From Elective Reviews - Bangladesh - LAMB Hospital, Bangladesh, 2013 - Nadine Hack-Adams
The prospect of spending all ten weeks of my medical elective in a Christian hospital in rural Bangladesh was both an exciting and a daunting one. I knew that there was only a limited extent to which I would be able to prepare myself beforehand for all the shocks and challenges that would surely come with a change of culture, language and approach to healthcare, so it was with no small amount of trepidation that I touched down at Dhaka's International Airport one fine summer's morning at the end of March. And Bangladesh certainly did not disappoint – seasoned travellers have described a visit there as "an assault on all the senses" and this would sum up my experiences there in a sentence. Everything from the overwhelming noise of the cars and buses in Dhaka to the seemingly endless stares that I attracted from every passing Bangladeshi served to remind me that I was further from home, and from Western Medicine, than I had ever been in my life.
Arriving at LAMB Hospital after a wonderful and slightly terrifying ten hour train journey across Bangladesh was a wonderful relief. The hospital itself has 150 inpatient beds, as well as a large outpatient department, and I had heard much about its reputation for serving the poorest of the poor in Bangladesh, particularly women and children. I was excited to start my time there with a four week Paediatric attachment. After morning handover, where I was introduced to the team of doctors, invited to introduce myself in Bangla, and given a short tour of the hospital, the morning ward round started on the general Paediatric ward. I found myself reeling from the effects of the language barrier, differences in disease burden and the overwhelming heat. I was suddenly face to face with tuberculosis and severe malnutrition, often in the same child, having only read about these conditions in text books. Morning and afternoon clinic followed a similar theme – parents bringing their children to see the Western doctors in the hope that we would be able to cure their intractable epilepsy or reverse the developmental delay which had resulted from years of malnutrition, a pattern of presentation which would be repeated again and again over subsequent weeks. Working alongside the team of foreign and Bangladeshi doctors was a wonderful and educational experience; seeing how willingly these professionals gave of their time and considerable expertise to reach out to those who had so little was wonderful.
Gradually, my medical Bangla expanded to include phrases such as "How many days has the fever lasted?" and "Can you show me where the pain is?" which allowed me to talk to my patients directly on the ward rounds and in clinic, rather than exclusively through other members of staff who could translate for me. I gradually got used to making diagnoses based on the balance of probability and clinical judgement, rather than on the basis of state of the art imaging or laboratory tests, and learnt new practical skills under the care and supervision of the senior doctors, including lumbar puncture. The first few deaths of children under our care were heartbreaking, especially those which could have been prevented back home. But the opportunity to pray in Bangla in the name of Jesus at the patient's bedside was given to us time and time again by the grieving families, nearly all of whom were Muslims, and this was very humbling.
My next rotation at LAMB was acute general medicine. I encountered a bewildering variety of diseases with which I was very unfamiliar (visceral leishmaniasis and organophosphate poisoning to name but two), as well as a range of illnesses which I had seen on the wards back in Oxford but which tended to present much later and at a greater level of severity in Bangladesh, such as diabetes and ischaemic heart disease. Again, it was a privilege to work alongside such a skilled and compassionate team of Western and Bangladeshi doctors, and I learnt much from their diagnostic approach, clinical acumen and bedside manner. I learnt to preface every diagnosis with the question "could this be tuberculosis?" and found that the answer at LAMB was invariably "yes" – at any one time, about a third to a half of our adult patients had a working diagnosis of TB, and it is the number one cause of death in Bangladesh.
Saying goodbye to the team at the end of the ten weeks and returning to Western Medicine in the UK was a difficult transition to make. After seeing and learning so much about developing world Medicine and health inequality, it was quite dislocating to have to slot straight back into the NHS. But I hope that my experiences overseas will make me a more patient centred, careful and humble doctor, and that I will have further opportunities to travel to developing countries as a doctor during my career. I would like to extend my thanks to the Walter Guinness Trust and to Oriel College, Oxford for their generous financial support of my medical elective.