Arrested Development

I forgot to mention the other interesting thing I learned during the course of my travels. At the start of surveying, we ventured to the char in a fairly massive group: myself, Rupa and up to four interviewers/logistics people. However, as part of our work here, we hoped to train the interviewers to go alone to administer the survey (sounds silly, but actually the concept of surveys is foreign, thus troubleshooting is often required). That way this survey (and then others) would not require our presence. We planned to send our female interviewer with one of the other NGO workers (who happened to be male) early last week, but quickly discovered that this was not possible: a female CANNOT travel with any male who is not family. Basically, you can get arrested for such “activities.” Oh, ok. Under the umbrella of the NGO, this may become possible later but because vigilance is heightened during Eid we decided to hold off at present.

In other news: am currently in Sylhet (northeast Bangladesh, ~4.5 hours outside of Dhaka) visiting a variety of medical institutions here. On Monday, I visited a private medical college. While this was certainly interesting (it is always intriguing to see a different medical institution, particularly one that is international), the highlight for me was yesterday’s visit to the leprosy hospital. Leprosy is certainly not as prevalent as it was previously, but still enough of an issue here to warrant ~3 government hospitals. Given that we NEVER see it in the US, this was the first time I was able to see patient’s afflicted with the disease. Most of the patient’s were doing well, though many had suffered debilitating injuries secondary to its natural course. [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0002323/]. Later in the afternoon, I witnessed another personal first – a patient afflicted with tetanus (remember how much your tetanus vaccine hurt? It is worth it). He also was doing fairly well (actually ready for discharge), had initially presented with difficulty swallowing due to lockjaw. He had inadvertantly injected himself with the bacterium when he tried to drain a foot abscess with a piece of metal. [http://www.ncbi.nlm.nih.gov/pubmedhealth/PMH0001640/].

Infectious Disease Hospital

In general, the government hospitals are much worse off than private institutions (similar to home, really). The infectious disease and leprosy hospitals we visited were government-run, so more dilapidated but not entirely horrible. However, these are relatively low-flow facilities (the leprosy hospital had ~48 beds). Today, we visited the Sylhet Osmani Medical College, a 500 bed facility typically at 3 times (!!!!) capacity. Where do the extra 1000 patients go? On the floor and every other available space in between. It was fascinating to see (we participated in morning rounds) but (not surprisingly) depressing as hell. The doctors are knowledgeable and doing a phenomenal job in a very difficult, resource constrained setting. But I could easily identify a handful of patient s that I knew would never leave. (There was a young girl who suffering from acute kidney failure who would have been an ICU admission at home, quietly suffering in a corner bed… dialysis was planned, but I am not sure there was a permanent solution. I did, however see a curable and SUPER INTERESTING case of cholecystitis (gallbladder inflammation)… the usual cause is an obstructing stone, but here it was… wait for it… a roundworm, ascaris (http://en.wikipedia.org/wiki/Ascaris). You could SEE it on the ultrasound!

Sylhet Osmani Medical College