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.