Dhaka, Bangladesh Surgical Volunteer Trip

Ways Of Dealing With Tension

  Fran Relaxing 
  Originally uploaded by interplast.

After a wonderful day off in which we took a city tour, visited the ancient capital of Bangladesh, saw some countryside, and ended the day with a bout of shopping, we had our first full day of surgery using general anesthesia. Shafquat was able to procure two anesthesia monitors for us and so we started on the cases that we could not do last week. With the bombings, the strike and the stress over the boxes which still have not arrived, the team is in surprisingly good spirits. We all have found different ways to deal with the tension.

Another Suicide Bomber

Another suicide bomber today, this time in a government building housing policemen. I'm not sure of the total number of dead, but 11 victims were brought to the hospital where we are working. When we left the hospital late this afternoon, the police were everywhere and the atmosphere definitely very tense.

On a brighter note, it looks like we are finally going to get our boxes. At least that was the news when we left the hospital. Shafquat should be able to confirm this tonight at dinner. We did some incredible cases today under local anesthesia.

Box Saga Continues

We are hoping to get the supply boxes today. What a hassle, but we have been able to operate by stringing many things together. But now supplies are very low. There also is a general strike today because of the suicide bombing, so no vehicles are allowed to run and it is too dangerous to be out on the street.

Bangladesh’s First Suicide Bomber

About mid-afternoon, two patients were wheeled in on gurneys—it was obvious that it was emergency care. The male patient kept screaming.  The female patient arrived in terrible condition—her legs had been blown off. We had briefly heard that there had been a suicide bomber who had blown himself up inside a courtroom in a town on the outskirts of Dhaka. It turns out that there was another bombing in another province. We soon learned that the two patients in the OR’s adjoining ours came from the bombing. One of them was the bomber himself.

When I exited the OR area, I found several police officers with machine guns standing at the entrance. They were everywhere in the hospital.

First Day of Surgery

The first day of surgery appeared to go fairly smoothly. With 15 people who had never worked together and who had to make due with what supplies we had, it was quite a successful day.

I spent the afternoon in Shafquat’s office helping him rearrange the packing lists that Jim had sent to us electronically. The computer had a virus and was working very slowly—sometimes it even wiped out everything we had done and failed to save. I was ready to throw it at the wall, but Shafquat was his usual, calm self, and put me to shame for my flare-ups. We laughed about it. 

Shafquat’s residents have been wonderful this year. He has four dynamic women who are among his registrars, and they are incredibly efficient and helpful. They have forced the males to be involved. A few minutes ago I passed by the lounge—four men were in there sipping tea. All the women were scrubbed in on cases. But I think that they are all excited about working with Tony and Kiran and they are asking lots of questions. This morning a young anesthesiologist walked in and he was brought immediately to the OR so that he could start learning about blocks.

Rashida

  Susan Wong and Rashida 
  Originally uploaded by interplast.

At the moment, I’m sitting in the post-anesthesia care unit (PACU) and the PACU nurses are giving an IV to one of our female patients who is about to have an operation. Her name is Rashida. She has just told us that she has her hand injury because she broke a picture frame and her husband beat her with a bamboo cane. She was crying earlier from joy and told us that she would pray for us because our medical volunteers are caring for her. Rashida also just offered to give us her 11 year-old son to adopt so that he could have a better life. Carrie, recovery nurse, is sitting next to me crying quietly — the depth of Rashida’s suffering was too much for Carrie who is also a mother. She had to move away from the bed so that Rashida would not see her tears.

First Surgery Day

This morning we were all excited because we were finally going to begin surgery. After we set up the OR (Interplast Australia, who we have no affiliation with, had left some supplies and Shafquat located some supplies he had from a previous Interplast US trip), we all gathered in the OR with the local nurses and Shafquat’s residents. After Jon took the team through the emergency scenarios (what to do in case of a number of different emergency situations), Tony addressed the residents. He explained that one of them would be assigned to each patient, and they would be asked to present each case and eventually perform surgeries. They seemed eager to participate. What a great learning experience for them! There are four women residents this year.

What To Do Without Supplies

We had a team meeting to strategize about what we would need to perform surgery without the supplies that were stuck in customs. Tony estimated that he had about 20 cases that would only require local anesthesia; we could do about 10 of them the next day if the boxes did not show up. Shafquat joined us and each specialty asked him about the availability of certain supplies that were essential. Those items that he did not have, he made arrangements to purchase. Luckily, many team members had brought items in their personal luggage and everyone felt comfortable about going ahead with the planned scheduling of cases. We left Tony, Kiran and Dr. Jon Hooper, volunteer anesthesia chief, at the hospital to sketch out a schedule for the next two weeks. We grabbed taxis this time for transportation back to the hotel—about $1.50 a ride.

Clinic

Monday we woke up early, eager to begin clinic. This was held in Shafquat’s office. Tony and Kiran spent a lot of time examining the patients with the local residents. Shafquat had pre-screened more than 110 patients and we had a list of all those who would be coming that day. Tony and Kiran accepted 70 for surgery. Many of the other patients were referred to Susie, our hand therapist, for treatment instead of surgery. The room was very crowded, but all of us were so interested in seeing the patients and participating in the clinic. Because our boxes were blocked at the airport, the whole team was able to participate in clinic—something that is rare on an Interplast trip. Usually many of the volunteers are busy setting up the operating rooms and the recovery room while clinic is being held and they are unable to participate for any length of time.

Shafquat was not able to obtain a hemocue for the pediatrician, so they devised a plan to have only those who she was a bit worried about sent to the lab for a hemoglobin test. Otherwise we didn’t really suffer from the lack of equipment and supplies. The day was long and the team was tired. All day we anxiously awaited news of our boxes. The team remained optimistic and kept saying they were sure that we would get them in the afternoon. By the end of the day, with little good news about the supplies, the team seemed a bit on edge.

"Sheraton"

  Bangladesh Transportation 
  Originally uploaded by interplast.

We had so much fun riding the rickshaws to the hospital earlier in the day, we all hopped on the rickshaws accumulated on the hospital grounds. Fran Fisher, the head nurse, and I shared a seat. We realized after awhile that none of our fellow teammates were anywhere to be seen, but there was so much traffic that we weren’t unduly alarmed. Our poor rickshaw driver had a bicycle that was obviously a bit worse for wear and it was clear that we were quite a burden to carry. More modern rickshaws kept whizzing past us. At times, our poor driver was forced to get off the bike and push it. As the minutes ticked past, we began to wonder where we were. The street scenes were quite unfamiliar, but we figured that he probably knew a shortcut. Just in case, we began to repeat “Sheraton Hotel”; each time he nodded, smiled and repeated “Sheraton.”

Suddenly we were in the middle of a market. Animals for sale in cages, clothes, fruit and vegetables, fish and poultry. And the traffic became especially heavy—we experienced quite a few near misses with taxis and other rickshaws. Fran and I finally figured that we were quite lost. We once again emphatically repeated Sheraton Hotel. The passenger in the rickshaw next to us seemed to understand what we were saying and said something to our driver. He appeared puzzled. Luckily a policeman was on the corner and he asked him for directions. We were off course by quite a few streets and the policeman stopped traffic so that our driver could find his way back. Fran and I had a great adventure, but unfortunately, the rest of the team was in quite a panic when we didn’t turn up at the hotel. They were back within 10 minutes. It took us an hour. We decided at that point that each volunteer would always carry the name of the hotel in Bengali. As in many Asian cultures, it is impolite to say "no" or "I don’t know" in Bangladesh.