to the land that afloats the Bay of Bengal: Bangladesh...

Missing Bangladesh

2008-05-29T22:54:00.000-07:00

Like a dream, I left Bangladesh thinking I was ready to leave, but now I'm back in Canada, thinking I haven't done enough and want to be back in conditions I became so accustomed to.

The days I spent in Uttara are still fresh - almost like I'm off on a holiday and will see my students in a couple days, jump on a local bus and survive the ride to Mohakhali to the Cholera Hospital on a scorching hot day. I developed the habit of wiping my orna (scarf) on my face to soak up the sweat, or cover my nose with it to block the upheaval of dust from entering my lungs... I'd travel on rickshaws almost daily for groceries or to recharge my mobile. I was getting used to bargaining 10 taka less on a kilo of oranges or a mosquito net... (that's about 7 cents CDN). The kittens outside my apartment were always around for a petting before I left for work and welcomed me home from a long day of what seemed like war. I had gotten to ask the neighbourhood children what myname was, by now they should know it for asking me so many times before! Amar nam ki?! The days spent at IUBAT seemed to just be getting better as I slowly knew more students and helped with English vocab or direct them to the right nursing textbooks - there was always a full days work in the office - preparing for lectures, marking assignments, reading clinical journals, taking a walk around the university with Reshmila, wondering what our lives entailed. Home became a safe place to reflect on the day, the interactions, the teaching, the culture, the language, (but also an exercise place for chasing roaches and sizzling mosquitoes)! These moments became a life that I loved, and I sincerely miss those days.

The students... I was just like them 4 years ago when I started my nursing education but very much a different context. Their experience became as important to me as it was to them, it seemed like I could feel and see what they did, but, how different it was! The resources? The value of nursing? The importance of health? The accessibility to adequate health services? Though I taught, coached, and lead, I gained so much more than I gave. I am grateful to the students for giving me a chance, the colleagues that gave me confidence, and the friends that trusted me.

My time was short, the places I went was limited, and my Bangla is still crap - nonetheless I can't add up how much this experience has taught me and continues to shape me. This only takes me one direction: to move forward, taking these lessons learned and experiences gathered for the next chapter in my life. The future is bright! :)

Amar students: onek onek donnhobhad...

eta cockroach, le ants, es spider...

2008-03-26T11:15:00.001-07:00

Cockroaches roam the pantry and scare the hijebes outta me - buz around with their ugly wanna-be-masculine wings, and land on my shoulder. A hairy spider creeps around my washroom as I bathe, crawls towards the door and traps me inside, preventing me from running into my bedroom with soap and shampoo, screaming my head off (probably a good thing, seeing that my bedroom window directly faces the construction crew next door). Ants parade across the table as I try to concentrate on my typing, messing up my home-row, attracted to my sugared-glass of this rare find-of-Sprite, simultaneously spoiling my evening appetite. These are the black ants; the tiny red ones found their way into my oats last week, dangit! I ended up cooking them into oatmeal soup anyway - well, who can complain about getting some extra protein?! If ya can't beat 'em, eat 'em!

Thus, are some of my many encounters with these little buggers (aside from the spider - twas not a little thing, in factoid, the size of me hand). Its funny how I'm getting used to them creatures as part of my daily routine - EXCEPT that when the buzzing cockroach found it funny on my shoulder, I found it disgustingly annoying. Spose it'd help if I ate it too, just like the cats do?

ki? bhai, kanno? price koto?!

2008-03-15T08:26:00.000-07:00

I walk out of the local market, pleased with my limited Bangla. Yes! My faux accent actually works in this country, little do people know exactly how bogus I am...

The colour and flair of Bangladesh is pompous and flamboyant. The streets are often decorated with sharees, salwaar kamees and punjabi's in rich, bold colours that jump at you before you expect it; the same goes for all sorts of transportation - bicycles to buses.

Life is vibrant in the city, life is rumbling, life is rich. From the ultra-poor to the richest-rich, I ain't see a developing capital like Dhaka. I took yesterday after clinical to explore - got on a local bus, called up my friend, and hung out. Its funny how I'm actually not that far from the city, but by bus, it takes up to an hour to get anywhere near central Dhaka! I am quite isolated where I live and work, and getting out into the capital really blows you away; coming home feels like I've been exhausted from multiple slaps in the face (in a good sense!) by the reality of it all.

outside inside

2008-03-10T00:59:00.000-07:00

10/03/2008

It's taken me a while to be able to write again. No, I did not end up in an accident, get kidnapped, nor have I concussion - I'm in this completely different world of miniature NGO-nursey life and student-teacher relationship with Bangladeshi and Nepalese students. I'm certainly not 'oohing and ahhwing' at the near-death rickshaw rides, the mis-matched colors of local wear, or the hard and tough labour that the women carry on their heads. There was a time when I finally started to integrate and think, my home for now is Bangladesh, stating "amaar bashai dosh number sector, noy number road" (my home is in sector 10, road 9), picking up essentials at the local markets and strutting along busy roads like I own this town (which I really don't, but it feels like it!)

So, I started to see things in a different light, understanding the situation of nursing in Bangladesh more, and in general, just getting a hang of things. I miss home a handful of times, but I also enjoy my work, coming in and out of the hospital and the university with the students. I got a bit lost in work, and felt bummed out for a bit, but, I'm back in the flow, and I guess I can call this blog outside inside work. I went out for a bit today, and as the rickshawallah pulled me home, I smiled at the veggie boy who shouted "haii", took in a wiff of dusty roads the trucks left behind, appreciated the old men on the streets gently carving out carrots and cucumbers for their food stand. The reality of life here was hard to accept, but now its sunk in, and I live along side it. Well, this is my temporary home.

3 and a half months...

2008-01-21T06:47:00.000-08:00

January 20, 2008 2312 hours, Uttara, Bangladesh

I sit under the moshori (mosquito net) wondering about what to write in this next, overdue blog entry. I’ve seen and experienced much in this past month, asking big questions and marvel about the next step in this journey. I have only a few hours before I wake up to lead 8 students on the wards of the country’s most respected hospital, however I can’t sleep; it wasn’t too long ago I stayed up long nights writing up drug cards and researching nursing care plans before clinicals, but now, reading and preparing myself to teach junior nurses on basic nursing skills. For how much I read, I always feel I’m not prepared enough or know enough to deliver information or carry out a class. I wonder if my past teachers also felt that way… oh how much I respect the perseverance of my tutors now more than ever!

Not too long ago, I made the decision I will return to Bangladesh… I know that I will want to see how things have progressed, and I know how much work is left to be done, and I also know that small steps will make small changes. I am learning to hold myself as a professional nurse and teacher, and how patience and determination will not fail as long as “giving up” is not an option. I anticipated prior to taking on this endeavor that I will be confronting the stark reality of uncertainty, and the art of compromise - coming from a society with the security and infrastructures that allows one to have a pretty stable upbringing compared to one with a scarcity of all that… at the time being, its finding the balance between the “ideal” and “less ideal.”

In a few months time, I will go home, and very likely be angry at things that I took for granted and scold others, pointing out how people half-way around the globe have far bigger issues to worry about than coffee breaks - but since when does that make significant changes?

I keep myself sane with the discovery of the local éclairs and chanachur, and watch pirated copies of LOST, and listen to the Fray on my iPod, with the sound of prayers in the distance. When I go home, I'd probably find the Albertan winters cold and bleak, lacking the colourful sights of rickshaws and sharee's drying in the wind. I’m still Katia, I just happened to have temporarily stepped into a world with so little of what I have been so blessed with.

5 and a half weeks…

2007-11-27T21:16:00.000-08:00

November 14, 2007 2115 hours

The only busy thing to prep for today was N116 in the morning. I think I’m getting to like teaching as I do it a few more times. It is the satisfaction that knowledge is transferred, and then exploring creative ways to do so. I’m glad that I am teaching basic nursing skills (team teaching that is; otherwise things that become more advanced are just out of my league). The advantage of being basic nursing too, is that I can bring in simple lived experiences slowly, without the huge pressure that I haven’t actually professionally practiced nursing since grad.

Most of my work really should be ICT (Information and Communication Technology) work, however, some things need to keep going, and that is why I am lecturing 3 hours a week. I enjoy it, and value it. I have figured out education is an important piece to this work – any development work: the transfer of knowledge, and with knowledge is power.

I’m also grateful to be among such willing and able people whom put out lots of energy and effort to do such things – without expecting immediate, or any return, at all. I suppose this is the personal rewards one gains, and that in itself is admirable. I hope I can one day find the courage that these volunteers have.

Lately I’ve been getting waves of fever symptoms, where I feel fine in the daytime, then feverish in the evening. I wonder what that is all about… but I suppose I should get it checked. What a weird thing though…

November 26, 2007 2312, speaking to the world...

I’m back from another day at the hospital. I really enjoy being with the junior students; its like reliving my days as a student, but on the other side of it, and making it fun! I wish I had more knowledge though to be sure of terms and the textbooky things that the students ask me - I guess that would be the rewarding part to teaching: its teaching and learning at the same time!

Again, I had an hour to “wing it” before their infection control class, so I spent some time discussing reflective journal writing and its benefits; how to assess for pain using OPQRST pain scale; and lastly and most enjoyably, what brought these students to take nursing. Listening to their “why I came into nursing” stories helped to build rapport, and I am glad to have that open space with them. I really dislike being in authority, but I guess sometimes it just needs to happen to get things going… though it’s definitely comfortable to get to the students level, and understand their situation.

My highlight of the day… we were de-briefing on the day, and I re-iterated what the sister told these young ladies in my own words: don’t be afraid to be push your limits and continue to improve yourselves – although this hospital is a very nice hospital and recently approved to international standards, be constantly looking for ways to improve yourself and practice, as a nurse. We were standing out at the terrace, top floor of this renowned hospital, and I felt like speaking to the world when I did. The quote: “the sky is the limit,” was literal, and despite a previous post on the depressive state of nursing, something felt good today.

November 27, 2007 0730 apartment
I’m here over 5 weeks. I think I’m getting used to cold showers and laundry by hand, sleeping with socks to avoid mosquito bites to the feet in 28 degrees Celsius, and ahhh, nonetheless, the power shortages where I needed to feel for matches and candles in the dark. All is fun… last night, some Nepalese students invited us over to their apartments for mo-mo’s, or, in other words, modified Nepalese dim-sum! Oh it was delish (and a bit too spiced up for my taste-buds, but good)!

November 27, 2007 2254 apartment
Oreo came home. We all thought she (cat) had been killed… and what a funny thing, the night before, I was looking at my pictures in my “Bangladesh” folder, and I had this one picture with Oreo sleeping on my lap as I worked on my computer a few days into my stay here. She was the first thing that greeted me in the apartment when I got off the plane, and she had been gone for about 3 weeks – perhaps emotions can be felt across distances, but what a funny coincidence. I’m glad she’s back, she makes this place more lively, now that Deirdre has gone.

Hurricane Sidr

2007-11-18T00:56:00.000-08:00

Just a brief call to the world: we are O.K, and survived the hurricane here in Uttara.

I experienced some extreme wind and rain the night that the storm came to Bangladesh, but nothing more than a day without power, tap water, and muddy backroads. You might have noticed on the news about the deaths in the coast. My heart goes to the families and friends affected by the disaster! News has said the death toll is up to 2000, but there could be more than that, considering the category 5 hurricane.

I am well and I am computer-less. For the time being, my Dell adapter blew/ fried/ whatever - it's not charging my battery, and I feel naked without my notebook I spent so much time with the past 3 years! SO, I will be temporary stalled for writing and doing my work here... but I'm surviving it, and keeping myself busy in other ways.

Cheers to the world,

Katia

The profession of Nursing: it’s not really a profession

2007-11-13T03:03:00.001-08:00

November 12, 2007, 1840, apartment.

I napped after a long clinical day at the hospital with the students. I woke up to read a research article about nursing in Bangladesh. It finally hit me, that this concept of nursing, truly isn’t a socially and culturally accepted career in Bangladesh.

Its dirty work. It’s black, its dark, and it stoops to the level of prostitution. And it’s real. Many cultural factors come into play, such as the caste system. You need medical care in the government hospitals? Sure, pay the cleaning staff, and they might insert your catheter, or suppository, so long as you give them a good tip too. Nursing is unpleasant work, and your status in the bride market is significantly lower, should a potential husband consider you for marriage. In fact, your family or relatives might disown you. Why would you want to touch feces, vomit, and urine? Its generally true nurses are female – well in that case, you might as well be considered doing sex work during night shifts. What a shame to touch strangers, dirty, and poor people.

A recent article I read, nurses here spend less than 6% of their time working directly with clients. It’s ironic: female doctors can touch and perform medical work on clients without effects on their social status.

It’s not a criticism, I have no right to criticize the values and cultural norms. I know though, it will take a lot of work to put quality nursing into place where strong belief systems deny its presence.

My eyes have seen it in action, and it shocks me to the core – what was it that took me into nursing?

November now... when I would be dreaming in snow.

2007-11-07T20:36:00.000-08:00

November 5, 2007, 2153, apartment, Uttara.

It seems the only likely time I have down time, is during the night. After dinner, I’d play a game or two of Blokus upstairs with Deirdre and the students (whom really are only 2 years younger than me!) and I would be exhausted by now. Though I just encountered this rare rush of adrenalin because I was shocked by this cockroach half the length of a toothbrush (the only analogy I can think of now) as I searched for junk food in the pantry.

The days go by quite fast, and each day is an eventful one. For instance, today, I was up at 0600 to get ready and be at the hospital at 0730 via rickshaw and bus. I went around with Katie to introduce her to staff and orientate her to the ward – she will be supervising the senior students, and I, the junior students (I’m grateful to have met Farida, an experienced nurse whom we will co-supervise with junior students, phew! Glad I’m not on my own!) I had a few hours before the junior students came, and in between that time was running around the hospital setting times and schedules to meet agenda items, find lockers for students, etc. etc. (and it is a huge hospital! Can’t say the name for formality reasons) Again, I need to expect that while this is all an ongoing process, I need to lay out all my cards and play it right… and I’m still trying to find my niche in all of this – what is my purpose? What is the bigger picture? How will students receive me as an ‘instructor’? How do I project myself among other practicing nurses, gain their respect and trust in order to let the students practice? How do I communicate with other volunteers when work could be slightly vague and over/ under-lapping? It’s all learning, and it’s also draining. I feel like I am constantly gathering information about differences I see here and there, potential connections I see happening here and there – but how much of that can I act on? If I take something on, I want to be sure that it is followed through. Someone once said to me, the developed world has disappointed the developing too much, so I expect it will take more work to uphold a project nowadays than it was perhaps 10 years ago…

I’ve hardly been much of a leader in my days as a student… so doing this “visiting lecturer” stuff is a huge leap! I ended up having an hour with the juniors, and I spoke to them about professional behaviour and interdisciplinary teamwork (go AIC! For the Alberta Interprofessional Conference crew, I’m slipping in this topic regardless! And Jenn, I’m wearing those AIC scrubs!) I have this dilemma of being a mentor, rather than an instructor, in fact, I’m not quite ready to be in this position of authority.

The day followed where Nick and I made a trip to the ATM machine at Mascot Plaza 10 minutes on rickshaw away from the University. I couldn’t get money from it, so we had to walk another 15 minutes to try another ATM, and by this time, traffic was congested and we had to walk up the walkway to cross the highway. Previously, I’ve heard stories about crippled people on streets of all kinds and ages begging for money, most likely put in that condition intentionally for monetary gain. I’ve been warned about the long term implications of contributing to their present condition, as it may mean encouragement for future practices of the same. I saw a child lying on his side with an open wound; old man with incongruent limbs; random older people with crutches; and perhaps most disturbing, was a child with megalo/ hydrocephaly carried in the arms of a woman, unusually mature. It almost seemed like the child could have had treatment by his/ her age, but its highly possible the woman was using the child’s condition for income. It’s like watching World Vision on TV, except 100 fold. It’s not about the concept of poverty anymore; it’s about being in the presence of it.

Children live and grow like this… umpteen times I have wondered, as I have the privilege to ride the rickshaw or the CNG past these children, how many of them will become rickshaw drivers, how many of them have not seen a better life… how lucky I am to have known such a luxurious one without worries of worms in my tummy or for warm water, or source of light. Where have I been, in ignorance of all of this? Human lives can be so fragile, just so…

November 6, 2007

I’m told these incidences of mosquito bites will gradually increase as the weather becomes a bit dryer and cooler. What a great conclusion to this year! This winter I will need to get myself prepared, not for the snow, but for the vampires that come out at night.

~80% of Bangladeshi people are Muslim, so it is not uncommon to see women more reserved, often with head wraps, and the very least, a salwaar kamis with a shawl covering the front of the chest. Prayers are often heard several times throughout the day, frequently projected on loud speakers on the streets. Sometimes it also substitutes the roosters in waking me up around 5 am. If not that, it might be the noise from hardworking people whom dump bricks and lay bricks throughout the night. Truly, every time I walk past construction zones (if there is such a thing), women, men, sometimes older children, are straightening steel bars, loading bricks (often at least a dozen stacked on their heads at a time), carrying sand – work doesn’t seem to stop.

November 7, 2007 National Revolution and Solidarity Day

What a treat! It’s a holiday today and we’re going into town, to Dhaka city, hopefully getting some fabric and a couple salwaar kami’s fitted. I’m excited to go out and see city life, as I have only seen Uttara and Bashundara district.

after Halloween

2007-11-02T22:56:00.000-07:00

October 31, 2007 0830, apartment, Uttara

Happy Halloween, and Happy Birthday Dajana!

I’m eating toast with Nocilla (Spanish equivalent to Nutella) with an unknown case of stomach upset. Usually, Chapa upstairs would prepares breakfast for everyone – two pieces of roti, eggs, potatoes, and finished off with chai, or tea. I woke up a bit sweaty with something funny going on with my GI (gastrointestinal) system so I decided to skip the heavy breakfast for oatmeal and toast instead. Heh, chocolate cream on toast isn’t that much better, but that’s all I have for now… until I figure out what this stomach upset of mine is all about. I took my Dukoral though! So it mustn’t be anything serious…

Yesterday was my first official lecture. It was a task I found out the morning of, that I’m to conduct a class on medication administration. Well, for the short period of time I had to put together a brief agenda, I survived the one hour class by teaching the formula for calculating IV infusion rates and parts of the needle. It was funny, as for exactly what I planned to teach was slightly astray from what the students had learned in the previous class, and I had to modify teaching on the spot. It seems that all classes are conducted this way, and really makes you appreciate those times instructors put into planning courses…

November 1, 2007 2128, in my bed, apartment, Uttara

I started writing in bed, but immediately after typing the last line, I fell into a deep sleep until 0738 this morning, November 2, 2007. It must have been all that I saw the past week, and I’m glad to be well rested. Yesterday was an early day at the National Institute of Mental Health in Dhaka. We took the rickshaw to Mascot Plaza, then a bus to the Institute, all taking us about an hour of traffic jam on the highway from Uttara to Dhaka. It is funny how we are a sight when we stand at the bus stop and then again on the bus. This also causes us to attract people asking us for money and others, staring intently at this rare sight of foreigners. I find that when I do walk alone on a different route to the university, I don’t get as much of a commotion of people crowding me and kids trying to touch me as much as when I’m with a group of Canadians. Perhaps with the Asian-ness, I sort of blend it… it is kind of nice that way.

2340 hours

I just came home from Dr. Miyan’s house party/ dinner for faculty. We had such a great time there, met other IUBAT faculty and the hosts were just so welcoming. It was such an honour to be in his presence and his home, such influence he has in this country. My lesson these few days, have been the NGO side of the world, as I had mentioned. Many things are very political, and it seems to take a lot of mental energy to pull some weight, and I often wonder what keeps one person committed to what they are doing. It is very intriguing, in both my mentor and the president of this university.

The bulk of the day was pretty productive. Deirdre and I ran some errands, and also visited Families for Children – a Canadian originated orphanage, not too far from IUBAT. It is interesting how these connections had formed – Deirdre had met Muriel some time through friends in Vancouver and had found out they had separate connections in Bangladesh. Now IUBAT are sending nursing students to the orphanage to practice and build their skills. The orphanage itself seems to be well kept. We met Mitu, a past orphan child, whom is now an adult, and a teacher himself and soon-to-be-father. It is amazing how one person’s influence can change someone else’s life, and what a place to discover that. Me and Deirdre had been to the National Institute of Mental Health the day before, where we met another orphan child who was coincidentally in the hospital… so we took some time to visit her a 45 minute drive away from Sector 9, and saw how the hospital ran. In many aspects, there is so much that is off from what I would call standards and much improvement needed, but there are aspects of it where opportunities are well evident if taken by the right strands - for the students to build their skills. I don’t know enough about it yet, but as a bystander, there seems to be things that would not be done back home. It is really a mindful challenge to judge whether one thing is more valid and justified than another, in the context of culture and societal norms. Anyway, aside from that, today was mind-boggling with the connections and coincidences that have happen! And what a way to take advantage of them…

These past few days certainly have been mentally draining. I am learning more and more that I have so much more to know, about the world and about myself… its not only the fact that being in a different country, but interactions with other people are so important and so essential for survival. I’m going to learn about my interpersonal competency as the months go on.

at last, wired to the world. a series of notes from the past days...

2007-10-28T02:35:00.001-07:00

Bloggin in Bangladesh: the first days.

Thursday October 25, 2007, 0931 hours. House no. 2, Road no. 9, Sector 10, Uttara Model Town, Dhaka, 1230.

I have been in Bangladesh since Monday now. It is now Thursday morning, where I’ve encountered a series of events, and mostly I have been adjusting to this thing called internet deprivation. I don’t worry about not the jet lag or sleep as much as my contact with home… I guess I’ll have to get used to slow, and the minimal internet connection for the next 5 and some months. It isn’t easy to call home either, and it is best for others to call me (soon I’ll get me a SIM card!) However, I’ll try my best to put up my thoughts on this blog. What I’ll do is write on my laptop outside of net connection, and just copy and paste when I have do have connection!

I have met many people on the project here in the university. The university is a 5 minute walk from the apartment. I live with Maureen, a nursing instructor from Langara College, and now Deirdre whom joined us last night, a counselor from Vancouver. Cara had also lived with us; she was volunteer whom taught English for 6 weeks, and had just left this morning. We live in Uttara, the suburb of Dhaka, also referred to as part of New Dhaka. To get to the university, often we walk past children who swarm around us and shout “Hi! Hi!” to us, pass by shanty homes, and puddles of water… then it is a huge effort to cross the highway safely which is conveniently right in front of IUBAT, with oncoming traffic of trucks, rickshaws, CNGs (Compressed Natural Gas – vehicles that run on natural gas, and would be equivalent to taxis back home), and cars from both sides.

In the university (the International University of Business, Agriculture, and Technology, or referred to as IUBAT from now on), the only international faculty are in the nursing program (there are other programs i.e. business, chemistry, hospitality and tourism, etc.) The nursing faculty are all Canadian, with a mixture of nurses, other health professionals, occasional interns from UBC and volunteers who have a variety of backgrounds in medical lab science, psychology, political science who come on volunteer trips of weeks to months, who somehow heard of this project from various sources back in Canada. Karen is the full time coordinator of the College of Nursing, whom has worked here with Dr. Miyan (the founder of this university, whom, I must also note, broke-ground in Bangladesh for a not-for-profit education system) here for about 3 years. There are 5 students in the most senior class (all from Nepal), and the students I have met have all been very welcoming. I have a feeling I’ll become quite close to many of them and the rest of the volunteers here in the next months.

It is quite warm here, despite the fact that everyone tells me this is the “cool” winter season, when the temperature is that of summer time in Alberta. I am occasionally left with good itching excuses by mosquitoes during the night (thank goodness for them mosquito nets!), and it is not uncommon to be greeted by ants, crickets, cockroaches, and spiders in the daily routines of squatting on toilets, drinking tea, or brushing my teeth.

My first dose of really concentrated culture shock was after classes the first day when Bimala (a senior student from Nepal) and Cara took me out shopping. The three of us cramped-in in one rickshaw, and through puddles, bumpy roads, and drivers who scream at each-other, we found our way downtown. I exchanged my Canadian dollars for Taka ($1:~70 Taka) and off I went to bargain with Bimala (whom is very good at it!) and got two sets of sawaar kamis for 2000 Tk (which I later find out, could be bargained for an even better price!) They’re long tops with short or long sleeves that go over baggy pants, completed with a matching ornaa (or shawl). The variety and colours of these outfits are overwhelming to chose from, but beautiful – some are decorated with beads, embroidery, and various glitters. They are quite flowy and pajama-like comfy. I tell ya, I can get quite used to them! J

These past few days have been almost dream like… I am not sure why I haven’t felt depressed yet or maybe I’ve been too occupied… almost like I’m sure I’ll have no trouble adapting… I’ve got so much to learn, but I also need to tell myself I am no longer a student, but a nurse, and draw out some confidence and put these skills to use.

Polio Vaccinations
Saturday October 27, 2007 – Uttara, Dhaka, in my apartment.

Today was a full Saturday of polio vaccinations. I should have reviewed the vaccination procedure the night before, because students have come up to ask me questions, and I feel that medicine is considered a prestige to know here, and I sense a form of expectation that I should know concrete facts to “get” to people. Nursing school seemed to have exposed me enough, however, I know I need to continue to read and update my knowledge and apply it in the practical field.

Anyway, the Rotary Club of Greater Dhaka organized this Polio Vaccination Clinic at IUBAT. I was up early with Karen here, to set it up. We came across some issues however… the vaccines were not present when they were supposed to be, and neither were the Vitamin A capsules that were to be given to these children 1-5 years old. Karen had to call and ask about them, and I found out later that there could have been some underlying issues about suspicious medicine distribution in the country. I can’t say for sure what it was, but it was a good lesson to expect situations like these could occur in a developing nation where resources are scarce. For the first hour medication-less, we asked the mothers and children already lined up, to come for minor treatments – we had a first aid kit, with most importantly these past few days – are the waterless hand cleaners (aka antibacterial gel/ antiseptic/ etc). Why I say that? It is because there is hardly any concept of hand-washing in the hospital I visited yesterday in practice – let alone a sink for washing your hands. What happened to infection control? It certainly is a flip to see this hospital coming from Hong Kong, where infection control was adamantly ingrained in ALL health care workers – cleaning staff to medical officers, influenced by the past cases of SARS. Anyway, many children had wounds on different parts of their heads, arms, legs, buttock…some open, some closed. The students and Karen suspect that these could be caused by the hygiene (or lack of it) being bathed in the mud water. Many of these children are clothes-less and shoe-less. It won’t be a surprise if these were from parasites or other organisms swimming in these rivers… Bangladesh has a lot of water, so I need to figure out what water-borne diseases are prevalent over here. The best we could do was wash to the wounds with antiseptic, apply some Polysporin, and maybe bandage it, if it could cover the affected areas. I am skeptical about how well the children will keep those wounds clean or prevent further ones. Now as I write this, the next time we host a polio vaccination, I’d hope to assess the parent’s knowledge of hygiene and perhaps integrate some education.

Volunteers from the Hospitality and Tourism Program registered the children, and then the nursing students proceeded to giving 2 drops of polio vaccine orally, and vitamin A capsules. (hah! I just encountered a power outage – apparently not uncommon at least once a day here! Ctrl-s-ctrl-s-ctrl-s!) The children ranged from clearly unhygienic and malnourished (in comparison to my life in Canada’s standard of living) to semi-healthy. I am constantly thinking to myself – how much of this that I am seeing is based on international terms/ my terms… I know coming to a different culture will blind me to the underlying ice-berg that exists – it’s a matter of just how much longer and to what extent will I see past these societal differences. The attraction and novelty of a new culture itself can blind one to see clearly – I’m still in the honeymoon phase of cultural adaptation. I love the rickshaws, the children, the dust that flows over the place at dusk, the fact that the water is dark every time I wash my hands regardless if I do anything dirt related or not… though from training, I am told that this won’t last, so I’m expecting a period of depression sometime in the next few weeks!

The rest of the day went by with me getting to know students from various levels of the nursing program and different faculties, getting some Bengali lessons and insight from local and Nepalese students. It is truly a rich experience I am getting, and I return home tonight feeling fortunate to be in such a place. I went with some students to visit other apparently sick nursing students (there seems to have been a wave of sickness infecting the nursing department these few weeks) and I was so happy to have been invited to their homes for lemon water and biscuits, and see life for them, as students. I was very happy when a student had mentioned I was very friendly. I say, it is reciprocated from the students, Dr. Miyan, Karen, and all the Canadian volunteers whom have welcomed me so warmly this past week. I was even given a business card as “Visiting Lecturer” from Canada! Wow… there is certainly lots to be learned here in Bangladesh, and I can’t wait to put my feet into it.

One last mention, is this NGO side of the world. I am putting puzzle pieces together from various sources directly and indirectly about how certain programs are run (and in my case, IUBAT College of Nursing). It seems to me, most resources can be found and put to use, except the big one: money. Finance seems to be the final deciding factor – it either makes or breaks the well intentions of these volunteers. It peanuts what we need to send nursing students to a decent hospital for clinical practice, in the international arena. It’s a matter of finding a lead and a stable source of funds to sustain such initiatives for upcoming and future students…

The Hospital Shock
Sunday October 28, 2007 0931 hours, in my apartment.

I want to take a moment to write out the vast differences I noticed in the hospital … Last Friday, the senior group of 5 Nepalese students did their practice in a private hospital. Dr. G invited me to join, and I was thirsty to see how nursing practice was. The hospital is about 20 minutes from my apartment via rickshaw, and it is a less busy part of Uttara. On the main floor, there is reception, behind it the ER (maybe 8 x 12 ft) equipped with a bed and some supplies, and the OR. About 5 floors high, the students take me up 4 flights of stairs where we enter the med-surg ward (really, the only active part of the whole hospital; the rest of the floors could be labs/ kitchen – not sure). There is approximately 8 beds for the female cubicle and 5 for the male. We enter a small room which is used as a private room the students use for changing, which I immediate notice is pungent with stagnant urine in the air.

We find the nurses station facing the female cubicle – there are about 4 nurses dressed in white sawaar kamis and a white lab coat with paper nurse hats. Much of the charts are written in Bangla, except the Dr’s orders and vital signs. Now, shall I mention the nitty gritty of what I’ve seen? The nurses don’t have any concept of hand washing, glove usage, or infection control with bodily fluids. The students need to bring their own supplies of gloves, hand washing gels, and alcohol for sterilizing the stethoscopes and other tools (no “alcohol swabs” that we often take for granted). The IV (intravenous) medications ordered that should be given IV drip over minutes/ hours are direct IV pushed. Not over 30 or even 15 minutes – for convenience sake, maybe pushed into the vein in one minute. Saline flushes are unheard of before, between, and after IV pushes (you’d be lucky to find any form of sterile solution). What does that do to kidneys function and medication compatibility between pushes, and thromboses and clots and medication concentration and healthy veins in general! There is no record of medications given, so there is much room for medication not given/ overdose/ etc. After injections, needles and broken ampoules are thrown in a red bucket. I was told the only presence of a sharps container was with the lab. Blood was being transfused to an older woman whom had a total abdominal hysterectomy. I did not notice an indication of time blood was given, nor a record of vital signs during the transfusion. Patients were lacking identification at the bedside, so there is potential for patient discrepancy and improper medication administration. Charting of vital signs (BP – blood pressure, P – pulse, T – temperature) are also a question of whether the nurses actually perform them, or if it is a copy from the morning’s or yesterday’s or last week’s vitals. A child had come to the hospital for a history of fever for the past 7 days. To do a differential diagnosis, the Dr. ordered blood work to be done. It’s expected to see a gloveless lab technician or nurse doing invasive procedures. The child was poked 3 times before any blood was taken (maybe because it was a 20 gauge needle for this slim child!) then the child was poked again by the nurse for an IV infusion. There is an example of where communication between the lab tech and nurse could have prevented this child from being poked 4 times in total. Blood could be taken easily from the IV start- these are observations I noticed, and there is probably more to that than this…it will be a challenge to bridge this gap of knowledge that I have been taught and with what is in present day Bangladesh…

I must note that the students practice in a private hospital because, for the time being, this is the only connection they have for clinical practice. From hearsay, the practice in public hospitals are far worse than that of private hospitals, and it would be very difficult to have nursing students learn in them, where health care workers are very likely not up to par with international standards. The profession of nursing is not even a profession – it is viewed as a step above prostitution, and it would be a shame to tell others that your daughter is a nurse… There is ongoing seeking for a decent clinical environment for the students to develop practical skills. All this so far, makes me appreciate my education that much more.

ah, the delightfullness of Singapore Air

2007-10-21T13:58:00.000-07:00

I'm in my hotel room of Copthorne Orchid where I'm unsure where the internet log-off button is... sleep deprived that I am, I suppose I should make use of these internet minutes that I paid for!

Its 5 am in Singapore, where I landed a few hours ago from Seoul (and in Seoul, from Vancouver). I'm in transit here on my way to Dhaka. Its funny how the plane ride seemed to follow the sun the whole way here, and I'm not sure how long it stretched my day, though in reality I lost a whole Sunday to spend. The flight was impressive. I babied myself to 11 hours of movies from which there were 99 channels to chose from, decadent airplane meals, free language lessons (Hindi anyone?) and just the finest service I've ever encountered in flying. What good things I heard about Singapore Air prior to departure, was better than I expected. It also sets me up to feel guilty that I'm traveling on the worlds finest aircraft to one of the poorest places on Earth. Sigh... the paradox.

Anyhoo, I'm just writing a short note to the world that, I've safely arrived Singapore, and well, I haven't seen my 3 suitcases since Vancouver (I suppose they'll be shipped directly to Dhaka). Each bag is 32 kgs of clothes and my stuff and textbooks and puzzles and more clothes... Thank you to everyone who contributed to this project, and I'll be looking for ever crevice and gap (at least, try my best to) to make valuable use for them. I can't express enough in text how much I appreciate each step someone took to put those books in that rubbermaid bin outside Marian's room (it overflowed!) though I couldn't take it all (even for 32 kgs on Singapore Air, EACH bag! way more than Air Canada! plus, that one extra baggage allowance...) I took what I thought would be most useful. Thank you, thank you, thank you.

At the time being, I shall put this throbbing head to rest, for I have a plane to catch and a flight not to be missed (well, before that, I suppose a city I might as well explore in half a day... which depends on how awake I am in three hours!)

Toodle-loo!

Katia

before departure

2007-10-13T23:40:00.000-07:00

I sit in comfort as I write. Full after rice and meat, comfortable in slippers and surrounded by warm air that hikes up energy bills during the snowy days. I am at home in Red Deer, Alberta. In a week, I will be taken to a place that awaits to be discovered, namely the nation that seems to float above water: Bangladesh.

I am a novice at web-logs (aka blogs), at swimming, in Bengali, and in international development. These are all things that interest me, that I wish to improve on, short-term or long-term. The difference is, the latter is my passion. Right now, my life seems to be driven by those two words. I draw energy from it, and I feed it energy - its a two-way relationship. My education tells me there is ignorance and poverty happening - this passion seemed to have stemmed from a variety of things... but most notable is the epiphany of my ignorance in a poli-sci course on worldy issues (hear hear! what a distance from nursing?) Though it is not. I chose it not to be - I decided to marry the two ideas, somehow put them in place with each other whether they liked it or not... this nursey stuff will find its way in global issues I yearn to immerse myself in.

For you whom have somehow landed your eyes on this and future posts, thank you. If I haven't said it to you yet, I am glad. Each encounter, person, and place has given me some wisdom and vision for this journey in international development. So what exactly am I doing?

I'll be going to Bangladesh on an internship through CSIH/ NetCorps, which will be funded by CIDA, and the project involves ICT development (aka Information and Communication Technologies), which is stated in the 12th target of the last Millennium Development Goal (MDG).

I will no longer be sheltered in my home town, in the soft walls of books and lectures, among the company of my family and friends. I, like most Canadians, encountered what my dear friend would call it: the quarter-life-crisis. I was unsure where this married idea of nursing and global issues would take me after convocation from 17 years of formal schooling. I was jobless, school-less, and vision blurred-ish. Perhaps it was clinical work in the local hospital or pursuance in further studies? But nope! While suffering from this 'crisis' early September, I found out in Costa Rica, (while exploring my birthplace with mom for the first time since the birth), that this was me: for 6 months I'll be lecturing/ supervising students/ developing a website/ creating databases for nursing resources... maybe some or all of the above? I learned to expect that this concept of international development can be ambiguous, and I'm sure my nursing colleagues would understand what it meant if I said "demonstrate competence in dealing with ambiguity and diversity." Hah!

The direction of my life right now is to Dhaka where I'll be among nursing students on their journeys to - err, the quarter-life-crisis? - I mean, to being full-fledged Registered Nurses in this mysterious country. Here I go, to capture it all in, to fuel and to be fueled by this passion of mine. This would be my first professional encounter in development work, and it means a lot to me. I hope through this web-log, you'll see why that is.

Wish me luck! and along my encounters, I'll be taking your words of support with me.

Cheers!

Katia

p.s. I am expecting comments! please and thank you... :)