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! : )

Civilization

Every morning we meet in the hospital to begin 'ward rounds' - seeing the hospitalized patients, deciding what the plan for the day will be, setting up special diagnostic tests and seeing any consultations.  Afterward we retire to the doctor's office and sit and have tea - which appears promptly at 10:30 in a thermos - and take few minutes, before heading off to outpatient clinic or to do procedures.

Our Kitchen

somehow this didn't get posted on 13-2-11 when I wrote it

The expatriate community here is multinational.  Though probably mostly British, as you might expect in Bangladesh, there are Danes, Canadians, Koreans, Dutch etc.  One of the short-term Brits (here for 6 months in pediatrics) was staying in the guesthouse with us, prior to our move to the Kim's flat.  We'd been discussing how much we were enjoying the food (rice with curried lentils, fish, chicken, vegetables) and she said (imagine a british accent), "Yes, but after fish one day and chicken the next, it gets a bit same-y".  We found it hard to believe.  

On the left counter is a plate with curried potatoes and egg.  We have eaten eggs and potatoes for 4 of the last 5 meals.  :-)  Good thing we like them alot!

Mosquito bites and curry

Inspiration from the kiddos...

Sorry we've been so quiet!  We are still dependent on a public computer for internet access and it is S-L-O-W (and we are still pretty pooped!).

I thought you'd enjoy a glimpse of our children's reactions to the Big Bang...

Mary, upon walking out of customs and getting her first view out the window of a hazy sky, dirty concrete buildings, and a few bushes:  "Bangladesh is soooo beautiful!!!"

Will, squeezed into the back of a tiny station wagon, sitting in noisy traffic, amazed by all the rickshaws and baby taxis: "It didn't take that long to get here!"

Annie, picked up and cuddled by no fewer than five Bangladeshi men in the bus station at 10 p.m.: smiling and obliging!

Jack, after vomiting three times on the night bus and commenting on how unsafe it was: "Actually, I like the Hoque because it's blue, and blue is my favorite color!"

We've been here about a week now, and last night Will blurted out, "WHAT is that SINGING?!?" when he heard the call to prayer.  I am still cracking up! 

More soon!  And pictures!

25 years old

Yesterday I sent a young man went home, most likely to die.
He had been at LAMB hospital for 3 months for a left pneumohydrothorax (air and fluid around the lung - from TB).  He had a chest tube in place for that time (we have no working suction, so simply to water seal) and was sent home three days before.  About 2 weeks before that he had developed neurological/spinal weakness in his legs.  He returned yesterday suddenly short of breath, from a pneumohydrothorax on the right this time, and had the fluid drained from around the right lung.  He was slightly better after that, though his legs still didn't work.  He probably had Pott's disease (TB of the spine) causing his leg weakness, but I can't know for sure; the family decided to take him home because he wasn't getting better

The View

In the background is a small pond, from which they irrigate the rice paddies.  You can just make out a cow or two along its edge.  We're still emerging from the jet-lag fog, but every day is a little better.

The Night Bus

We took the Haque night bus from Dhaka to the LAMB hospital front gate: riveting.  James Bond in his most daring and hair-raising chase scene can have nothing on the run-of-the-mill Bangladeshi bus-driver; overtaking slower traffic by passing in the oncoming lane has been refined to a high-speed science.  In the first fifteen minutes, after 17 impossibly close brushes with another hurtling 12 tons of steel I began to realize that nobody else was even slightly perturbed, and the driver seemed to be in a groove (he put on some music).  This was an exhibition of prowess the like of which I've not seen before.

After 4 hours I realized I should stop trying to guess how many inches we'd missed the oncoming truck by and try to doze.  Then we had a couple of misses where the driver began to get excitable; I thought if he was praying out loud, perhaps I ought to as well.  But it's interesting - even after so short a time, you begin to habituate to the danger.  I thought, "Well, if I'm getting used to this, how much more dangerous can it get?".
Six hours in we began to hit fog.

No photos yet - some technical difficulties.

Have you ever had a day that seemed to last forever?  'Today' -spanning 11 time zones, 3 continents & 2 days - was so packed with new experiences that it seemed that way.  Eating a McArabia, realizing I was directly over Bahgdad, seeing the delta of the Tigris, then watching sunrise hit the the Himalayas - all within a span of 7 hours.   This morning, dodging rickshaws & goats, with ALL of us in the back of a car, we found the train - the Ekota Express - 7 hours behind schedule.  We were grateful that Akhil (the driver) and Stacy (an expat nurse of 28 yrs at LAMB) knew how everything worked.  We expect to take a bus to Parbatipur tonight and arrive tomorrow at LAMB hospital.

The Visas

The Visas

The Bangladeshi embassy approves long -term tourist visas (90 days) but gives you 3 months FROM the the date of approval, promising 3 business day turnaround once received. Or, if you are going short term, you can get a 30 day tourist visa once you arrive. We waited to apply until January 19th, to give ourselves a little wiggle room (we're slated to return on April 4th) but I had the applications filled out and sitting on the mantle for about 3 weeks ahead of time.
We should have received them last tuesday at the latest, but they had not shown up by wednesday evening. Thursday I called - had to leave a message, then again left a message friday (maybe I left two). No response. So I called twice and left two different messages Monday morning - still no visas and no call back and we're in the last week! Finally reached a human Monday afternoon:
"Oh, we received it on the 20th, but you only sent $131 per visa and our rates changed on the 15th, did no one call you? We've been waiting for you to send us the additional $19 per visa." "
"No, nobody called us - I've left five messages"
"Well, If you send us a check, when we receive it we will mail the visas 3 business days later"
"But I leave on Thursday!"
"Oh. Well, then I can mail you back your passports and you can decide what to do with them."
"But we need visas!"
"Well, you can get them once you arrive there."
"But those are for 30 days and we will be there for 60 days!"
"Oh"
"Is there any way you can expedite the processing? I can have a check overnighted to you by 10:30am."
"Well, the visa officer is in with the consul right now. I can ask him when he returns. I'll call you back"

And by some miracle, she did, and by an even greater miracle, the fedex tracking number for our return envelope was activated yesterday afternoon, so it's in fedex's hands now. Of course there's a blizzard.

Ben

Testing, testing, eck, dui, theen...

Right now I wish I had one of those signs that reads "Thank you for your patience while our site is under construction!" I'm hoping the learning curve will be steep, but for now my venture into the blogosphere feels... tentative. : ) Hopefully y'all will be as willing guinea pigs as my sweet girls...