A Tale of Two Kids

Today, we were out doing fieldwork and I had two special interactions with two special kids that I wanted to remember. One taught me curiosity and the other love.

A girl named Curiosity: We had just finished interviewing a mom and I had noticed that one of the girls listening in had a world map notebook. I took the notebook from her and pointed to Bangladesh, "This is where you are from." She nodded her in head in understanding. Then I pointed to the US, "This is where I come from," and then pointed to myself. Her eyes bulged out as she understood that I am coming from more than half way across the world---a huge distance in her map. She then smiled in astonishment and followed me as I went to her neighbor's house to elicit our next interview and smiled at me each time I turned to look back at her.

A boy named Love: After interviewing the mother's in their homes, we walk them back to our office to take the depression screening and answer some questions about how they get along with their husband and mother-in-law. One mother brought her 10-month old son and her toddler son, Love along with her. I showed her into the room and then planned to go with one of the psychologists to buy a few things from the shop across the street. Love saw that I was planning on going out so he asked his mom if he could go with me. I said sure because if he had stayed with his mom, he would've listened to her interview and I didn't want her to hold back on her stories. So we left the office, and I took his hand. I was buying salt and soap (gifts we give to the moms) from the shop and he sat on the bench. He was being so good so I told him to pick out a treat. He picked the "Bengali tiger" chocolate bar. We went back to the office and he gave the bar to his little brother, and carried his brother to the room that I was in. I opened the bar for them and Love would take a bite and then feed his little brother. This continued until they finished their chocolate bar. Nobody told Love that he had to share. Love did it on his own desire.

Animal Appreciation Day

Today we moved out of the student guesthouse to "house-sit" for an American family as they vacation in Paris and the States. I've developed an annoying cold in the past two days so I haven't left the house all day even though we really need to go grocery shopping for this week. I just hate going outside and dealing with all the stares.

Yesterday was a really fun day. Khoshal, Saria, Humali and I took a trip to the zoo! Besides the initial pseudo-war zone of the entrance (no really, the zoo staff was pushing, shoving and fighting with people in their attempt to organize the masses), the zoo was a relatively peaceful place. The majority of the animals were the malnourished versions of the species with the exception of the glorious Bengali tiger. It's a beautiful animal and if it were not endangered I'd want one as a rug or throw....At the zoo, we bought peacock feathers (that's THE official souvenir), ate snacks, got stared at A LOT, climbed a tree to take a picture and....rode on an ELEPHANT. It was a very scary experience. Getting on and getting off in particular. But it was great!!! Hopefully we'll get to do that again in Nepal ;)

After the zoo, we drove back to Banani and got lunch at Dhaba. On our walk back home, we saw a man selling birds. He had about six cages with beautiful birds on each side. Saria and I decided it was well worth it and bought two tiny birds. (We called them H5 and N1 since everybody and their mother freaked out about the nonexistent chance that they might be avian flu carriers). Since we're on the topic of the birds, I must report that this morning one of them killed itself. I found it with its head pushed outside the cage and of course it was stuck and probably suffocated. STUPID BIRD! So because we didn't want to touch a dead bird and didn't want the other one to develop post-traumatic stress disorder from being in a cage with a dead fellow bird, we let the other one go. :( So we had pet birds for less than 20 hours.

After buying birds, we stopped at Movenpick, an AWESOME Swedish ice cream parlor. We stayed there and chatted for almost 2 hours about being pre-med and med school with Khoshal (a 5th year med student in the Netherlands) and Humali (pre-med at Harvard). Afterwards, we walked back home and sunk into our domestic routines of laundry, facebooking and sleeping. :)

Hospital Day

Today we saw a guy selling live chickens on the street. They were all in a basket, looking severely dehydrated (probably suffering from cholera). Saria, Kushal and I decided that we would copy Joey from Friends (he had a duck) and buy one, to have a pet chicken. However, we've decided to move from our student guesthouse to a very nice apartment to "house-sit" an American doctor's while she and her family vacationed. So we can't get a chicken. Instead, we will have a pet cat. :)

This morning, after a morning presentation on acute renal failure, we shadowed at the special care unit of the hospital. Special care essentially means not-diarrhea cases. The chief attending (an American doctor) who is a big fan of the UVA ID dep't, taught us for a couple hours. We admitted a cholera patient, treated a 60yr old lady with an asthma attack, a newborn with pneumonia and a long-standing diarrhea case in a 4 year old. Dr. Cobb also told us that he sees many Addisonian crises here because people take dexamethasone (steroids) to gain weight (b/c they are so thin!). One of the nurses in the peds ward today also came up to me and asked if I was Christian (she had seen my cross). I told her yes, she smiled and said she was too and that her name was Agnes. :) So sweet.

After a quick lunch and a trip to the travel agency, we did some mock interviews with moms at the hospital in the nutrition unit to gauge how the interviews will go in the field. The moms enjoyed the interviews and one out of the three asked us to come visit her again. :) There are several differences between how interviews in general are done here versus the States. In the States, there is usually an introduction when asking people questions. Here, we had to tell the psychologist administering the interview to INTRODUCE the project and ask the mom if it was okay if we asked her some questions. The psychologist was in the habit of simply going up to the mother and beginning the interview. Aaaah. Another point was responding appropriately to answers. One mother said that she had had a miscarriage before this child. The psychologist simply noted it down and wanted to move on but when I saw her write that, I told her, WAIT. Tell her you are sorry to hear that. I think the mom was so surprised by the statement that she laughed and shrugged off the event. *sigh*

Okay, its way past my bedtime and tomorrow is our first legit day at the field. Oh!!! I forgot to mention-IT RAINED today!!! Oh it was so nice. But it didn't last long...

Typical Day Pre-Fieldwork

Inspired by Saria, here's a typical workday for the two of us.

4 am Wake up----because of Jet-Lag
7 am Make breakfast: toast & jam and 3 in 1 coffee (coffee, creamer, sugar) They love 3 in 1 in BD
7:50 Go to the shuttle stop, miss the shuttle, grab a CNG and risk our lives getting to the hospital
8:30 Morning report with the doctors (special cases, mortality & morbidity, etc.)
9:30 Meet with Dr. Fahmida to go over our to-do-lists for the day
10:00 Tea Time #1
10:30 Go to the Library, work a little, Facebook a lot
12:00 Lecture on a clinical or science topic by a visiting scholar (today's was Typhoid Fever by a Cambridge ID Doctor)
1:00 Lunch time :-D
2:00 Do some work, meetings, etc.
3:30 Team Time #2
4:00 Fill our time with some reading?
4:30 Buy fruit from the nearby stands
5:00 Get on the shuttle back to our house

So there you go! Life in the day of an ICDDR,B research fellow. We're enjoying our time at the Center. It's really great and a great experience. The doctors are incredibly nice and knowledgeable. It kinda feels like summer camp with our "shuttle", our two tea times, and a two-hour lunch period. We're meeting more and more "foreigners" which is really nice too. All in all we're getting adjusted. Time for dinner---gibna and tamatim sandwich.

A Mere Tour

1. I saw my first cholera patient. Chances are most American medical students will never see a cholera patient. Positive skin sign, not alert, severely dehydrated, severe diarrhea and vomitting. He couldn't have been more than five years old. His mom looked at him with sadness and hopelessness in her eyes while Dhaka rushed around her in its intoxicating whirlwind.

2. The meaning of out-patient will never mean the same to me. During the diarrhea waves, the ICDDR has to set up make-shift tents of bamboo OUTside to accommodate the thousands of diarrhea patients it gets. We went to the tent during our tour of the hospital with our white coats (and heavy material--unsuitable for equatorial temperatures) and immediately the patients and their families got up from their beds to look at us. Patients who were laying down on beds with circular openings on their bottoms so that their stool can fall right down to the bucket placed underneath the wooden bed got up to look at our white coats.

3. I didn't come to Dhaka to buy shaliwar kameezes that I will never again wear in my life. I didn't come to eat Bengali food. I didn't come for the possible tourist excursions outside of Dhaka and Bangladesh. I came to see these patients. I have absolutely nothing to offer them but I will never forget what cholera, intestinal tuberculosis, marasmus, kwashiorkor and hopelessness look like.

Quantifiying what 101 Degrees in Dhaka Feels Like

Me and Saria came back exhausted today at 3:30 pm. Our key would not open the front door to our flat. Four other people came to try unlock the door, using everything from a screwdriver to lubricant oil. All to no avail. We borrowed someone's phone to let the ICDDR people know that we were locked out of this awesome student guest house. Nobody ever showed up. Two and a half hours later in the heat, Saria and I are woken up my our nice neighbor lady to come into her house. (We were both sleeping on the dusty floor in the heat, drenched in sweat). Five minutes after we went into her house, the girl who we share the flat with came home from work and after a little bit of struggling, unlocked the door. Turns out the heat sometimes melts the metal of the locks and then we get locked out. It also is the cause of the electric outages. The hotter it gets, the more frequent the outages.

Things I can't complain about: our shower, our toilet, and the wireless internet connection....and my eighty cent lunch of beef and rice, veggies and a coke bottle. :-D and the turbo fan that we've taken hostage into our room :-D

Tomorrow's mission: grocery shopping, shaliwar kameez shopping and possibly the first rickshaw ride. Aaaahhh

Dhaka.....

I was told to prepare myself for a huge culture shock. Well....I haven't really had that yet...BUT let's talk about HEAT SHOCK. When Saria and I left the airport, I literally felt that I had walked into a steamroom. OMG. I can't believe we contemplated the idea of staying in a place with no AC. A little part of me dies every time we walk outside. But, we're both really exhausted and jet-lagged. Dr. Hobbes taught us that for every time zone crossed, it takes a day to recover. I don't know how many time zones we've crossed to reach Dhaka but I think it'll take us about a week to get used to the time difference.

My flights to London and Dubai were awesome. I love Emirates Airlines. Especially the warm towels they give you at the beginning of the flight...and the lamb for dinner. And the ice cream. And the endless coffee and tea. And their amazing entertainment selection. But of course the plane to Dhaka was a different experience. Okay must go will tell more later. byeeee

The Beginning of an Epic Summer

I've changed my template in honor of a switch from my ordinary blog to my TRAVEL BLOG. Follow me as I conduct my research on malnutrition with Saria at the famous International Center for Diarrheal Disease Research hospital in Dhaka and take trips around Bangladesh, to India and to Nepal!!!! Here's to hoping that our trip is as glamorous as Slumdog Millionaire. Aaaaaahhhhhhh. :-D :-D :-D

A Note on Sexual Promiscuity

Upon learning any facts, one usually interprets them. Here is my interpretation (i.e. understanding) of some of the things I've come across in my pathology course...

1. Traditional definitions of sexual promiscuity are no longer applicable. How so? Historically, Human Pappilloma Virus (HPV) was referred to as a sexually transmitted infection/disease. Of course--its the major cause of cervival, vaginal, vulvar and penile cancers, not to mention unsightly warts in its early "benign" stages: google condyloma accuminatum. However, now that 80% of all sexually active people by the age of 50 will have or have had an HPV infection, it's considered "a marker of sexual activity" and not "sexual promiscuity". Note that the two most significant risk factors for HPV are: early age of first intercourse and multiple parters.  But apparently those aren't "sexual promiscuous" traits anymore...

2. Could the Creator be sending us a message about marital relationships by us recognizing the biological manifestations of "untraditional" relationships? 

a. Sexually transmitted disease (mostly gonorrhea and chlamydia) cause pelvic inflammatory disease in women. What's so bad about PID in the long run? Infertility. These infections cause wreckless scarring the woman's Fallopian tubes (the tubes which the growing embryo will travel through from the ovary to get to the uterus where it will stay the rest of pregnancy) that is detrimental to pregnancy. Don't let yourself get a STI and you have less of a reason to worry about infertility...

b. Much is still not known about how and why certain women get a condition called Preeclampsia (hypertension during pregnancy...all the way to seizures due to pregnancy). Preeclampsia is harmful of course not only to the mother but also to the baby. Fascinating research has shown that multiparous women have an increased chance of preeclampsia if they switch partners, i.e. their 2nd+ child has a father different from the first time they were pregnant. It is thought that a type of immune reaction is built against the "new antigen", i.e. that of the "new" father. Hmm....monogamy as a way to protect yourself from a severe pregnancy disorder. Interesting...

c. Two sperm do not equal a baby. Instead, they form a tumor. No really, they form what is called a "complete hyatidiform mole." This tumor has no fetal tissue but only placenta-like tissue. It must be removed immediately when detected in a woman because in a minority of cases it can cause a malignant choriocarcinoma. 

d. Two sperm and one egg also do not equal a baby. Instead they make a very messed up looking partial fetal tissue and placental tissue tumor called a partial hyatidiform mole. This one is not as bad as (c)...the maternal genes makes it a little better but still no cigar. 

I thought these examples for gynecology pathology were quite enlightening and these are my own takes on them. I'd be interested to hear what other people think of them too!