March 20 (Sunday)

The cool relief of the night masked the inevitable this morning—wow, it’s hot in Bangladesh! We’re talking 95+F with 100000% humidity. I’m pretty sure that the minute I left the A/C in our room, I started dripping. Luckily, our trip to ICDDR,B was via closed van, and the comforts of Toyota brought us to the main gate of the hospital before any of us melted down.

Photo: Carey Lee

ICDDR,B was established in 1960 by an international consortium as a cholera research center and clinical site. Most people may know it best by the fact that ORS (oral rehydration solution) for use in severe dehydration was invented here (thereby saving millions of lives around the world). Today, the spirit of innovation continues, as the center leads the charge on the advancement of low-cost medical solutions for the developing world.

We were greeted at the gate by Musaid Kamruzzaman, Office Manager and MBA extraordinaire. He was to be our point person for all communications and logistics during the trip. Musaid then ushered us into a conference room where we met the true stars of the show: Dr. Pietroni, Medical Director of ICDDR,B; Muhammad Ullah, Chief of Nursing and member of the Ethics Review Board; Dr. Sharif, co-Investigator of the Bubble CPAP Device; Lisa Chambers, Nursing Education Consultant; and Khuku Moni, Charge Nurse of the ICU. After a round of introductions, we were set loose on a barrage of action items for the week: Dedicated needs-finding time with various members of the medical staff, rounds in the ICU, meetings with the engineering and maintenance staff, a trip to a private medical market, a visit to a government hospital (ICDDR,B is a private hospital), and a trip to LAMB hospital, a mission hospital in the rural northwest of the country. Whew!

Our day then launched immediately into morning rounds, and I was struck immediately with how much of our initial empathy-building in the States had only scratched the surface of the seriousness of the problem—ten-month old children less than half their expected weight, suffering from profound dehydration, chronic malnutrition, and a horde of infections were being hooked up to the existing bubble CPAP device, a shampoo bottle and infusion set cobbled together and plugged into a central oxygen line. It was just heartbreaking watching the mothers, many of whom had traveled hours by foot and bus to get to the hospital, stand vigil over their tubed-up babies, refusing to move lest their children’s labored breathing come to a stop in their absence.

Photo: David Janka

In this regard, ICDDR,B has been truly a champion of their struggles—the hospital charges absolutely nothing for any of their services, and even brings meals to the companions of their little patients. Despite the not-for-profit status of the hospital, it is widely considered to provide one of the highest standards of care in Bangladesh.

Dr. Chisti showing a mom how to read her baby's chest X-ray
(Photo: David Janka)

We were also lucky to catch a glimpse of Dr. Chisti, Primary Investigator and all-around miracle-worker. The father figure to our bubble CPAP device, he had studied in Australia, where he had heard of the technique and decided that it would be of great use at his hospital. Despite his great intelligence and legendary clinical skills, Dr. Chisti was still a very young physician, and with his perfect hair, charming charisma, and movie-star smile, had all the nurses and his junior colleagues standing at attention the minute he appeared. Several passes through the charts and percussions of chests later, he vanished back out into the hospital, called away to consult on an emergency that only he could solve.

The day concluded with meetings with Rahmat Ullah, Head of the Biomedical Engineering unit and Mizanur Rahman, Senior Manager of Infrastructure Service. Rahmat Ullah revealed to us that all the equipment in the labs and clinical wards of ICDDR,B are serviced by a single six-man team, most of whom learn their skills just once when the company technician arrives to install the device! Clearly our product was going to need both simplicity and locally-available parts. Despite the shortage in manpower, however, the squad is extremely resourceful. We toured their workshops and found them fixing everything from uninterruptible power supplies (UPS) to ventilators! It is clear that we’re working here with people who themselves are committed to extreme affordability and noble aspirations.

Photo: Pamela Pavkov