Thursday, May 21, 2009


I had a great last few days in Dhaka, hosted by the wonderful Margarita of Save the Children, in her beautiful home bedecked by artifacts from around the world. I visited Shishu (meaning children or baby) Hospital, the largest pediatric hospital in Bangladesh, and had the opportunity to see where the swabs taken from umbilical cords of babies in Sylhet, came to be tested. The lab was interesting, though most of the explanations I received about testing processes and the chemistry behind diseases left me wishing that I had held onto the stuff I learned in my high school science courses a little better.
After visiting the lab, I followed a group of med students to the NICU where I saw the tiniest babies ever. From what I understood of the lecture the professor was giving, the students were learning how to tell the gestational age of a baby when there was no way of knowing how many months pregnant the mom had been when she delivered. We went around and tested little reflexes and listened to heartbeats. I tried to smile at the mothers and grandmothers, and found that they were kind and friendly despite how tired and worried they must have been. One mother handed me her baby to hold, and I held him carefully, amazed at his alert and sparkling eyes. He almost fit into the palm of my hand.
I was told that babies are often born early because the mom is malnourished, very young or old, or works too hard. In the hospital the baby mortality rate is around 2 out of 10, but outside the hospital it can be closer to 4 out of 10, especially in rural areas.
I felt that the visit needed a little digesting, but in a city so full and exciting it was hard to take a breath and think. I saw the equivalent of Times Square in Dhaka and marveled how such wealth and poverty could be so entangled. I went swimming at the American club, where beautiful flowers practically poured off rooftops and I could have ordered a hamburger and fries (I ordered a falafal, and laughed when it looked like one -in pita bread and all- but tasted exactly like the fried squash patties that Kahala had made for me at the guest house.)

The flight home was long, but I was blessed to have the best traveling companion ever for the 13 hour flight from Dubai to New York. His name was Amber and he was one of the 40 10-13 year old Indian students who were on my plane headed for NASA Space Camp in Huston, TX. He was so thrilled to be headed to New York, in love with the in-flight phone that allowed you to call other seats, highly amused by the Hindi-dubbed version of The Incredibles, and terrified of any and all food items offered to him. He had no problem climbing over me to look out the window or over the poor fellow on the aisle to go visit his friends. Best of all, he liked to tell jokes that made no sense. We had a great time.

I was picked up at the airport by my wonderful father early in the morning and arrived back in East Chatham to 20 little lambs and lilac bushes in full, glorious bloom.

Saturday, May 9, 2009

"Look out the side window, not the front one..."

" as not to see too well what's up ahead. Otherwise, you get constant adrenalin rushes from
the close calls and that's exhausting," my mom wisely advised in an email before I took the bumpy six-hour bus ride to Dhaka today. I thought it was scary being in a tiny taxi on a Bangladeshi road, but something about the tipsy tendency of buses in addition to their slow response time has put them closer to the top of my "scary vehicle" list. It was, however, not a bad ride and the seats beat Greyhound's hands down. Not that that's difficult to do.

As we left Sylhet the rice paddies began to thin and were soon interspersed with a variety of other crops including lots of hemp, eggplant, and squash. Though the Hindi movie playing in the front was at full volume, I got some sleep and when I woke up we were in the biggest crowd I'd ever seen. I didn't understand how the bus was still moving. Over the heads of people, goats and cows, I could see a little of the city, whose outskirts we entered hours before we arrived at the bus station. We passed a railroad track lined by hundreds of tiny tin-roofed houses and lines and lines of garment factories. There were fruit stalls and shoemakers, beggars and restaurants everywhere, and the sun was out.

I am excited for this new part of my adventure, though it was sad to leave my new friends from Projahnmo. They threw me a really nice tea party this morning before I left, and all the women put their palms on my cheeks and smiled into my eyes.

I thought while I had some quick internet connection I would share with
you some of the pictures from my last week in Sylhet.

This is Tamanna and me outside her uncle's house in Sylhet.
Tamanna is a Training Officer for Projahnmo, and just completed her Masters Degree.
She took me on a great rickshaw ride to meet a bunch of her family.
Like many families in Sylhet, three of the four sons of her grandparents
are overseas, sending money back.

This man is washing betel leaves. Many people here chew betel leaf and nut like
some people in the States chew tobacco. Most men here smoke cigarettes,
and most women chew betel nut or leaf. It turns your teeth orange.

This is the squash bed outside of my friend Tamanna's auntie's house.
The vines are strung up onto the bamboo structure and the fruit hangs down,
instead of resting on the ground.

These are the things that CHWs use and carry in their bags.
(including safe delivery kit, baby doll with placenta, CHX solution, and a scale)
Though they are only carrying the most necessary items,
the bag is quite heavy, and they have to carry it many miles a day.
(The clock is just mingling...most CHWs use their cell phones as watches)

There are piles and piles of trash everywhere.
Some gets sorted out by hand, like these plastic bottles...I don't know why.

This was my first plate of Jackfruit.
Jackfruit is the national fruit of Bangladesh, very nice smelling,
really huge on the tree, and very slimy inside.
Most Bangladeshis that I've asked have said they don't really like it very much.

The black embroidered cloth is actually a bed spread, hand embroidered in a traditional way.

The cloth and patterns here are mostly festive, bright, and very light.
Because in this culture women must be so covered,
the material has to be thin or else all those clothes would be dangerous in the heat.

Tuesday, May 5, 2009

A Visit to Nazma Begum's House

Yesterday, I went out with Neela to Charkhai to do the last of my Field interviews and observe a BNCP 2 Visit (I think "BNC" stands for "before neonatal care" but I'm not sure what the "P" is for. ) A BNCP 2 Visit is a prenatal home visit by the CHW between 7 and 8 months of a woman's pregnancy (a BNCP 1 visit is between 3 and 4 months, I think) .

I was thrilled when we left the Charhai Field Office and got into a baby taxi. For those of you who have never seen one, it is an impossibly small, 3-wheeled, green vehicle that still manages to seat 5 and reach probably 30 mph. It has no doors, seatbelts, or emergency brake, and every single one is heavily decorated, including a fringe around the tiny windshield immitating those on the huge buses whose back winds nearly knock the little thing over. Besides the big buses, a major hazard to baby taxis are cows. Cows, or goru in Bangla, have free reign, which includes the road. Being about the size of a full-grown cow, a baby taxi has only one resource when it comes to getting a cow to move out of the way: its horn. Baby taxi drivers drive mostly with one hand and often will use that hand along with the other in order to most emphatically beep at just about anything within a rather large radius. Having now experienced a rickshaw and baby taxi ride, I feel I can go home and say that I visited Bangladesh.

We got out of the baby taxi when it couldn't make it any further down a rutted path about half an hour out of town. Walking on the raised path between low fields in the sunshine was hot and beautiful, I'm not sure how far I could see, but it was far. We turned right onto a bricked road and walked through a swaying, cool green bamboo grove, past houses half hidden behind tangles of vines, and long sari cloths draped along low fences, arriving eventually in a courtyard facing several cement buildings. Leaving our male escorts outside to smoke cigaretts and kick at chickens, Neela and I ducked into an dark open room of the main house. Seven or eight women were sitting in a circle on reed mats, with four small children climbing about, and Neela introduced me to the CHW, Kohenur, the FSS, Rienu Das, (the woman who supervises CHWs-basically, she goes around on home visits like this one to make sure that CHWs know what they are saying and are giving out all the information), and the mother, Nazma Begum. The other women in the circle were the VHW (village health worker), Nazma's sister-in-laws, and other female family members.

Kohenur began with an oral explanation of safe labor and delivery practices, and then using a picture flier went over danger signs (excessive bleeding, longer than one day labor, baby in a bad position) encouraging everyone present to take the mother to a medical facility if they noted any of these. From her bag, she took out the delivery kit that Projahnmo hands out for free, that includes 3 sterile strings, blade, plastic sheet, gauze, and soap and explained how to use all of the items. She took out a doll (with umbilical cord made of yarn attaching a placenta to the doll's belly with two snaps), and used it to demonstrate how to dry off the newborn (instead of giving it a bath-which could cause the baby to get cold or an infection, they encourage waiting 72 hours before the baby's first bath) and wrap it to allow chest to chest contact with mom and still keep the baby warm. She showed them how and where to cut the cord (undoing the snaps), and gave some breastfeeding tips. She wrapped up her talk with a demonstration on how to best wash hands (leaving them to air dry). Though this was the third time that I've seen this demonstration, it was Neela's first, and she particularly enjoyed the baby doll wrapping.

I was interested to note that Kohenur was mostly directing her talk to the eldest sister-in-law, and when I asked Neela why, she said that after the delivery the mother would not be clear-headed, and it would be this sister-in-law who would be doing all the after delivery practices. I also thought Kohenur used a good technique when she first asked for someone to demonstrate the practice that they usually use (for baby-wrapping or cord cutting) and then while showing Projahnmo's suggested method, explained how and why it was different, patiently answering questions. For the most part, the women seemed to like what Kohenur was saying, and were especially interested at looking at the picture fliers that she brought that depict everything she was explaining in cartoon.

As the other women sat around chewing betel nut and leaf and cuddling the children that ran in and out, Kohenur took Nazma's temperature, and measured her upper arm to make sure she was healthy. She gave her iron tablets tied up in a piece of plastic, and left a new delivery kit along with the fliers. Then she did a little interview about tobacco use and cooking practices that Neela explained is part of a substudy of Projahnmo, and gave the VHW a sheet (with letters and pictures) to fill out about the number of births she attends and how long they lasted (suns and moons to be circled).

We said thank you and goodbye, and walked back out into the blinding sunlight. All the ponds and rivers here have staircases that go right down to them, and even a foot or two under the water, so Neela climbed down the one to their little pond and dipped her feet into the dark water. The walk back did not feel very long, and we only got stuck once in the baby taxi when a herd of cows refused to move and the men all had to get out and shout and shake their arms.

On the car ride back to Sylhet, I thought about what it would feel like to have a strange woman come into my living room and watch as my doula and I had a prenatal visit. I thought about how in this culture, everything revolves around family, and how close women are to each other. I thought about how comfortable people are sitting on the ground or squatting, and how children wear necklaces and bracelets that hold protective verses to keep them safe. I wondered if I could ever answer with certainty about what is most important about my culture, what holds us together? And then I wonder, who is "us"?

Sunday, May 3, 2009

Pictures from Week Two!

Learn Bangla With Me!

I now have the privilage of being able to say "hello" and "thank you" in over five languages! I have been enjoying this opportunity to learn a new language, and so I thought I would share some of my new vocabulary with you. (Note: all Bangla words are written according to how they sound)

Hello- Asalam walakem (Note: this is similar to Arabic, but with a 'w'. This is a primarily Muslim country, so there are a lot of Arabic words and sayings that have crept into everyday language. N'shallah is another saying used often, meaning "god willing")

How are you? Tumi kamon acho?

I am good. Ami valo ache.

My name is Natalie. Amar nam natalie (or natalee, or natali, or natilee)

See you later. Abar dekha hobe.

What did you have for breakfast? Tumi sokale ki diya nasta korecha?

I had bread (which is more like tortillas), eggs, and tea. A mi ruti, dim, abong cha keyechi.

What is happening? Ki hoche? (Note: I don't actually know what verb tense this is, but if I ask it, people tend to explain to me what is going on.)

I don't understand. Tumi ki bolcha ami bujhi nai.

No need-Lugbena (for example, when Kahala asks if she should bring me water to my room, I can say lugbena)

Too hot-koob gorom

Condom-dam koto
Scarf- Orna
Banana- Kola
Pineapple- anarosh

(Note: both the words "brother" and "sister" are used before someone's name as a form of respect and politeness.)
Sister- Apa

Sit here- boukka (or in Sylhetti, Boso)
Come- Asho