The Xray that should never be.

I will keep medical posts to a minimum, but this one was worthy of relating.

One of our responsibilities in the hospital is to read X-rays ordered by the MAs.  This one caused us to run out of the office to try and locate the patient.

Some of the findings are easier to see: at the bottom of the patients left lung, the diaphragm appears flattened out, the left lung field appears larger than the right and I'll tell you the heart is shifted to right as well.  It's being pushed to the right by what's going on in the left half of the chest - a tension pneumothorax.  What this quality of image can't show is the fine line in the left lung field that shows the left lung has 'popped'.  What makes this different from a plain pneumothorax is that the hole in the lung is acting as a one-way valve, slowly pressurizing the left half of the chest.  Initially this pressure just pushes things to one side, but eventually the pressure can build to where blood return to chest (and heart!) is diminished... then it becomes very quickly life threatening as the blood pressure drops.  This should be picked up clinically - you should never makes this diagnosis on an X-ray.  This Xray should never be.

We couldn't find the patient.  He was out getting lunch!  So he couldn't be that sick.  After lunch he turned up to find out the results of his X-ray and was shuttled into the emergency hallway.  Though quite short of breath, his blood pressure was not yet low, so it hadn't progressed far enough to be immediately life threatening.  We placed a chest tube (the very tip of which can be seen on the edge of the X-ray below) which permitted the left side to decompress.  Over three days he improved and we removed the tube.  You can see the diaphragm is less flattened and the heart has shifted back its accustomed position.  He went home very happy.

Ants in the yeast

Tk30.00 is about $0.40 - this makes 2 loaves

As a family with four growing kids, we go through about a loaf of bread a day.  So we blasted through the little bit of yeast we brought with us and are now trying out local and imported brands to see which works best.  The best live yeast seems to be this local brand, but it came with a bonus feature: ants!  There were dead ants in it when we opened it - easily picked out.  It reminded me of a story one of our friends told of living here:

  He was being visited by someone from the US who purchased a sleeve of crackers.  Upon opening the sleeve he found ants!  He took it back to the shop where he purchased the crackers and spoke to the shopkeeper: 

Indignant "There are ANTS in these crackers!"

Puzzled    "Of course there are, there are ants in all the crackers!"

Speck

Smog over Lake Banani

The rails rattle under the floor and cigarette smoke swirls - we're on a train heading North through the fog: our first time traveling with no one to hold our hand.  The hospital will be short-staffed over the next week or so, so I'll be taking call and rounding.

For now though, while we study, we stay in Dhaka.  I've been mostly writing about interesting differences and beautiful things here but, believe me, I could tell you about the lack of infrastructure, the grit and dust, the open sewers, the trash, and the dead rat I stepped on.  But I won't say too much about them.  Especially about the rat.


There are days when I feel quite small.  There are more than 14 million people in Dhaka and from a rooftop, if you sit and look for a while, the density begins to press on you.  So many people.  So I mostly think about the small details of our small life.

I haven't written (yet) much about the poverty everywhere, but it is everywhere.  In every neighborhood sidewalks have families lined up living under tarps.  From the beggars outside the bazar to the whole family that lives on our street corner, you are surrounded by it.  It threatens to overwhelm you - what can one person do against this tide? I can end up ignoring beggar after beggar out of a felt need to just keep my head above water.

Disease follows poverty, and what can I do against that flood?  Very little, in truth.

But while my human nature wants to be significant, to be somebody, I'm just one person.  OK, so we are six people, but we're still just specks.  It's not a bad perspective to keep.  I am just a speck.  Speck. Speck. Speck. This small speck will do its speck best to affect the specks around it.

"Family Connections are always worth preserving..."

Just a few fun bits from yesterday's class - family relationships are quite specific here.  You know how the inuit peoples have an unusually large number of different words for snow?  Well, in Bangladesh, there are a lot of words for family relationships, and they're different depending on whether you are muslim, hindu and where you live.  Some of it can be a bit confusing, especially since they sound like US English.

Here are my favorites (out the >70 I know of):

Baba - father (hindu)
Ma - mother (hindu)
Didi - older sister (hindu)
Dada - older brother (hindu)

Dada - Paternal grandfather (muslim)
Daddy - Paternal grandmother (muslim)

Nana - Maternal grandfather (muslim)
Nanny - Maternal grandmother (muslim)

Chacha - Paternal uncle (muslim)
Chachi - his wife (yes, the character from happy days, but I'm dating myself)

Momma - Maternal uncle (hindu)
Mommy - his wife

And my personal favorite:

Phuphu - Paternal aunt (muslim)

So my sister is a phuphu.

Advertising

First, a few amusing shots:

Remember the muppet show?  Kermit went into real estate after the show ended.

For that accessorizing spirit.

Second person imperative?

Flattery will get you everywhere

Ice cream shop.

This one, however, looks completely normal until you remember that it's in Bangladesh.  That happy-looking suburban family is not Bangladeshi.  Our advertising has changed the world.

A few adjustments

Here's a couple of adjustments we've been making:

* The weekend is Friday/Saturday and the work-week begins again on Sunday.

* Occasions and meals tend to run very late - both starting and ending.

Last night Laura & I had our language school's certificate recognition and pre-Christmas program.  Various students sang songs in Bangla & I was in a Christmas play (a shepherd with one line, "cholo!").  The program was supposed to start at 5 and run 2 hours 'til dinner at 7.  We arrived and the AV system and stage had not yet been assembled.  The program ultimately began at 6:30 and ran until about 9:45, when we (and our kids) ate and eventually straggled home after about 10:30.  This is par for the course and we had specific training to help us adjust our very American expectations, so we were not surprised. :)  But we were tired.

Voltage

Transformer outside our flat

BOOM!!!  We just heard two sequential explosions: transformers exploding on telephone poles.  This has not been an uncommon occurrence but these were close enough we saw the flash and we jumped!  Instantly our power was out.  Usually this is short-lived (an hour or two) but this time we'll see.

The wall outlet voltage here in Bangladesh is 250V, but the grid is not exactly stable; voltage surges as high as 600V are occasionally documented.  Anything with delicate electronics needs both a voltage stabilizer and a surge protector.

'Privately installed' electric lines 

The other morning we woke to a warm refrigerator.  The eggs and butter were salvageable, but most other food was not.  A couple of technicians pulled the control board, showed me the fried capacitor and managed to make me understand that though we had purchased a voltage stabilizer, it was not of high enough quality.  They disappeared for an hour with the control board then brought it back with a new capacitor soldered in place, and we were back in business.

Just another day in Dhaka.   BOOM!!  I really hope the fridge and other things survived this time.

Me talk good

Clotrimazole

 I have a bit of an unofficial 'clinic' going on in the parking garage.  Ever since the guards found out I am 'ekjon daktar', I get asked for medical advice about every 3-4 days.  Some friend will come by, usually with a minor dermatologic issue like athlete's foot, acne or eczema (none of which require much language) and I write out the appropriate salve, which they pick up at the pharmacy.  A tube of clotrimazole for athlete's foot runs about $0.40.

Our daily life is mostly about language, however.  Just when I feel like it it's going sooo sloooowly that I'll never be able to speak, I have a conversation like this one with our house guard (in Bangla).

Mustafa: My friend has pain here, here, here & here. (points to his knees,ankles, shins & hips). The doctor ordered extra blood tests.  Will you look at them and help? (This sounds like a rheumatologic illness - these can be a bit subtle and more difficult to diagnose.)

Me:         For difficult things, my Bangla is small.  I help try can to.

Mustafa: 'I can try to help'

Me:         Oh, thanks.  'I can try to help.'  Did I say that right?

Mustafa: Yes. At 9pm my friend will come?

Me:         No, I usually sleep by 9pm.  I'll be down at 7:30 am.

Mustafa:  With the kids for the school bus?

Me:         Yes. 

Mustafa: OK,Take care!

Me:         See you then!

Even though my grammar is moderately poor and my sentences are simple, I COMMUNICATED!

Very very encouraging.  

  B

International Team

Sitting politely - for 0.004 seconds

Our company is an international one - I think we're the only American couple currently in Dhaka.  Today three couples from the company got together for a social afternoon meal: a British couple, an African couple and us.  It was a delightful time and the food was savory, but one of the highlights for me was the tangle of children.  Imagine side-by-side various gangling boys running through an apartment, sitting playing chess, Mary reading (of course), two tiny British voices saying, "Mummy, may I have a gloss of woter?" and Anne balancing a tray of plastic teacups on her head.

What it was like the rest of the time

Wild Animals

We live in an urban environment.  On a daily basis our eyes are primarily on where to step, how to avoid being hit by  bus, CNG or rickshaw, but every now and then we look up or pause and notice what's around us.

Within the last week here are a few of the things we've seen.  As a disclosure - I did NOT take these photos.  It would be challenging to snap photos while dodging traffic!  However, these are exactly what we saw.

Brahminy Kite

Lesser Goldenback

Small Asian Mongoose

We've see multiple mongooses - they live beside Lake Banani.  Makes me smile and think of Riki Tiki Tavi.

Nobody here but us chickens

   Walking down the street I saw a vendor selling chickens.  He was ignoring the chickens, yet they were all remaining right there.  I looked more closely and realized why -- each chicken was tied by one leg to a comrade.  It kept them in one place until the vendor needed them.

   Chickens are not, by nature, very bright, nor are they particularly cooperative, so they never will walk in the same direction at the same time.  I think there's a lesson here.

Football Diplomacy

Football Pitch

   We have been away for a conference up at the hospital the past few days and have just returned to Dhaka.  It was a tiring weekend but a very good one; wonderful to see people we knew before and to meet new ones.
    I confess I have harbored a fear for my children.  We took them out of school in the States and dropped them in Dhaka, where, truth be told, they do seem to be thriving.  But we plan to take them out of Dhaka after this school year again and plunk them in yet another school at the hospital where we will be working.  I worried for their social situation.  It appears I needn't have worried.
    This weekend the boys played football (US: soccer) nearly every minute they were conscious and so made immediate connection with boys up there.  Mary came home and said, "I made five friends on the playground!"  And Anne? we never worry for Anne in that way.  The children returned exhausted but happy and confident, so I did as well.

Banana Coke

In Bangla, each spoken vowel 'belongs' to the consonant before it - i.e. this is Ko-Ka _ Ko-La.
But in the script, the vowel can follow, precede, be under or even bracket its consonant. In this case the 'O' vowel has an ে before and an া after the consonant ক (k), making েকা (ko).  Can you see the great swooping curve they made of the ে in each word?
Pretty clever use of grammatically correct Bangla to make a recognizable logo.  Maybe I'm just punchy, but it's also funny because because Kola means Banana, so I see this and think, "Banana-Coke!".

TCD

Bonnet and Tip

Meet Bengali-Dolly.  

   Mary has treasured Bengali-dolly since 2011, when we were last here.  Bengali-Dolly typically can be seen in a Sari.  Today she tried on a traditional 19th century American bonnet and liked it, by all accounts.  She's a cross-cultural doll, you see - rather than utterly westernizing her dress or, alternately, rejecting western clothes entirely, she has blended them into something new.  She is becoming a 'TCD', or third-culture doll.

Value

Looking at each other 

We have a few days before formal language school begins, yet.  Though I have been studying and we're still outfitting the apartment (it takes a couple of hours just to go purchase the simplest items), today there was an hour when I was not doing anything.  I felt a little uncomfortable - good grief, I should be doing something!

Where does our sense of identity and value come from?  I suspect there are a variety of very common sources.  Do you draw a sense of value from what you accomplish each day or from your job? I think these two are quite common.  Do you find your identity in what others think of you?  How you look?  In some group membership? What happens when any of these falter?

Annie (5) and I had this interaction today:

"Annie, do you know why I love you?"
"Ummm... because I did my work and my teacher was happy?"
"No, though I'm glad you did"
"Because I'm kind and tell the truth?" Oh, it was very tempting to say 'yes'!
"No, though those are good things."
"Because I hug you?"
"Oh, I like hugs! but no, I love you because you are my daughter."

As a very young child you know you have intrinsic value, that you are loved unconditionally by your parent.

Daily life #2

I didn't expect to be writing a medical post so soon!

Unfortunately, I've developed a case of conjunctivitis (pink eye). It will get better so it's not that bad; it's just unpleasant.  It occasioned my visiting a pharmacy.

Virtually every box on those shelves is a prescription medication in the States.  Here it's not.  Anything back there can be had without a prescription - hopefully you know how to use it properly. This does not create an issue with medications of abuse (i.e. narcotics) - none are available.

Daily Life #1

Our cook top

Some initial impressions of daily life here:

This is an aluminum pot that I believe is called a 'Calabash' - and it does look like a Calabash Gourd. We use it solely for boiling water - tap water in Dhaka must be boiled first, then cooled in the pot next to it and then passed through a high-quality filter system.  We boil a full pot each evening and let it cool overnight to keep the filter reservoir full.

Very light traffic

There is construction everywhere in our neighborhood (Banani).  Each of the high-rise tenement buildings you see in this photo are actively under construction.  Lower floors may be inhabited even as the upper floors are being built.  It seems every other block has one or two new buildings with piles of rebar and gravel outside.  The children's school lost its only access to a small sports field to a new building.  And the only direction is up.

This is Unimart.  Basically like Walmart.  Yep.  Even in Bangladesh.  It's fairly new.  It is convenient because everything is in one place, and there are certainly things you can purchase that are hard to find elsewhere (Quaker Oats Corn Meal, for example!).  But it is much cheaper, after haggling, in the old market (much more about that later).

   Traffic: when riding in a car, this is a common view, aside from the double decker bus.  For anyone who notices that this was taken from the left front seat, the driver sits on the right in Bangladesh, as in the U.K. - I wasn't driving.
   Traffic is ... there are hardly words.  Take 53 bicycles and rickshaws, 17 motorbikes, 5 big buses, 20 cars and a bunch of CNGs (the little green three-wheelers above) and put them on about 100 yards of road.  Have some parked, some making U-turns, all of them constantly weaving and jockeying for position, a few rickshaws going the wrong way, pedestrians crossing mid-traffic and add some intersections without traffic lights.  Horns & bicycle bells are in constant use, but not as expressions of displeasure; they are used to announce your presence to vehicles in front of you to help everybody adjust to your arrival.
   What is amazing is that it is not *quite* chaos.  Your progress forward may be in fits and starts, and the standard distance between the rickshaw you are in and a car is measured in inches, but it flows (more or less) in a constantly adjusting, risk-balancing, organic motion and din.

Apartment

We are settling into our apartment in Dhaka.  Well, unpacking anyway.

We have a water view!  Granted, the shores of Lake Banani are, perhaps, less-than-pristine, but it affords a cool breeze through our windows.  That's the other side of the lake, by the way.  It's not very wide.

Apartments in Dhaka are generally supplied bare.  There are no ceiling fans, no built-in AC units, no washing machine, no fridge etc.  We were able to purchase the fans and AC units from the previous owners, along with some furniture and a good water filter (very important).  This very nice couple also left a few basic dishes, a drying rack, and generally a few essentials to make our life easier in the first few days (i.e. TP).

We are still quite jet-lagged: we were coherent enough to run errands this morning (with help), but not this evening.  Clear progress!

Dhaka

We're in Dhaka! and more than a bit jet-lagged.  I find it hard to think straight, can't do simple math and have no appetite, but I'm happy to be here, finally.  It will improve.  We'll have some photos in future posts when we're a little more put-together.

Tonight is our second night in the guest house.  Tomorrow we will move into our apartment and try to get local cell phones, shop for food and other necessities, etc.  Our country director and teammates have been wonderful, helping us plan and think through everything, and accompanying us when shopping.

I feel like a two-year old.  I don't know how anything works, don't know what most of the sounds I hear are, and don't understand most of what people say.  This is exactly what I was told to expect during training, but it's wild to experience it.

Good night!

Tickets!

We are the proud owners of six one-way tickets to Dhaka on 14 Oct.

Slow Down!

I have waited for this moment for several years - the time when we will actually be 'in the funnel' to leave for Bangladesh.  It has frequently seemed just over the horizon, and on the few occasions when it seemed nearer, it wasn't.  I've been antsy, restless and even occasionally persnickety for the last six months.

Now, with the house under contract, departure suddenly seems imminent.  Part of me can hardly stand to hope, of course - certain something will go wrong with the sale.  The rest of me, unexpectedly, is saying, "Slow down!" - I walk across the yard and it seems too vividly green.  The cool Maine summer seems more perfectly temperate.  Our friendships seem unbearably sweet.   How can we possibly leave this?

In this place I've been consistently shown the need to slow down and pay attention, and it seems it has now been arranged.  I will remain on blood thinners until early October and we may not leave until after that, but for once I'm not champing at the bit.  That will come soon enough.  

"Get Well Soon, Daddy"

This is the view from my hospital bed - I especially like the banner.

Right now I am profoundly grateful that we have remained in the States longer than anticipated.  I have spent the last two weeks in the hospital after unexpected surgery followed by a few complications, and had we been in Dhaka, it seems probable that the outcome would have been different.  I am almost entirely better now, though I will have to remain in the US for three more months to finish my treatment.

As a little icing on top, our house went under contract today.  If all goes well between now and closing, then I will be the last hurdle for our departure - a year later than hoped, almost to the day, but right on time.

Sufficient.

Sometimes in my profession I have to say, "I'm sorry, there's nothing more I can do."  It's very old-fashioned.

It seems impossible that in this day and age there's anything that medicine can't do, and physicians are often reluctant to use those old-fashioned words.  Instead we say, "Well, now we have to change our focus." or, "I'm not sure, let's see what the specialists have to say." or, "We can't cure this, but we can continue to treat it".  There's lots of ways around it, but we musn't ever say something as hopeless as, "There's nothing more I can do."!

In the movies, the doctor always says this when someone is about to die.  But it's  not uncommon in less serious situations.  There are injuries from which we never fully heal.  There are illnesses from which we reap some permanent damage.  There are scars that never disappear.  We may have a permanent ache.

Perhaps we wish it away, whether the 'thorn' is in our shoulder or our heart.  But sometimes we shouldn't.  Because of that ache we may be reminded regularly of something we must remember but would wish not to.  Or it points us to something we need that we'd like not to.  Or it imparts wisdom (like my left shoulder does, every time it goes, 'clunk!').

The interesting thing about that old-fashioned phrase was that whenever I did use it, the effect was never hopelessness; instead, it was usually peace.

Another edition of our regular column "Overheard in our family"

Episode 2:  
On the way to Sunday School.  (AE is 4, MK is 6.)

AE: "When will ALL the schools end?"

MK: "At the end of the world"

AE: doubtfully "That's a long time in school..."

MK: "Yeah, it is. You'll learn lot."
pause
MK: singing "I'm a frog...on a pony...I'm a frog...on a pony...." etc.
The rest of the song is pretty standard fare: a protracted narrative about the frog and a pony going to our Sunday meeting.  The frog may not have had much choice - apparently he was stuck to the pony's nose.  We heard rumors that the frog was a dark jedi.

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Episode 3:

"Daddy, It shouldn't be 'Scaredy cat'; it should be 'Scaredy cow', don't you think?"

A lego wedding "This is the bridesmaid.  Here's the bride waiting for the groom....              AAAAARRAAARRRRAAARGH......I'm a zombie!  I'm attacking the bridesmaid!"

"Jack, please don't rub your toast in your hair."

"Mommy & Daaaddy are 'diculous....Mommy & Daddddddy are 'diculous...." meant as a compliment.  Sung while surfing around the kitchen on a dustpan.

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We are fully funded.  Thank you, all!
In addition, there are several interested parties looking at our house right now.
You know what we need!