I've decided that I'm going to live to be at least 100 years old, if not 110. I feel like that if I can make it through this then I can do anything :-) Yesterday was the lowest point for me yet (scratch all those other times I've said that, this time it's for real- at least till I say that again..) Not only did I mentally exhaust myself but my body failed me too. Either that or my body finally woke up and couldn't take anymore. I ended up with severe heat exhaustion, which is much better then my first conclusion thinking I had malaria from all my bug bites...

When we arrived at the hospital yesterday, we were informed that the electricity was out. Truthfully at first I just shrugged, it's not like they have air conditioning anyways. But the heat was about 100 degrees with 97% humidity and 4,000 patients in total darkness, turns out that is the exact recipe for a difficult working environment. I also forgot my water in the car and was wearing dark clothes due to my bug attraction problem.

The class was cancelled due to the extreme circumstances but we still attended meetings working on our objectives for the programs. After we requested to visit some more wards to be able to understand more about the resources and working conditions at the hospital. I went with one of the nursing students who works in the ICU. ( I was told there is only one ICU here.)

The hospital is quite large and takes a considerable amount of time to navigate through the hallways. The first two hallways we tried we were too dark (no lights with no electricity) but the hallway  on the first level was dimly lit by emergency generators. The prime minister visited the hospital the previous day while we were there, glad there was electricity for that!

Anyways, as we walked down the hall I could feel the oppressive heat starting to take it's toll. The constant flow of bodies (busier then MGH in the morning) and patients lined against the wall or on stairwells without beds added to the energy. The ICU was closed off with a locked gate and an armed guard outside. He quietly waved us in where I was informed that I could either walk around barefoot or put brown cloth sacks over my shoes to help reduce risk of infection.

I was ushered over to a stool to sit upon while securing my booties. I reached out to the table next to me to steady myself and quickly uttered an apology after realizing I was touching an arm. I glanced over and realized it was a wrapped body, needless to say he didn't seem to mind.

The nurses and doctors working in the ICU were proud to show off their ward to me. I introduced myself to each patient and family member. I felt very welcomed but somewhat overwhelmed as each  family member pushed their loved ones medical charts at me and asked me to read the scans desperately trying to gain any encouragement on the prognosis.

The compassionate care they are able to provide to the patients despite the limited resources is amazing. One physician calmly introduced himself to me while speaking English beautifully. He gave a breif description of the some of the patients around us and then pointed to one woman who lay vented in the bed. He told me that was his mother and had been here for quite some time. He lovingly stood at her bedside providing her direct bedside care, suctioning her mouth as vomit came pouring out. His polite, gentle demeanur was inspiring as we stood amongst a room full of suffering. The strength of the people in Bangladesh is something I cannot even put into words.

I met two young, enthusiastic nursing students who were studying at the Dhaka Medical College. I asked both of them what made them want to become nurses, both gave similiar answers of wanting to help people; simple yet honest.

I wish I could tell you that I was impressed with the amount of supplies available or that pure panic didn't show spread across my face when they showed me the code cart or dressing supply cart. (Please see pictures below.) Many of the famillies just kept smiling at me and asking me to pray for their family members, all of them so appericative simply for my presence despite me feeling completly useless at times.

I visited a few of the victims from the building collapse tradgey. They ranged in ages from 15 to 28, all with unimaginable injuries. I wanted desperately to tell the families that everything was going to be okay, but all I could was offer my empathy because I don't know how things will turn out, I just pray they find peace.

We have been teaching about documentation in the nursing profession and wanted to see how it was currently done as there are specific ways we want implement it on the bone marrow transplant clinic. They showed me a few notebooks where the written work was kept in the ICU. One  notebook kept track of expenses, one to log the deaths and one for a census of the patients. I clarified again where I could find nurisng notes on the patients. A nurse provided me a journal where they only documented about patients who they felt were "really serious." I had to stop my self from laughing out loud because I'm not quite sure how much more serious we can get in regard to the patient conditions. The book listed different patient names with a plan next to them. Sadly, all the plans were the same and read, "patient is very serious and condition deteriorating very fast. We will watch closley in ICU."

I'm continuing to adjust to life here as it's quite a shock compared to the life I've become accostomed to at home. Despite being absoloutely amazed by the incredible work and amount of compassion the healthcare workers have, there is still a part of me that is in survival mode as I try and cope with what I'm seeing aroud me. By that point in the day my dehydration and heat exhaustion started to take effect. I felt myself fading and remembered I hadn't eaten or drank anything since that morning. Each step walking back towards the exit felt harder then the next in the midst of all the pain around me.

Once back in the safety of the car I tried to drink water and eat a granola bar but it was too late. My head started pouding and the nausea took over. The car ride home through all the traffic in the unpaved bumpy, hot air was possibly the longest of my life. I don't remember much about the ride but each time I came to as Laura rubbed my back I'd look out the window and thought, "oh I'm still here." The only good thing about the traffic was that I was easily able to open the door and vomit outside of the car when I needed; there's always a plus side!

Once home I somehow got into a shower and hysterically cried between throwing up thinking I was slowing loosing my mind. The air conditioning in my room wasn't working so we put the yoga mat in the living room and I lay there under a quilt for hours as I questioned every belief I ever had.

The funny thing about our darkest moments is that they often are over as quickly as they come. Around 8pm that evening I started to come back to life as if a switch in was turned back on again. Sometimes I feel like that blow up clown that keeps getting knocked down only to find someway to get up again and again. Each time I find strength I didn't know I had as the challenges seem to get grow as I understand more about my surroundings.

I was able to walk around again and slowly started keeping water down. By midnight I started working on solids :-) It truly is the small accomplishments in life... That and I was almost deliriously happy when it became quite obvious that I didn't have malaria.. either that or I may be the only person in the world who survived six hours of malaria!

However while I was discovering my weakness was passing and I could walk again, Laura and I received an alert e-mail from the US Embassy concerning the May 2nd protests which will likely be violent and shut down the city. This warning was more broad and concerning then the other ones we have dealt with. We immediately switched to survival mode again as I started googling flights to Dubai. I turned to Laura and said, "hopefully we can get to the middle East if we need to evacuate," a sentence I never thought I'd say.

By this point we have been in constant communication with MGH and the officials we work with here. Just to stress, we feel very safe where we live, it's just a concern that if all the highways are closed we would be unable to get out in an emergency. We will buy groceries from the market today that will sustain us for days to come.

We are well connected in Dhaka and feel that our safety has always been a priority for the organizations we work with. Our current emergency evacuation plan is in place as we keep our bags packed by the door in case a problem does come up. Despite all the power outages in the city, for the most part we have been unaffected and continue to have internet.

Laura walked past my room last night after our insane day and noticed a bunch of blankets in a huge pile at the end of the bed. Due to the net around my bed it looked like something was hiding under the covers, she then found the courage to run in the room with a rolling pin to make sure it was safe for me. I refused to go in with her, we all have limits and apparently mine are possible monsters hiding at the bottom of my bed. Many things change in life, but some stay the same :-) Namaste.

I checked the CNN front page when I got home this evening as I normally do. The article to the left highlighted the Dhaka tragedy of the building collapse as we are now post accident day five. The article to the right was about Boston and focusing on the terror links in the marathon incidents. I never thought that I would find myself in the midst of the two widely publicized international events simultaneously. As a Boston native living in Dhaka, Bangladesh my empathy goes to both situations and reminds me just how connected we all are as people; we all feel pain.

The protests continue as the country continues to mourn the building collapse. The death toll continues to climb as the rescue efforts continue for survivors. The unbearable heat and lack of resources has severely hindered rescue efforts. The first account stories of the victims from my nursing students today was heart breaking. One described a story of nine workers trapped in a tight space where only one was found alive. They described the bodies brought to the hospital and what they did to assist with the rescue efforts. They told us how the victims families reacted to the news upon hearing about another casualty. Again, pain is a universal emotion which takes no preference to class, religion, culture, country, wealth, education, gender or occupation.

I visited the oncology ward today to gain a better understanding of the nursing profession in Bangladesh. I met some inspiring and courageous patients each with a different survival story to be told. Just like my patients back home, everyone has a story to tell. I find that in times when I don't have answers for patients the best thing I can do is listen to assure them at least someone heard them.

The nurse showing me around knew his patients very well and could describe their personalities in great detail. One particular patient who I'll refer to as "Adan" stood out with his bright affect. I was immediately drawn to his wide smile and kind eyes. Adan is a 22 year old who was diagnosed in 2007 with Leukemia while studying at college. He handed me his medical record (which he kept in his bed) with his scans spilling out. He proudly recited his labs to me and explained the different treatments he has gone through. His positive energy gave me a sense of hope as his mother stood loyally at his bedside. He asked for pictures with us and excitedly stated that he was so happy to meet us. Although I'm sure that's true, I tried to relay to him the gift his presence had given me; a renewed sense of hope.

I know I've mentioned before how grateful I am for all the support I've received, I wanted to say it again because it's worthy of repetition. Without the amazing support system that I have, I would not be able to do this. All the messages and encouragement literally means the world to me and gives me the strength to continue with this type of work. In a world where we often focus on all the "bad" things that happen, I feel like I am very fortunate to be able to see how much "good" there really is.

I've been lucky to have worked at the greatest hospital in America and now at one that would be at the opposite end of the spectrum in regard to funding. Although the differences are very evident and obvious, the similarities are also there. Each day I travel to the public hospital I think about this concept. Despite all our differences we all can still feel; that and illness doesn't discriminate. If people in the most dire circumstances can find a way have gratitude and be kind then most anyone can. "Be kind whenever possible. It is always possible."- Dalai Lama. Namaste.

Sometimes while here I find my best coping strategy is to get through the day or other times the hour. Each day has become a roller coaster of emotions in terms of survival. I must have missed school the day they taught us how to deal with situations where we find ourselves on Jupiter. That's the best way I can describe how I feel today, I just can't.

I started my day with laundry. I actually really enjoy doing laundry. It's one of those routines that feels productive and the end is something clean, easy! Well, in the first world anyways... So this morning the air was literally stagnant, around 100 degrees with rings of haze. We have a "washing machine," turns out these machines are not universal... I spent twenty five minutes googling "how to use a washing machine in Asia." For some strange reason Wikipedia does not have a guide for this.

My interpretation of how to make it function involved using our rice pot to run back and forth between the bathroom and balcony while pouring the water in. In between trips I put a tiny bit of soap in and manually moved the clothes around so that the dirty water could drain out. I kept running faster so that the dirty water wouldn't mix with the clean (obviously a priority...) as sweat drenched off my body defeating the entire point of keeping everything clean. Of all the things I've been through, the frustration of not having perfectly clean clothes almost threw me over the edge. (Well not literally because I was on a balcony with bars...)

After my 90 minute laundry ordeal I have to say I felt pretty proud of the fact my laundry was not only clean but drying neatly in an orderly fashion by size on the line. These ridiculous accomplishments are turning out to be the most empowering and allowing me to feel control in situations where it appears I have none.

They also put me in a pink crib, no really. During a meeting at the office I showed them some of my 32 welts thanks to the bugs. (This is despite Laura covering me in Deet three times a day.) Their look of horror and telling me "that's not normal here" did concern me slightly. Before I knew it they had a pink enclosed net sent over for my bed. Poor Laura who only has one bite has to deal with a purple net around her too. (Sorry Laura!)

I was able to Skype with my parents this evening which helped a lot. A professor from Simmons and nurse educators from the oncology department at MGH sent me amazing resources for lectures. I am so grateful for these materials! We resume lecture at the public hospital tomorrow pending the riots. They have suggested using an ambulance to assist with safety in the crowds for commuting, I'm going to put that thought out of my mind for now and just pretend I'm on the MBTA at rush hour. ;-)

That reminds me, Laura and I experienced our first ride via rickshaw today. I'm confident the marks on Laura's arms from my nails are probably still there. However we survived! If it wasn't for all the holes and turns in the road I'm sure my stomach would have enjoyed the ride too. Namaste.

Friday is considered the "day of rest" for the people of Bangladesh. The standard week consists of six (if not seven) work days. The week has been particularly trying given the current political unrest and now the factory tragedy. Protests and riots have become increasingly a problem and more so with the outrage from the textile factory workers. The constant tension and new environment has me on edge more than usual. I find myself forgetting how important rest can be, or at least recognizing the stress I'm coping with.

Everything had me feeling particularly upset last evening. Normally I would go for a run or walk to physically put my mind at ease. Unfortunately the safety risks are too great for those types of outlets. In these situations you realize how important those small routines are to your daily life. But you also are reminded of how amazing your support system is despite being on the other side of the world.

The amount of people who have reached out to me during this journey has meant so much to me. I'm truly thankful for all your support and kindness, it keeps me going during the tougher days :-) I think I spent almost two hours this morning Skyping with a friend and venting about my week. Fortunately, he was very patient as I grumbled about each petty problem. It's funny that no matter how trivial an issue can be, it appears manageable once you say it out loud.

Laura and I spent the afternoon at one of the few first class hotels. It felt odd to visit a place that involved a short car ride by the horrendous realities of a developing country but it was just what we needed regain our focus. I was able to run (yay finally!) at the health club followed by use of their outdoor facilities. The pool was gorgeous surrounded by serene gardens. The majority of the guests were from other countries outside of Asia (mostly European), in the area for business.

We ate the best cheeseburgers, chatted about life, read, listened to music, walked freely around the grounds, showered with hot water and basically felt like we could breathe for the first time in awhile. We felt normal. The day was exactly what I didn't know that I needed.

I started a conversation with a woman in the locker room once I heard her accent. She was from Denmark and I remarked how I had heard that her country was considered to be one of the happiest. She smiled and nodded but said she didn't know the secret for happiness. She added that she was here on business to tour the textile factories but was unable to due to the violent protests increasing around them. Just like that, reality crept back into the day but now I feel ready to face it again. Namaste.

A director of nursing from the global department at MGH gave me a paper about the DABDA model of grief. It helps to understand and process the five stages of adaptation. The first stage is in relation to denial and the shock factor. The stage following denial is anger, which is where I find myself now.

I know that anger is not considered a productive or positive emotion but it exists nonetheless. I'm angry at many things, people and myself. I wish there were more available resources, mostly more of everything and less suffering. I want to everyone to share my Utopian ideas of how a society should run, but I know that's unrealistic and not the answer. I don't know what the answers are to situations that I'm currently facing but I do want there to be some light at the end of the tunnel. The question "why" keeps flashing through my head. It seems so simple yet so unbelievably complex in terms of humanity.

Many people ask me what they can do to help. I don't know that answer either since I'm struggling with that myself. I do know that education is power and brings about change. Therefore all I ask is to bring awareness to global issues through talking. Words are powerful and lead to change.

The BBC has done a tremendous job reporting on the most recent tragedy in Dhaka. A large factory building collapsed yesterday after having a known structural problem. The death toll continues to rise but is currently at 200 with around 1000 injured. My heart is heavy desperately trying to relate or grasp the amount of destruction around me. The clothing factory mostly employed young teenage girls who worked unimaginable hours for meager earnings. It was said that US clothing labels were found out in the street blowing around the rubble.

Today, Laura and I met with the nursing director at a private hospital in Dhaka regarding future seminars. It's considered to be the wealthiest hospital in the city. The stark differences between this hospital and the public hospital are unsettling. But I also understand that I don't need to travel to the other side of the world to see health care disparities.

Although this day has been full of major frustration and anger, I also know that each day is a step towards acceptance which will begin the work towards sustainable change. Namaste

"You must be the change you want the world to see." -Mahatma Gandhi

My confinement to the apartment continued today as the political tension in city rises. Observing a hartal in Dhaka has become a way of life for the people here. We receive security alerts directly from the US Embassy and MGH, our safety is the number one priority for the organization we are working with. I do feel safe where I live since it's away from the protests. The nursing students raised concerns about traveling to the hospital during these times. However many of them continue with their work schedules in spite of the hardships, their motivation is incredible.

Yesterday, the hospital was busier then a train station in New York on a Monday morning. A commute that should take ~15minutes without traffic takes 1-2 hours depending on the traffic and the route we have to take due to the protests. The first visual of the hospital is of all the people spilling out because there just isn't enough room to accommodate the thousands that need care. Despite the horrendous conditions you can't help but feel content when you're there. The appreciation and sense of hope the health care workers and patients have is truly unlike any other hospital I've been to. 

The pride the nurses and doctors have for their work shows in all aspects of their care. Our lectures went over really well and the students were able to grasp more then we anticipated. One of my topics including basic aspiration precautions for a patient with cognitive deficits. I was mentioning the nursing rationales of why we keep a patient upright when taking anything by mouth. The example I gave was simply to raise the bed. One student raised her hand and asked, "many of our patients don't have beds, what do we do then?" This is a very common reality for the patients here. I paused for a moment and reiterated the importance of creativity in nursing. I told her that if the best she could do was to use a wall then that would have to suffice. She smiled, I think because she felt I understood how limiting their resources are.

After the class we had a meeting with the organization to discuss how to best utilize our time here. We thought it would be best to increase lecture time by adding on a day and adding clinical time with the nurses. The office we met in was also being used by medical students who crowded around the one microscope available. Others were using the sunlight to read different X-ray scans. Per usual no one had any complaints about what they lacked, just suggestions on how they could improve.

I welcomed the chance to have a day of rest today. I don't think I fully realized just how exhausted my body was from everything I put it through in time since leaving Boston. I'm starting to settle into a routine here. As each day passes my "first world problems" have turned to gratitude for the smaller amenities that I do have. I've mastered a cold shower in three minutes, something I didn't know was possible for me. However the temperatures in the afternoon rises to ~100 degrees so the refreshing water is not exactly a terrible problem.

We've discovered that we can eat pineapples and watermelon because of the thick skin they have. I almost danced around the living out of pure joy that I could eat fruit again! The salamanders no longer bother me- I do have to keep reminding myself of all the bugs they eat.. I'm learning the hard way to put my bug spray on regularly, but at least I'm learning :-)

I have a yoga mat! I'm not sure how they were able to find us two in Bangladesh but they are even pink. My current goal is to master the scorpion inversion before heading to Thailand. The picture below is from the beautiful sunset from the roof this evening. Namaste.

I've cried twice since beginning this journey. The first time was saying goodbye to my father before going through security. I think it was when I finally grasped that I would be leaving. The second time was this morning after Skyping with a friend from Boston. Recounting the details as I described the conditions of the hospital forced me to confront my thoughts on what exactly I was doing here. Fortunately the challenging morning turned into one of the most rewarding days yet.

Today was the first official day meeting with the nursing students and physicians at the public hospital. I tried to pull my thoughts and focus together on the car ride through the city. This is not an easy task with the massive crowds pouring into the streets while post war-like buildings surround the background. Once arriving at the hospital I took a deep breath, reviewed my intentions and jumped out ready to go again.

Laura and I were brought into an office to meet with two physicians who are working closely with the bone marrow transplant initiative. One of the physicians had been to MGH and worked closely on the bone marrow transplant floor. Their humility, knowledge and compassion for the patients they were treating astounded me. They gave us a brief tour of an oncology ward and explained how difficult it is to know how to treat a patent's condition but the frustration that follows when the resources available don't allow that type of care. He then explained that many cases turn towards a palliative care approach (end of life care) when in wealthier countries this would not happen. He introduced us to a young patient who was in that exact situation; heartbreaking.

We met the ten nursing students in a conference room that was assembled in a classroom fashion. The nurses here are each assigned to one ward and care for all the patients in it. Each student introduced themselves briefly (in English) with a bit of information on their nursing background. Most of them have been in the nursing field for >10years and have extensive knowledge in their specialty. All of them were married with families. You could feel their excitement and enthusiasm with each question they asked. They loved our Bengali clothes and my poor attempts to speak in their native languages. English is a new language to the students and yet their understanding was phenomenal.

Throughout our meeting various physicians came to meet us including the "principal" of the hospital. Each physician was kinder and more welcoming than the next. One quote that stood out from the principal was him expressing his gratitude to us for being here but then he said, "I do feel that no matter who you are or where you are we are all connected as people." This sentence speaks volume to the perseverance of the Bengali people.

One of the nurses I met with told me that "working in the public hospital is very hard but makes her heart happy." She also said they feed every patient for free since no one is ever turned away. They are able to make do with the most dire circumstances. Even while in class, the nurses are still responsible for their ward. I was told there are far fewer nurses than physicians. They have the strong belief that nursing is the key to success in their patient outcomes, for a developing nation they are intellectually very advanced. Namaste.