New posts over at the globemed blog

We have a couple new posts up over on the globemed blog, one of which I've written so please go and check it out. I will try to get a new post here within the next few days.

http://tuftsgrow.blogspot.com/

What I’ve been Reading

There are not a whole lot of updates since my last post. Its been a pretty quiet week at the hospital. I've just been sitting in the office every day chugging along, getting work done.

I thought, to at least give some update, I’d talk about the books I’ve been reading since I left the US. I’ve actually just finished the 26th last night. I’ve read a lot of really great books and some that were okay. I will briefly mention a few that stood out and give a list of each of the books at the end.

I’ve been doing all of my reading on my nook eReader. It was a great investment, and has allowed me to vary around so many more books than if I was still using paper books. For only a hundred dollars (probably less as there are newer versions out) I’d definitely recommend it for anyone who reads a lot. The other tool I’ve been using is the Calibre ebook library tool. Its free to download and it makes organizing your books and converting them to different formats extremely easy. I organize and rate my finished books on GoodReads.com which is how I know how many I’ve finished.

The first book I finished since getting here was called Jonathan Strange and Mr. Norrell by British author Susanna Clark. It’s a long book but was a fun historical fantasy epic that’s written as if it were written in the time period it took place in, which was the 18^th century.

I read John Scalzi’s Old Man’s War series which is a good intersteller war scifi saga. They are pretty fast reads and I’d recommend them to any scifi fan.

I read Brandon Sanderson’s Allow of Law book. Sanderson has recently probably become my favorite fantasy writer. I’ve not read all of his books yet, but I’ve loved all of them that I have read so far. Allow of Law takes place in the Mistborn universe which is an incredible trilogy I’d highly recommend. His books average at least 700 pages though so prepare to be with them for a while.

I also stared rereading the Wheel of Time books. I first read them years ago. There were 11 book, each 800 pages with the 12th final one on the way until Robert Jordan, the author, died before finishing them. Fortunately, he had left a lot of notes for people to follow and the aforementioned Sanderson is working on finishing them up. He split the 12th book into 3 books. The first two of which are out. The third and final book in the epic series is coming out this winter, so I wanted to reread some of the old ones in preparation for the final one.

I read Good Omens by Neil Gaimon and Terry Pratchett. It was a fun read and offered some nice commentary on good and evil and the human condition.

The best book I’ve read so far has to be Red Shirts by John Scalzi (who I mentioned above). It is his newest scifi book about the idea of the redshirt characters in science fiction (the characters that don’t really have names who just get killed off for dramatic tension) realizing that there is something going on with their mortality rates. It is well written and hilarious. If anyone has watched star trek, you should read the book right away.

I read The Last Wish and Bloods of the Elves which are the first two books and the only ones translated into English so far of the Witcher Series. They were written by a polish author and are really great, and pretty fast fantasy reads. There is now a video game series based on them.

Recently I finished up Pox: An American History which is all about small pox epidemics in the US during the progressive era. It offers a great deal of social commentary, and shows just how much power the government has when it comes to dealing with disease.

I’d be remiss if I didn’t mention that I’ve also read 3 or 4 Vonnegut Books since coming here. I finished Hocus Pocus last night, and with that, I’ve actually read every one of Kurt Vonnegut’s novels. I might blog about them some other time. While they were not all as good as Slaughterhouse-Five, they were fun and fast satires.

Well, those are the highlights. Below is a full list of the books I’ve read so far, as well as the ones that are next on my list. (I’m not going to hyperlink to all of them as that would take too long with the slow internet.) If you’d like any of the books, let me know and I can email them to you in any eBook format.

Books I’ve Read

Jonathan Strange & Mr. Norrell by Susana Clark
Situations Matter by Sam Sommers
Old Man’s War by John Scalzi
The Ghost Brigades by John Scalzi
God Bless You, Mr. Rosewater by Kurt Vonnegut
The Last Colony by John Scalzi
Jailbird by Kurt Vonnegut
The Alloy of Law by Brandon Sanderson
The Marriage Plot by Jeffrey Eugenides
The Eye of the World by Robert Jordan
The Great Hunt by Robert Jordan
The Dragon Reborn by Robert Jordan
Infections and Inequalities by Paul Farmer
The Shadow Rising by Robert Jordan
Good Omens by Terry Pratchett & Neil Gaiman
The Bhagavad Gita
Hero’s Trial (Star Wars) by James Luceno
Jedi Eclipse (Star Wars) by James Luceno
Redshirts by John Scalzi
Balance Point (Star Wars) by Kathy Tyers
Deadeye Dick by Kurt Vonnegut
The Last Wish by Andrzej Sapkowski
Blood of the Elves by Andrzej Sapkowski
The Checklist Manifeso by Atul Gawande
Pox: An American History by Michael Willrich
Hocus Pocus by Kurt Vonnegut

Book I’m Currently Reading

Cloud Atlas by David Mitchell

Books I’m Reading Next

House on Fire by William Foege about Smallpox eradication
The Lies of Locke Lamora by Scott Lynch, a highly rated fantasy book
Ready Player One by Ernest Cline, a scifi book
Elantris by Brandon Sanderson
1Q84 by Haruki Murakami

A crazy couple weeks

Firstly Happy 4th of July!

I’m sorry that it has taken me so long to submit any updates. It’s been very busy here and I was sick for a little while. A little over the week ago I had some bad stomach and digestive problems. I had diarrhea for a few days straight, and I also vomited a bit. The doctors here eventually hooked me up to an IV so I could take in fluids as I could not keep anything down and things were passing through too quickly. The doctors were great, and the ones from the US that were here took care of me. They checked on me frequently throughout the day, and made sure I had a steady stream of fluids coming in. I ended up losing about 10 pounds in 3 days, which brings my total weight loss since Bangladesh up to 20 pounds. It is not the healthiest, but I’m eating fine now and hopefully it will start building back soon.

After I was sick, because of all the weight loss and the inability to eat, I was weak for a lot of the last week. I could not walk around too much without getting dizzy, and I was having difficulty eating all that much. As a result I was not able to help out a whole lot with the mad rush to get all the construction finished before the VIPs arrived. I was feeling better by the end of the week, just in times for the guests to arrive.

The VIP’s arrived on Friday, in time for the hospital’s third year anniversary celebration. There were a few of the upper level Nyaya staff here from the US. Then there were a couple major donors, and Paul Farmer was here with his team. For those of you who don’t know Paul Farmer founded Partners in Health, one of the largest global health organizations out there. He is also a professor at Harvard and has a posting at the Brigham. I’ve read both books about him in classes I’ve taken, as well as books written by him in classes I’ve taken and for fun.

At the ceremony a number of people got up to spoke about the work the hospital has been doing. A number of politicians also got up to speak, and they spoke for quite some time. That night there was a banquet at the hospital with outside food brought in so things tasted different which was nice.

The next day, first thing in the morning a couple of the hospital staff actually got married and invited all of us to their wedding. We drove for about 45 minutes to get to a Hindu temple where the ceremony took place. I really had no idea what was going on most of the time but it seemed like a nice ceremony. After that, we went with Paul out to a community where we met with some community health workers. It was my first time actually making it to a community as I was sick the past two weekends, so It was nice to get out into there for a change.  That night there was a wedding celebration where there was another big feast, and a lot of dancing. I did not dance at all but I did eat quite a bit. The food was great. I got a stomach ache again, but this time it was from eating too much, rather than eating too little or eating something that was no good.

The next day we took a trip to the district capital at a town called Mungleson. It was about an hour and a half drive but it was not a bad trip in the jeeps we took. When we were there we had a number of discussions about how Nyaya can further connect with the public sector here in Nepal. We also had a meeting with the district health officer at his office. He is in charge of all health initiatives in Achham. He gave us a tour of the district hospital which was unfortunately in a sad state and was pretty run down.

Monday was the group’s last full day at the hospital and we stated on campus and got work done for most of the day. The last of the VIPs left yesterday and it has been business as usual since, albeit a little quiet as few people that have been working here returned to KTM.

To summarize, it was an incredible time having them here. It was nice to have a new group of people to talk to, and getting to work with Dr. Farmer was just incredible. It’s one thing to read a book about someone or to read one of their books. It’s another thing entirely to learn from them and their experience. Everything became a teaching moment, whether it be about how to deal with a patient’s clinical manifestation, to discussing the systemic issues that negatively impact the health of a population. I learned as much or more in the last weekend about global health than I have from entire classes that I’ve taken.

As of right now, I’m feeling healthy, and the work is going well. I’m going to be here in Achham for another 4 weeks, and I’m looking forward to what happens next.

Some clouds just about at the height of our living quarters

The VIPs sitting at the celebration

Another picture of the celebration

A few from the drive to the temple for the wedding

A picture of me at the wedding. I have some Tika on my face

A picture of a lot of bugs that have been all over the place by the thousands the past couple nights

Working in Achham

Today is my fifth full day working in Achham. There are a lot of things I could take about, but not really great stories from over the past few days. I thought I would take a few minutes to just mention some of what it is like here.

Sleeping: I’m currently staying by myself in a room in one of the hospital’s staff quarters. It is not a big room but it is more than enough space as it is not furnished with the exception of a bed. The bed itself is a wooden board, but I have put a few layers of blankets on top of it to make it more comfortable to sleep on. I’m used to it by now.

Food: I eat three meals a day at the kitchen. The food is normally rice, and some sort of vegetable, normally potatoes, so it is not the most nutritious. It is also quite salty. Breakfast is normally has some kind of bread instead of rice. There is also always this thing called Dall to eat which is like a beef broth that is alright. Breakfast the past two days however has been pretty good as yesterday was kind of like a pancake, and today was homemade rice crispies. Both were good. I have not been eating a whole lot, but I am starting to get used to it.

Average day: Wake up whenever the sun wakes me in the morning, go to the community health and data office around 9 am to start working. Take a lunch break at 12:30, then work again till 6:30. Read for a couple hours, then eat dinner and go to bed.

The Work: Most of the work I have been doing so far has been working on some documents for the community health program. The phones are arriving in a couple days, so I will be able to get to work on that data project soon.

Electricity/ Internet: Very unreliable. There is not often electricity as the hospital’s solar panels have broken down and we are waiting for a replacement part for it to work again. Until then, the hospital has been using a generator but only when a patient needs it for treatment or when construction is going on as they are doing a lot of work here. I only have internet when the power is on, so it is not very often.

Water/ Sanitation: The toilet consists of a squatter toilet which I am still getting used to using. There is only water sometimes as it often gets disconnected somewhere away from the hospital, and when it turns back on, it is used for the hospital before it can get to the staff. I’m getting enough water to drink, but there is often not enough to fill up my water bottles (though it is getting better)

Weather: Very hot, and very dry. It has not rained once, and it is scorching in the afternoon.

My Health: Okay. I’ve had a lot of stomach and digestive troubles since getting here, but that is to be expected. Hopefully it will improve soon, and I’m not worried because I am at a hospital if anything happens

From Dhaka to Achham

I’ve finally arrived in Achham after quite a bit of traveling.

The last couple days in Dhaka went by rather quickly. We had a couple more meetings at the ICDDR,B before I left that went well enough. The last couple nights, Maia’s family made a big feast to see me off. The food was delicious. Then, Monday morning, I woke up early to go to the airport and get on my way.

To get to KTM, I flew Biman, which is the national airline of Bangladesh. It was about a 100-150 person Jet, though maybe ¼ of the seats were full. The flight was fine, but the plane was not very clean, and there was gum caked in the pouch in front of my seat. It did not matter too much though because the plane left relatively on time (about 20 minutes late) and landed in KTM after about an hour flight.

In the airport I met up with Laura who is also from Tufts Globemed interning at Nyaya this summer. We then met our driver who took us the rest of the way to the hotel. Kathmandu (KTM) in definitely a different city than Bangladesh. The buildings are not as tall, and they are much more sporadically spaced, but they give the city a certain character. Driving was mostly the same- a total free for all, and it was almost as hot as Dhaka though it had a slight breeze. The hotel we were staying at was called Hotel Ambassador, and was a affordable, yet comfortable place near some of the touristy parts of the city.

After setting our things down at the hotel, Laura and I went out and explored some of the city by foot. We went to this place called Thamel which is a major tourist location. It was filled with all different sorts of souvenir stores, alternating with hiking and climbing stores. Thamel is a major location for people to go to before they begin Treks or climbs in Nepal, and the shops were filled with hiking boots and northface jackets. We ate lunch at a restaurant called New Orleans, which had a very ex-pat vibe, and spent most of the day exploring.

The streets of Thamel

In the evening, back at the hotel, we met up with Nyaya’s KTM administrator Pradip. He brought us some Nepali Rupees that we could use as spending money, and we chatted while taking tea for a couple hours on topics ranging from Nepali culture to the US presidential election. He then brought us on a quick tour of the city showing us a few of the temples. It was dark out though, so we would definitely like to check them out again at the end of the trip.

The next day we woke up early to meet Pradip once more so he could drop off a box of insulin for us to take to the hospital with us. We ate a large breakfast at the hotel before heading to the airport to leave for the far western district of the country. The domestic airport was pretty small so we were able to get through it without difficulty. We were flying Yeti Air, one of two local airlines that send flights out to Dhangadi which is the closest airport to Achham.  The plane was a small one with only 30 seats, and propellers. The first plane we boarded had technical difficulties so we had to switch, but it only took them a few minutes to move our luggage over and we were on our way.

The plane ride was a little bumpy owing to the fact that the plane was just so small. There were some refreshments on the flight- soda, water, peanuts, etc… that were distributed by the one flight attendant. Soon after getting to the top of the cloud level, we looked out our window and saw to the north, the tips of mountains passing through the clouds. There are some pictures below but they do not capture just how incredible it was to see something so large and tall. After about an hour we landed in Dhangadi.

Dhangadi was probably the smallest airport I have ever passed through. It has a paved runway which was nice, but aside from that there was one small terminal, but we did not exit through it. We walked off the plane and through a gate to the front of the building where our luggage was dropped off on a hand cart. After waiting for a few minutes, the jeep arrived and we started our long drive.

Mountains above the clouds

We drove out to Achham with Ranju, who used to run the community health worker program for Nyaya. She went to Mount Holyoke for her undergrad, before coming back to Nepal where she grew up. She was great company on the trip that ended up lasting about 9 hours of straight driving.

The road started out pretty smooth, but before long we were driving up a twisting mountain road filled with sharp turns and steep slopes. Fortunately, most of the road was paved so while it was a bumpy ride, it could have been much worse. We left at about 3:30 and we did not arrive at the hospital until around 12:30 at night. Our driver was great, and managed to get us there in better time than most trips (Sindya, a Tufts med student who we are also here with came about a week ago and her drive took roughly 13 hours). We pulled into the hospital and were greeted by some of the other staff and interns here before being led to our rooms. My bed was essentially a slap of wood with a sheet on top that I will have to get used to, but I was so tired from the trip that I fell right to sleep.

A typical view out of the jeep window

Today was the first day at the hospital, but this post is already too long so I will try and get some of the details of what it is like here posted tomorrow.

Also, be sure to check out the Globemed blog that I will also be writing while here. Some of the material will be the same, but there will be a couple other people writing there, and some different posts about our work and the work of Nyaya. There is also a page where you can submit questions, and we will try to answer them when we have internet.

Sightseeing

Yesterday we had a fun day full of sightseeing.

We woke up early to leave with the family we are staying with to meet up with another of Maia’s aunt and uncles and cousins. Both families rented a big van that we were all able to fit in as with all of her cousins, there were quite a few of us. The first place we went to was the Martyr’s Memorial. It was a large concrete structure that was built to commemorate the lives of the people who died in the Bangladeshi Liberation War. For those of you who have not touched up on your Bangladesh history recently, when the British pulled out of the subcontinent, their territory was divided into the predominantly Hindu India, and the predominantly Muslim Pakistan on either side of India. Tensions between East Pakistan which is still Pakistan today, and West Pakistan which is now Bangladesh eventually grew to a point where war was declared. West Pakistan was able to win it’s independence becoming the new nation of Bangladesh in 1971. The monument we went to was to commemorate the lives of people who were lost in the war. It actually reminded me much of the Washington Monument. While it had a very different shape, it had the same color, and overlooked a reflecting pool like the mall. There were also a number of graves for unknown soldiers who died during the war.

After the monument we went to the Lalbach fort. The fort which is now a museum was constructed in 1678. It was never finished however and was not able to get to full use. Within the fort there was a palace, a mosque, and the tomb of Bibi Pari which was the most well preserved structure. It was pretty neat and not too crowded. The palace building had a small museum inside with a number of displays ranging from knives and pistols used by the Mughals to sets of Mughal armor. I had never been to any Mughal structure before the fort, so it was totally new for me. After the foot we went out and took a quick Rickshaw ride through the nearby streets. I took the ride with one of Maia’s uncles who pointed out the various things that were going on in the street around where we drove.

After the fort we returned to the apartment to relax for a couple hours before setting out again. Our next stop was at a restaurant called Boomer’s Café where we went for lunch. Boomers was a Chinese Indian fusion restaurant with a western music theme. It was on the upper floor of a nearby mall and looked like it could have fit in any American mall. There were posters of U2, the Beatles, Pearl Jam, and a number of other artists all over the walls. There was also a life sized Mick Jagger painted onto one wall. It was an interesting place and the food was pretty good.

After lunch we went to a palace called the Ahsan Manzil built in the 1860s. It is now the Bangladesh national museum. It actually might have been one of the more uncomfortable parts of the trip. It was extremely crowded and a number of children kept begging for donations from our group. We tried waving them off which always feels horrible in settings like this. While we might have some money to give, there are so many people who need the aid, and you just can’t give to everyone who walks up to you.  One of the guards at the museum saw the children and yelled in order to shoo them away as they were not supposed to be inside without having bought a ticket. It created a bit of a ruckus, and a lot of people pulled out their mobile phones and started filming us. There really was not a whole lot to see, but we stood out quite a bit, so we had everyone’s attention. People eventually moved on, but we left before too long just because it was so crowded, and we were afraid we might lose a couple of the young children that were in our party.

After the Ahsan Manzil we took a scenic tour around the city. We passed the parliament building and the president’s house. We also drove past this sculpture garden that was in the middle of the road. There were sculptures of famous Bangladeshi’s as well as just famous politicians and thinkers in general. It was pretty easy to spot the Ghaddafi, and the Stalin. Seemingly out of place, there was even a sculpture of Isaac Newton. After driving around for a bit, we headed back to the apartment for the evening.

Overall, it was a fun day, and definitely better than sitting around the house.

Back to Dhaka

After a long day, we are finally back in Dhaka after a great trip to Matlab.

Yesterday, we had originally planned on going into the field, but due to logistical reasons, we were unable to. We woke up in time for breakfast which was as delicious as the other food we had at the ICDDR,B guest house, and spent most of the morning doing some work. Maia did an excellent job of restructuring our website which you should definitely check out. In the afternoon we got in touch with Dr. Fazul (the doctor who showed us around the day before) and he gave us a tour of their lab and their computer room. The lab was not very large, but it seemed to be very well stocked to run all different kinds of tests to identify different pathogens. There was not a whole lot to see in the computer room itself, but we learned how all of the ICDDR,B’s data is collected through one integrated database. We also saw some information on the PDAs that all of the ICDDR,B’s community health workers use to collect their data to great success. After the tour, we headed back to the guest house to do work for the rest of the day. The only other interesting thing that happened was we met the ICDDR,B’s gender equality officer. She was staying at the guest house also and joined us for some of our meals. She wrote a lot of the non-discrimination and sexual assault policy that the ICDDR,B uses and was in Matlab to give a gender training about a wide number of issues such as workplace discrimination issues and differences between femininities and masculinities. She was an interesting person, and we were able to see her at a couple times.

Today we started off the day with a couple field visits. The first field site was a village that is within the ICDDR,B’s surveillance perimeter. Dr. Ali who we talked with about the demographic and health department was our guide. To get to the site we needed to hop onto a motor boat for about a 15 minute ride. It rained a lot last night, so it was pretty cool out, and seeing Bangladesh by water was very interesting. A lot of people were swimming or fishing in the water, and there were several boats irrigating nearby rice paddies. Before long we arrived at the Barri we were touring. Barris are essentially small clusters of houses that make up larger towns. We met one of the ICDDR,B’s community health workers and were able to observe her collecting data from a couple different families. Seeing the use of a PDA in action was encouraging as it shows the potential for different technological interventions in this field. For the second site we were visiting we had to return back by boat to the ICDDR,B campus and switch over to a van to drive there. For the second part, one of the ICDDR,B’s field research officers was our guide. Her job outside of showing people around was to ensure the quality of the services provided by the institute’s workers in the field. She took us to a clinic that was set up to provide contraceptives to women as well as consultations to women who were pregnant or who had recently given birth. They could choose form a wide range of contraceptives to use, and if they needed it they could be referred to the hospital for the treatment of any complications. From the field clinic we drove to one of the ICDDR,B’s subcenters where they provide services for pregnant women. They could go for checkups, and there was a delivery room as sonogram for pregnant women. Overall, it was quite an impressive system they had set up that seemed to work quite well.

After the field visits we said farewell to the Drs who had been helping us, ate lunch, and began the drive back to Dhaka. The return trip was much more arduous than the trip down there due to rush hour afternoon traffic. We left around 1:30 and did not arrive back to Dhaka until after 6. I managed to finish an entire book during the drive though that had a small surprise in it. It was the book Jailbird by Kurt Vonnegut. In one of the chapters I came across the following quote: “They knew about it about as much as a cholera epidemic in Bangladesh”. I thought it was quite ironic to come across that line while doing research into cholera epidemics while in Bangladesh. When the book was published in 1979 not a whole lot of people cared about cholera outbreaks here internationally which is what inspired the quote. Things have changed now. Many people are doing work with Cholera, but it is still out there causing a great deal of hardship. It is still a major problem, one that we are trying to face.


If you want to see any photos check out the slide show at our website: www.villagezeroproject.org. We have gotten a few up there and there are more on the way.