Doors? Well, an open flap in a massive tent would be a more appropriate description.
We take hygiene and hand washing seriously in the health facility. There are half a dozen blue barrels filled with water around the hospital. Each barrel is mounted on a metal frame. Beside the tap, there is a pink plastic string bag containing a bar of soap. Beneath the tap there is a bucket to catch the sullage.
I had just finished a ward round in the measles isolation tent and stepped outside to cleanse my hands. I turned on the tap, but there was no water. I glanced down into the bucket and saw there was a couple of centimetres of water. I really felt I needed to wash my hands so I decided to cheat, to use the waste water and throw it away afterwards. After I’d started washing my hands, I realised that this short cut was a big mistake. I noticed that the water wasn’t clear. I expected it to be soapy but instead there were half a dozen gobbets of phlegm, floating like stranded jellyfish.
Just beside the measles tent is TB Corner. This is where patients with suspected tuberculosis queue up to give sputum samples for testing. I could see patients crouching down by the tent trying to cough up a sample. It didn’t take long for the awful truth to dawn on me.
Initially it reminded me of “Îles Flottantes” – meringues floating in custard, but it’s one of my favourite desserts, so I banished the memory immediately before any lasting associations could be made. I replaced it with the image of a prairie oyster – I never drink enough alcohol to require a hangover cure.
There are no towels to dry your hands because of the risk of infection, so I couldn’t wipe. Twenty metres away, outside the toilets, there was another blue barrel, but this was empty, too. I stretched out my dripping, doubly-contaminated hands and walked like a zombie to the Emergency Room, where I gave my hands a good scrub under the tap in the sink.
I mentioned this experience at the Hospital Hygiene Committee meeting this afternoon and we came up with a plan to ensure that patients knew where to spit, where to wash their hands, and how frequently the barrels need topping up with water. I found it comical that my colleagues were bemused why I hadn’t just used alcohol gel to clean my hands in the first place.
I was surprised when the Bangladeshi police officer flagged down our car at the check point this morning. Normally the MSF logo on the vehicle allows us to pass without hindrance. We stopped and I rolled down the window, kept my hands visible and still on my lap, and looked straight ahead. This is standard operating procedure. No sudden movements, no sunglasses, no earphones or music playing. The senior person in the car is the spokesman.
“Where are you going?” asked the officer.
The medical team leader is an African lady, half my age. From the back seat, she replied, “We are visiting the Memorial Christian Hospital, just past Cox’s Bazar.”
The officer glared at me. “Is she your wife?”
“No, sir,” I replied. “I am old and she is young. I wouldn’t be able to cope.” I smiled to show I was joking in a self deprecating manner. The policeman snorted derisively and waved us on.
“I apologise for the bad joke,” I said as we drove away.
“Next time it would be better just to say we were married,” my boss replied.
Memorial Christian Hospital (MCH), in Malumghat, Chakaria Thana, is run under the auspices of the Association of Baptists NGO. The American and Canadian health workers who founded the original hospital in 1966 selected the location in southeastern East Pakistan due to its desperate healthcare needs and proximity to major transportation corridors.
In 1971, East Pakistan descended into war when it tried to secede from West Pakistan. Between 3 and 5 million people died in the war of independence. During the conflict, the American health workers attempted to leave the country, but the Pakistan Army advanced rapidly and cut off their northern escape. Most of the team wasforced to cross the border into Burma, travelling to safety in Maungdaw in Rakhine State. Ironically, this is the reverse of the route that half a million Rohingya took over the past six weeks. Two doctors stayed behind to keep the hospital functioning. Following independence, the site was often approached by the US government toassist in distributing aid. Since then, the hospital has outgrown the original buildings and a new four storey hospital is being built.
Two doctors stayed behind to keep the hospital functioning. Following independence, the site was used by the US government to distribute aid. Since then, the hospital has outgrown the original buildings and a new four storey hospital is being built.
Surgeon Steve Kelley has worked here for 21 years. He is my main contact when I want to refer difficult surgical cases, especially war-wounded Rohingya and the victims of road accidents. Including elephant attacks.
In response to the massive influx of refugees, MCH built a temporary ward in just two weeks. It is a sophisticated structure of bamboo (painted black or white) and white plastic sheeting. There is a strip above the head of each bed with power outlet, oxygen and an alarm button. It is kept cool by ceiling fans.
Some of the patients I had sent to MCH recognised me from their beds. Despite being in pain, all of them smiled when Steve came to their bedside. We moved on to the male and female surgical wards, then had a tour of the operating theatres and recovery area. Despite being fifty years old, the main hospital was incredibly clean. This, and scrupulous surgical technique, would account for the fact that not a single patient we have referred has developed a wound infection. If anything serious happens to me when I’m in Bangladesh, this is where I want to be treated.
The BBC, Channel NewsAsia and CNN have all visited the hospital in recent weeks. One of the patients spotlighted was a five year old girl who had been shot through the forearm, destroying all the extensor tendons and shattering her radius. Her father had been carrying her when she was shot. After exiting her arm, the bullet hit her father’s head and killed him. Her bones are mended and she is going back for tendon reconstruction.
Neither her surgeon, Steve Kelley, nor Memorial Christian Hospital, featured strongly in the piece. But Steve, Brad and their colleagues perform life changing surgery every single day. The expat doctors and nurses here do this without getting paid. They have to raise money to fund their flights, their living expenses as well as running the hospital. No money comes from the US or Bangladeshi governments. They are all heroes, saints even. I was overcome with admiration for their selfless work.
Half a million Rohingya have sought refuge in Bangladesh over the past six weeks. Most of them have camped in the area between Kutupalong and Balukhali, west of National Highway 1. This used to be forested rolling hills. But the trees have all been chopped down and the ground is covered by makeshift dwellings made of plastic sheeting stretched over bamboo.
For the past two weeks, I have been confined Kutupalong Hospital. Now that I have been joined by another expat doctor, I can have some time off. In fact, I have been ordered to have some time off, so I decided to go walkabout in the camp. For security reasons, I needed to go accompanied, so I asked our “mapman”, JG if I could accompany him. He is teaching refugees to map the camp by recording GPS coordinates of all the blocks of housing, noting the mosques, shops, rivers and bridges.
The driver dropped us at the roadside close to Balukhali Bazar and we walked down a muddy path to the site where the new MSF hospital was being built. Two wards are close to completion. The outpatients’ department is situated across the paddy fields. It was constructed in a couple of weeks and is working to capacity. The camp was buzzing with activity. People were carrying plastic sheeting and thick bamboo poles to build homes.
We met our local GPS plotter at the clinic and walked to one of the MSF health posts in the more remote parts of the camp. JG called the path “shit street”, which was accurate. After the health post, we followed a stream (no prizes for guessing what JG called this), jumping from bank to bank, trying to avoid sinking deep into mud contaminated with faeces. The sun broke through the clouds and it became very hot.
Good places to build are scarce. Some people have even constructed homes over pit latrines which have filled up with excrement. There are some tempting flat sites next to the river, but when the rainy season resumes in April, homes built here will be washed away by the monsoon.
We bounced across a bamboo pole bridge spanning the river. Beneath us, children were playing in the water, women were washing clothes. It looked tempting for a minute until I remembered the effluent. This was unmapped territory, so we needed a GPS reading. We could have walked to the centre of the block, usually where the mosque was situated, and taken a reading. But our plotter was (literally) more pedantic. He led us around the perimeter of the block – through swamps, traversing muddy cliffs, past latrines and boreholes. Then we walked up the hill to the mosque.
The imam came to meet us and put up his umbrella to shade me from the heat. We took a break under the awning around the mosque and I drank a litre of water. I took some photographs to stitch together a panorama. To the north and east was the established part of the camp, dating from 1992. The demarcation between old and new was clearly shown by the appearance of the roofs. Gourds and pumpkin plants covered the old roofs; the new roofs were bare black plastic. Beyond the established camp there was a belt of trees and greenery, marking the best land which was occupied by Bangladeshi villagers.
At the mosque, we recruited another plotter and taught him how to do the work in the next two blocks. I stood back in the shade and watched naked children pumping water from a borehole and pouring it over themselves in delight. We set off in the direction of another health post, situated on a hill to the north. It was almost complete, with a roof and internal bamboo walls forming consulting rooms. The floor was bricked, laid in a herringbone fashion, which would be concreted over. The builders were lying down, resting on plastic sheeting. We disturbed them, so they went off to pray.
“Let’s go for a stroll,” said JG. This part of the camp had shops. There were smells of perfume and cooking. People poked their heads out of their homes to see the strange white people walking past. We turned left to pass the cemetery and the plantation of mango saplings and crossed the stream.
The black clouds on the horizon signalled rain was coming, but it crept up on us quicker than we’d thought. We considered seeking shelter, but by then we were already soaked. JG’s umbrella provided some protection, but within minutes we looked like a pair of drowned rats. White rats.
I was wearing some lightweight walking boots, lined with Gortex, but my feet were so wet that when I put my feet down, bubbles squirted up through the material. It looked as though my socks had not been thoroughly rinsed when they were last washed. I was completely drenched.
The path back to the health post was now a torrent of yellow muddy water. Steps which had been cut into the clay were now treacherous and slippery. At first, children came out to play in the warm rain, but as the rainstorm became a cloudburst, even they took shelter. We reached the new health post just as the rain began to stop. The sun came out and everything looked shining and brilliant, but not clean. Children started playing in the rivulets between homes, making dams, racing twigs – Pooh sticks would be an apt term.
The rain began again, then stopped. It was a bit like colic – increasing in intensity, then dying back. By now we were surrounded by a pack of feral children. JG let them try on his spectacles. Then he taught them a drumming game and led them around the health centre like the Pied Piper.
He checked the work of his GPS plotter and gave him his marching orders around the camp to complete the mapping over the next couple of weeks. We squelched through the camp for half an hour until we reached the road, by the Kutupalong Hospital. Even though I hadn’t even started to dry out, I saw a few patients and picked up a pile of paperwork to do at the office. I started to sneeze…
Back in my shared room later in the evening, I emptied my pockets. My notes, written on paper, were sodden and illegible. My wallet was wringing wet, with £50 worth of Bangladeshi taka forming a costly mush. I carefully separated every ancient banknote and laid them on the table to dry. It looked like a scene where a forger had been producing counterfeit notes. They were almost dry by morning.