Passionate words on the essence of this nation…

"That large-heartedness - that concern and regard for the plight of others - is not a partisan feeling. It is not a Republican or a Democratic feeling. It, too, is part of the American character. Our ability to stand in other people's shoes. A recognition that we are all in this together; that when fortune turns against one of us, others are there to lend a helping hand. A belief that in this country, hard work and responsibility should be rewarded by some measure of security and fair play; and an acknowledgement that sometimes government has to step in to help deliver on that promise.

This has always been the history of our progress. In 1933, when over half of our seniors could not support themselves and millions had seen their savings wiped away, there were those who argued that Social Security would lead to socialism. But the men and women of Congress stood fast, and we are all the better for it. In 1965, when some argued that Medicare represented a government takeover of health care, members of Congress, Democrats and Republicans, did not back down. They joined together so that all of us could enter our golden years with some basic peace of mind.

You see, our predecessors understood that government could not, and should not, solve every problem. They understood that there are instances when the gains in security from government action are not worth the added constraints on our freedom. But they also understood that the danger of too much government is matched by the perils of too little; that without the leavening hand of wise policy, markets can crash, monopolies can stifle competition, and the vulnerable can be exploited. And they knew that when any government measure, no matter how carefully crafted or beneficial, is subject to scorn; when any efforts to help people in need are attacked as un-American; when facts and reason are thrown overboard and only timidity passes for wisdom, and we can no longer even engage in a civil conversation with each other over the things that truly matter - that at that point we don't merely lose our capacity to solve big challenges. We lose something essential about ourselves.

What was true then remains true today. I understand how difficult this health care debate has been. I know that many in this country are deeply skeptical that government is looking out for them. I understand that the politically safe move would be to kick the can further down the road - to defer reform one more year, or one more election, or one more term.

But that's not what the moment calls for. That's not what we came here to do. We did not come to fear the future. We came here to shape it. I still believe we can act even when it's hard. I still believe we can replace acrimony with civility, and gridlock with progress. I still believe we can do great things, and that here and now we will meet history's test.

Because that is who we are. That is our calling. That is our character."

- President Obama

Looking at the Israel-Palestine conflict through a Public Health Lens

There is a health crisis in Palestine – 52% of the families live below the poverty line, access to fuel, electricity, water, and raw materials has been limited because of increased restrictions on goods since 2007, the prevalence of stunting in children has increased and the child mortality rates stalled at 1990s rates, and after the recent Israeli offensive, 22.6% of housing units were destroyed or damaged. (1,2) Many critics may see this situation as a combination of unrelated and unfortunate results in a volatile Middle East; however, these realities have a compounding effect on the health of all Palestinians.

The World Health Organization (WHO) defines health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.(3) A more recent report by the WHO took this a step further by acknowledging the role social determinants play on health including housing, employment, sanitation, and a social security network.(4) Health does not exist in a vacuum and affecting it takes comprehensive measures. This could not hold truer in Palestine.

The poor health status of Palestinians matters for multiple reasons, not limited to it being a “fundamental right of every human being” as stated by the WHO constitution.(3) It can also matter to American foreign policy and to our security. In President Obama’s recent speech addressed to the Muslim world, he argued that a Palestinian state living in peace and security is in the interest of all stakeholders involved including Israel. He goes on further in his speech to say, “And just as it devastates Palestinian families, the continuing humanitarian crisis in Gaza does not serve Israel’s security…Progress in the daily lives of the Palestinian people must be part of a road to peace…”(5) Taking this viewpoint, one can see how improving the health of Palestinians in a comprehensive manner, can lead to a safer, just world.

Israel has been perpetually intertwined with Palestinians’ health since its creation in 1948. Countless battles, uprisings, peace treaties, and occupation have stymied progress and hope in both areas. In more recent times, escalation of war and force has taken a disproportionate toll on Palestinian society. Since 2000, more than 6000 Palestinians have been killed by the Israeli military and over 35,000 injured. Hamas’ Gaza takeover in 2007 has triggered a strong response from Israel including increased checkpoints and the construction of the separation wall (10% of which is built on Palestinian land) which severely restricts the free movement of goods and people. This has a drastic effect on people traveling for religious or social reasons, limiting and/or delaying access to medical care, and restricting economy to the extent that 98% of industrial operations shut down the following year within Palestine.(1,2) Another example lies in the fact that within one month in 2007, there were 40 recorded cases of ambulances being denied access to patients in the West Bank.(6)

In Israel’s latest offensive on Gaza, a more direct hit was taken on the Palestinian health care system when 16 medical personnel were killed and 25 wounded while being on duty.(7) Israel has a right to self defense and to defend their freedom of life. However, they must do so with respect to the International Code of Medical Ethics which obligates physicians to “give emergency care as a humanitarian duty” unless assured that others can provide this care and their own army’s ethics code which states, “IDF [Israel Defense Forces] soldiers will not use their weapons and force to harm human beings who are not combatants”.(8,9) Israel’s hold on Palestinian life from food and medical supplies to land and shelter is complete and does not bode well for the overall health of Palestinians. This repressive approach only leads to increased vilification on both sides.

The current system of health care in Palestine is a hodgepodge consisting of the Palestinian Ministry of Health, Palestinian non-governmental organizations, the UN Relief and Works Agency, and the private sector. The public sector was only started in 1994 following the Oslo Accords which handed over certain administrative duties from Israel to Palestine. Since then, it has been characterized by a lack of coordinated funding, poor prescription drug practice, supply shortages, non-existent health information systems, and corruption. Palestinian’s lack of involvement in health leadership during the 1967 to 1994 Israeli occupation has further hampered development of the health system. Health worker shortages, especially within the allied health field, and poorly trained staff create more inefficiencies and increase costs.(6)

President Obama gave strong words towards developing the everyday lives of Palestinians as part of the peace process, but he must bring action along with oration. Over the next decade, the US will be supplying $30 billion in military aid to Israel ($2.38 billion last year alone), while $225 million economic aid was given to Palestine as of February 2009.(10,11,12) It is both counter intuitive and counter productive to fund a peace process in this manner.

In a study looking at life-satisfaction scores, Palestinian students scored the lowest compared with 35 other countries.(1) It is a dire situation, however, if we decide to look at this from a health and human rights point of view, legitimate steps can be taken towards peace. Israel must loosen its grasp on Palestine allowing for the free movement of people and goods, hand over control of their water, land, and environment, and use force responsibly and sparingly. The funding of the health system from multiple outside donors should be linked towards long term health care projects and shifted from a relief mindset to an empowering and sustainable one. Lastly, the Palestinians must join together towards establishing ethics within the public sector, using money wisely towards sustainable projects such as allied health schools and health information systems, and establish public health infrastructure.(5) There is hope in improving the health of Palestinians and a peaceful Middle East if we can look at this issue with humanity and health as a guiding force for policy

References
1. Giacaman R, Khatib R, Shabaneh L, et al. Health status and health services in the occupied Palestinian territory, The Lancet, Volume 373, Issue 9666, 7 March 2009-13 March 2009, Pages 837-849, DOI: 10.1016/S0140-6736(09)60107-0.
2. Batniji R, Rabaia Y, Nguyen-Gillham V, et al. Health as human security in the occupied Palestinian territory, The Lancet, Volume 373, Issue 9669, 28 March 2009-3 April 2009, Pages 1133-1143, DOI: 10.1016/S0140-6736(09)60110-0.
3. Preamble to the Constitution of the World Health Organization as adopted by the International Health Conference, New York, 19-22 June, 1946; signed on 22 July 1946 by the representatives of 61 States (Official Records of the World Health Organization, no. 2, p. 100) and entered into force on 7 April 1948.
4. Commission on Social Determinants of Health. The World Health Organization 2006. Backgrounder 2: Closing the gap in a generation – how? http://www.who.int/social_determinants/thecommission/finalreport/closethegap_how/en/index.html (accessed July 23rd, 2009)
5. Obama, Barack H. Remarks By The President on a New Beginning. Cairo University. Cairo, Egypt. 4 June 2009. http://www.whitehouse.gov/the_press_office/Remarks-by-the-President-at-Cairo-University-6-04-09/ (accessed July 23rd, 2009)
6. Mataria A, Khatib R, Donaldson C, et al. The health-care system: an assessment and reform agenda, The Lancet, Volume 373, Issue 9670, 4 April 2009-10 April 2009, Pages 1207-1217, DOI: 10.1016/S0140-6736(09)60111-2.
7. Physicians for Human Rights—Israel, Ill morals: grave violations of the right to health during the Israeli Assault on Gaza http://www.phr.org.il/phr/files/articlefile_1237966037140.pdf (accessed July 23rd, 2009)
8. World Medical Association International Code of Medical Ethics. DUTIES OF PHYSICIANS TO PATIENTS. http://www.wma.net/e/policy/c8.htm (accessed July 23rd, 2009)
9. The Israeli Defence Forces. Spirit of the Israeli Army. http://dover.idf.il/IDF/English/about/doctrine/ethics.htm (accessed July 23rd, 2009)
10. Sharp, Jeremy. Congressional Research Service Report for Congress. U.S. Foreign Aid to Israel. 2 January 2008. http://www.fas.org/sgp/crs/mideast/RL33222.pdf (accessed July 27th, 2009)
11. Erlanger, Steven. "Israel to Get $30 Billion in Military Aid From U.S." The New York Times 17 Aug. 2007. http://www.nytimes.com/2007/08/17/world/middleeast/17israel.html?_r=1 (accessed July 27th, 2009)
12. Zanotti, Jim. Congressional Research Service Report for Congress. U.S. Foreign Aid to the Palestinians. 20 February 2009. http://assets.opencrs.com/rpts/RS22967_20090220.pdf (accessed July 27th, 2009)

Ami Bangla Bolti Pari Na

I have become lazy in blogging my experiences as I am coming closer to the end of this journey. The excitement of being back home soon makes me think that I can just tell you all of the last experiences, but for the sake of continuity and my poor memory, I’ll try to summarize some stories in my last 2 weeks.

Khulna Journey
The journey to Khulna was approximately 300 km, however it took me close to 9 hours to reach. Part of the journey involved taking a ferry across a river. The actual ferry ride was 20 minutes, however, the traffic and the inefficiency of loading and unloading made this part of the trip about 3 long hours. It was an interesting experience though, with the bottom floor full of vendors selling fruit, fish, and chaat, the middle floors with a restaurant and rooms, and the top floor a place to sit and enjoy the view. The bus conductor served as my mini guide for this part of the ride and treated me to a cup of cha.

SMO Excursion

On a couple of my days in Khulna, I took a break from the hospital and accompanied the WHO surveillance medical officer to rural areas where she works in various roles. One case involved a child with acute flaccid paralysis (can’t move limbs of body, usually legs) which has to be investigated for fear of polio. For this trek, we took the WHO truck to a river, a small boat across the river (2 min ride), and a flat bed rickshaw (called a van because it’s also used to carry goods) to the patient's house. This ride was one of the most enjoyable parts of my trip. The SMO and another surveillance officer sat in the front, while I sat in the back with my feet dangling off the back. The weather was beautiful with a slight breeze, clear blue sky, and just enough shade along the way to not become too hot. Basically, we went down the main road of the rural area for a 40 minute ride. Along the way, we passed small market areas areas, huts covered by different forms of leaves, government schools, rice fields, banana trees, betel nut plants (closed off areas covered by cloth since they grow better in less sunlight), the river, a lake, ducks, chickens, cows, people using man made ponds to take showers, wash clothes, or play in. This list can go on and on. It was the quintessential rural scene that we’ve seen in the movies of the subcontinent's rural areas.

We approached the patients house by walking along a narrower road made of caked mud. The house was approximately 20 feet across by 8 feet with a bed on one side, and everything else on the other side, including a black and white tv. They were expecting us as the mother was dressed up and had biscuits served in individual bowls. The SMO determined that this was most likely not polio, but probably juvenile arthritis or another infectious cause which was temporary. While there, I met the uncle of the child who knew Hindi. We talked about India, my experiences, and then he invited me to his house (30 feet away) for fresh coconuts. He climbed the tree in front of his house (about 30 feet high), cut down a couple of coconuts that dropped to the ground with a thud, and began using a sickle to cut them with his father (who looked like the reincarnation of Tagore). He poured the contents of the coconut into a steel cup and handed me the glass. The taste of the coconut water was delicious, looking a little like lemonade, with a slight coconut taste (not overwhelming), which was perfect for that warm day (though here, they usually drink it during the winter). He then cut open the green outer covering to reveal the light brown exterior which we are more familiar with, and peeled away the exterior, handing me the white meat of the coconut. The taste was amazing and unlike any coconut I had ever eaten. It was firm and fleshy, but not hard such as the ones we find in our supermarkets, so I could easily eat it by biting. As we parted, he cut two more for me and packed them in a polythene bag for me to take back to my hotel. As he apologized that he did not have much else to offer, I told him that this was more than enough and I appreciated his hospitality.

Touristy Excursions

I made a friend at the medical college. He was a physiotherapist who had trained in Dhaka and found it hard to make a living doing what is relatively a new/luxury field in Bangladesh. Out of his kindness, he offered to take me on a couple of outings so I could see more than my boring life between the hospital and the hotel.

The first involved renting a boat and going along the Rupsha River. The boats were what you typically see in Bangladesh – an approximately 15 foot long wooden boat, with an engine attached to one end that sounds like a diesel engine. It was relaxing and nice just to see life along the river. Within in the river were dolphins, which my friend saw three times and I did not see once.

The second excursion was to a nearby old Mughal town named Bagerhat which housed a 400 year old mosque known (not too creatively) as the “sixty dome mosque” (actual number was 67). The mosque was modestly designed and sized compared to other Mughal structures, however, was still impressive to see with its various domes. We then took a “van” to the famous mazaar of Khan Jahan Ali. I didn’t go inside the actual mazaar (was not going to make this mistake twice a la Ajmer), but there was plenty to observe around the area. Most famous is the lake, about 50 feet from the mazaar which is famous for having crocodiles. We walked to the area where there are supposed to be crocs and to our luck, there was a female crocodile with her head out of water, sitting motionless in the water, looking directly at the stone bank 15 feet away from us (CRIKEY!!). For some unknown reason, I wasn’t too scared (though I always made sure there was someone between me and the croc) and we all just watched in amazement at the crocodile sitting there still as statue. From the distance, we saw the water moving in a pattern that meant another crocodile was approaching. We waited to see what would happen, both in fear and excitement. It came closer and closer to the other one sitting in front of us. The huge male finally arrived, made a couple of grunt sounds, and (in front of all of us) began mating. Yeah, what an experience. I took pictures and videos and could not believe that I was standing 15 feet from wild crocodiles mating. After doing his deed, the crocs dispersed and so did we as the two year old child of my friend began crying hysterically.

Failed Mutiny Attempt

While at the ICDDR,B (famous research center in Bangladesh) for a meeting with other people working on my project, we heard from others that was a situation unfolding at the BDR (Bangladesh rifle) complex. Gossip was widespread as fears of curfew, mutiny, and the number dead starting spreading. My colleagues told me to go straight home and wait to see what happens. The complex is approximately 6 km away from us, on the other side of town, so we couldn’t hear the gunshots and fighting going on in the midst of a pretty busy area. A few people standing by the complex were shot from stray bullets, however, most of the dead were those inside the complex. Apparently the BDR was not happy with the way they were being treated, getting less funded than the army, and had other complaints, so during their annual ceremony, a team of them rose up against those in charge and basically had a standoff with the army and other armed forces. The number dead is still up in the air, but the latest news is saying up to 130. After two days, the BDR surrendered and investigations have started. Though I was initially scared as I was taking my auto back from the icddr,b office, things since then have been pretty calm in the area where I'm living. Most businesses and life is running as usual, besides schools being closed and markets around the complex being closed. As all news channels are in Bengali, I had to wait for the English newspaper to really know what was going on (my family here translating leaves out a lot of the details, they’d mainly tell me the big news and not to worry). It was a little boring to sit at home and not go anywhere as I was reprimanded from doing so from family in three different countries, however, it was probably best to be safe. I have now seen just about every side of Bangladesh including the good, bad, and ugly.

Closing Remarks

In my closing days here in Bangladesh, I’ll leave with these words from the poem, “Gitanjali” by Rabindranath Tagore. I think this does the best job of summarizing my sentiments with the people I was able to bond with, in such a short time (enjoy Nani and Ashraf Uncle).

Thou hast made me known to friends whom I knew not. Thou hast given me seats in homes not my own. Thou hast brought the distant near and made a brother of the stranger.

I am uneasy at heart when I have to leave my accustomed shelter; I forget that there abides the old in the new, and that there also thou abidest.

Through birth and death, in this world or in others, wherever thou leadest me it is thou, the same, the one companion of my endless life who ever linkest my heart with bonds of joy to the unfamiliar.

When one knows thee, then alien there is none, then no door is shut. Oh, grant me my prayer that I may never lose the bliss of the touch of the one in the play of many.

(the pictures accompanying this email can be seen at http://picasaweb.google.com/samustafa/LastWeekInBangladesh# note: the last picture of the set is going to be the cover for the Bangladeshi version of Swades.)

Valentine's Day in Dhaka

Yesterday was the first day of Spring here for which they have festivals and programs across the nation. I went with a couple of young guys (friends of my family here) who took me around to the performances, the university campus, photography exhibits, etc. More than anything else they explained, the guys sit around, and the girls all dress up for the guys to look at them (I swear Sophia, it wasn’t me). The girls all wear the colors of Basanti – orange, yellow, red – mainly in sari form. The guys wear whatever the hell they feel like wearing though a majority had on kurtas. (I had my American version on – jeans, kurta, and Converse All Stars). It ended up being a day of us basically walking around in various parts of the city and observing Dhaka more than anything else which I enjoyed.

We ended up eating at a chicken joint eerily similar to Ravi Kabob in DC – it had simple tables, a simple menu, tons of customers, and the inside even featured a mirrored wall. You have two options there – roasted chicken or chicken schwarma so I decided to go for a little of both. The schwarma was lackluster and pretty standard, but the roasted chicken served with fresh french fries, a tomato chutney, and a mayonnaise/hot sauce combo was excellent. Cooked through with the right spices and served with your choice of paratha or a Mediterranean style naan, though it was probably best eaten plain or with the chutney. The day long adventure was capped with my first ride on a local bus (I haven’t even done this in India), in which we both climbed onto and departed off of a slowly moving bus with a “conductor” yelling the bus route and hitting the side of the bus as needed to pick up passengers or to signal to go on.

Today was Valentine’s Day. This holiday has really taken off in countries outside of America. In today’s largest circulated English newspaper in Bangladesh (The Daily Star), there were huge ads of different businesses seeking Valentine clientele – Pizza Hut (“love happens at Pizza Hut’), KFC (we celebrate love), and a condom company introducing a chocolate scented condom (fall for the seductive fragrance of love). I explained to the Utpal (18 yr old son of Uncle) that if a guy took a girl to these places in the states, he’d be asking to get slapped. (side note: if we really want to tackle the influence of globalized food like McDonalds, we just have to show the world what these places mean in America). Beyond this are the usual flowers, couples going around, etc. Being solo in this country, I decided to go to the opposite spot of lovebirds – The Liberation War Museum.

Finding this place was quite a pickle. My map was incorrect therefore I ended up walking in circles around the actual location (one block away from where I’m staying). The sign in front of it was quite discrete as well with a sign probably made 20 years ago in the standard tin and paint combination. After paying the admission of 3 taka (5 cents), I walked in.

The museum, though aesthetically simple, was a wealth of information that really let you understand the soul of this nation. Outlined in the chronological exhibit were the times of the Mughals, British Invasion, India and Pakistan independence, the language movement, and the eventual liberation war. The heroes of the country were detailed in various forms such as the Dhaka university students who died in protest, Sheikh Mujibur Rahman, women fighters, Shere Bengal and others whose names I can’t recall. Using clothing, photographs, and other memorabilia, it told the story of all this in an excellent manner. Here are some of my reflections following this.

- The importance of violence in forming this nation is something that Bangladeshis embrace. I don’t see it as barbaric by any means. It was what they had to do to gain the independence they desired from both the British, and then Pakistan. The red circle in their flag represents the blood shed for the nation (the green represents the greenery of the country).

- I never really understood the implications of creating a West and East Pakistan but I think I have a better picture now. It really never made any sense from the get go. These two Muslim areas are separated by location, culture, and language, though they may share the same religion. I’m sure the Muslim League and Jinnah saw that if Muslims were divided even more, then that would make for an even weaker Muslim agenda in the region. I’m also sure that India saw it to their benefit to support Bangladesh through all of this which they did. It seemed like this rift between East and West Pakistan also stifled the progress of these nations from 1947 as well, creating a wastage of resources and mental effort towards war. (I’m 100% sure that the British knew what they were doing in the midst of all this).

- Interestingly enough, Russia was one of the first countries to show support to Bangladesh during their liberation struggle, while the United States turned somewhat of a blind eye to the genocide and were even supplying arms to West Pakistan at the time. Senator Edward Kennedy was one voice in the US who stood up against the Nixon Policy.

- Bangladeshis seem to have a respect both for India and Pakistan. India they admire for their secular viewpoint, economic progress, and support during most of their history. Pakistan, it seems mainly for just religious reasons, honestly. Though Bangladesh has a long ways to go as far as development and are still forming their soul, they have an interesting location in that they are within India, yet close to the Far East of China and Burma. They seem to borrow and side with the different countries/ideas when necessary but it seems now that they are headed in a more pro India direction.

- The Bengali language is something that is coveted and taken with great pride here. Part of Bangladesh’s reason for leading this Liberation War was based on Jinnah and West Pakistan’s policy to make Urdu the official language. A movement in Bangladesh was against this from the beginning which erupted in violence, February 21st, 1952. In honor of those who died, and to recognize the importance of Bengali, February 21st is a day of mourning (as well as International Mother Language Day started by Unesco in this day’s honor). Part of the festivities is a month long book festival with about 200 stalls taking place at the nearby university. Though 98% of the literature there was in Bengali, I was able to find a couple of English books by Bengali authors.

In a lighter story, I was able to meet a couple from Colorado spending time here in Dhaka (as part of a larger tour of the whole of India, for which they left their jobs) at the museum. We talked about our experiences and what we’re doing here. Though they are loving their trip, they said it becomes both a blessing and hassle to stick out so much. I told them that it’s a little easier for me to deal with being here since I blend in pretty well. We starting walking out when a well dressed Bengali man approached them and struck up a conversation of what they’re up to, where they should go, etc. He glanced at me for a split second and said, “Oh, I see you have guide”.

Chitta GONE (get it? The actual city name is “ChittaGONG” but i'm not there anymore. yes, I have put in my application to the national enquirer)

So I’m back ‘home’ in Dhaka. Good ‘ol Dhaka. Where the food is always coming and the traffic noise constant.

Here are some closing thoughts on Chittagong.

So staying in Chittagong was my first real experience here living ‘alone’. In Dhaka, I stay with the family, in Rajshahi, I basically had an uncle living 20 feet away from me who’d do everything for me. So how did I survive in a third world country on my own? Simple! By booking a good hotel, getting room service, and paying more than the normal charge for transportation!

The hotel was pretty good. It was made less than five years ago and featured internet in the lobby, a great restaurant, good maintenance/cleaning, and a decent location. The tv situation was subpar as some channels came clear and some didn’t. There was no pattern to this and the channels that were clear could change depending on the day. So sometimes I’d watch national geographic or bbc, somedays mtv india and espn but never all in the same day. The restaurant featured great Chinese/Thai soups, spring rolls, and ravi kabob type food in the kadai and kabob dishes which I’d get with the best naan I’ve had in Bangladesh. This was more than sufficient.

(while typing this, aunty brought me my evening snack which was another variation of Maggie – this time with cauliflower, carrots, aloo, and 2 mini jaali kababs on top – kinda like a combo b/w a shaami and chapli, crispy on the outside, soft in middle. Seeing that ramen was once loved by fifi and currently by anu bhai, I think you guys have a new standard for how to make that 10 cent ramen)

My main issue with the place, and being on my own in general here, is something all people who look different in a foreign country must face (esp south asia) – getting taken advantage of. I know, I know. Big deal. It’s a difference of 50 cents in a transaction. But it’s the principle of it that gets me. Whenever I’d take an auto or rickshaw, I’d be quoted a higher than normal price. The one time I went shopping for pirated music/movies, the price was raised for me and I knew it as I saw someone else just quoted a cheaper price. Even some of the hotel staff, which really got to me. One guy claimed he had broken sandals and he needed money, but then the next day he had sandals that were of a different color and well intact. The inconsistent and random charges I’d get for using the internet, etc. However, this is something I will have to expect and account for, especially if I’m going to be wearing my Dansko clogs around Bangladesh. (it’s the one thing people stare at most when I’m walking by. Not my dashing good looks, not my dapper style, but more, what the hell are these monstrosities on his feet).

I was able to make a friend, with one of the hotel staff actually, who took me around to a couple of places. He happened to have roots in India and could therefore talk in pretty good hindi which I could understand 80% of the time. He was one of those guys that you’d say, “shakal se sharif lagtha hai”, and though my guards were up, I took up his offer to go sight seeing. He took me to Foy’s lake, which is basically like a state fair crossed with Jordan Lake with standard rides, boats, zoo, trails, etc. It was relaxing, peaceful, and aesthetically pleasing though by no means breathtaking. We climbed up a hill and got a decent view of the city, which was clouded with a haze (not sure if it’s fog or more pollution). He told me about his family, friends, and desire to go abroad. We went to the zoo which was really a site to see. Every animal essentially had the same style of accommodation – concrete and/or sandy grass with a big chain link fence around it. Not too much to frolic and be animals I guess. The “please don’t feed the animals” was ignored by most so that was interesting to see. The only staff I saw was one guy who fed the lions and one Bengal tiger. For being a bare bones zoo though, they had a good range of animals – peacocks, pythons, a tiger, lions, different breeds of monkeys, birds, and other local animals so someone like me can get a good idea of what is the local fauna here. Yes, fauna.

Chittagong is most famous for being a port city where most goods of Bangladesh come through – cars, tv’s from china, you name it. So one afternoon, Imtiaz took me down to the Bay of Bengal where I was able to see and appreciate the huge number of both commercial boats from around the world and local fishing boats. We went to a beach area which is a popular place to hang out and enjoy yourself. Shops, horses/atvs for rent, picnics, boat riding, and of course, couples trying to meet outside of the public’s eye. The beach didn’t have much sand on it and was pretty much a muddy bank. It was still beautiful to see with the ocean there and the sun setting into it. We basically walked around, talked, and sat on the humongous boulders placed by the government for visitors. Not too many people go to the beach to actually swim but there were a few kids and women in full shalwar kameez enjoying themselves. It was a really nice scene – with the sun setting, people enjoying themselves, the air force doing practice runs overhead, and a cool breeze.

slumdog broke

Today was a day in which I saw poverty in my face. More so than other times. I have seen the poor in the government hospital that I am a medical student at in Greenville, NC, but this was different. I have seen the poor of India on the streets, but this was different. Maybe because this was in my face versus from the backseat of an a/c Honda City. I spent half my day observing as my unit on peds was admitting patients today. In the evening, I went walking by the river.

This morning at the hospital was everything you’d expect a third world country government hospital to be and more. This ward is bigger than the one in Rajshaahi as it houses all 3 units in one humongous ward (roughly 75 – 80 beds but many more patients). I saw one ten year old boy come in stiff as a board with muscle spasms. He was diagnosed with tetanus and it was feared that the portal of entry for the bacteria was through a broom his mother used to hit him. There was a pustule type lesion on his left arm that was mildly swollen. Tetanus basically keep your neuromuscular junction from relaxing therefore you get locked in place. First your limbs and jaw, and if time passes, your face locks into a smile, your neck and back into a backwards C shape, and eventually your respiratory muscles, preventing you from breathing. He was in the beginning stages with his left arm locked into a flexed position and neck/jaw rigidity. He would grimace every so often whenever he would have spasms. He could open his mouth slightly but not all the way. The necessary steps were taken to help him but no staff really flinched or missed a beat as they had many more patients in dire conditions to see. He was put into an isolation room which was quiet and dark, but he had to lay on a mat on the floor as the one usable bed was occupied by someone else.

Another patient had cerebral palsy (a group of conditions that affects control of movement and posture, also lacks mental capacity). As with other people with terminal disabilities in third world countries, her future is not bright and it will be tough for her to have any functional therapy she can afford. She was foaming from the mouth and I’m not exactly sure why. The attending, mother, and other doctors didn’t seem to mind. It left a disturbing picture in my mind. Even more disturbing was seeing her grimace in pain when the doctor tried examining her. Bedside manner in government hospitals doesn’t exist. The patient and family are assumed to be ignorant and therefore treated as if they are a child no matter the age. Patients and families are talked down to, poked and prodded without warning, and become the specimen of 20 so medical students at once without permission. The poor are learned on by students and doctors around the world.

Another patient had probable tubercular meningitis. Since the doctor wasn’t sure of the diagnosis, the patient was receiving a slew of antibiotics (at least 6 including TB drugs, vancomycin and ceftriaxone). The patient was obtunded, malnourished, and lying there as if death was approaching. Antibiotics are given like candy here. Since diagnostic procedures and lab capabilities are limited, doctors treat everything and hope one of the drugs works. I can’t imagine the resistance bacteria are gaining in these countries and even though non communicable (non infectious diseases) are on the rise, I foresee a future where the bacteria fight back bigger and stronger than before.

The sounds/noise of a pediatrics ward, full of 80 – 100 or so patients is something that will stick with me forever. In the midst of patients coming in today, a baby from the next unit, approximately 20 feet away from the tetanus patient, passed away. The mother was rocking back and forth, crying at the top of her lungs, while reciting what seemed like a dua/cry for help as I’d hear Allah every so often. Onlookers were staring but this did not matter.

Food is provided for the patients by the government. A small sized cart carrying huge pots of gosht ka salan, rice, vegetables, and daal stops by each section of the ward and gives out food. Patients/families bring their dishes up to the cart where they receive the food. The smell of it is not appetizing.

One girl was repeatedly having apneic episodes so cpr was performed twice under the most calm circumstances I had seen doctors carry this out on a ~3 month old girl. A scary looking suction device was used to remove phlegm and fluid from her airways. Each time material was stuck in the miniscule size suction device, it was dipped in water and cleared out.

Bangladesh is not all poverty, but a huge percentage of it is. The fact that I’m in a government hospital everyday allows me to see the sick of this population. It’s in my face. I try not to think about it and focus on the project. I think I’m reaching a saturation point. I don’t know what to do or how to solve the problems. I try to make kids smile but what does that do for their families, for their future life. This trip has confused me even more. What is my place in this world and how do I solve what I think is not right.

Walking towards the river was not too touristy as the lonely planet book describes. The smells are possibly the worst I’ve smelled in my life – a mixture of sewage, trash, and seafood. The trash stations are every 50 to 100 meters or so where crows, chickens, dogs, and people forage through to find what they can. I walked on this road parallel to the river where there was very little going as it was mainly a loading area. I did happen to see one person bringing in a manta ray on a cart approximately 6 feet by 5 feet across. After praying asr in a masjid, I walked out onto the “pier”. This was one of those scenes of poverty you usually see in pictures and movies. The pier was made of wood and was pretty sturdy. On each side of it was a muddy bank where about 25 children were playing. Some were running around, others were making “mud balls” and throwing them at the other kids, others playing this game where you use a stick to hit another stick in the air. A goat was tied down and watching the fun. There were old rusty boats that were wholly on the bank, god knows how old, or what their story was. On the river you could see lots of cargo boats and those of the small variety used for fishing and transporting people. Close to the river bank were people carrying sacks of something (guessing rice) on their heads to a nearby waiting truck. About 200 feet from the water were some homes constructed of bamboo and tin. I imagined one of the patients I saw in the hospital I saw today coming from here.

Chittagong-6

Alhumdulillah, I reached Chittagong safely. The journey was not bad - a comfortable bus ride that lasted about 5 hours. Though sitting in the front has its advantages for feeling less bumps, hearing the horn every ten seconds can get a little annoying. We stopped at a rest stop where I had a chicken salad sandwich, chicken cutlet, and mithai for about $2. Surprisingly, the chicken interpretations weren’t bad.

I took a risk on the hotel by looking it up in lonely planet and it ended up being a good choice. About ten bucks a night, but with clean rooms, great staff, new furniture and tiles, and a decent view of the city from it’s 9th floor courtyard. I’m on the 7th floor. Namaz is on the 10th (more to come later on that).

I’m in the old heart of the city, where the train station is, the river not too far away, and more vendors than you can count. I went walking around and it was an intense experience in which every sense was on alert from the smell/stench of the dried fish market to the yelling of shopkeepers telling their prices. You name it, you can find it within walking distance. There is a fish market, produce market, traditional mall, vendors selling everything from bobby deol’s greatest hits (I thought you had to actual have a hit to have a greatest hits) to jewelry to fake purses. It’s like Chinatown, the fair, the farmer’s market, and the mall wrapped into one. The markets here are more of the Old Delhi style but even more congested. So many people were in this area that you have to use your traffic skills to get around. I even did some bargaining though the fact that the shopkeeper was only too happy to accept my counter offer of 100 taka for an 8 in 1 Bruce Lee movie collection and MP3 collection of the latest Indian songs (including Delhi-6 which I really wanted) made me doubt that I got a good deal.

The staff has been interesting. One guy is from Kolkata so he knew hindi and we talked a little bit. Another told me about where the staff prays namaz on the 10th floor. I went there at maghrib and they were about to start praying separately when they noticed me looking around waiting for the jamaat. In broken hindi, someone told me that none of them are imams, to which I replied we’re all imams (I know, give me an askar). I ended up leading namaaz and I’m not sure what kinda reaction they had. A couple were confused when I didn’t lead du’a after namaaz and they just waited until I got up to pray sunnah. But overall, I think I’ll be ok here. They have an overpriced restaurant which is convenient and internet in the lobby. Can’t ask for much more.

Ps. I need emails from you guys to let me know what’s going on there!

maach, cha, and fried green tomatoes

I take back everything I said about the food of Bangladesh. I must revise it to just don’t eat out and eat at some momma’s kitchen. The home cooking in Dhaka has really spoiled me and has let me get to know what Bangladeshi food has to offer.

Their subzis have a common spice (I think haldi/turmeric) that is in most of them so they all have a similar taste. What’s in season these days is carrot, papaya, aloki, gobhi, bhaigan, lal saag, cabbage, etc. They’ve all been excellent which is the case abroad with most produce. The different one I had was this fried bhaigan dish that isn’t breaded and keeps the skin on. They have both purple eggplant and a green one as well. Still not fully sure if they taste differently.

The roties are extremely soft and can’t really compare to any taste as far as Indian roti. Apparently they put boiling hot water into the aata before making it and this makes it really soft. They almost look like flour tortillas, but use the same flour as rotis in India. Made fresh, these are pretty good. They have parotha (which I think is slightly fried and not like ours), puris (both plain and stuffed with beef, not complaining here), naan, etc. The main thing is that they’re not eaten often and usually at breakfast or dinner if at all.

Side note : Pizza hut in india is currently running a stuffed crust deal there that stuffs it with your choice of paneer or chicken sausage. And we thought we had it good.

They have something they call singhara, which is essentially a aloo samosa. Their samosas usually mean stuffed with beef and the aata is made differently almost given it a puri crispness to it, versus flaky singhara.

The only daals I’ve had have been yellow. I couldn’t really tell you what types, but I know I’ve had moong. Besides that, they seem to be local varieties that are slightly different from ours.

Mithai has been par excellance at the household. Saveyaan, shondesh, rosgollah, sooji ki mithai (which is kinda like the saveyaan consistency), firnee, this one where they took frozen mango pulp (preserved in the freezer from summer) and mixed it with milk powder (sounds weird, but tasted good once again). Haven’t had a bad mithai yet.

The fish. The first day I was here, they had a fish that had quite a bit of bones, but since then, auntie has made fish with easy to remove bones. I couldn’t tell you the name of them, but they’ve all been pretty good. One kinda like bass, one tilapia type. Most are of the white variety, some flaky, some a little tougher. They seemed to be cooked pretty similarly in a salan, cut in pieces from the head down to the tail, cooked with skin on which is easy to remove. Usually aloo, pyaas, tamatar are added in a haldi based salan.

I haven’t had two cups of “cha” that tasted the same. Cha without milk seems to be pretty popular. I’ve had cha with elaichi, wth cinnamon, with milk, etc. I guess the variety of tea leaves is pretty high as they do produce tea here and are close enough to india to get tea from there.

While writing this email, uncle just came back from a weeklong business trip along the northwestern district of Bangladesh. With him, he has brought an arsenal of food from the region. Huge bags of “super quality” rice, a damn tasty fruit called kewel (a combo of an amrut because of its consistency and apple because of it’s outward appearance and sweetness, but the size of an extra large grape), a special kind of matar, green tomatoes, green bananas (to cook with fish), green eggplant, 2 humongous fish from a friend’s pond, 2 King ducks, 4 boxes of mithai (types specific to their region which were mainly milk based), green coconuts (to drink the healthful milk) , a ripe papaya, and a partridge in a pear tree. Man, it’s like when pappa comes back from his meetings, except these things don’t have pharmaceutical companies written all over them and are edible. They were happy to see me excited (and thought I was a sheltered American boy though I tried explaining I like this kind of stuff). They also commented that it’s a good trait that I eat and enjoy whatever they feed me. The legend continues.

It is now 11 pm, and we are eating snacks while cooking dinner. I helped by cutting onions for a fish stew using rewey fish (cross between the white flaky nature of flounder and steak like qualities of tuna). It was first fried and then put in a salan with onions and tomatoes and may have been one of the best fish dishes I’d ever eaten. With the fresh green tomatoes, I cooked fried green tomatoes to share my food with them. I used a tempura mix, salt, and pepper and it turned out pretty good, owing mostly to the great tomatoes. Everything happens for a reason, and I have thoroughly enjoyed having my train cancelled for today. Though I had planned to lose enough weight to fit comfortably into my sherwani, signs are now pointing to doubtful.

strangers with kindness

I’m starting to think there is something in the water here (besides arsenic) that makes the people of Bangladesh extremely helpful to strangers.

Today was a long day. After waking up early, I headed to the Bangla Biman office which is more like a train station type setting with the busy crowds there. (the actual train station on the other hand is extremely clean and well organized unlike India’s). I looked at the ticket number being served, “143” and looked at my ticket, “253” and headed to one of the empty spots on the leather couches. After waiting what seemed like an eternity, my number was called and I got my flight changed in 5 minutes. The employee was nice and helpful, though she didn’t really react when I complemented her bracelet.

Waiting in line at the office for longer than planned, forced me to rush back to my place to finish packing, eat lunch, and leave. After gathering my things, we were about to head out when the electricity went out. We were on the 8th floor of the building with my super size suitcase, pilot case, and messenger bag. Without a choice, we hauled the bags down the stairs. Mithun put me on a rickshaw and I held on to my belongings as we headed to the station.

After reaching the station, I thought I’d be cool and take my bags myself as I am an American and that’s what I’m used to. Once I quickly realized that I have no idea where I was going, I agreed to pay the ~15 year old coolie 20 taka to help me out. While trying to confirm if I was at the right platform, I approached a well dressed man and asked if he spoke English or Hindi. He said English and I asked him if this was the right place. He looked at my ticket and said he was in the same car as me and he’d help me out. We got to talking and he told me about his family and job, I told him about mine. He talked to the ticket person to put our seats together so we could sit together and he’d help me once we arrived. After watching a couple of trains arrive with thousands of people from Biswa Ijtema, things were not looking too good. (Biswa Ijtema is basically a tabligh-e-jamaat worldwide conference in Dhaka once a year. It’s the second largest gathering of Muslims after Hajj so around 1-2 million people make it here.) Out train had been delayed and then had technical issues with all the people riding on top of it. At this point, the earliest my train would come was another 2 hours (in addition to the 2 I already waited). The uncle told me I could return my ticket and try again tomorrow, as he rushed to catch a bus.

I reached one of the ticket counters and asked again, Hindi or English, and then he told me to go to another area of the station to return my ticket. Someone happened to overhear this and seeing that I was clueless, he told me to follow him, and he took one of my bags. The queue was pretty long, so Raqul (the nice person) told me to stay with the bags (including his) and he took my ticket to wait in line. After consulting with some people, they advised me to take the bus the next day (which Raqul was planning to take tonight). He returned my ticket, and then said for me to follow him again, this time to the bus station to get a ticket. We took two rickshaws, and he actually even had one of my bags ( I know I should never trust someone this much, but I just did.) We reached the bus area, and he was waiting and looking for me. He told me to wait again as he left me with my bags. After coming back with a general class ticket, I told him I wanted A/C coach (I know, I know, forcing a stranger to get me A/C). He said no problem, asked for more money and came back with a ticket confirmed for tomorrow morning. After exchanging numbers and thanking him, he put me on a rickshaw to go back home.

I have now come back home, am lying down and typing on my laptop, while auntie is making noodles and cha for me. God bless Bangladesh.

(note: the family I’m staying with is usually really helpful, but one son had to defend his thesis today, the father is out of town for work with the car, and the other son and uncle are on vacation)

ami tamako baalo bashi

Salam all,

So I finished my two weeks in Rajshahi, and I am now in Dhaka for a couple of days break before heading to Chittagong. Chittagong is the second largest city here so it should be a lot different than my experience in an old town with mainly rickshaws. I’m going to write this email with a couple of stories (vignettes if you will) to give a more detailed experience of a couple of experiences rather than a little about a lot.

Scene one – going to get something besides Bangladeshi food

So walking distance from my guesthouse is a sketchy looking place with a sign that said “mini Chinese and fast food” restaurant. I didn’t think it looked good, but desperate times called for it. It was early by dinner standards as it was only 7 pm. There were three young employees/workers watching Sri Lanka vs Pakistan in a very dimly lit restaurant. After conversing in broken Bengali/Hindi, I finally received a menu. I picked what I knew and went for the “Cheken Chow Mein” which I guess is a different meat from the “Chikin Chop Suey”. They leaped into action. One of them picked up what looked like an old antifreeze container, and all three left the restaurant and handed me the remote. I switched through the channels and settled on watching “Zara Zara” from Run. Five minutes later they came back with the jug full and an unopened box of noodles. They went back to the kitchen and started cutting vegetables, singing, and preparing my food. Ten minutes later, my food was packed and ready to go. The food tasted like cheap Chinese here which is a mixture of Ramen noodles, desi food, and meat all mixed together (which isn’t that bad). Though I was pretty sure the water probably had cholera mixed in, I couldn’t complain about the freshness.

Quick comment, though I’ve been lamenting on the subpar quality of Bangladeshi food, there have been some bright spots. Once, I had this Tuna sabzi almost that was amazing. Another time, these cabbage pakore/tikki that actually looked more like Latkes.

Scene two – children’s ward in the hospital

To survive in developing and third world countries, many have to numb themselves to poverty and what surrounds it. In the case of the hospital, one does this frequently (this is more worldwide) as getting emotional can sometimes influence your decision making capacity and skill. Though I go between what is the right balance, I was put to the test while on the pediatrics ward at the hospital.

The situation in the peds ward is much the same as it is in the medicine ward. Approximately 20 beds in one big room, 30 beds in another bigger room, with each maxed out forcing 2 patients to a bed at times and many on the floor. It’s one thing to see sickness and poverty in adults, and another to see it in kids. The unsanitary ward, patients eating what looks like watered down kichari, babies crying, families talking. There is a constant hum and a specific smell of antiseptic, body odor, latrine, rice, and sickness all in one room.

Like I said before, they present very late in their sickness so usually they already have a diagnosis and the disease is known. The kid which made me break down was an approximately 10 year old kids with his eyes practically swollen shut and his stomach protruding about the size of a 36 week pregnancy. He was so full of fluid that he couldn’t get up on his own. Why did they not come earlier? Why was this not detected by the local level doctor? How did this kid live life for the past month? For simplicity sake, his kidneys had failed and therefore fluid was staying in side of him. He was now laying on the floor as all the beds were taken. I wanted to talk to his family but unfortunately, Hindi/English can’t get by with gaonwale.

The next day, I tried communicating with him the way all kids know how to – by making funny faces. At first, he was like who is this guy that is rounding with his team but is making a face at me. I tried again when my team moved to the next patient and this time he smiled and copied my face. This continued for some time and other nearby kids and mothers started smiling as well. I pulled out my camera (as it’s the only toy I keep on me) and he allowed me to take his picture. I attached it to this email.

Scene three – Medicine Department Grand Rounds

We’ve always heard that there is no such thing as a dumb question. I think we may have been wrong.

Following a lack of participation from residents and students, the frustrated medicine chairmen had this to say. “You must ask question, not foolish one, but intelligent ones”

Scene four – Kismat

I guess I’ve always believed in fate but sometimes things happen that strengthen your belief even more.

I was hanging out on the medicine wards one day and it happened to be the day medical students were being tested. I decided to watch one student stand by his patient and get grilled by the attending. He performed with a smile and did ok as I saw the professor write “80” on the score card (it ended up being the highest grade in his class. Unlike in the states, there is no desire to have a certain number of A’s or high marks). He came up to me afterwards and asked me in bengali how he did. I told him I don’t know Bengali, and he talked in English. Ends up being that he is a foreign student from Calcutta doing his medical school here in Bangladesh. We decided to meet later that day and I hung out with him and his future wife who is also in med school. We instantly clicked and learned a lot from each other. It always amazes me the perception people here have of Americans so they were happy to see me change what they think. It also happens to be that they want to go to America eventually to practice there. We ended up meeting several times the rest of the week and it felt like I had family there with me basically. They took me out to dinner my last night and then dropped me off at the train station the next day. He even wrote me a letter to read when I was on the train.

While on the train, I was worried about how I would get to my friends apt. He couldn’t pick me up at the station as he was too busy working on his thesis which he had to defend in two days and all other male family members were out of town. When I was about an hour away, the person sitting next to me told me that Dhaka wasn’t safe. We got to talking and it ends up being that I had met his brother that works as a doc at the same hospital I was visiting for 2 weeks. This fellow worked as a government employee, basically the IRS, and was visiting family in Dhaka. He told me to come with him and he’d take care of me getting back. A government car and driver were at the station to pick him up and after driving together to drop him off, he paid the driver to take me to where I had to go. God is great.

The hospitality and care I’ve been receiving here is more than I could’ve asked for. My roommate/servant also came to drop me off at the station and then has called me three times since yesterday to make sure I’m doing ok. I’m sure there are crooks and cons out there, but I thank God that so far, so good.

Today, we are all Palestinians...

Israel's offensive on Palestine has created more of a wasteland situation in a land already saturated with hopelessness. In one of the most densely populated areas in the world, Palestinians are now being bombed relentlessly and face a dire situation with scarce provisions, meager health care, and little to no security for civilians. Over 100 civilians have already been killed, including 87 children according to hospital authorities.

Even if Israel is our ally, what does this say about us if we do not condemn this sort of war? It is one thing to defend your country and selectively attack, but another to punish an entire state and deprive them of the necessities for life. Why were we selectively "all New Yorkers" on 9/11 or "all Georgians" as Senator McCain put it last year when they were attacked unethically? Why are we not all Palestinians?

Obama commented last year that if rockets were being fired at his home while his daughters were sleeping, he would do everything to stop that and would act in a similar manner to Israel. Why not ask if his daughters were one of the seven school children that died in the December 27th bombing outside of a United Nations school in Palestine? Are the values of justice, freedom, and pursuit of happiness entitled to a selective race or people?

Countries around the world are dealing with terrorism and the innocent deaths it causes. Other countries are dealing with state-sponsored militaries causing the deaths of innocent civilians. Though the means are different, the end is the same.

A human is a human is a human. We cannot be selective in our principles of humanity. Today, we are all Palestinians.