New pictures from trip #2!!!

Pictures include- slight confusion with finding our connecting flight in Qatar, the protocol officers waiting for us in Dhaka, the rickshaws lined up on our streets, the copious amounts (40lbs) of hibiclens we brought ot supply the hospital (with my cheez-it stash of course), teaching in the classroom and on the Oncology ward with my colleague Meg Garvey and our students, the full medical list at DMCH, (un)safe public transportation in Dhaka and my extremely sweaty back after a long day in the 98 degree weather without A/C

Back in Bangladesh!

After an abrupt departure from Bangladesh in May due to concern for safety  amongst the growing political riots and heightened tension, I have returned back to the “desh” for 10 days with additional Mass General staff to assist in the continued education and guidance of the nurses who will be working on the new Bone Marrow Transplant unit. It’s been 5 months away, but,  with my old Bangla friends and DMCH  nurses back at my side, part of me forgets that Maryanne and I ever left at all. 

The Bone Marrow Transplant (BMT)  is scheduled to open on the 23^rd of this month, and while the diligent volunteers from MGH (on the ground, and back in Boston) seem to be fixing a problem at every turn, four new challenges seem to appear in its place. Because BMT is one most complicated oncology procedures performed due to the isolation, precautions and strict scheduling required for a patient to thrive, it feels like a bold contradiction to build one in Bangladesh, a country lacking in such basic medical resources. I told one colleague today that every time I think about the work to be done, I am left with a head filled with doubt but a heart full of hope.

Everybody keeps asking how it feels to be back in Bangladesh on a personal level and it hasn’t been an answer I could sum up in a few sentences, so for those of you who want to know my honest answers enough to read my blog,  here are my extended thoughts to the Yes’s and No’s, I so routinely deliver to your questions.

  Are you scared? To this I have thought, only that we won’t get the work done, and that I will be the only person in the history of global health who ever gained weight in a third world country from the copious carb diet.

What are you thinking, going back to a place you got evacuated from, have you not learned your lesson?To this I usually giggle and assure you I have thought it through but really want to tell you that “every lesson I have every learned enough to carry to the present has been built on the grounds of perseverance, finding a window when the door shuts, never giving up and putting human life above all other worth, so no I guess I haven’t learned whatever lesson you are referring to”. For the record, if you’ve asked me that question, I still love you more than words can say and that I know you have my best interests at heart.

Is it worthwhile to endure a 24 hour trip each way for only ten days on the ground? I answered a hesitant yes last night, but I knew I answered correctly at the end of the hospital shift today. My colleague Meg (who has been a BMT RN at MGH for 20 years) and I returned back to the classroom after being on the floor for clinical practice, and I was hot, exhausted and really, really sweaty (pictures to follow) but then I looked at these nurses who are so excited to advance their education despite lack of pay raise or benefits but just because they love nursing and so my answer may be a tired, exhausted and sweaty yes, but nonetheless, always a yes.

International Nurses Day!

The Nursing Bridge Program asked Maryanne and I to write an article on what International Nursing Day means to us. Below is what we came up with. Enjoy!...

Every year on nurses day, we as nurses, take time to reflect on how proud we are to have chosen the nursing field. We reflect on the incredible importance nursing is as a profession. In the United States, nursing routinely tops the Gallop poll of "Most Trusted Profession" with 85% of Americans rating the ethical and honesty standards of a nurses at "very high/ high". These standards continue to amaze us. It's such a unique profession with so many different roles which has a universal acknowledgement for being so "noble."
   
We have spent countless hours listening to our friends and pondering their stories of nursing across the spectrum. We heard the stories of a neonatal ICU nurse after she described the experiences of helping a mother rock her dying baby for the last time. We have beamed with pride as a friend told us the signs and symptoms she recognized when her patient was having a heart attack, and assisted in getting him immediate and lifesaving treatment. It's not an uncommon site to see a coworker braid a patients hair and massage her hands through a chemotherapy infusion despite her heavy workload because she wanted to calm the patent's nerves. And most recently, we fought back tears as we walked around a crowded unit at Dhaka Medical College Hospital and witnessed the nurses comfort the victims from the recent factory collapse in Savar.
   
 Nursing continues to be a profession that while growing and changing, remains to be a necessity for improved outcomes in patient safety. We were chosen by Massachusetts General Hospital through a Global Health Care fellowship to promote, encourage and educate nursing with the eventual goal of opening a Bone Marrow Transplant Unit. While coming here with the primary goal of teaching, we find ourselves learning from the nurses just as much as we hope they learn from us.

At a recent class at Dhaka Medical College we asked the nurses what drew them into the nursing profession. Each and every single nurse told us through their native language, "I chose to be a nurse because it is the work of the heart". Fortunately, it was a sentence we could understand without the use of an interpreter.

That evening while discussing our newest lesson plans, we discussed how well we were adapting to our roles in Bangladesh. We may have been brought into Dhaka through the nursing AK Khan Healthcare Trust to assist in advancing the nursing medical expertise and instructing clinical skill set, but every student in our classroom already had the nursing "heart", which is the only requirement of the profession that cannot be taught

THANK YOU!!!

As many of you may already know, last night I had the pleasure of being interviewed by CNN’s Moni Basu. This was an incredible honor, not only because Moni is an astonishing writer (no seriously, check out her personal  blog - http://evilreporterchick.com/, her stories are unlike anything I’ve ever read), but she made me feel incredibly safe and comfortable during the interview AND grew up in India but is Bangladeshi by birth!!! How cool?

http://edition.cnn.com/2013/05/02/world/asia/from-boston-to-bangladesh/index.html?hpt=hp_c1

 

While I initially submitted the story from my blog (errr….or was forced by Riley Fadden), my hope was that I could have a few Americans wake up to the horrors in South East Asia. Horrors, that I, myself had not known existed until I moved to Dhaka. I would never have imagined that the story would become a cover feature on CNN, although to be honest, I would still have preferred to live in a world where no such story existed. 

Someone said to me when I was trying to process explaining the scene of meeting the victims “Laura, you can’t save this, stop stressing yourself out”. I know that, but I am glad the majority of people were on my side saying “You might not be able to save it, but you don’t have to stop trying to get people to listen”. I am an incredibly lucky girl to have these cheerleaders just a skype, imessage, whatsapp and face time away.

The article may have made me look like a hero, but the real credit goes to the masterminds that took an improbable idea, and have us here, working to turn the dream into the reality of Bangladesh’s first Bone Marrow Transplant Center:

Dr. Bimal Dey, who was born in Bangladesh and is now an incredible Oncologist and asset to MGH. Being one of the most intelligent MD’s I have encountered he is also the most down to earth, has an INCREDIBLE respect for nursing, and is always just a phone call away when we need him.

Anne-Marie Barron who was my favorite professor at Simmons College and who has been my biggest mentor at MGH. She is an incredible, kind and intelligent person who has spent much time in Bangladesh to open a nursing school and help promote nursing. She is also an incredibly calming presence, even just on skype.

The AK Khan Trust and family, the Nursing Bridge Program, the honorable Health Minister of Bangladesh, The oncologist/hematologist at DMC ( especially Dr. Khan), and supports back at Massachusetts General Hospital including Jason Harlow and Mark Breznia, NP who have all  supported us so much, continue to listen to our thoughts and are working tirelessly to see the first BMT center through.  A thousand thanks to you all.

Maryanne Meadows, my partner in crime and savior in this new and different  world. We made a pact to laugh at the end of the day and she has made me keep that promise even on the hardest of days here. Her incredible blog gives much more insight to our journey, check it out- http://maryannemeadows.blogspot.com/

 

And most importantly, to the Nurses and people of Bangladesh,  I hope the world never forgets about your incredible resilience in the face of a  tragedy that is so horrific, I continue to be at a loss of words. You will forever be tattooed on my heart and I promise to never stop telling your story to anyone who will listen.

More Photos!

Photos includes:  My new fitted pants, lecturing in the classroom, instructing on the medical ward, meeting with the directors of DMCH Oncology and the nursing bridge trust, the sunset from my deck, the sunrise from my roof, a riveting ride on a rickshaw, my bedtime bug protection, and the escalating riots.

 

 

Bangladesh Building Collapse

When I was 17 my least favorite morning of the week was Saturday.  With an ever-changing extracurricular activity schedule, Saturday morning was my one set shift at the local dry cleaners, which dragged me out of bed before 8am, and at that age indicated torture. The shift lasted four hours and always included a bagel brought by a sympathetic friend and a pile of gossip magazines supplied by my boss to entertain me while in-between helping customers at the counter. I should also mention that I received $40 for those “hard” worked Saturdays, totaling $120.00 a month pre-taxes.

On Wednesday, any avid news watcher would be able to tell you that a factory building collapsed in Dhaka, Bangladesh which housed 3,122 employees who produced garments  that are out sourced for the western world. And by this morning, any avid news watcher could tell you that the death toll count of these factory workers is up to 364, with 2,200 rescued (many at the cost of their limbs), and an estimated 550 people missing under the debris. With today marking Sunday, the 5^th day since the catastrophe, it is well past the estimated 72 hours a human being can survive without food and water. I mentioned those who would know these facts would have to be an avid news watcher because it has been my observation that these stories, even in Dhaka, run second and third to what is happening in the first or Western World. On Thursday I could tell you more about how much the Boston Marathon bombers mother shoplifted from a Natick, MA mall then how many factory workers were still missing from watching the news. 

I was reminded of my job at the local dry cleaners and my $120.00 a month I then received, as I watched a 17 year old girl interviewed today after her hand was cut off from the slab of cement it was mangled under to rescue her from debris. The station called her lucky and I went numb thinking how at age 17 I would have defined lucky. It would have incorporated more than a minimum wage of $38.00 a month, it would have indicated that if a building was deemed unsafe on a Tuesday, I would not have been forced to return on a Wednesday, and without question it would have included 2 hands.

Being American I know that I am just as much part of the problem as the solution. As I walked the hospital corridors down to the ward filled with women rescued from the collapse today, I realized any of the items I was clothed in may have come from a similar unsafe factory in Asia, as Bangladesh reports they release 23% of their garment productions to America annually. I realized while I was being brought down to comfort them, I just as much owed them an apology for being part of a world that allows this kind of treatment and I caught my breathe when my guide was asked to bring us to the unit at another time  as the Prime Minister of Bangladesh was currently inside visiting.

As we turned to leave someone asked me, “If you want I can take you outside to see the piles of bodies that weren’t pronounced dead until they got to the hospital”, and while I politely declined, I turned in time to see a lifeless woman my age being wheeled by to join the others. I said a prayer, not knowing if it was to the god she believed in or the one I had been raised to believe in, but pictured both fundamentally  saying “We hate this too, were working on it, and so can you”.

Riding home from Dhaka Medical College Hospital

Each day I have spent at Dhaka Medical College Hospital has ended the same. After finishing our  meetings, Maryanne and I are accompanied outside by members of the trust and I pretend to not notice the vastly growing crowd that surrounds our small group. Our driver  pulls up and we are shuffled into a van while people either bang at the windows or take our picture and we are whisked  off into the sunset.  I know how it sounds.  It sounds romantic and glamorous, like, say, a celebrities blog which accounts her stressful day as she tries to shop alone.  But it is neither romantic nor glamorous.  The people who surround the car are not paparazzi, in fact they are living on less than a dollar a day according to water.org and are suffering from a variety of ailments, some of which don’t even exist in the western world. And they bang on the windows because they think the two, western girls inside the comfortable, air-conditioned  van, have the answers on how to either feed or cure them or maybe even both. 

Dhaka Medical College Hospital (DMCH)  is meant to be a 1,700 bed hospital. I say meant because it is government run, meaning it is free to those who can’t afford payment and it turns no one away. According to the hospital’s director, a daily census may run anywhere from 2,500 to 4,000 patients and due to the overflowing population in the building, every turn of the head shows patients sharing beds, lying on the floor or sitting in stairwells mid- treatment. While patients lying in stairwells defies fall prevention protocol at every turn, contact precautions are non-existent  and the roles of physical, respiratory , speech and occupational therapist all falls onto the doctor or nurse, amazingly,  DMCH still manages to get patients better. 

The nurse’s role at the hospital is quite different from what I am used to, which is what we were brought into assist with via lecture and one-on-one clinical training. As one DMCH attending physician explained to me “Your skill set would make you a doctor here, the nurses here act more like maids.” And with one nurse to a ward that averages 25-30 patients, no skilled assistance and orders written in English instead of their native Bangla language, I am concerned with the lack of room for improvement. However, despite their heavy workload and lack of break (the nurses work up until lecture time and then get someone to cover their ward for 2-3 hours to hear us present, I am beyond amazed at their rising English skills, perseverance and optimism as they come to lecture not only motivated but excited to be selected and trained for the end result, Bangladesh’s first Bone Marrow Transplant unit.  

Each day I ride home with DMCH and its many faces of illness, despair, need and hope in my thoughts long after the vast white building is out of sight. And while I spend the ride wishing I had the key to fix the suffering of the Bengali people, I know I do not, I could not.  So, I repeat a favorite Florence Nightingale quote of mine “  never lose an opportunity of urging a practical beginning, however small, for it is wonderful how often in such matters the mustard-seed germinates and roots itself “, and I hope the small group of nurses suffice.

Photos of Maryanne and I shopping, touring Dhaka Medical College Hospital, with our 10 nursing students for the Bone Marrow Transplant unit, getting fitted for Sarees and with our helper Shilipi!

Shilipi

We have been away from home for almost a week now, and what a week to have been gone. According to a Google search, I am approximately 8,653 miles away from Boston. Given the horrific scenes of Monday, followed by the conclusive events on Friday, my head and heart are still somewhere lost over the Atlantic. I hope, however, to slowly drift back to the bay of Bengal shores and the work at hand. 

The directors of the trust have been very gentle with us these past few days while we recover from jetlag and have not taken us many places. We are staying on the “Beacon Hill” of Bangladesh known as Baridhara. Baridhara is the most prestigious neighborhood in the area, complete with a gate and guards at the main entrance. However despite this, every fifth building appears to have been demolished by things I have decided not to fully investigate. (Dad,  stop googling)  And, while our apartment wouldn’t necessarily be considered luxury by American standards, it is well above the definition of luxury to the Bengali people as it consists of 3 bedrooms, 3 bathrooms, a full living room, dining room , kitchen, remote controlled A.C., Wi-Fi and a servant whom for the remainder of my writing, will be referred to as our helper, Shilipi.

When I visited Punta Cana last year with my college friends we bought the elegance upgrade for a small additional cost, and the part I remember we were most excited about was that the package included a butler at our beckon call, should we want a bath drawn or a pillow fluffed. So while fluffed pillows and lavender drawn baths sounds perfect in an informative booklet, Vladmir met us at the door to our suite upon arrival and then was never to be summoned again, because it was a lot less work both mentally and physically to just fluff our own pillows then to sit and watch someone else do it.

That brings me back to the absolutely lovely Shilipi who is scheduled to be with us every day in the morning from 7a-10a and again in the evening from 5p-9p, but who we always let leave a couple hours early. Shilipi cooks us breakfast and dinner every day, does our grocery shopping and then cleans every inch of the apartment on a daily basis. I got out of the shower yesterday to find her folding all the clothes I had ferociously thrown on the floor while searching for a culturally approved outfit that wouldn’t make me sweat more than a bikram yoga session. I have since tried to be more mindful of the messes I leave behind. 

While Shilipi is employed by the trust to keep us “comfortable”, she has probably had as much effect on my mental comfort as she has had on my physical comfort. Being one of only 5 people that recognizes and smiles when she sees my face in this new world, she is becoming a fast ally. And while we are not at the level where I would ask her to play with my hair or discuss boys , she will sit on my bed while I skype and has already met the majority of my friends and family. It occurred to me how ironic it is that the only word I know in bangla is “dhanyabada”, which happens to translate to the only word she knows in English…thank you.  So Shilipi and I walk around continually thanking each other, which seems like a pretty good definition of friendship to me.

Safe in Dhaka but thinking of Boston...

Here and safe in Dhaka, Bangladesh! With the warmth of the people and the clean and “homey” apartment my initial transition has been great, or at least from the external views. Internally has been a bit more difficult than I would have hoped but that has nothing to do with the culture shock I was forewarned about. Let me explain.

When I first read the headline "Deadly explosion at Boston Marathon finish line" I was suspended 50,000 feet in the air and somewhere over Africa. I had just woken up from my very comfortable seat (no sarcasm, air emirates is like a tropical vacation compared to any other airbus I've ever been on), and re-read the brief BBC headline three times before reminding myself to breathe. This year, like past years, I had organized a volunteer nurse team for the finish line, better known as the "sweep team" as we triage patients between medical tents; When I found out  the conflicting date of my flight to Dhaka,  I cajoled one of my co-workers to taking over the "captain" role of our volunteer team. So, because there was no other information, my thoughts jumped to worst possible scenario, which was my coworkers and dear friends whom I had encourage to volunteer alongside me were injured or worse, and I was comfortably suspended 50,000 feet somewhere above Africa.

The panic set in and I woke Maryanne up and we both purchased internet access to check in on everyone and I am still counting my lucky stars that my Boston "loves" while mentally bruised, heartbroken and angry, were safe and sound. But, it has been and continues to be, rather difficult filtering the news from over 8,000 miles away.

Again today, I woke up heartbroken and angry that anyone could hurt my home on easily one of it's favorite holidays. By lunch time, the ache turned to guilt that I wasn't there to help at the marathon as initially planned, but mixed with extreme pride that my friends, fellow nurses and amazing hospital institution jumped into action and saved the day as best they could. And by dinner time I have read so many facebook statuses that I almost forget I am over 8,000 miles away and not sitting in Boston, drinking Dunkin Donuts and about to go for a jog on the Charles.

But I am not in Boston and I was lucky enough to be given an opportunity to represent MGH Nursing in Dhaka, Bangladesh. Perhaps, had my emotions not been clouded, I would have processed how truly strange it was to wake up on the last plane ride with people in the surrounding rows taking photos of the two white girls sleeping (I can only imagine how beautifully my 3 chins and drool captured on a flip phone camera). Or how awkward it was to stand and smile at the maid who unbeknown to us was waiting to be verbally released from her morning duties after she made Maryanne and I breakfast, and then cleaned our bedrooms while we ate. But instead I feel more like I am in a daze, with a dash of excitement as I look at myself in the mirror, draped in clothes a Boston girl wouldn’t usually chose.  

So I remember that while  it's hard to not be home coping with friends and family or working alongside coworkers, I get to show a very different part of the world what Boston and its idea of nursing is all about, and I would never let my city down.