Thailand!

So I have been in Thailand for about 3 days now, but it feels like much longer. I have been staying in Krabi at a good little guesthouse. After Bangladesh, it feels so civilized here. People actually follow basic traffic laws, there are street lights, and turning signals are used as the manufacturer intended. I am loving the cheap food here and I've been having a pastry and a mini pineapple for breakfast - for about 50 cents total. On the weekends here there is a night market with tons of food stalls selling various meats, rices, fruit, drinks, you name it. Most things are on a stick or you get a little take out bag. There is also tons of jewelery and clothing. It has been a good place for me to practice haggling and, frankly, I suck. Thank goodness I have several more weeks and markets to practice.

Krabi town is on a river, not the ocean, but the entire province as these huge ridiculous limestone cliffs everywhere. They're gorgeous. Yesterday I took a sorngthaew (spelling is something like that) which is pretty much a truck with 2 benches across the back that do local routes of transportation regularly. I went to a beach in a nearby town. According to the guidebooks its not a beach worth stopping at, but I thought it was lovely. The town felt really touristy - full of resorts, and even a Best Western Hotel. But it was nice to finally get in the water - which was ridiculously warm and felt wonderful.

Today I went rock climbing in a nearby place called Railay which is pretty much famous, worldwide for climbing. I started out the morning with a couple girls from Singapore and our guide. It was high tide so went went into the island a bit to a small rock wall. We did 3 climbs there and my poor technique resulted in a banged up knee, but it was a ton of fun and you get a real rush when you are able to make it to the top. After lunch we headed to a different rock wall that was on the beach. It was much bigger (about 30m was the highest climb I did) and at the top you had a beautiful view of the area. I could not believe how much the water went out a low tide here - a good 400m it looked like, although I suck at estimating. There were lots of people climbing on this wall, and after 3 more climbs I was done, with shaking arms, and bruised knees. So I head through some limestone caves to the other side of the peninsula and a gorgeous beach. This area is resort central, but it is low season so the beach wasn't too busy. I spent a couple hours alternating between baking to a deeper shade of red (after what seems like a million applications of sunscreen too!) and cooling off in the water.

Tomorrow I head across the Malay peninsula to Koh Phangnan, an island that apparently has some great beaches. It is where the full moon party is held each month, but that's too crazy of a scene for me so I timed it to arrive a few days after the party.

And that's how they rope you in...

After being in Rangpur, a decent sized city, for the last 9 days, I had almost forgotten how beautifully green this country is, and the drive to Kurigram was great for reminding me! The drive up was more or less in the countryside (still people everywhere of course) and the sides of the road were full of fields of rice and jute. Along the road were huge trees that were hanging over the road too, making a canopy of sorts. It was a nice drive and I would have takend some pictures if we weren't hurtling by at the breakneck (by Bangladesh standards) speed of 70km/hr. The rains which are becoming more frequent, and lasting longer with the approaching monsoon season, made traffic a little lighter on the highways so travel was a bit faster. Although it still takes over an hour to drive about 55km.

I was only in Kurigram for 2 days, and one of those days was the best of my trip so far, from a medical learning standpoint. Instead of standing in the corner of the OR watching a surgery (which was interesting, but got tiring) I went on rounds with the doctors, and the ones I were with that day were fantastic for explaining things to me and understood that I had done cardio and resp so let me examine those patients, look at chest xrays, and talk about treatments. It's not much compared to the early exposures people are having in Canada I am sure, but its the most medical interaction I've had since I've been here. I also walked out into the village to see a nutrition centre with both and inpatient and outpatient ward. The outpatient ward does workshops and screens for severe malnutrition in children under 5. If their weight is less than 3 standard deviations from the WHO average for their height, they are admitted and put on scheduled feeding protocols. The recovery they make is so rapid - within a week they are often discharged. The centre was staffed by what seemed like a great group of boisterous nurses. They were also giving out H1N1 vaccinations as they are apparently hitting their outbreak now.

The guesthouse in Kurigram is small - only 3 rooms I believe. The person running it, Joseph, was working in Rangpur when I was here last and he was very excited to see me. The perfect word to describe him is simply kind. He is soft-spoken and pulled out his camera to show me pictures of his daughter, son, and wife who he is very proud of, plus some pictures of the other U of M students who went through. I also got to meet his son when he came up for a visit. I had such delicious suppers there as he said that rice and dahl get so boring. It was a wonderful note to be leaving Bangladesh on. People like Joseph are what makes you keep going back to places like Bangladesh, even though I can say that, on more than one occasion I looked around and thought, "what the hell am I doing back here?" But because of people like Joseph, I may just be back again.

I'm not creative and can't think of one

So I realized I haven't really done a good job of describing my surroundings very well. And my description of the hospitals I'm in really hasn't been giving the places justice. The government hospital I was at in Lalimonirhat (and I will be going to another one in Kurigram over the next couple days) is the main hospital for the district. This is a bustling, big, busy hospital, that also happens to be pretty disgusting. Every surface is dirty with god knows what and there are red spit marks everywhere - everyone spits constantly in this country. It is red from paan - and nut/leaf/spice type thing that is like chewing tobacco here. Everyone uses it and it turns the mouth red. There are people everywhere (which is not unlike the entire country) and the facilities leave a lot to be desired. The beds that are there have lumpy old mattresses and rusted metal frames that look like they are from army barracks from WWI. The operating theatre was a bit of a relief from the smell and grime, but even there, equipment was very outdated and everything from gauze to gloves is boiled up and reused. They can't afford to throw things away. This and the patient's blood being wiped off the floor with a rag and a bucket of water before the next patient came in. However, there were attempts at sanitation, and the whole thing was not just a free for all of scalpels, it just clearly was nowhere near Canadian standards. The private hospital, like I mentioned in a previous post, was a lot cleaner and better organized, and did have more up to date equipment, but there is still the same beds with people everywhere. I saw several patients with surgical drains leading to a glove that had been taped to the end of the tube.

The streets of Rangpur are a congestion of rickshaws, autorickshaws, bikers, pedestrians, motorcycles, and some vehicles. There are actually sidewalks on some streets here, but they are shared with small businesses and vendors, goats, dogs, cows, and the occasional motorcycle that is too good for the road. Everything is loud - from the colors to the endless horns and bells from every vehicle as people squeeze by each other. Some cars and motorcyles have been outfitted with the most obnoxious horns playing songs or just high-pitched whistling. Yet streets are somewhat organized in Rangpur - with boulevards and roundabouts, but that doesn't mean people obey the traffic courtesies (I don't know if I would call them laws here). However, it is fun to go down to the supermarket (more or less a 3 story mall) that is filled with tailors, fabric shops, shoe shops, and cell phone stores. Women here love fashion and shoes as much as in Canada, so long as they can afford them.

Tomorrow I am off to Kurigram for a few days at the government hospital, then back to Dhaka, Kuala Lumpur, and off to Thailand. It has been very different being back in Bangladesh for a second time, alone, but it was definitely an experience that has pleased me, frustrated me, and tested my patience. I am looking forward to the next part of my journey that I am more in control of and to hit the beaches in Thailand!

Football Frenzy

So Bangladeshi people are really into the World Cup. In the evening when games are on, every little TV, in every shop will be tuned in. At the hospital I am at now they have lounge type areas (a couple plastic chairs on the landing of the stairs) with TVs and in the evening people crowd around them. The favourite team by far is Argentina, followed by Brazil. Flags for these 2 countries are everywhere and you can see tailors making them in the street. It is enough to make me watch the games, even if I don't care too much for the sport.

People in Bangladesh are often very vocal, strong, persistant people. In the hospital, the doctors are often yelling at people - obviously I have no idea what they're saying, but emotions run strong, be they good or bad. People in the street will yell at me, "Hello, how are you?" and if I don't answer, will keep yelling "Hey sister" at me. You may think it is rude not to answer, but it is pretty much a constant barrage as I am alone and I have my limits. The staring is also much worse now that I am by myself. I even have some people who will point, whisper, and laugh, and then stick their camera in my face to take a picture. I know I am new and exciting to them, but this gets almost exhausting after a point and I feel bad when I feel myself getting frustrated and bitter about it. When I was here with a group, there were other people to divert some of the attention to. However, not all people are like this, and there are many people who are helpful - I was directed around to several cell phone shops yesterday and managed to finally find a charging cord for my Ipod, something I had forgotten at home.

Surprisingly, in such a poor country, there are not many beggars on the street. Perhaps this is because everyone is poor, and so few tourists, etc. go through to help condition people. However, yesterday at the supermarket I had a little girl come to me holding out her hand asking for money. For various reasons that I have heard from various sources and people, giving money out, especially to children does very little and may cause more harm than good. So I said no and kept walking. She chased me and grabbed hold of my leg and wrapped herself around me. I had to pull her off me and she kept chasing me and doing the same thing until I managed to lose her. If you have never traveled anywhere like this, I may seem calloused, but if I gave in to this one child, no doubt I would have another 10 at my feet and as kind of a person I like to think I am, this was not something I was giving in to. It was a disturbing and troubling experience for a number of reasons and is definitely the first and only time I have encountered this in Bangladesh.

Night Surgeries

So the schedule that doctors work here is definitely very different than back home in Canada. There are few patients and work to be done before 11am and most scheduled surgeries at this hospital take place from 9pm into the wee hours of the morning. It is very weird. I have been able to watch a couple surgeries and the facilities at the private hospital I am at now are definitely much better than at the government run hospital I was at last time. Some patients have paid for private rooms with a bathroom and sometimes with a TV. Even the common wards are nicer - though not Canadian standards of course. There are probably 20 patients in a room with half walls between every couple beds, but fans and plug ins. I guess this is what money can buy in Bangladesh. In Lalimonirhat wehn I explained our public healthcare a doctor seemed amazed and kept posing different situations to me, "so if I came in the middle of the night and needed an emergency appendectomy....it would still be free, doctors would come?"

As for surgeries, I have seen a hysterectomy, circumcision, and hernia repair here - all things I know nothing about. I also finally saw the use of general anesthetic - I had begun to think it was just spinal blocks for all! In the middle of the intubation, the power went out and while the hospital has generators, there is always a moment before they kick in that we are left in the dark. I have been spending most of my time with the Obs/gyn doctors and hopefully I can remember some of the things I am learning come block 4. One of the doctors I am with takes my recognition of the names of structures she mentions to mean that I know all about anatomy - which in the case of the abdomen and reproductive structures, is definitely not the case. I got a taste of what upcoming clinical placements will be like - me standing by and watching the surgery and her saying, "in order from outside to inside, list all of the tissues I cut through and then what types of stitches we are using to close everything back up!" and various other questions, putting me on the spot and making me feel like an idiot as I don't know the answers.

The different ways to become a doctor

So I definitely end up explaining many times over what medical school is like in Canada and what the process is. Their schooling in general is different here with many students entering university type courses after grade 10. Grade 11 and 12 end up being more specialized towards science or business, etc. Then after grade 12, medical school is 5 years followed by 1 year of internship. It was quite difficult trying to explain, through a language barrier, that I had already done a degree and explain the varying lengths that our "internship" could be. And they also ask what subjects I am doing my first year, lol, and I struggle to explain the systems approach in simple English as their first year is just straight up anatomy and physiology.

One of my fears coming to Bangladesh was that people would think I knew more than I did, and ask me to do clinical procedures I was not comfortable with. Up until now I have faced the opposite and have only observed from the corner of the room. I wonder if this is because 1st year med students in Bangladesh would have so little clinical knowledge. It has been a bit frustrating as today I was told that I was looking at and EKG machine. While it was archaic, I still knew exactly what it was and they seemed surprised and entertained when I counted the HR from the strip.

Today, I also decided to treat myself with some retail therapy in Rangpur, purchasing 2 new salwar kameez(es?) and a new saree, as well as navigating through shops to buy fabric and instruct a tailor as to what I wanted for my saree blouse and petticoat. It was a long, hot walk around town, but I felt like I had accomplished something and it was nice to come back and put on clean, new clothes after wearing old ones for the past 8 days.

you are only one?

Hey everyone, if you are wondering why there have been no posts yet it is because this is the first I have reached internet since I have been gone as I spent the last week in Lalimonirhat.

Often when I am introduced to people, they have seen the previous group of 5 U of M girls go through and ask, suprised, if I am alone. A lot of things have been different this time being alone - good and bad. It gives me a lot more time to reflect by myself...and read and play solitaire also. And because this is my second time around, there is no longer a shock and awe feeling for all of the things I see around me. I switch from being completely at ease with what I see, and probably not reacting enough, to being to see past the fact that yes, there are crazy things around me, but I expect that. Instead I think I ask why things are happening instead of just noticing they are happening. Like I wonder why people are going places, and whether people on the side of the road are homeless and begging, or are field workers on a break.

There is a huge bridge being built (currently all traffic crosses on the rail bridge) literally brick by brick by hand. I imagine the pyramids being built the same way.

Anyways, I had a lot of downtime in Lalimonirhat, but when I did get a chance to observe surgeries I saw several C-sections. Many women do not seek out obstetrics care until there are complications. As well, I saw a really sad case of a woman who had been slashed by her lover who attempted to murder her. She had extremely deep cuts all over her head and torso and because she had eaten in the morning, they used only local anesthetic to stitch her back together, so she was screaming in pain. It was awful. Her head was so swollen, with blood everywhere, and her finger had been cut off. It was all because her lover had lost his job, but she was working. And her mother refused to let the lover marry the woman if he did not have a job. It was an awful glimpse into the social problems faced by women in this country daily, and the medical limits in this country as clearly in Canada she would be getting a CT, MRI and much better pain control at the very least.