Dhaka, Bangladesh Surgical Volunteer Trip

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.

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.

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.

Seeing Patients

Plastic surgeons Tony and Kirin started examining about seven patients that Shafquat had arranged for them to see and it was a super teaching experience for all the residents. The rest of us were taken on a tour of the hospital facilities. We began to talk about what we would do for clinic without any of our secretarial supplies and equipment for examining the patients. Luckily we now send the intake forms ahead of time to the trip coordinators, so we had those sheets along with the wrist bands. We left the hospital at around 5:30, tired but satisfied that the next day we would be able to at least hold clinic, where we evaluate patients and create a surgical schedule.

First Day in Dhaka

I decided that we wouldn’t use the buses as Shafquat told me that it would cost us $70 a day. I thought that would be a hefty price to pay for a two mile trip back and forth to the hospital. We decided to walk as it was so nice outside and the route is rather beautiful. Once off the main road, we found some bike rickshaws and decided to hop in (two at a time) for the rest of the way to the hospital. It was a fun experience for all of us. The price was around 25 cents (US) for each rickshaw.

Once at the hospital, we went directly to Shafquat’s office. He had chairs arranged for us and we introduced him to the group. He had sent Dr. Shankar Man Rai (our surgical outreach director from Nepal in Dhaka for further training) and another registrar to the airport to see if they had any luck with the boxes, while he worked on the phone at his end.

Box Saga Continues

Shafquat is now producing document after document again and it is slowly making its way through the governmental offices so we can bring our equipment and supplies in tax-free. Yesterday he believed that we had a 70 percent chance of getting the boxes before the end of the day, but at 5 pm he came to see me with the bad news that yet again he must produce another document. The news was a definite downer for the team.

Customs

As the happy group made its way toward the exit, a customs official stepped forward and started to quiz us about our boxes. I pulled out our letter of invitation from the Bangladesh Ministry of Health as our international partner Dr. Shafquat Khundkar had asked us to do. The customs official was interested in our countries of origin and began to ask us many questions. I saw Shafquat outside waiting for us and I gestured to him that all was not going as planned with customs. Somehow he was able to enter the customs area and then began the long discussions with the customs official.

In the end, the customs official was insisting that we did not have all the proper papers for bringing in our equipment and supplies “tax free” and so he was not going to release anything until we either produced the proper documents or they went through every item in the boxes to levy a tax.  This was the first time in 15 years Interplast has had a problem in customs with our boxes.

At this point, the team was sagging and it was very late. We had to leave the boxes at the airport until everything could be straightened out. Every box had to be inscribed by hand into a notebook with a description of its contents. Luckily we had the box list that we gave them. Shafquat told me that there was nothing else we could do and suggested that if Dr. Tony Sudekum remained with him to sign the document the rest of us should leave for the hotel. I was only too relieved to finally be able to take the team to bed. They were exhausted, and by the time we arrived at the hotel and sorted out the rooms it was 4 am. Tony came in about 4:30am. I asked everyone to meet at 11 am for our team meeting, after which we would have lunch and then head over to the hospital to meet with Shafquat and his registrars.