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.

Arrival in Matlab

To continue where I left off, when I woke up this morning I was feeling well enough to travel to Matlab. Matlab is an area in Bangladesh a couple hours from Dhaka in the Chittigong region. The ICDDR,B who we have been working with runs a hospital in Matlab, and conducts a great deal of research in the surrounding towns. We left at about 6:30am to try and avoid traffic as much as we could. There was still quite a bit, and an area of the city we had to get through that was filled with giant buses which was kind of frightening with our car dwarfed by them, but our driver was excellent and managed to get us through.

Much of the drive on the highway was pretty uneventful. The road we used for the first half of the trip was crowded, but it was well maintained. There were a couple large bridges to drive over that offered great views of the rivers we were crossing. After crossing a couple of these, it was time to turn off of the highway onto back country roads. There used to be a better road to Matlab however it was destroyed by the Monsoons over the past few years to a point where it is no longer viable. The route instead was drivable, but the roads were very small. There was hardly enough room for our car to fit, and the road snaked along a slight drop of a couple meters into water, which we did not want to fall into. There were several times when it did not seem like we were going to fit, but our driver continued to be great and was able to navigate the roads well, even though he had not driven them in the past.

The drive was different in that we were able to take in some of the sights. We were driving through rural areas and saw large farms, and many people living a different kind of lifestyle than the city. The further we went the more blue we were also able to see in the sky. We cannot see much, but when in Dhaka it is always a perpetual grey due to large amounts of pollution in the atmosphere. Any sky that was able to peak through that was certainly an improvement.

After snaking through these tiny roads for about an hour, we eventually got to a river we needed to cross on a ferry. We waited about 20 minutes for the ferry to arrive, which we were able to drive onto in order to cross. After it brought us across the river, we were finally in Matlab. It was about another 10 minute drive before we arrived at the ICDDR,B campus.

The facility they have here is pretty incredible. We are staying in their guest house which is often used by international research teams. Maia and Kate are splitting a room while I have my own room. They are air-conditioned, and the beds are quite comfortable. It is almost like staying in a hotel. The food is standard Bangladeshi (rice, veggies, assorted meat) but it is delicious here and there is plenty of it. The only drawback is that the rooms don’t have internet. Instead we have to use public computers which will fast, are just a little inconvenient.

After arriving, Maia and Kate took a walk around the campus while I took a quick nap. Then after lunch we went to go and meet with one of the doctors who works at the ICDDR,B. He introduced us to the director of Demographic and Health data here. They were both interested in our project, and offered to help us over the next couple days while we are here. After meeting with both of them, we went with the Demographic data director upstairs to his office where he described to us the program they have here. It is really quite incredible. For the population of around 100,000 within the reach of the ICDDR,B in Matlab, they have up to date health and census data uninterrupted dating back to the 70s. To demonstrate this, he showed us a number of census books over the span of about 30 years and we were able to track one person all the way through. His department has around 40 health workers that collect health and demographic data from every single household in Matlab every 2 months without fail. There are a number of other researchers who are also doing work on side projects across these populations. The health workers collect all of their data on PDAs so the ICDDR,B understands that mobile technology has a ton of potential for this kind of work. They also have extensive GIS mapping of all of Matlab which will be incredibly useful to the first phase of our project- where we hope to use already existing data to create some sort of visualization about the spread of cholera.

After finishing that meeting, we were given tours of the maternity wards of the hospital, as well as the diarrheal disease wards. They use completely up to date procedures, and can perform pretty advanced operations here. The hospital is quite large, clean, and beautiful, and seems to run with great efficiency. They have offered to give us all of the clinical and demographic data that they have, which we can use along with the GIS data to create our visualization. We are quite excited to get to work on it now that all the data is almost in our hands.

We’re not sure how long we are going to remain in Matlab. Tomorrow we are going on more tours of the facility to places like the labs, and they are also going to give us a tour of the research sites in the field so we can get a better idea of where the data is coming from. Matlab has been great to us so far, and I am looking forward to what we will do next.

Also, on a related note, currently the project that I’m working on here is in a competition on a website to raise at least $4,000 from at least 50 different donors in one month. We are well on our way towards reaching that goal, but we need all the help we can get! If you think you can spare even $10-15, it could go a long way towards helping with our project! Just go to: http://www.globalgiving.org/projects/mapping-cholera-in-bangladesh/

The Past Few Days

Sorry that I have not updated for a few days. Not a lot happened so I did not take the time to write a post.  Right now I am at the ICDDR,B guest house which I will get to in my next blog post (which will probably even be posted later today).

A few days ago we took a trip to the Dutch embassy. It was in a part of the city called Gulshom which took a little bit of time to get to with all of the traffic but it was not too bad. It was a nice part of the city, and many of the foreign embassies are located in that area. We passed a few from other countries when we passed through. The Dutch embassy was a nice building. There was a pretty garden in a courtyard near the entrance once you entered through the gates. We met with the Director of the Dutch Development program in Bangladesh who worked at the embassy. He told us about some of the work the embassy was doing with BRAC as well of many of the clothing factories in Dhaka. He seemed interested in our project and while he could not offer any resources to us directly, he was able to connect us with some of his contacts in the field of development who we are currently following up on. Before leaving he introduced us to the Dutch ambassador who we said hello to before heading home.

The next day we went and did some shopping. The store we went to was busy, but had almost every type of Bangladesh crafted item you could think of. There were decorative pieces like paintings and carvings, but there was also a lot of clothing and household objects ranging from kitchen dishes and silverware to candle holders. I picked up a few things to being home that cost only about $8 USD. There was no haggling involved, but it was still probably the best prices I have found in really any country I’ve traveled to in the past couple years.

Aside from shopping we did not do a whole lot over the past few days. At times it actually got a little boring. I was more than able to entertain myself. I have plenty of TV to watch and I’ve finished 8 or 9 books already, but aside from the one thing we did during the day, the rest of the days have been pretty uneventful so I had been getting a little stir crazy. Yesterday was a little more interesting however. We did not do anything in the morning, but in the afternoon we decided to go to the movies. There is a huge 8 story mall not too far away from the apartment we are staying at. On the top floor is a cinema that is currently playing Hunger Games, Mirror Mirror, and Planet of the Apes. We decided to go and see the Hunger Games, which Maia and Kate quickly read through beforehand. We were going to go with Maia’s cousins who were interested in seeing it, and it was shaping up to be a great evening, until I got sick…

As we arrived at the mall, I started feeling my digestive track acting up. I knew that I needed to get to a bathroom so I tried rushing the group through the mall as quickly as possible. I began to feel quite a bit of pain in my abdomen, and also began feeling queasy. I rushed into the movie theater and ran straight to the bathroom where I remained for the next 40 minutes. I did not throw up, but suffice to say, quite a bit came out the other end. Fortunately, the bathroom was pretty nice.

I eventually made my way into the theatre about 20-30 minutes late. I had already seen it so I did not mind too much. The movie was good for the second time and the theatre was quite nice. The seats were very comfortable, though it is culturally acceptable for people to talk and have conversations through the film here which was distracting at first, but after getting used to it fine.

After the movie we headed back to the apartment. I was still feeling a little sick so when we got back I had a few slices of toast for dinner, and drank some oral rehydration solution, the same solution which the ICDDR,B is credited with creating. It tasted like saltwater and was frankly a little disgusting, however, whatever it took to get me back to 100%. There was some question about whether I’d be well enough to come to Matlab today, but as I mentioned before, I was obviously well enough to make the trip.

I will try to write about that and more later this evening to be published soon.