March 21 (Monday)

Our work today was split into two teams, as Chris, wanting to see the poorer action area of rural Bangladesh, chose to take the bumpy four-hour ride down to ICDDR,B’s surveillance site in Matlab instead of spending another day in Dhaka. The rest of the squad began rounds in the morning with the amazing Drs. Chisti and Sharif. If yesterday was an awakening for us in the clinical severity of what we’d seen, however, today did not soften the blow. One of the babies with severe anemia and respiratory distress the day before was no longer there that morning. In his place was a new child, nearly comatose, with a triple malady of diarrhea, pneumonia, and neurological symptoms. Dr. Sharif gravely noted a differential diagnosis of tubercular meningitis and pulmonary TB. The little patient’s mother, an emaciated whisper of a woman, gravely looked on.

As for the children on bubble CPAP, we shadowed Ranjit, the respiratory technician, as he explained the device with Pam’s expert translation.

Photo: David Janka

First, the device is constructed by taking a standard pediatric nasal cannula with nasal prongs:

Photo: David Janka

Next, an infusion set is cut at the elastic.  

Photo: Pamela Pavkov

One end of the infusion set is attached to the cannula, the other goes to a shampoo bottle, which is filled with water.

The nasal cannula is plugged into central oxygen or an oxygen tank, and the bottle functions as a back-pressure regulator, whose pressure can be adjusted by varying the depth of water in the bottle. It’s quite an elegant device, considering it only costs a few hundred Bangladeshi Taka to make (less than $5 US) and saves babies’ lives.

It was wonderful seeing Ranjit educate the mothers of patients on how to help their children breathe easier, a measure that not only contributed to the care of the child, but made the moms feel less helpless and more empowered on doing something for their kids.

Our remaining time at ICDDR,B was then spent on an extensive hospital tour given by Mohammed Ullah. Our first stop was the outpatient ward, where children not in acute distress could be brought for supervised care. Mothers there watched with rapt attention there at a flash of yellow, a Shasto Shebeika (health worker, literally translated health woman) as she excitedly educated them on both the warning signs of severe illness as well as introductory nutrition.

There are few things in the world more exciting than health education.
I'm serious. (Photo: Pamela Pavkov)

Pam, after several minutes of writing down the ingredients suddenly exclaimed, “She’s making kichuri!”

“I hated kichuri when I was growing up, but my parents made me eat it all the time!”

We then passed through the emergency room, the short stay ward, and finally, the place of Muhammad Ullah’s “magic bullet”, the Nutrition Center. There, Pam was again amazed that the solution to childhood malnutrition was the boiled mix of rice, lentils, onion, spinach, potatoes, and oil from her childhood. The results were stunning, and the photos on the wall were proof of their efficacy.

Photo: Carey Lee

“The saddest part is that sometimes, it’s not due to a lack of food,” Mohammad-da sighed.

“Sometimes, young mothers just don’t know how much or how to properly feed their children.”

David should be a pediatrician when he grows up.
(Photo: Carey Lee)

After our own lentil-filled lunch, we headed to downtown Dhaka to check out a medical bazaar, a dimly lit collection of shops made yet dimmer by the far-too-common power outages in the city. Fumbling in the dark, the team split up to procure items possibly of use to us for the project. The bottle, infusion set, and nasal cannula were the easy part. Oxygen in Bangladesh, it appeared, was monopolized by the Bangladesh Oxygen Company (BOC), and O2 sources were going to be the priciest part of bubble CPAP.

"So the Dow Jones is down today, huh?"
(Photo: Pamela Pavkov)

The day finished with some hardcore brainstorming, as tomorrow will be our last at ICDDR,B.