Wednesday, April 25, 2018

Medical Mission: The Clinic

In my previous post I shared some thoughts and emotions from my medical mission trip to Bangladesh, to volunteer at the Rohingya refugee camps. In this one, I will share a little about how this trip came to be, as well as more about the clinic itself. Note that this post is directed towards an audience that would most likely not have a medical background.

Since August 2017, hundreds of thousands of Rohingya Muslims have fled from Burma due to violence and persecution, and have found temporary refuge in camps in Bangladesh. The number of displaced Rohingya varies based on different sources, but according to UNICEF, the number is about 655,000. Other estimates are closer to 800,000, and some close to 1 million. Nonetheless, these numbers give an idea of the immense magnitude of the displaced, of which about half are children. This map gives a perspective:



I learned about MedGlobal's Rohingya mission during some fundraising efforts in a group I am a member of. Donating money is one thing, but as I read into the details, I realized that this is a place where I would be able to donate my skills and gifts I have been given. I had never been on a medical mission before, although I have been volunteering as a family physician at a free clinic, quite consistently over the past 4-5 years. As I delved into the details of the project, I became determined to become a part of it. With my part time hours at work, being self-employed, and having a very supportive spouse who would be willing to hold the fort for a week or two, I almost had no excuse not to. So, bit by bit, the details fell into place, and I had the honor to become part of this project in April 2018.

MedGlobal collaborates with the HOPE Foundation whose mission is to provide medical care to needy people in Bangladesh, with a special focus on women and children. The clinic I worked at was run by the HOPE Foundation, located close to a main thoroughfare, instead of deep inside the camps as certain other clinics were located. This allowed for the needy local population, as well as the refugees, to access medical services when needed.




The clinic inside is laid out as many others in the western world would be, with a large waiting area, a row of exam rooms and even a medicine and supply closet. What is novel, are the materials use in construction. One would see a lot of corrugated metal and bamboo. This is the exam room assigned to me:

My desk and the exam table, and the supply closet:




All patient photos on this blog have been posted with permission. As far as patients go, I saw mostly adults, and particularly women, since there was also a pediatrician in our group of physicians. The ratio of women to men patients was a little over 2:1, based on my estimates from the daily census. A lot of the medical conditions that I saw were not very different from what I might see in my daily clinic; such as gastroenterological complaints, high blood pressure, and diabetes, with some exceptions. These diseases we managed with a much more limited formulary, and I saw massive thyroid enlargements, as well as many incidental enlarged thyroids. These are mostly a consequence of iodine deficiency, although there are government programs in place to provide iodized salt. This lady did not have symptoms of an overactive or underactive thyroid, but had pressure symptoms in her throat due to the immense size of the gland.

I also saw a patient with end stage Hepatitis C, who was also seeing another physician in a nearby town, and had just had her eighth paracentesis (fluid drawn off her abdomen) two days prior.



I saw many patients with asthma, made worse by the dusty conditions in the camp, and the fires that were lit to cook food. Educating them to use inhalers was quite a challenge, but our amazing nurse, also a volunteer from the United States, was very patient with them. The pediatrician saw many acute illnesses, that we typically only see in textbooks, thanks to immunization rates in the United States, such as chicken pox, measles, and mumps. There had been an outbreak of diphtheria not long before we arrived in the camps, and this has a very high mortality rate among young children, but we did not see any active cases during the time we were there. There was also malnutrition, mostly among lactating women, and some children; the primary food source is rice, with very little protein in the diet.

I worked with Ayaz, my interpreter for the entire duration of the trip, a bright young man who aspires to work for a UN agency. He was great with the patients, particularly explaining the mostly illiterate population, how to take their medications.


This is an example of direction marked clearly on a bag of dispensed medications:


Take one a day, in the morning (hence the sun), and the 'x' inside the circle signified on an empty stomach. If a medication were to be taken after meals, the circle would be filled in.

This gentleman was quite inspiring to me; he was able to speak 3 languages, had set up a madrassa in the camps for young children, and was also raising his orphan niece as his own:

The children were precious, and interacting with them was the highlight of every day. This little guy was thrilled by the 'puppet' I made him to play with.





With the money that many of my friends donated, the clinic coordinator was able to purchase toys for the children, medical supplies and a fetal doppler for the clinic. A child's laughter at being able to play on a simple see-saw, was too precious for words.

The team of interpreters, physicians, nurse and clinic staff that I worked with were all wonderful, dedicated people. I hope that some day I have the opportunity to work with them again. I only had a week in the camps, but I feel as if I have left a little part of my heart there, and hope and pray that I get called back to serve again in the future.


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