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