icddr, b – the hospital

The hospital is comprised of a “short stay” ward, a “longer stay” ward, a  “special care” ward (ICU), and an HIV ward. Pretty much all people who come to the hospital come for diarrhea and dehydration-related illnesses (cholera, E. coli, rotavirus, and invasive diarrhea). The people who have other problems (e.g. respiratory infections) also have concomitant dehydration. All the services the hospital provides are entirely free, but they don’t have extensive equipment (no ventilators, cardiac machines, etc) and so the majority of people are just on IV saline and ORS. It used to cost 20Tk for the facilities, but they had too many problems finding people change that they gave up – hilarious reason to stop asking for money.

On average during the dry season, they have approximately 200-300 patients per day and in the rainy season, 450-600. In 2007 after a major flood, they had 1045 patients in one day!! In a city of 10 million people, this is a small amount, but just in sheer numbers, it’s HUGE! Most years they treat over 100,000 people. Also impressive is the fact the hospital is entirely computer-based – there is no paper used anywhere. The doctors use handheld PDAs which are directly and wirelessly linked to a computer system and a back-up system.

So Dhaka has a reeeeeaaally low HIV prevalence (less than 0.01%) and even though there is an HIV ward, I don’t know how much it’s used. UNAIDS estimates that ~13,000 people in the country are HIV-positive, but the actual number of people who have been tested and know are less than 2,000. ICDDR, B has 10 beds for HIV patients, but only 3 were full when I visited…

I plan on seeing more of the hospital and getting a better tour, but that will be soon to come!

IRB Awesomeness

I got conditional ethics approval for my project!!! yaaaay!! Now I can finally start to get some work done!

Jaflong and Other Thoughts on Sylhet

After the house visits on the second day, the project people took us on a “tourist visit” to Jaflong, the town on the Bangladeshi-Indian border. We drove for about 50km to the border, looked around for 10 minutes and drove back. While the view was totally amazing to see, I thought it was great that they were so willing to drive for a long while just to see it. The Indian state of Assam is on the other side and as you drive through the rice paddies of Sylhet, these massive mountains appear majestically out of nowhere.

The border follows a large river and so the town economy is based on getting rocks from the river and processing them into bricks. The men take canoes into the river, using bamboo sticks as “oars” – the bamboo sticks are long enough to reach the bottom of the of river and they are used to push the boats along. They are amazing at filling the boat to the brink of sinking and then pushing it back to the river’s edge.

Other Thoughts 

One: So in Dhaka, you can pretty much walk around anywhere and someone will speak English; if you dress appropriately, you semi-blend in; and white people are just the norm. In Sylhet, however, this seems to be less so. As three white girls walking around, we got followed and gawked at everywhere. And not discrete staring, like groups of men blatently staring…we would walk around and have auto-rickshaws, rickshaw-wallahs, and motorcycles stop, pull-off to the side of the road, and just watch us. It’s not like we were doing anything exciting – just standing and talking to each other or sitting in a car or getting gas – and we would have people lined up around the block.

 (from in a car, stopped to drop someone off)

Two: What is also surprising is that A LOT of people here ask me if I’m Bangladeshi. I’ve never thought I’ve looked South Asian before – Hispanic if anything – but here people seem to know I have something different about me. I’ve even gotten called Indian a couple times. I’m not sure if it’s because they expect all Americans to be white and that they’re worldview is not big enough to include many other countries or if I can actually pass for someone from around here. Either way, it definitely makes me feel great that when alone I can vaguely blend-in to the local culture.

Three: One of the doctors who accompanied us to Jaflong invited us to his house for Iftar (the food you use to break fast during Ramadan). It was amazingly sweet of him and his wife and the food was delicious. The traditional foods were all present (dates, apples, jalabee, budjees, mango juice, and water) and she had also made channa (chickpeas) and cucumber and pasta. This was finished with some chaa (tea). We went to another Iftar dinner this week and they served pretty much all the same food – no channa, but these cabbage roll things. It would be interesting to me to see what the surge of sugary foods does to the body…doesn’t seem healthy to me. 

Four: Being in Sylhet gave me an appreciation for the independence that icddr, b gives us in Dhaka. Here, the staff was really overprotective us of and wouldn't let us do simple things - take a rickshaw into town, go for a run that was too far, etc. In Dhaka, no one really cares what we do or where we go. Here, we had an escort to take a private bus (like Greyhound) to the project site and almost home from the project site - we had to argue like mad for our independence. It's nice that they care and I know it's their job - if anything happens to you, they are responsible - but it definitely inhibits the experience you have here as a student. It's hard to figure out what it's like to live in Bangladesh if you aren't allowed to go out and the power goes out in the guesthouse at 9pm for the night...

So that's the experience I had in Sylhet. It was great to get outside of Dhaka for a week and experience more of what Bangladesh has to offer. Hopefully I will get to see A LOT more in the near future...

Projahnmo 3: Chlorohexidine Efficacy

One of the main reasons for going to Sylhet was to see the Projahnmo 3 study site. This is the neonatal health project I was writing papers for this summer for those of you who know. The Stage 3 intervention is comprised of two parts: 1) testing the efficacy of chlorohexidine (CHX) application to the umbilicus in decreasing neonatal mortality and 2) operational research (OR) to see how much village woman would pay for and where they would get CHX and clean delivery kits. 

CHX has been proven to decrease neonatal mortality in other areas (e.g. Nepal) so I think this study is just further confirming that. Right now, if you buy CHX from a pharmacy or a trained birth assistant it costs 45Tk (~$.65), but if you give birth in a government facility it's free. A clean delivery kit costs 18Tk (~$.25) in the same way. The intervention uses pamphlets, community meetings, posters, and songs to describe how to use the CHX and where to get it, etc. 

The program manager set-up two field visits for us. On the first day, we went to an OR community meeting and the second day, we went to a neonatal home visits for the efficacy trial and a pre-birth community meeting. 

The first day: From the office in Syhlet, we drove about 70km northwest, which took approximately 2.5 hours. We picked up some materials at a local field office and then attempted to make our way to the community meeting. We ended up getting massively lost among the miles of rice paddies and drove around for about an hour and a half asking random people on the side of the road for this community. When we finally found someone who said we were near, we decided to walk. After about 40 minutes walking through the sweltering heat with no cover, we arrived to about 15 women, waiting and upset. Apparently the meeting couldn't start without our evaluator and they had been waiting for more than an hour. I completely understand. 

In addition to the 15-ish women who sat in the meeting, so did about 15 kids. A lot of the kids kept crying and fiddling, which I thought would disturb the meeting, but they pushed right through, even yelling at the kids sometimes. A group of men gathered at the window to stare at us because we were white (it was reaaaallly funny)! The community health assistant gave a brief demonstration on how to apply CHX to the cord and gave a handout to the women. Lots of the women asked questions, which I thought was good - it indicates they showed at least some interest in what was being said. Most of them also listened to the actual presentation and demonstration intensively. After the question period, the communications officer we were with asked a series of questions to evaluate what they had learned, but also how much they were willing to pay for the supplies, where they would get them, if they thought it would work, etc. So the data that's being collected is really useful and informative. Unfortunately though, the switch from the CHW to the communications director involved some re-shuffling, so there a lot of the women left during this time period. 

Once we were done, we were supposed to go see a male community meeting and visit one of the satellite clinics, but the time we spent getting lost messed that up, so we just went home.

Impressions of the village: I'm not sure what the economic status of the community was, but their house was multi-roomed, had electricity with fans, and numerous cell phones. All the kids looked healthy and well-built and one of the men even talked to me in English (he asked me to take a picture of all the men together!). All the kids were great and were laughing and playing and having great fun! I took a couple of pictures of the women and kids, which they didn't realize. When I showed them the pictures from it, they were sooo excited and had me take a bunch of pictures in a little photo shoot! It was awesome.

The second day: Today we visited the main trial in a village about 70km from Sylhet from India. This community was located in the most AMAZING location - a perfect location in which to place a cottage. 

The first visit we went to was for CHX application for a neonate that was 3 days old. A CHW first asked the mother a series of questions to assess the health of the baby and if there were any signs of infection, then provided a physical examination. The CHW comes on day 1, 3, and 7, I think to do the same thing. There is also a VHW (village health worker) that works in the group of households to apply the CHX every day. THe VHW also has communication with the CHW so that if there are signs of infection on the days that she doesn't come, she can be called. The whole process took about 20 minutes.

The second visit was a community meeting for a woman who was 7.5 months pregnant. The CHW encouraged her to go to a facility to deliver, but if she couldn't (cost, transport, etc), how to have a clean, safe birth, how to cut the umbilical cord, how to wash the baby and prop him/her up, how to breastfeed (positioning, attachment, timing, etc), and how to contact the VHW for CHX. In addition to the pregnant women, there was her mother, her mother-in-law, a TBA for the community, the VHW, and a couple other women. It was great to see that the woman and the VHW had so many women for support. We stayed for about 45 minutes and then left, but the women were free to ask questions and get advice. Total, the meetings last for about 2 hours. 

Impressions of the village: According to the doctor we were with, this village was one of the lower economic-class communities. None of the houses had electricity, they were mainly one-roomed with a huge bed that multiple household members would sleep on, and the roofs were made of patched together rice-bags. You could definitely get the impression of the poorness, but all of a sudden this 12 year old girl pulls out a camera phone to take pictures of us (the white people)! It was sooo odd - I know that phone companies get around and that it's possible it was a community phone, it was just so odd to see such a poor community with a cell phone nicer than the one I owned in the States.

It's also amazing what a communal event birth is. Both the CHX visit and the pre-birth visit brought out about 15 women, even though the visit was targeted at one specific person. It's great that everyone pitches in to help and that multiple people benefit from the information provided at the meetings.

Week Four: Sylhet

The day after we went to Old Dhaka, I went to Sylhet (a city in northeast Bangladesh) to visit a classmate and a neonatal health project. Sylhet Division (similar to a state or province) is full of flat plains filled with miles upon miles of rice paddies.

History: in 1303 AD a Muslim saint (Shah Jalal) arrived to Sylhet from Mecca with 306 Sufi saints and army generals.  This group of people defeated Raja Gour Gobinda (current power holder) and converted all the Hindus and Buddhists in the area, who then began to further spread Islam in the region. Shortly after Shah Jalal’s death, Sylhet because a centre of Islam in Bengal and in historical documents, Sylhet is often referred to as Jalalabad during the era of the Muslim rule. 

In the late 18^th century, when then British East India Company had moved into the region, they became interested in it for its placement in the war against Burma. Gradually, Sylhet was assimilated into British control and was governed as a part of Bengal and then Assam, a state of India which it borders on the North. It remained as part of Assam until independence in 1947, when a referendum made it part of East Pakistan. 

At the same time of independence, many British settled here, so it is not uncommon to find people with lighter skin (definitely saw) and slight London accents (apparently!). Also, the majority of Bangladeshi immigrants to Britain is from this region (like 95%) and has stronger ties to the homeland than other Bangladeshis. These immigrants send tons of money back, which is fed into the local economy and has allowed the development of this area. This is apparent in the huge stores that have been built, but no one seems to shop at.

Landscape: So, like I said, miles and miles of rice paddies. They are divided in two ways: 1) split into squares that are separated by thin raised aisles of soil so people can walk between or 2) by use of canoes that just maneuver through the water. Water floods the divisions to help the seedlings grow and then once it gets there, people hand pick the stalks, and remove the rice from the stems and leave them to dry in the sun on mats. It was pretty cool to see the process and I'm sure this doesn't serve as a great explanation. The men who used the canoes to maneuver through the rice wore straw, circular hats reminiscent of South East Asia. It was the typical BBC picture of Thailand or China - definitely not what I expected to see in Bangladesh. Granted, I'm not sure if I had any expectations to begin with. 

Fishing also seemed to be a popular choice of vocation in the area. Men set up bamboo poles against bridges in order to create a triangle of net. They left the net in the water long enough for enough fish to get caught and then removed it and, ahh-ha, fish! Although Bangladesh used to be a huge fishing port, apparently a lot of jobs are being lost in the industry due to industrialization (makes sense).

This is more of what I expected Bangladesh to be like - agriculturally-based, cows grazing in green fields, villages of houses with corrugated tin roofs. It was great to get out of Dhaka and into the country-side to see more of Bangladesh...

Puran Dhaka

The history of a city tells you a story about why it is the way it is. Last week-end, our group of people took a tour of Old Dhaka in attempts to learn part of this. The tour is led by an NGO in Dhaka that fights for the preservation of historical landmarks; the government really doesn't seem to care and is continuing to tear down hundreds of these buildings to create high-rise apartment buildings. The NGO is advocating for the creation of "historical landmarks" on the basis of the locations role in the history and development of Dhaka and its architectural significance (with all the changes in rulers of the land, there is an amazing mix and blend of styles).

A little about Old Dhaka - Dhaka city is approximately 25-square miles of which Old Dhaka is about 8 percent of this. However, about 70% of the wholesale industry is conducted here. It's a mix of businesses and homes, but for some reasons many of the people who work here don't live here and vise versa. From where we live in Dhaka, it takes about 45 minutes to an hour and half (in traffic) to reach.

The walks change every week-end and so our three-hour tour (which began at 8am) covered the Armenian settlements of Old Dhaka, now in a sub-neighbourhood called Armanitola. The Armenians settled in the late 17th century and having just been leaving throughout the 20th century. The settlers were heavily involved in Bengali trade and commerce during the 17th and 18th centuries and propelled the export of jute and muslin. They also opened the first non-governmental school in Dhaka. During the time they flourished, the whole community was considered to be "locals" from the perspective of the previous inhabitants and from the perspective of the Armenians themselves. Some intermarriage existed between the Armenians and Bangladeshis (or what was to become Bangladesh) and many of them are buried in the area as well. The oldest grave found was a man buried in 1714 and we saw a very recent grave from 2005 of a 108-year-old woman!

Our first stop on this tour was the Church of the Hold Resurrection (locally known as 'khristan bari') and it's associated cemetery. The church was established in 1781, but no long has regular mass due to the lack of Christians in Dhaka. Apparently there are about three masses per year, but only for special occasions - and for the Australian Archbishop who comes twice a year ('Why does this Australian man come here', you may ask. No one can tell me and its frustrating...). The inside of the church fits just around a 100 people, so at some point there was definitely a sizeable community. The church itself is very simple - red, white, and blue paint with little ornamentation and most of the original furniture that was imported with the first settlements. Fun fact: the arch over the alter is the largest arch to have survived the massive earthquake of 1897 (?) that downed tons of the city.

We then visited a smattering of old, beautiful buildings that had been gutted and were being used as pharmaceutical warehouses or were dilapidated houses still being used for temporary housing. It was upsetting to see such gorgeous buildings completely unkept - dirty, broken, and just uncared for. Most of them are probably possible to fix, but would require lots of money and time and effort - something the government or the people who own the houses are willing to do. Our tour guide explained to us that when you own the building, there are restrictions on continuous building, e.g. adding more layers to the house, so it is a common practice to sell just the top floor of the building to a friend and then build on top of this (apparently the rule is per person, not per building - odd no?). 

Mosques are obviously popular in Bangladesh and we passed two along the way. The first, who's name I can't remember, was a mosque and an attached green shrine, depicting traditional Mughal architecture. 

The second, which is the mosque depicted on the 100 Taka note, is called the Sitara (Star) Mosque and dates from the early 18th century. Throughout the years, there has been lots of destruction and re-construction of it and so the existing mosque is not really what existed back in the day when it was one of the first mosques in Dhaka. Around 50 years ago, a local businessman financed its redecoration with Japanese and English china-tiles and so there are a whole bunch of tiles with Mt. Fuji on them. The mosque is built in the traditional Mughal style of having four corner towers and is decorated with a mosaic style called chini tikku...and of course, there are tons of stars all over the mosque in this style.

The last place we visited was a public school, which for some reason, I thought was the most beautiful building we saw. It had this quiet openness about it - a place where you know you could just read a book and be completely happy.

So that concludes tour 1 of Old Dhaka...we really only covered about 5 streets and there is tons more to be discovered!

Ramadan

In the past week, I've definitely done a lot of exploring and travelling, so I will spend the next week trying to recount it all. 

First, last week-end, Ramadan started. It's amazing how quiet the city becomes during the morning and evening hours. The city is peaceful and quiet and very un-Dhaka-like. This morning, I was up and out of my house at around 5:30 and the streets were completely dead (which was expected, right - it's 5am!), but on my way home at around 7:40, the streets were equally as dead. Surprising considering that I can hear horns from my apartment window as early as 6:30 during the week of non-Ramadan times and that when we exit our apartment, we are flocked by rickshaw-wallahs who want some business. Now it's difficult to even find an empty one, let alone an awake driver.

Walking around this morning though made me realize how much beautiful potential this city has. There is a large amount of greenery for a large city of 10 million people and without the hoards of people, you can walk on clean areas of the streets and avoid the post-monsoon floods. The air seems clearer and the sun more bright without the smog of the cars and CNGs. The best part though is that its just QUIET! You don't want to bury your head in your legs trying to drown out the honking...you can look around, take it in, and hear birds chirp and rustle in the trees. It was a great feeling to walk around and enjoy myself in Dhaka - even if I had to get up at 5am to do it!

With Ramadan came a vast change in the work schedule: our car and shuttle to work is delayed by an hour, so we now get picked up at 9:15, meaning we don't get to work until around 10. The evening shuttle leaves at 4:15, so there is really only about 6 hours of the work day remaining and I'm not even sure how productive it is since everyone is hungry, thirsty, and tired. It will be interesting to see how much work gets done over the course of the next month and watch how the city changes as they prepare for Eid celebrations!

What religion are you?

"What religion are you?" 

When I venture out into the world of Dhaka, I am asked this question at least once a day. At first, it struck me as odd because it seems like one of those questions that would be a social taboo to ask upon first meeting a person...right next to "How much money do you make?" But here, it's the norm - lab technicians, book sellers, and rickshaw drivers all seem to have standard questions when they come upon a foreigner: "What country?" "What religion?" and "Are you married?" The appropriate answer to the latter I have learned is "Not yet." as opposed to "No." 

The first time I was asked this, I wasn't sure how to respond. Is saying Catholic okay or should you say nothing? What is the motive behind asking the question and will they think of you in a different light based on your answer? Taken aback, I said Christian. The man looked me up and down and nodded with neither approval nor distain. After talking to some people, no one seems to know why people ask this question and from what I understand, they don't care how you answer, as long as you have a religion. If you are an atheist, you best not be expressing that to the people on the streets. While I still find it odd, I think it's wonderful that the people here are so accepting. They don't care what you believe in, they just want to know that you believe in something. 

My roommate brought this subject up with one of her lab technicians. She asked what he thought of people who were not Muslim and his response: 'Maybe all the people with different religions might be praying to the same God.' I was impressed with this response just for the fact that I didn't expect it, but am coming to appreciate how open minded the people I have come to know are. Maybe it's not like this in other parts of the country, but seeing as the area my fieldsite is in happens to be an amalgamation of Buddhists, Hindus, and Muslims, I think it must be so. However, hopefully I will soon come to know.

Week Two: Hanging Out in Dhaka

THE WEEK 

Work: This week, nothing really got done with the actual project I am supposed to be doing, so I am just hanging out. I have finished most of the things from home that we imminent to get done and I have finally submitted my paper for publication!! SUBMITED!! Yay! But now, there is nothing really to work on…In addition, the week-end here is Friday and Saturday, which makes the work week Sunday – Thursday. With the time difference in the States, it basically means that there are only three overlapping days in which to communicate with most people about work stuff, making it infinitely harder to find things to do...It has, however, given me a chance to catch up on my reading. I can now read multiple papers in the morning and I’ve finished four novels in the past week: The Thirteenth Tale, People of the Book, By the River Piedra I Sat Down and Wept, and Eat, Prey Love. I definitely like the free time, to an extent, but I know soon, if not already, I am aching for something to make myself productive.

Food: We’ve gotten better at grocery shopping, but the apartment I am staying in is not outfitted with all the essential tools and pantry-basics needed to make a proper meal. I didn’t think I would be here for this long, so I didn’t bother buying these things. Also, to be social and meet people, we (my roommates, Alison and Evelyn, and I) have been eating out quite a bit – we’ve gone out for Indian twice, Thai, pasta, and ice cream. All pretty delicious, but I really am missing just making food for myself. I’m going to get on that this week!

The clubs: As I mentioned before, all the expats we’ve met have said it’s great to be a part of the “club scene,” so I went to check out the American club this week. Because I don’t have a membership care yet, I had to show my passport to three different people and be escorted by a security guard as I got shown around the premises. It seems nice – there is a pool, a playground, two tennis courts, a coffee shop, an a restaurant. Apparently there’s a gym, but I didn’t get around to finding that. To become a member, you need to get a diplomat to “sponsor” you – I asked how was I supposed to find a diplomat if I didn’t know any yet and the man responded, “I don’t care, but you need diplomat.” It seems a little excessive if I have a passport and a visa and a driver’s license, but oh well!.

I also went to a BBQ at the International Club – this place was definitely more open and friendly than the American club seemed. There were people from pretty much everywhere – Canada, the States, France, Belgium, Germany, and even Bangladesh. They had alcohol, which is pretty impressive here because the entire country is dry. Because the majority of the country is Muslim, they don’t sell alcohol at any of the stores and only a few restaurants will serve alcohol, but only to foreigners (we haven’t found any). The commissary, which only high commission and UN staff can get at, is filled with “illicit” substances – alcohol, pork products (bacon, hot dogs, slice ham, pepperoni), skittles, Kraft dinner, Oreos – all the things apparently high commission staff crave after being outside of their country for extended periods of time.

Other things: One thing that has totally made an impression on me this week is showering. Although I have finally figured out that we do have hot water (!!) I have become accustomed to the cold showers of the day, which provide a nice break from sweating in the 100˚F weather. It’s not uncommon to have three showers in a day depending whether I exercise or even just walk around the city. While I love the cooling effect of it though, it just doesn’t feel as clean as scalding hot water.

We also got invited to a wedding this week-end to the daughter of the man who lives upstairs! We felt a bit uncomfortable attending, although I don't think it would have been a big deal. We didn't have appropriate celebration clothes and figured there would be many more weddings throughout the year. However, because of the celebration, our entire apartment building has been decked out in Christmas lights all week - photos attached! It's absolutely gorgeous and I will be so sad when they are gone...

SATURDAY – THE NATIONAL DAY OF MOURNING

National Day of Mourning: We had a holiday on Sunday, so a three-day week-end! Saturday was the National Day of Mourning, for which we had an observation day on the Sunday. In 1975, Bangabandhu Sheikh Mujibur Rahman and most of his family members were assassinated by “Islamic radicalists.” Rahman is considered the Father of the Nation, leading Bangladesh to independence from Pakistan in 1971 and then becoming the first President of Bangladesh and then later the Prime Minister. Bangabandhu means "Friend of Bengal" At the time of the massacre, two of his daughters were visiting Germany and were therefore spared. One daughter, Sheikh Hasina went on to become the Prime Minister (and still is). [see: http://en.wikipedia.org/wiki/Sheikh_Mujibur_Rahman]. Apparently this is the first time in 8 years that the National Mourning Day has been observed, but I am not sure why. From what I gather, a recent political party re-instated its celebration, which would lead me to believe that a prior one thought not to.

We had planned to go shopping in Mirapur for the day, but one of the woman at work who was going to accompany us said there were many protests and it was not safe to go outside because of them. With the language barrier with this woman, it was difficult to determine why there were protests, but she did say that often tourists are more targeted in these instances to make a statement. We sat inside our house until about 4 when we decided that it was probably safe to go to the mall...Driving through the city, there were black flags and Bangladeshi flags everywhere to mark the day. We passed one gathering of young men and numerous posters of Bangabandhu’s face in the colors of Bangladesh (red and green) – kinda how the now-famous picture of Obama’s face in red, white, and blue. It was great to see how the city rallied to celebrate.

The Mall: The Bashandara mall that we ended up at was probably the biggest mall I’ve ever been in, not just because of the size, but the number of stores. It was 8 stories tall, with a movie theatre and a food court at the top. Each floor had 4 rows of stores and since the stores are so small with not really any displays, there were about 30 stores per row. It was intimidating.

We got some salwars to wear to work with the great bargaining skills of one of Evelyn’s colleagues and so now we can dress is as much style as we can muster. The tops are lovely and unfortunately the pants didn’t come with any ties, so we are at a loss until we can find them. For those of you who don’t know, the pants aren’t actually fitted, they are just large pants (kinda a one-size-fits-all) with a drawstring. Also something interesting I learned – apparently all the decorated salwars are made in India. I find it odd that they import most of the clothes since it seems like such a lucrative business to make them within the country.

We also hit up the DVD store – I have never seen so many pirated DVDs in one place. Most of the music collections seemed like they were in official cases, which I’m sure they weren’t, but all the DVDs were in Ziploc bags with photocopied covers. And they had everything - TV series, English moves, Bollywood movies, documentaries, made-for-TV-movies….I picked up a sufficient collection of Bollywood movies (15 for around 18 dollars). I’m sure I paid more than necessary, but, to me, it was an awesome deal. So now I think I’m decked out for my stay in the Bandarbans. (There is also Dollywood – the Hollywood of Dhaka, but I’ve heard the movies aren’t so good. Most of the men at the store who helped me and the colleague we were with said that most people only watch Bollywood movies!)

Our colleague from work brought her kids so all of us went to dinner in the food court and we had Indian food…see a trend? Pani puri, mango lassis, and channa and roti (as I saw it), which here is called Dohi Fuchka and Chole Bhatora….I’m not sure if these are Indian names I’m not aware of or Bangla names. Either way, the food was delicious and we left feeling extremely stuffed. Fauzia and her family treated us to an after-dinner digestive – pan. In India, I think pan is the red stuff people constantly chew and spit out on the side of the road, so I was a little apprehensive about trying it, but her daughter swore to me that it was delicious. It’s basically made of a bunch of spices (no one could tell me the names) wrapped in a betel nut leaf covered with silver foil. You put the entire triangle in your mouth and chew until your mouth is filled with the juices, which apparently aid in digestion. You’re not supposed to swallow the entire thing until all the juices are out, so as we wandered around the mall, we continued to chew for about 15 minutes.

On the way out of the mall, we were standing just outside the exit doors and Evelyn was showing us some earrings she bought. Soon, we were surrounded by about 8 people, who were just staring at us (the three of us and Fauzia’s three kids). I immediately thought it was because Evelyn’s earrings were gold in this tiny case and people wanted to look at the purchase. I must have made a face because Alison turned to me and said “Oh, this has happened before.” Now, I definitely don’t completely blend in with Bangladeshis, but I’ve never had people stare so awkwardly at me. I was suddenly so happy to not be a blond, white, American and I can’t imagine what she feels like walking through the streets on a daily basis. Also, we’ve just seen so many Americans or Aussies here already that I really didn’t think it was as big of a deal as it maybe was….

The Ride Home: As a group, we are pretty good at getting around Gulshan (the area where we live). However, we have found that once you go outside of the boundaries of the district, people really aren’t willing to drive you there – earlier in the week, Danny and I got caught at work because no one would drive us. After walking for about 40 minutes, we finally were close enough to convenience someone – who ended up getting pulled over by the cops…haha. Anyway, I was pretty confident that we could talk to the auto drivers to tell them where we wanted to go, give directions, and haggle about the price, but I was less confident that we could actually find one willing to drive us. The first one we did, we took and as we piled in, the three of us realize that it seemed to be smaller than all the others. We stuffed our packages in between us and Evelyn sat on our laps for the next 40-minute drive back. It was uncomfortable and stuffy, but we made it! And gave directions in Bangla and got a price that we all thought was pretty decent!

Bollywood Movies: I finally convinced my roommates to watch some Bollywood after our trek to the DVD stores. Khubi Kushi Khubi Guam had the most number of actors in it, so we settled on that. After getting over the shock of how long they are, I think I have found my new movie buddy in Alison, who has decided she is going to marry Shah Rukh Khan (Sara, you have some competition!). If we could learn the dance moves next, I would totally be set!

 

SUNDAY – THE DAY OF OBSERVATION FOR THE DAY OF MOURNING

New Market: Today, we decided to try a stab at New Market. We had all heard that its full of shops, bookstores, and jewelry – it seemed like the place to be! It took us about an hour and a half to get there in a cab, cost just a little under 10$ and was only ?? km away!

I have to say, I didn’t really like it – it was dirty (much dirtier than just like walking around on the street), there were soooo many people (made me claustrophobic), and we couldn’t find anything. I’m sure once you know what’s there, it would be easy to find everything, but we were definitely lost. Our faces must have shown it because all of a sudden, two men appeared out of nowhere and started telling us that they would take us to where we needed to go and were trying to get us to go with them. We told him nicely that we didn’t need any help, but of course, he continued to follow us…and talk to us, although we ignored him. Eventually we found some bookshops where we decided to browse and we separated into two-somes. Apparently the guy had been listening to us for quite a while and now knew all of our names and followed us saying them and answering questions – I was odd and kinda scary. I didn’t understand what he wanted from us or what his role was there – were we supposed to tip him for showing us around? I’m not sure, but Evelyn ended up telling him to get lost, which he then did.

The one thing I did like about the market was all the vibrant colors. The clothes here are just wonderfully gorgeous in their ornamentation and colors that it’s hard not to get mesmerized at all the people walking by you. And somehow, no matter who you are or what you look like, every woman wearing a sari looks like a princess. The women here mostly carry themselves with grace and elegance, which seems difficult to do walking through the massive crowds we ran into at this market.

Now, starts the beginning of a new week and hopefully some progress on this trip to the fieldsite!

Week One: Getting Accustomed to Dhaka

The apartment: Since my project hasn't started yet, I've been in Dhaka, the capital city, for the past week. The city has a total of 12 million people, making it the largest city in Bangladesh and one of the most densely populated cities in the world. I'm staying at the program's guesthouse with two other girls who are here as Fogarty fellows. The guesthouse is in Gulshan, the richest part of Dhaka and a large expat area. The apartment is a large 3-bedroom apartment with running water in a shower head (no bucket baths!), AC, Wifi, and a maid who comes to clean, do dishes, and do laundry three times a week. There is also a hired car that comes to pick us up and take us to work everyday. With all this included, it costs approximately 25,000 Taka a month (approximately 350$ a month). Compare this to the monthly pay of a public school teacher = 3,500 Tk ($80). This is definitely not what I expected to have when I came here and I am struggling with the disconnect between what I, and others, are doing and how we live. 

The expats: Although I've only been here for a week, I worry that it's too easy to ignore the world here. We live in a very rich area, shop at imported food stores, have people to drive us to and from work, and there are even expat clubs to provide air-conditioned restaurants and gyms, an outdoor tennis and basketball courts, and a pool. As much as it spoils you, it allowed you met foreigners who are working at NGO's, writing their dissertations, or volunteering - everyone seems to be doing something pretty cool. However, from what I hear, often, rich Bengali's sneak their way into the clubs without having passports, which is a requirement for entrance. Our apartment is right behind the America club and there are also Australian, British, Dutch, Nordic, International, German, and Canadian clubs. I've never been to the other ones, but apparently some of them are much nicer than the America club, which I already think is quite posh. If you just close your eyes when driving through the city, it's almost like you are living in the country from which you are from. 

There are many other young students and volunteers here. Last night we went to a party, where we met about 40-50 other students here doing internships and volunteer work from a variety of countries - Australia, Canada, the US, Finland, Ireland, the Netherlands...it's nice to know that there is a community here, since it is very difficult to make Bengali friends without speaking the language. I'm not sure that there will be this many people when I go to my fieldsite in Bandarban. From the people we talked to, everyone says its gorgeous, a resort, but absolutely nothing to do socially, so I'm not sure what I plan to do for six months there - I'm sure many more trips will be taken to Dhaka. 

The job: I've been to ICDDR, B every day this week and just sit in a small room working on papers that weren't finished when I went I left the country. The project ran into some set-backs and household data is still being entered before we can randomize our samples. All the data is in Bengali, so I really can't do anything until that is done. Anyways, the organization is large and has numerous floors of laboratories for research and then clinical science offices for more research, and then an attached hospital. The hospital (known to the locals as 'cholera hospital') is very large and provides free services, so there is a tremendous influx of people. Apparently this year there has been even more people than they normally have and there have been three tents set-up to house extra people. No one seems to know why there is so many more people, but hypothesize that it's because of the delayed monsoon. 

The weather: Since the rains haven't been coming at their normal pace, it's about 32˚C and humid every day. It makes it terrible to just stand or sit outside and I feel like I have heat exhaustion all the time. I drink about 3L of pure water a day, if not more and shower 2-3 times a day with cold water, just to cool off. Hopefully it will be nice in the forests of the Hill Tracts, but I'm learning to deal with it. 

The food: The first day I got here, there was an arrivals/going-away party with about 15 people. We went to a Mexican restaurant and ordered tacos, nachos, burritos, and enchiladas. Definitely not something I expected on my first night. The second night, we went to a terrible Thai restaurant to which I will not return, and the next we ordered in Indian food. The extent of Bangladeshi food I've had is at lunch at ICDDR, B where a meal costs about 15Tk (~$.25USD) and we have dahl everyday, which is more like a soupy, water mixture, as opposed to a thicker curry. There is always a vegetable, which tastes okay and then a meat curry, which I've never gotten yet. I am also severely disappointed in the lack of chai - they only have tea bags here, which I find odd. Hopefully I will be able to try a greater variety of Bangladeshi food to see what else is available and maybe find some chai in the smaller villages. 

The transportation: When we go out on our own, we usually take a rickshaw or an CNG, which is an auto-rick in India. The rickshaw is basically a man riding his bicycle, pulling between 1 and 3 people on a cart behind him. There are about 15 million rickshaw-wallah's in Bangladesh and their job is so physically demanding that after 10-12 years, it becomes impossible to continue. After carrying around 300-400lbs for about 15 minutes, they are only paid about 40Tk (~$.50)! Also, since the price is never set,  some people walk away giving even just 10Tk...pitiful. I'm trying to pay a little more because I think it's inhumane to make them to that for such little money. However, when you go out with people who have been here for more than a week, they know what is considered normal fare and will argue about payment. I can't tell whether it's better to follow the trends in payment or to pay what I think would be a fair price. I was talking to one of the girls here to was telling me about the drivers...they are about 10% of the entire population, but almost 99% of them didn't own their own rickshaw! Instead, they rent from the owner for about 100-150Tk a day, while they make only 300-400Tk. Last night, we took a rick home at midnight, illustrating the long hours they work just to make enough money to pay for the rickshaw and their food and living. In the last 50 years, the number of rickshaw drivers was less than a quarter of the 15 million that exist today. This isn't just due to the population growth, it's due to the rapid urbanization of the country. Most of the drivers parents and grandparents were farmers and, although still poor, had enough to provide for their families without the struggles of today. However, when the foreign agricultural companies came to the country and took over the land, thousands to flee their areas. Further, the foreigners switched to hybrid, unreproducible seeds that made the remaining farmers to be slaves to the market. It's a very sad reality, but if you took away the entire market, these men would have no other source of livelihood.

The sickness: I though I could make it a month or so without getting sick, but last night I spent the entire night puking with my roommate. One Aussie girl just got over the same thing, so hopefully it will be a short sickness. The girl who arrive on the same day as I did is also sick and numerous other people we met last night were just getting over some sort of sickness. It's great to know that about every two weeks people are coming down with something....

What Am I Doing in Bangladesh?

As part of my Master's internship for Public Health, I'll be spending 6 months in Bangladesh, exploring local conceptions of malaria during pregnancy. This means that I'll be interviewing pregnant women and their families as to where they think malaria comes from, how you can prevent it, how you can treat it, and if there are any extra problems that arise if the patient is pregnant. 

My field work will take place in Bandarban, which is a district in the Chittagong Hill Tracts, on the SE nub of Bangladesh, bordering with Burma. The area is comprised of 13 tribal groups and, recently, and increase in the number of Bengalis. At the split of Bangladesh from Pakistan, this area wanted to stay with Pakistan, which created issues for a while. In 1997, the area reached a peace accord and so just recently has there been political stability and the development of health services. Apparently, the militants who have been there for the last 10 years will just start to move out in the next couple of months. So that should be exciting to witness. 

The area in which I am working has an average age of marriage of 14 and an average age of birth birth just under 16. The new health advisor of Bangladesh has taken maternal mortality as something the government should be investing resources in. Unfortunately, the girls do not use the antenatal care services that are in place, nor the emergency obstetric facilities that are equipped to do C-sections and blood transfusions, in case of emergency during birth. An additional part of my work will be to determine why these young girls are not using ANC, where they are going for advice, and if the system could be changed to accommodate their needs.

The project I am working on is a collaboration between an NGO in Bangladesh called ICDDR, B and the Hopkins Malaria Research Institute. Over the course of the next three years, the group is going to take blood samples and interview over 9,000 people in the area to determine the epidemiology of the different parasites that cause malaria and the parasitic prevalence in the general population. Bangladesh has the highest number of people at risk for malaria in the world, just because of the shear number of people who live in the country (it is the most densely populated country in the world), although the rates of infection are apparently higher in Africa. However, there has never been any active surveillance done before on malaria in Bangladesh, so this project should be super exciting and should outline what the disease burden is for future projects. 

Unfortunately, I don't speak any Bangla, but I'm learning slowly already. My supervisor here though is Bengali and says that he cannot communicate with the tribal people we will be interviewing, so I wont be able to do the interviews, no matter how much Bangla I learn over the next six months. Hopefully I will learn enough to integrate myself into the community, even if I can't use it for fieldwork!

The project hasn't actually started yet, so I'm sure there will be a lot of kinks to work out, but the program has tried to get as many local people to work on the project as possible, which is nice and I'm really excited to get started!