (rice with lentils)

"I smell chocolate."  (I have noooo idea what you mean..... chocolate? what chocolate?)

"We've been playing in the dirt!"  (usually fairly obvious)

"I have 137 chickens!"  (a counting game played while riding the vangari - categories: cows, chickens, goats, dead goats, dogs, cats, ducks, goats with birds on top of them, pigs)


"I can't wait for Shasta!" (central character in The Horse and his Boy by C.S. Lewis - bedtime stories

"Daddy, will you sing me another song?"

A splash of color...

There is plenty here that is drab, gray-brown, and dull.  But the Bangladeshi women certainly make up for it in the clothing department!

     This is the cloth shop where I purchased the fabric for my first shalwar kamizes.  The shops are three-sided and open onto the alley, somewhat like an open-air strip mall.  In order to be helped, a woman must sit down on one of the stools and wait to be assisted by one of the young men.  She tells them what she is looking for, and maybe a color, and then they spread choices before her.  As a Westerner, I have to file this in the "Could things possibly be more different here?!?" category.  I got a bit impatient with them spreading things that either looked like nursing scrubs or were covered in sequins before me, so they eventually allowed me to use a stick as a pointer to select things I'd like to see.  Now that I've been around a bit and learned a little Bangla, my shopping skills are coming right along- I recently went in to buy fabric for a sari, and they bought me a Coca-Cola!  : ) 

What do I need to be content?

We have been unable to post responses to comments for 2 weeks, but we have enjoyed reading yours!

This morning, Rob Rossow reminded of one of the the threads I mentioned in my first post.  In 1991 I was in the Dominican Republic, on a work trip.  Out in the barrio where we'd been working, past bannana trees, an open sewer, the tangled lines of pirated electricity, one detail has remained with me.  Though each shack was made of corrugated tin or fiberglass on a pole frame, though poverty crawled in at every corner of my vision, the dirt in front of each door was swept clean and neat.  I was 16, and I didn't know to expect that pride in the setting of such poverty.

It's similar here, and I caught myself again: imagining people could not be happy amidst the poverty, illness, and hunger.  Not that everyone's content - you won't find that in the most affluent and sated suburban neighborhood in the States - but many are.  

Whether material or relational, contentment is a choice made, not a reaction to circumstance.  

I need to learn from that, again.

Bread and Butter

About a week ago, I admitted a 52 year old man who'd lost 25 lbs over about six months, and was coughing.  He was gaunt,  tired, and complained of "buk bheta, badikay - teen mash" or 3 months of left-sided chest pain.  Fevers, well everyone says they have fevers here.

In the States, my bread and butter diagnosis might be pneumonia, or perhaps coronary disease, but here it is tuberculosis.  TB is so common in Bangladesh that a pleural effusion (fluid around the lung) is TB until proven otherwise.  This Xray shows fluid around the left lung, extensive left lung damage and, if you look very carefully, cavities even (they look like white donuts in the lung field).  Cavities or holes in the lung are the hallmark of TB.

It's such a massive problem (11 million cases worldwide) that here in Bangladesh, the 4 different antibiotics used to treat it are rolled into a single pill, provided free-of-charge by the government.  Each person who is treated is personally seen every day for 6 months and observed taking their pill, just to make certain they take it - also free-of-charge.  This is "Directly Observed Therapy - DOT".

I would venture to guess that we diagnose a new case of TB, here at LAMB, about every 2 hours.  It's a near certainty I have been exposed so upon return I fully expect to take the 9 months of antibioticsthat will prevent active disease.  Thankfully, it is very unlikely that my family has been exposed.

I think I heard the IRS was offering to Directly Observe my Wallet  - also free-of-charge.  :-)

Annie

And, our Goodbye with the Thorpes (they leave for Rajshahi in the morning)

Reuse

If you have ever worked in a hospital's basement, or perhaps in a biology laboratory, you will recognize these: autoclaves.  An autoclave, under pressure, heats anything within it to 250deg F - enough to kill almost any microbe. 

I had noticed that the gloves I typically use on the general ward for minor procedures were wrapped in white paper, taped shut.  What I noticed today is that those gloves are taped shut with autoclave tape.  Then I learned where they are from - they are used once in the operating theatre, then cleaned, rewrapped, autoclaved, and sent to the ward.  What I can't understand, though, is why the only size they ever seem to have on the ward is 6 1/2 (I'm an 8).

This is a pattern: when we ride on a vangari (earlier post) the front forks are, often as not, reinforced with welded rebar.  Anything can be reused and repaired here.  On the way to the market, you pass shop after shop  - machine shops where very creative solutions are employed to repair motorcycles, bicycles, vangaris, anything.  Your average autobody is 50% bondo.  An random engine can be mounted on almost anything.  Bicycle seats are made from old tires.  Mudflaps from old inner tubes.

I think the entire country of Bangladesh may have a smaller carbon footprint than I do.

Annie in an Orna

The Orna is a length of cloth (usually colorful!) worn draped over the front of a shalwar kamiz and is mandatory in public for any woman over the age of about 13 or 14, unless they wear a sari.  Annie is practicing, though footie pajamas substitute for the shalwar kamiz.

Check your boots...

This morning I slipped my foot into my shoe to head out the door, but my shoe didn't fit.

I've heard of checking your boots for scorpions in the morning, but this particular peril, I suspect, is unique to parents.

Back home, when teaching medical students, I’ll occasionally say something like, “In medicine, anyone who isn’t constantly humbled isn’t paying attention”.  And I mean it.  But here, with the unbelievable breadth of disease, the limited diagnostics available, and the 'if-you-don't-do-it-nobody-will' reality I frequently feel like a medical student again.  It's not a bad thing.

But, it's not only medicine.  In daily life we don't know what we don't know.  In interactions outside of the hospital we constantly wonder if, in some way that we're wholly unaware of, we're giving offense.  The body language is different, the thought patterns shaped by the language are different, the food is yellow (did we mention that? ;-)

Have you ever read something a hundred times, then had an experience that made it new - made it resonate in your mind with a strength you hadn't suspected?  Try on, "My strength is made perfect is weakness".   I think, in the future, I will leave off the "In medicine" bit.

Not sure if you will see this photo either.    Right now, though, I'm chuckling (insert evil cackle here) because I looked down and the floor is littered with the casualties of war - mosquitoes.

If you can't see this photo, I'll briefly describe it.  Annie, looking back at you, standing in the pathway to a small house, surrounded by marigolds.  The look on her face, which can sometimes be impish, is this time simply joyful - the joy of 17 month-old independence and adventure in a flower bed.  I think that kind of joy requires the security of knowing that your parent is as near as the next breath, a heartbeat away.

LAMB is bathed in flowers this time of year.  I recognize and enjoy many of the flowers, but there are some spectacular varieties I have not met before.  The dusty tan of the paths makes the vividness of the many flowerbeds less expected and taken for granted.  This contrast sharpens your attention to the details of individuals - if it did not, you wouldn't carefully note individual petals and subtle shading of the different colors.

Those who have been here a long time assure me, that in just a few weeks, as the truly hot weather begins, the grounds will dry out and the flowers will be less in evidence.  Initially I was sad at the thought, but I think, like the contrast with the path, this ultimately makes them all the sweeter now.

You do what's needed.

Do I look happy as a pig in a poke?

   Alright -- so I forgot to smile for the camera, but I was.  I like procedures and working with my hands.  Here, I'm in the small operating theatre awaiting a patient for endoscopy (which costs $14.30).   I marveled at how what happened next happened.  

   We had just begun when Dr. Bob (the surgeon) backed into the room (so his sterile gloves and front never touched the door) and asked if we were just starting or just finishing.  He was in the large OT in the middle of an exploratory laparotomy, and decided he needed an intraoperative endoscopy.  We stopped, washed the scope, rolled everything into the next room, did the endoscopy, rolled out, washed the scope again, and did our endoscopy.  As with everything here, the entire thing was accomplished without hoopla - you just do what's needed.

Some technical difficulties - been unable to load photos for two days, so I'll tell you about a junior doctor in pediatrics right now.  Junior doctors in Bangladesh have less formal training (nil) after medical school than a consultant (I'm considered a consultant) but may have varying amounts of real-world experience - anywhere from six months to ten years.

Hassan is a slim Bangladeshi, I'd guess around 26 yrs old though he could pass for 17.  Although his hair and clothes may occasionally seem a little unkempt as though he's been on-call all night (even when he hasn't), there's an air about him that seems content and maybe a little distracted.  He lives in a small apartment the building next to us, with a few other staff.  I believe he is married.

We've had little opportunity to interact before, given that we're on different services and it has been quite busy, but the last few days have been slower.  Sitting in the doctor's office after tea yesterday, we found ourselves across from each other and I asked him about working at LAMB as a junior doctor.  His response:

"It is a good job.  My father wants me not work here, because our family have a medical diagnostics business and run a nursing home.  He wants me to work with him, 'Why should I pay someone else to work a job you could do?' then he say, 'At least you could work somewhere where they pay more', but I think he understand now.  

"I like it here, with the poor.  I have everything I need, and I feel ... something make me ..."

"Your heart tells you?"

"Yes! my heart tells me this is a good thing to do.  I think maybe my father understand now."

Illness

Have you ever been seasick?  At first you're fine, then something's not quite right.  You still can't pin it down, but something feels wrong in your stomach.  If you've been sick before, you recognize it now - seasickness.

I've never been homesick before in my entire life, so it took me a week to figure out what was wrong.  The morning sun outside has that beautiful hue of early summer, dappling the leaves of of the trees I can see.  But it's wrong - the dapples are the wrong size, the leaves are too big, and I catch myself thinking about snow.  I walked around thinking perhaps I had a touch of some local virus, but two days ago I woke up and realized what was wrong.  I'll be fine, but it's a new experience.

B

How many generations do you think this tree has seen?  How many more will it see?

Swings

  LAMB has a small office in Dhaka for managing official business, finances, etc.  One of the staff there remarked, in passing, that he obtains work visas more often than he used to.  People used to work here very long-term (think decades), but the trend has been for long-term workers to stay shorter and shorter periods (2-5 years).  

  LAMB also hosts short-termers regularly; the same doctor who said the food "gets a bit same-y" was here in the guest house for six months.

  This swing is near the house of one of the long-term couples (with small children) we'd like to know better.  The constant flux of short-term people can be tough on the long-term staff - how do you get to know, emotionally invest in, and care for someone who will be gone in six months, much less another 5 weeks?  

Xanthochromia

Impress your friends by dropping the word 'xanthochromia' into your next conversation.

 

This is a sample of cerebrospinal fluid (CSF).  Normally it is clear like water; were you to taste it (no I haven't and I don't recommend it) it would taste salty.  If a spinal tap is traumatic, it will be light pink.  If it is yellow (aha! xanthochromia!), it is old blood in the CSF.  The number of probable diagnoses is very small, and in a young woman who had instantaneous onset of an excruciating headache 6 days ago and still has a stiff neck and headache? ...  This is sub-arachnoid hemorrhage, better known as a ruptured brain aneurysm.

Sometimes people have a "sentinel bleed" where the aneurysm bleeds a little bit, once, first: a warning shot across the bow.  This is fortunate, because it permits diagnosis before catastrophe; even more fortunately, her family is not poor, so she will probably be able to afford the scan and neurosurgery that will be curative.

If you read the comments & the post below, you know the word for 'tumeric' (the spice) and 'yellow' are the same in Bangla - holud.  All our food is holud.  

I guess that sounds a little more down-to-earth than "All our food is xanthochromic".


I sent R home today, better.

"Why is all our food yellow?"

This was Jack's question recently.  When I looked into it, I learned that the Bangla words for yellow and turmeric are the same!

I'm pretty sure I've eaten as much cauliflower as this guy is hauling on his vangari since we got here!  Every day we are presented with dal, a seasoned mix of cauliflower, carrot, and potato, eggs, veggie cakes- you get the picture:  YELLOW.  It's delicious, though I can't blame Jack for wishing for a bit more visual variety!  : ) 

Gratuitous Cute Kitten

Ok.  So this is a gratuitous "cute kitten photo", right?

He and his 2 siblings were hanging out on our neighbor's stairs in the sun, trying to warm up.  They all looked soaked from the neck back, as if they'd been dunked while held by the nape.  I picked this one up thinking to move him near his sibs for body heat, but as I put him down something smelled funny - like...like...what is that smell?  Ahh - I've got it, Kerosene.

You'd be suprised at the solutions I've seen employed for common problems: there's no "frontline" here.  So if you are strange enough (here) to want a cat for a pet, how do you de-mite, de-flea and generally prevent unwanted hitchhikers coming indoors?  Kerosene, I guess.

As a follow up: thank you for praying for 'R'.  Honestly? I thought she'd not survive the night, but she has turned a corner and appears to be on the mend now.

Finally, if you wonder whether we read your comments: Yes!  They are a great encouragement, especially when we are feeling homesick.  Now, I must get some sleep.

What's the exchange rate for tooth fairies?

JACK LOST HIS FIRST TOOTH!!!  He has officially started to be a Big Boy.  But the questions started to arise:  Will the tooth fairy come to Bangladesh?  What will she bring?  What does she do with all those teeth, anyway?  Jack insisted on putting the envelope containing his precious tooth on top of his mosquito net, just in case the tooth fairy couldn't make it through.  In the morning he found SEVENTY taka in the envelope!  In the States, he would have received a silver dollar; here he got a dollar's worth of taka.  Their faces say it all!

In other news, Ben and I are having C O F F E E this morning for the first time since London. Ahhhh...

Pathology

I promised myself I'd limit the number of medical posts.  Here's my first.

This is our emergency room - 4 beds in the hall outside the female ward.  In the picture you can see (from left to right) a suction machine that doesn't work, a defibrillator (the yellow thing - this is what you see on medical scenes in movies when they yell "CLEAR" and you hear a 'thump' as they shock the patient), a very nice, functional anaesthesia monitor (in back) and a barely working oxygen concentrator (the blue thing).  We ran out of oxygen tanks last night, which is why the concentrators were in use today.

The pathology - illnesses - I've seen take my breath away.  In the last 24 hours alone we've admitted 3 patients in cardiogenic shock (that's a gnat's whisker this side of full cardiac arrest) - one died, one got better, and one ... we'll see.

********** warning - medical terminology below - not for the faint of heart **********

This afternoon I saw a young (35yo) woman with a 15 yr history of heart problems.  When I met her, she was breathing 40 times a minutes, had a heart rate of 160 bpm and an undetectable blood pressure.  Her exam was consistent with cardiogenic shock.  An ECG showed rapid atrial fibrillation and I pulled the ultrasound machine in and did an echocardiogram: she had severe mitral stenosis (from rheumatic fever) and a dilated cardiomyopathy with an ejection fraction of 15% (normal = 55%).  What she needed, paradoxically, was to slow her heart down, to allow it to fill a little better between beats.  I gave her a little IV valium so she wouldn't remember what I did next, then pulled out that yellow machine in the photo and said, "CLEAR!".   Thump.   Then she had a blood pressure.  We'll see.

If you would pray for her, her first initial is R.

The Weather

What's fit for conversation? According to Jane Austen, "The weather and the state of the roads".
I've already made reference to the roads, so here's the weather: Two sequential thunderstorms, each with hail about 1cm in diameter, on our tin roof were a din like I've seldom heard - and nearly pitch dark outside.

 And this is about 20 minutes later:

We're following the developments in Bahrain with interest, since our tickets home are on Gulf Air, the Bahraini national airline.

Vangari ride!

Doesn't this look fun?  A rickshaw only holds two people, so a group like ours needs a vangari (van-GAH-ree).  Ben is sitting in front with our friend, Joanne, a Dutch woman who runs the finance side of things at LAMB and accompanied us on our first big ride to the market in Parbatipur.  I hopped on back between the boys and felt like I was a kid in Texas again, jumping into the back of my dad's pickup! : )