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Shingara, Betel Nut, Diptheria and a Whole Lotta Love

Shingara, Betel Nut, Diptheria and a Whole Lotta Love

28 Jan 2018

It is hard to believe that I arrived in Bangladesh almost 2 weeks ago. I’m back in that crazy time warp where it feels like I have been here for months and like I just arrived. It’s hard to explain the phenomenon unless you have experienced it yourself. I am already mourning my departure, as I know it will come all too soon. My days here are long but it is a good kind of long. I am reminded almost immediately how much I love this type of work.

I wake around 6 am to prepare for the day, load into a van around 7:30 and head out to Kutupalong camp (6 days a week). It takes 1hr plus to drive to our drop off point and another 30-45min to walk in to our clinic. The walks in and out of the camp are actually one of my favorite times of the day. Another colleague described the walks as an exhale. I would have to agree. The camp is constantly in motion, an anthill of activity where everyone has a job to do. Yesterday as we walked out of the camp for the evening we were constantly having to give way to children and adults hauling 20-30 foot long bundles of bamboo. The kids that were too small to carry the bamboo instead opted to drag it through the dirt, leaving snake like patterns in their wake. If you looked away or got distracted for five seconds it could mean getting impaled by a shoot of oncoming bamboo.

Kutupalong Refugee Camp-for as far as the eye can see.....

They Things They Carry.

Every day a new market, enterprise or home has sprung up; a new ditch dug, a road improved. I have been told that the winds are coming early and this means an early rain. The awareness of which sits like the smog of the Los Angeles basin, trapped by the heat and with no winds to move it. Unfortunately, the reality will be a perfect storm of disaster and disease. It will be an absolute nightmare with homes and latrines slip-sliding down cliffs and hillsides. Homes and bridges will be buried and swept away with sewage and garbage-filled water. I honestly don’t even want to think about it. It is almost too much to bear. I cannot imagine this being my reality. It is no wonder that people are using every possible minute of the day to prepare as best as they can for the oncoming storm.

'local business'

Stagnant water during the dry season--a taste of what is to come with the rains

This beautiful new road sprang up overnight!

As we enter the camp, the children greet us and wave. As we walk out they say ‘bye bye’, ‘ta ta’ and ‘thank you’ with different cheering sections for each. The ‘bye bye’ kids are the first to greet us as we depart the clinic. They are followed by the ‘ta ta’s and then the ‘thank you’ kids come near the end. We pass barber shops, pirata and shingara vendors (delicious, fried, samosa-like dough snacks), tea stands that sell pineapple cream cookies, hands down the best cookies in the camp, fish vendors selling baskets of both dried and fresh fish, abnormally large cucumbers and squashes, curry-color dusted peanuts and of course the local favorite, the betel nut leaf. The betel is a central nervous system stimulant and is chewed until your teeth become rust-red and then begin to fall out. It is not uncommon to hear people expectorating huge betel nut loogies. I have almost been bathed in the acidic juices on several occasions. Walking through the camp, one has to laugh at all of the saliva 'nut' trails, which cover the path.

Betel Nut preparation.

In order to arrive at the clinic we have to traverse up and down several sets of mud-carved steps and have to cross several bamboo bridges, all of which will be impassible once the rains arrive. The primary health care center is small, however rapid expansion efforts are underway. Currently we are treating minor burns and wounds, upper and lower respiratory tract infections, diarrheal diseases, malaria, diphtheria, measles and mumps. Diphtheria cases, severely ill patients, severely malnourished kids, mental health and patients requiring surgery or obstetrical interventions are all referred to other local actors. We probably transport 3-15 patients to nearby hospitals or specialized clinics daily. The acutely ill are carried in either on chairs and or in blankets tied to two bamboo poles. It is truly incredible to behold. The other day we had a patient with late stage leprosy, which proved to be a good teaching opportunity for the local, Bengali nurses. Diphtheria is fortunately decreasing, however we continue to see many mumps patients, both diseases I had never before seen. We probably see 200-260 patients a day at our primary health care clinic and satellite clinics combined.

I have the privilege of working with six Bengali nurses who are truly running the show. They are amazing and it will be up to them and the national Bangla physicians to run the clinic once everything is handed over. I’m trying to support them as best as I can, looking for any available opportunity to teach and to mentor. In the upcoming months, we hope to hire 30-40 more national nurses who will then staff our new primary health care centers along with the Bangla physicians. While each new day brings its own challenges and gifts, I have begun to find my routine. It is a routine that is both simple and complex, devoid of the distractions and often misguided priorities of life back home. You almost have to ask yourself which is real life….my life back home or the life here? A colleague of mine recently commented upon returning home, 'well, it's back to reality'. For myself however, I find that I need to ask, 'what really is reality'? Is it being able to eat a fresh salad and choose between 200 micro brew options, or is it the here and now? For the Rohingya, the daily reality of life is a reality that few back home can comprehend nor will ever experience. So then, how do we allow ourselves to become immersed in another's reality, a reality that sits in stark contrast to our own? For many, the answer is to ignore these parallel realities because for one, it is much easier and let's be honest, we are inundated daily with news that goes from bad to worse. It's the boy who cried wolf playing out in the form of school shootings, racial violence, terrorist attacks, earthquakes, landslides and flooding. Soon, one tragedy blends into another. We become blind and dare I say apathetic. But this is how we cope, because what is the alternative? How do we hold the tension of the weight of the world and not become so weighted down ourselves that we are unable to move; paralyzed by sadness and overwhelmed by the magnitude of an incredibly broken world? As hard as it is, I challenge us to not grow apathetic. Start by choosing one topic that gets your heart pumping and place your efforts and your voice here. Learn all that you can about this topic, engage your community, call your legislators, speak out and while you do this, don't forget to seek out the stories of hope, joy and restoration, which can be found embedded within the layers of injustice and pain. Without this reminder of goodness, the weight will become too much. And in everything, always remember to love. 

Bangladesh and the Rohingya