Playground of the Emirates

Just a few words on the vacation portion of our trip. We stopped in Dubai for 2 ½ days on our way home from Bangladesh and had a great time. For those of you who have no idea where this is, google it! You will see some of the most unbelievable pictures and display of wealth. Dubai is in the United Arab Emirates, a small country along the Persian Gulf, close to Saudi Arabia. I suppose in some way it’s like the Vegas of the Middle East, except without all the gambling and “sin” associations. Everything in this city is over the top. They have the Burj Al Arab, world’s only seven star hotel (shaped like a sail—see pictures), where rooms start at $1500/nt. They are building the Burj Dubai, which will be the world’s tallest building. They ran out of coastline and so are building islands of the coast in the shape of palm trees, Arabic letters, and one developer is making islands in the shape of the world—continents and all. AND they have an indoor ski resort inside the largest mall outside North America, with ski lifts and a black diamond run. Crazy.

We stayed at a really nice hotel near the old portion of the city, with markets and a creek that small wooden boats need to ferry you across. And from there we also explored the fancy modern part of the city with the malls and hotels and such. We also took a day trip to the capitol of the UAE, about 90 minutes away, Abu Dhabi! Mostly just to say we had done it…like going to Timbuktu, or any other place Garfield tried to mail Nermal in the Garfield comic strips. The highlight of our stay was probably a desert safari we took on our last night. We took a 4 wheel drive vehicle out into the Arabian desert a few hours before sunset and our guide took us off-roading over tons of sand dunes. It was exhilarating, and also spectacularly beautiful. Right around sunset we stopped at a “Bedouin camp” (not really) and got to ride a camel, watch the sun set over dunes, drink Arabian coffee and eat dates, get henna tattoos, smoke the shisha pipe (or bubbly pipe, or hookah, whatever), and try on traditional outfits. Look, we converted! Just kidding. And finally there was a huge Arabian BBQ with traditional meats and food which we ate while sitting on pillows and carpets.

The only downside to our trip was that Ramadan was going on, which means not only do people not eat during sunny hours, but the restaurants are not open during this time, and tourists are expected to respect Ramadan by not eating or drinking in public. This was a bit of a surprise to us, and we actually spent one lunch time in a handicapped public bathroom with the door locked, eating Lebanese food from a small shop in a food court that happened to be open…but we couldn’t eat it in public!

Good things coming to an end

Sorry to those faithful who have been reading our blog—our last Bangla-blog has been a bit delayed due to our being “in transit.” We left the hospital on Tuesday morning after saying our goodbyes to fly back to Dhaka (capitol city), and then flew out to Dubai on Wednesday morning, where we stayed until early Saturday AM, when we FINALLY flew home.

Our last week in Bangladesh was as enjoyable as all the previous weeks, and we got a chance to pack in more fun elements of Bangladeshi culture. Last week we showed you some market pictures—a good friend had taken us to the only place most Bengalis go to get their food. Hundreds of stalls are packed together under little bamboo walkways (with ceilings too short for Eric by about four inches) and men (rarely women) haggle for spices, rice, lentils, vegetables, fresh fish, and live chickens, as well as other small items and packaged goodies. On our way back to the hospital we passed by stands selling Iftar snacks. Now, for those of you familiar with elements of Islam, currently we are in the month of Ramadan. Muslims fast from sunrise to sunset for four weeks, and the specific dates change yearly based on a lunar cycle. Every day at sunset the fast is broken by a sort of celebratory snack or meal called Iftar. While we never participated in the fast, we did enjoy the celebratory snacks! For one taka each (69 Bengali taka to the dollar) we could buy fried patties of spiced lentils, deep fried battered eggplant, spicy chick-pea salad, and our favorite, deep fried batter in a pretzel-ish shape soaked in a sugary honey syrup. Do you notice a theme (mm, fried foods)?? Supposedly they also sell deep fried hot peppers…no wonder everyone here has stomach ulcers!

We also got a chance to ride a rickshaw (see picture—like a bike taxi), visit a safari park to see barking deer and a Royal Bengal tiger, eat one last meal with our hands (goat biryani!), try on a sari (Rachel), learn to play the tabla drums (Eric), and actually buy a set of the same. Yes, we hand carried two large drums onto four flights and around three cities with us. All in the name of buying cool international percussion instruments, I guess. We also included some “medical” photos of us so we can prove we did SOME work this month!

But in a final moment of introspection, many people in Bangladesh wanted to know if the trip was what we had expected. Difficult to say—we tried to come with no expectations but that’s never truly possible. We learned tons of medical aspects, and Rachel got a chance to do a number of fistula repairs, but the biggest surprise was probably the non-medical learning that took place. We really feel that God was using this time to help us think through a number of issues regarding where we’ll end up, what kind of hospital we should work at, how we should approach language study, and call schedules, and what we should focus on for the final two years of training. It was a really blessed time. Who knows if we will return to Bangladesh or not? We certainly didn’t get strong calling one way or another. But we did receive incredible hospitality from all the long termers at the hospital, as well as all the people of Bangladesh we met. And we believe that Acts 17:26-28 was true for this month: “He determined the times set for them and the exact places they should live. God did this so that men would seek him, and perhaps reach out for him and find him, though he is not far from each one of us. For in him we live and move and have our being.”

Thanks for your prayers and support. We would love to connect with each of you in the months to come. And we plan to keep our blog going, just with little things that come up in our lives, so check back from time to time! Love, Rachel and Eric

Xray answer and thanks

Two quick things:

1. Yes, the xray is of a pregnant lady. You can see her lower spine off to the side and the baby in the uterus is head down. They take these xrays in Bangladesh, looking at bone maturity as a proxy for whether the lady is full-term, in a culture where most people don't know today's date, much less their due date. Thanks for the colorful guesses on the xray. =)

2. Thanks much to Clayton Ingalls for all his help posting these blogs while we were away and for emailing everyone. He rules. Check out he and Teresa's adventures at their website.



Here’s two pictures from the biweekly Malumghat Bazaar. Mmm… tasty snacks.

Hunting the Water Buffalo

The time had come. The rains had let up for a couple days, and we thought ourselves hearty enough to tromp through the mud in search of the water buffalo. BJ, one of the long-term guys here, took us down to the tidal river that runs alongside the hospital property, and we set off barefoot (apparently shoes can very easily get lost in the mud) through the kahl. A kahl is a wide marshy expanse where the Bangladeshis grow their rice, sometimes harvesting three times annually in this fertile country. Through this expanse run some rivers, which irrigate the crops and serve for crab and shrimp fishing, some very small homes, and slightly-raised footpaths a couple feet wide that served as our trails.

Many things happened on this lovely journey, but finding a water buffalo was not one of them. We had seen them along the roads, but thought it would be more fun to see them in the rice paddies. We saw them off in the distance a few miles, but decided not to make the trek. We did see lots of goats, cows, crabs, and even a fish that walks on land (very weird). As we hiked along, our presence had a pronounced pied-piper effect on the children of the paddies, and they walked behind us in droves, wanting to have their pictures taken, and showing us the crabs they caught.

O Water Buffalo! Behemoth of the Paddies! You may have victory this time, but it shall not be forever. One day…

OPD (Mis)adventures

We thought you might like a description of a typical day in the life of a Bangla-doctor, since we haven’t really delved into the medical side of our trip to much extent. Usually, we get up and have breakfast at 7am, then head to the hospital by 7:30 or 7:45. Rachel rounds on the postpartum patients, fistula ward, and GYN patients until 9am or so, and Eric rounds on male and female medicine patients until 10:30 or so. Maybe Rachel will have a case in the OR, a C-section or fistula repair or some such thing. Tea break with the other “white folks” from 10-10:30 if we’re free, and then it’s OPD for the rest of the day, aka Outpatient Department, or clinic. Here’s a picture of an unusual x-ray you won’t see in the US. Can you figure out the image?

Patients typically arrive at the hospital by 8am if they want to be seen that day. They line up at the hospital gate and a certain number of tickets are issued for admission—maybe 60-80 depending on if some of the doctors are in surgery, or have afternoon meetings or are otherwise unavailable. Then from 10:30-12:30 we see patients, write out treatments, and order labs/x-rays. All patients with lab results then get re-seen between 2:30-4:30 or so. These can be rather vague and frustrating visits from time to time, and Eric and I have had more than a bit of difficulty in the communications department. Let me give an example.

A young woman walks in to my cubicle/exam room and sits down, followed closely by an older woman who I assume is her mother. She clutches a large stack of papers in her hand (uh-oh, I think, lots of “outside treatments” and lab results that I probably won’t be able to decipher). I look at the white cardboard card issued by the hospital with her age, vital signs, and chief complaints, all scribed by one of the Bengali medics. It reads, “abdo pain x 1 ½ yrs.” Great. This could be anything.

“So,” I say through my medic/translator, “You’ve had this pain for how long?”

Long interaction between translator and patient. “Since one and half years.”

“Where is the pain?”

The patient gestures widely across the entire lower half of her abdomen.

“Does it come and go?”

“The pain is all the time.”

“Does it ever get better or worse?”

“Pain all the time.”

“What kind of pain is it? Sharp, cramping, burning?”

Long discussion ensues. “Pain is since one and half years.”

“But what kind of pain?”

“Pain is all the time.”

OK. I can see I’m not getting very far here. So I switch tactics and ask to see her outside records. I get a sheaf of papers stapled together from outside doctors. They are inevitably moldy smelling (like all books in this humid country) and covered in a mixture of Bangla script, which I can’t read, and medications in English scratch, which I can’t read, and even if I could they’re all brand names of medications manufactured in Bangladesh, very different than the names of meds in the US. I have my medic get a 1000 page manual of all the medications in the country and set her to deciphering, while I look at the lab results and ultrasounds. Something catches my eye—the ultrasound shows an ovarian cyst. And there are other test results from 3 days ago.

“Did you just go see a doctor three days ago?” I ask the patient.

Long discussion here, with much hand gestures and the patient’s mother keeps picking up a heart monitor rhythm strip (that looks completely normal) and handing it to me. I set it down, she picks it up and hands it back to me, repeat half a dozen times.

Finally, from my translator, “These medications,” pointing to the cryptic script on a piece of paper dated one month earlier, “do not work.”

OK. “But what did she see a doctor for three days ago?”

I get handed the rhythm strip three more times while the translator and patient talk. “She is having abdomen pain for 1 ½ years.”

I thought we had already covered that part. “These tests are from three days ago. Did she see a doctor then? And then why is she here today?”

Finally, about 15min into this visit, the translator says, “Patient has mass in rectum and she is here for surgery.”

What?!?! That’s not on any of the papers; in fact, none of them even mention the patient’s rectum. Finally, my translator gets another translator who speaks a bit more English. “The patient has a mass on her ovary and she is here for an ultrasound. The doctor sent her for an ultrasound.” Ah, now we’re getting somewhere.

I review the ultrasound—looks like a benign cyst. I put her on birth control pills and ask her to come back in one month for an ultrasound; it has only been three wks since her last U/S. That could have been much easier….

Granted, most patient visits go a little easier than this! But still, we commonly get chief complaints of things like, “Burning whole body for 3 years.” I don’t remember learning the differential diagnosis for that in med school… “Inside fevers for two weeks.” Now, this is apparently not the same as “outside fevers” which are really (probably) fevers. No one can quite translate the concept of “inside fevers” to us, but I think it’s generalized malaise. Eric commonly gets things like “pain since six months,” and when he asks how long they’ve had the pain, he gets an answer like “one week.” I thought it was for six months? No, pain “one week since six months”. This apparently has been figured out to be, six months ago they had one week of pain. No pain now.

It’s been an adventure, and we laugh about it every night. Hopefully God has given us the grace to understand enough to care for these people. And we look forward to being able to work somewhere long enough that we can learn the language, and someday communicate better.


Week 3

Wow, three weeks since we left home. Times like these have a way of flying by and simultaneously seeming like you’ve been here forever. The rains are just starting to lighten up (meaning 1 or 2 showers per day) after a solid 10 days’ taste of the monsoon season.

We both had last weekend off, and the lovely hospitality of our newfound friends here filled up the time nicely. We went to two Bengali churches last Friday, the first being a rather large one near the hospital, and the second being off the beaten path a ways, where a friend of ours was invited to speak. This little congregation of 45 met in a mud floor/bamboo wall building, maybe 10 feet by 15 feet in size. Wonderfully cozy. Eric was afforded a bench of honor in the back, made for people with shorter legs, and Rachel sat on the opposite side on the floor, trying not to offend anyone by touching them with her feet while in these close quarters. We loved it. =) Later that night, some other people invited us over for cards and mango milkshakes.

Sunday we traveled to Cox’s Bazaar, a small seaside town (by Bengali standards, maybe 1 million people. There are people everywhere in this country) that is home to what is reported to be the world’s longest uninterrupted beach, some hundreds of miles long. It was kind of cloudy, and Rachel would have had to swim in her Shalwar Kamiz, so we quickly dipped our feet in the Indian Ocean and grabbed some Thai food for lunch.

A few quick words about night call. There are only a few docs here currently, and so we are taking a total of 16 calls this month, with veteran docs as our backup call. The way it works is that, if we are needed, we are either called on the phone (newly up and running again!) or a peon (see previous blog) is sent to find us with a chart. What follows involves us having a hard time understanding each other, repeating ourselves lots of times, and usually with one of us heading down to the hospital, via a very cute bike, ridden often through the rain, over the brick path to the hospital. Most of the time, the doc’s role is minimized during the night, so being on call this frequently is feasible, though Eric was up all night this past week with a lady who ended up dying from what we assume was bacterial sepis after superinfection of her amebic dysentery.

The picture is meant to be humorous, and there is an element of bizarre humor to be found during those late night purple bike rides, but these times are also probably our biggest challenge, mostly because of the communication difficulties mentioned above. As in most everything in life, and especially in medical training, we’re slowly finding our way in caring for more and more patients and their unique problems.

Roach Wars

This blog is not for the faint of heart, nor the faint-stomached. So if creepy crawlies just gross you out immensely, skip over this one.

I (Rachel) had one of the most disgusting experiences of my life last week. We’ve seen a roach or two in our bathroom, no big deal. There is a plug in the sink drain and a small black rubber mat over the shower drain to prevent them from getting in. So, there I was, a Thursday morning at 6:15. The rain was pouring down outside and I was looking forward to the weekend. I turned on the shower, took off my glasses (effectively blinding myself), stepped into the shower and slid the black rubber drain mat away, so as not to flood the bathroom.

In my visually impaired state all I could see was a seething mass of brown under the drain mat. Shrieking, I hopped backwards out of the shower and grabbed for my glasses. Placing them on, my “grossest experience ever” nightmares were confirmed. Roaches now covered the floor of the shower and were starting to scurry their way onto the bathroom floor. I shrieked again, louder, and grabbing a towel, I ran out of the bathroom.

My shrieks had awoken Eric by this point and he got up to see what was going on. So there we were, me in a towel and Eric in his boxers, frantically putting on our shoes so we could squash roaches before they invaded our bedroom. We counted 22 by the time we finished our killing rampage, maybe not tons and tons but a sizeable number none the less. I was so disgusted that I couldn’t use the shower until someone cleaned it out (being covered in roach guts and all). I ended up using the shower in the room next door.

Oh, if only it would have ended there. The next morning, feeling slightly PTSD, I again inched the mat away with my toe (glasses still on this time, prior to turning the water on) and there were about 4-5 baby roaches hanging out. Ew! This had to stop. So we enlisted the help of a powerful aid, our new friend and ally, Mortein (Bangla-Raid). Twice a day, we spray the roach poison (with insect seeking technology!) down the drains. I did forget one day and found a roach sitting in my retainer case that afternoon. I will never forget again.



We’ve found a good source for quenching our hunger for native food this past week—the hospital “cafeteria.” The mess hall, as it’s also called, is a small building next to the inpatient wards (large rooms with about 20 beds each, one for men and one for women) with some picnic tables out front. As we don’t know exactly what’s on the menu, and the proprieter (a Bangla man with his two young sons) doesn’t speak English, figuring each other out is always an adventure. Not sure how to pantomime such things as “rice” and “vegetables”, we got some friends of ours to write down the Bangla words for some of the menu, so I put it into use.

I walk into the shop. “Mach bhat? One? Cha?” (Fish and rice for one? Tea?)

“Mach bhat?” he replies.


I walk outside and sit down at the picnic table. That seems to have gone well. There’s a bunch of smiles inside the shop, presumably because it’s funny that I’m trying out this little experiment. A couple minutes later, the younger of the two boys working at the mess comes out to me.

“Machka bhat?” he asks. Hmm, I thought we had this figured out already. The words sound a bit different, but I think we’re talking about the same thing.

“Mach bhat.” I confirm.

Some expression of understanding dawns on his face, and he runs back inside yelling “Machka bhat!” with a tone of triumph. I smile and wonder what my plate will actually contain. Sure enough, in a few minutes, I get a plate of rice, and two little bowls of fish (that is, fish curry) and veggies (that is, veggie curry). A small miracle has taken place. The tea is tremendous, and the fingers of our right hand are stained yellow because there are no utensils, and eating with the left hand is considered “unclean”. Smiles all around and I’m out the door with a tasty lunch and a great cultural moment for 44 Taka (60 cents).

Week 2 Bangladesh

At the end of another week here at Malumghat (remember, Thursday is Friday here, Friday is Sunday, and Saturday is still Saturday), we find ourselves settling in a bit more, and gradually becoming more involved in the daily workings of the hospital and becoming more familiar with the culture.

Rachel has also been involved in her first few fistula repairs, which has been exciting for her to begin to learn the surgical techniques. One of the women with a fistula is 25 years old, with a very sad but very typical story. She married young, in her mid-teens like so many girls here, and then had three babies in a row—all stillborn. (If you don’t recall the details on fistulas, see the “Shalwar” blog from a month ago.) There is a program here called Engender which is trying to raise awareness of fistulas in the community, and also fund surgical repairs. Most women, as they have become social outcasts, cannot pay for the surgery themselves. The surgery we performed for her went OK, but she had a complicated fistula and we were unable to repair it fully. Please pray for her, for complete healing and also for openness to spiritual healing as well.

On a happier note, Rachel has delivered a few Bangladeshi babies via C-section, which is always fun! The first one was a “giant” by Bengali standards—almost 8 lbs. To put this in perspective, the average baby comes out around 5-6lbs, and we have some almost term babies in the hospital right now that weigh 3 lbs.

Eric’s been busy at the inpatient and outpatient departments, trying to learn to care for a whole smattering of diseases not seen at home, with a whole smattering of tools also not usually seen at home. Cerebral malaria, pulmonary tuberculosis, viper bites, rickets, all manner of worms, cholera (he now washes his hands obsessively), and organophosphate poisoning from rice pesticides that currently has landed a 3 year old boy with a tube down his throat, getting oxygen through a bag pump operated 24/7 by his family members. Needless to say, there’s a lot to learn.

Busy week, but a few quiet moments find their way in, when the rain is pouring onto our sheet metal roof and we think “We’re in Bangladesh!” and smile.


We have arrived! The road to Malumghat hospital from Detroit contained many unexpected twists for us these past few days. Out flight to NYC was delayed four hours, but then the connecting flight to Dubai was cancelled, so we really didn't miss it... We ended up with a later flight to Dubai that evening, allowing us about 10hrs in NYC. We took the subway out to Manhattan for a surprise visit with Rachel's family, the Rimbos. Upon returning to the airport, we found out that our new flight to Dubai had a layover in Hamburg, Germany for 2-3hrs. Hmmm. Eventually, we did make it to Dubai, and caught our flight to Dhaka, only to find out....out luggage was still in Dubai. Oh well...our luggage did catch up with us on Wednesday.

We were met at the airport by a very welcome friendly face—one of the American nurses at Malumghat hospital was returning from a trip to Bangkok. She picked us up and took us to the guesthouse. Unfortunately, the change in flights brought us into Dhaka in the morning instead of the evening, and we wanted to wait as long as possible before going to sleep. So we ran errands with her.

Anyone reading this who has been to a developing world country will appreciate stories about foreign drivers. Dhaka driving is

pretty crazy, with lanes full of rickshaws (drivers on bicycles w/ a seat for several people on the back), baby taxis ("motorcycles" with a metal carriage plopped on top for riders), and cars, all who regard lanes and traffic lights as abstract ideas. We had lunch at an A&W restaurant, enjoying cheeseburgers and frosty mugs of root beer….surreal.

Dhaka has been in the news lately for student riots, and the city had been placed under curfew from midnight to 5am. The curfew was lifted our first full day there. Bangladesh has also been mentioned for the significant flooding—we posted a picture from the flight down to Chittagong. It is monsoon season, but fortunately the hospital remains unaffected due to its position on a hilltop.

These first few days at Malumghat hospital (aka Memorial Christian) have been spent attempting to get over jet lag, orienting, meeting tons of new faces, and adjusting to a completely different way of doing things.

We both started at the hospital on Thursday, mainly shadowing our mentoring docs (Eric works w/ a family practice doc and Rachel w/ an OB-GYN). Although we are becoming fairly comfortable taking care of US patients in a US hospital with US diagnoses and technology, all bets are off here where a patient with a fever after her surgery is just as likely to have typhoid or malaria as a bladder infection. Rachel did get a chance to assist in her first fistula surgery, though, which was very exciting.

Today, Friday, is the first day of the Bangladesh weekend. We went to Bengali Christian church with some fellow Americans who have been here for 20 years, who were gracious enough to translate for us, and then to a Bengali woman's home afterwards for tea. A small village has sprung up around the hospital, and we enjoyed walking through on the way to church, seeing the blacksmith's shop (a hot occupation esp in Bangladesh!), snack shops, barber, and countless other little shops. In the days ahead, we look forward to adjusting to the hospital, caring for patients, and figuring out how to cool off in this very steamy country.

Bangla-lessons learned thus far:

*Weekends are Friday and Saturday, and church is on Friday.

*Water buffalos live in the nearby rice patties, and we're planning a hike down to them soon.

*Rude things to avoid doing include giving a thumbs-up, showing the sole of your foot to someone (esp touching your foot to anyone else without apology), and any contact between opposite genders.

*Cricket is the national sport, but there's a full-blown soccer/football tournament going on behind the hospital every day.

*When we are needed on call, the hospital will send a "peon" to come get us. Not kidding, this Bengali word describes a very important office.

*Many of the common meds at the hospital are referred to simply as a number, e.g. Rachel was told to prescribe 3, 6, 17, and 25 for all the postpartums. ("Prescribe" being a loose term, since no script is required for pharmacies, just money, a med name, dose, and amount, and it's yours for the taking.)