Monday, April 29, 2013

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.

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