Clinical rotation, campus guards, boat rides down the Buriganga River and the busride of near death

I know, my postings are becoming increasingly lengthy, yet you keep coming back! Welcome back, friends.

Since my last posting, I have gone on my first clinical rotation to United Hospital near the Gulshan area, right outside of Uttara (I live in Uttara, near Dhaka, the capital of Bangladesh)! Last Thursday was honestly the best full day I’ve had in Bangladesh. That’s a bold statement, hey? Haha. So I woke up and we were at the hospital around 0730. Clinical starts around 0800, but the students still have to get changed when they arrive (there’s a school van that leaves at 0700 but some students arrange for transport independently). I found it really frustrating at first. The students have around the same skills set as I do, if not more, and many of them have yet to give PO meds. That baffled me, honestly. At first, I was so disappointed with it, I thought, ‘how is that even possible?’ The possibility for me to do skills was but a distant dream, if the students weren’t even able to. Why is this the case, you ask? Apparently it’s a part of the culture over here – the nurses are not very receptive to students doing the tasks and would rather do it themselves. It was frustrating for me as well, because I didn’t see the students GOING OUT THERE and being assertive and saying what they wanted to do. I even went to the nurse to ask if she needed help with anything and if she needed help with anything to not hesitate to let me know. She said ‘no’ and then didn’t even bother looking at me after that. It didn’t bother me too much, I just let it roll right off my back. What also saddened me was that the students didn’t take their own learning into their own hands. BUTTTTT I am well aware that it’s a different culture here, the ppl here are taught to listen to their elders, not to challenge the status quo. Interestingly enough, I had a flashing image of Family Theory go through my mind, about challenging status quo, and I guess I really just take advantage of being able to do so freely.

Rest assured, friends, I did not just sit back and wallow in my frustrations. I took the opportunity to go over pharmacology with the students on my floor (cardiac floor)! I felt so alive. I can’t even begin to explain how thrilled I was to see Arif, one of the students, put two and two together after I had pointed out the pharmacokinetics of calcium channel blockers. I had to clap out of glee when he made the connection between the –prazole drugs. We looked up proton pump inhibitors at the back of the book where it listed a number of them (esomeprazole, pantoprazole, lansoprazole etc) and he mumbles, “oh, all –prazole) and you have no idea how wide my eyes were when I was staring at the top of his head. Eyes wide, face full of hope and he goes, “oh!” and it clicked. I loved it.

Next was Tanjina. I went over some drugs with her, but what I love is how I have been able to adapt things I’ve liked from all my previous levels and show it here. For example, the drug tips were from level 1 and from level 2, I remember explicitly on the first day that my instructor said, “You can usually get a pretty good glean of your pt’s condition by looking at their drugs” (ex. They might be in pain if they’re on morphine and have taken it regularly) So I’ve poached it and worked with that concept here with Tanjina. I have also been able to talk about post-op complications (ex. Why would a post-op pt be on domperidone?) in relation to their meds, so to really try and get her to understand why things are ordered and to ask questions when things don’t make sense. She seemed quite receptive and excited to make her own connections. I’m also trying to foster confidence in the students here and I do that by offering positive reinforcement and really just letting them know that they really DO know the answers, but that I just guide them there. It’s really exciting to see them smile when they get the right answer. Knowing that they’re smiling because of you is…..so heart-warming.

After I came back to school, I had 30 minutes before my first round of first aid classes to the campus security guards. Can I just say that I have never had so much fun teaching first aid in my life? These men (ages ranged from my age-50’s) were so full of life and were so captivated by the content. They loved the practical component and were so engaged in the conversation. Thank god for Shahed and Asha (senior nursing students) for coming as my translators! I laughed so hard with them and found them very endearing, actually. The second class was also fun, I had two trouble makers. You guys, they were THE cutest!! When they were checking breathing, one of them would be blowing into the other person’s ear and they would both be giggling. SOOO cute! But of course, I had to split them up cuz they were being counter-productive. I wouldn’t even let them face each other with different partners cuz they were getting each other all riled up. I took pictures, so I’ll def post some up, now that my pics are on my USB key!

On Friday, I went on a boat ride down the Buriganga River with Rhodina, hit up Hindu Street in search of Deepak’s wedding cake topper, and walked around a bunch of Bazars in old Dhaka. The boat ride was so much fun, though the boat guide made me a bit uncomfortable. He kept on saying I reminded him of his wife (no resemblance at all). We got a tour of the social housing area where he lives with his family and his neighbors. It was quite fun and I got henna done on my hand! It was fun, but also very overwhelming. The boatride was definitely a highlight of the trip, though! I’m glad I went, despite there being huge freights that wouldn’t hesitate to trample over our smalltime boat.

Busride of death. It says it all. I’ve never been on a bus SO full in my life, where I’ve been so afraid of falling out a window and been rubbed up against so much. It was both upsetting and a learning experience. I was more upset about my submissiveness than about the act. Instead of verbally telling him to stop and get away, I just moved. And he followed. And I moved again. Lather, rinse, and repeat until I finally managed to get a seat. I was just more disappointed with myself than anything. I think it was more a matter of me not knowing how to react and how others would react. I did hit him in the face with my bun multiple times. Not painful by any means, but unpleasant, especially considering how sweaty I was after that day. HAHA, sucker. Also, he’s lucky he isn’t a student at IUBAT, otherwise he’d be in for it. I’m good friends with the security guards now, you know! Haha.
Oh!! One last note, I’ve assigned the students lab values to look up and we will be going over them at the hospital instead of in class. I was very firm with them and said that I expected them to be in on time and that two days was plenty of time to look up 2 lab values (which I think is true!). I also offered them my help in any way possible and invited questions. Here’s the exciting part! This morning, three students came to me with questions! And I said I would help them as long as they had SOME work done, but I wasn’t going to do their work for them, and they came with questions ABOUT what they had already done!!! I felt so triumphant. I have high hopes for them and I know they can do it. I hope they know they can, too.

Love you all,
Cass Ma

Sprained ankle, night sweats, money changers, and language barriers

Almost three weeks in now and I’m adjusting quite well to everything and everyone.

Last weekend, in Gulshan, I managed to sprain my ankle while jaywalking, dodging a kid asking for money, and looking for oncoming traffic. I stepped off the median onto a rock and rolled my ++ weak left ankle (the one I sprain ALL the time). I fell onto all fours in the middle of the street and almost got run over by a car. For real. I was so scared. I don’t know if it was the shock, dehydration, or heat, but I was so dizzy and started seeing spots. I knew if I tried to walk, I’d pass out in the middle of the street. But no better place to hurt myself than with 3 other nurses and a decently sized crowd of hospitable strangers, n’est-ce pas? A few local ppl helped control traffic while I seeked shelter behind the gate of a restaurant. The security guard of that restaurant gave me his bench to sit on J while another person went to get me some ice for my ankle. I felt much better after about 15 minutes. As soon as the dizziness subsided, I started laughing at myself but more importantly, I was SOOOOOO angry with myself! I knew I’d have to miss clinical the next day cuz of my ankle. Luckily, I popped two Advil and then another two before I went to bed and iced my ankle for a long while. I also had it elevated (RICE!) and thank you SJA for teaching me how to help myself. J FA nerd for lyfe.

It gets pretty hot at night in my room cuz the AC is pretty much broken. I wake up drenched in sweat. I’ve not felt my prettiest in my travels. Haha. Oh well. If you can’t take reading about me at my worst you can’t have me at my best. Hahaha!

So the other day, I was so upset because I thought that I told Vincent the wrong dates for my return ( I didn’t) and I thought we missed each other by a few hours. How tragic would that have been, hey? Haha. But for real, I was so upset I started crying in the nursing office – I am so ridiculous, I’m borderline ashamed to type that. Hahaha.

So I left the office early that day cuz I had some errands to run and it totally put an Eeyore cloud over my head. I had to go buy groceries and get money changed. En route to the money changer, I hit prayer time and there were a number of devout individuals praying in front of the money changer. I didn’t want to be rude and step over them, so I stood there, pacing kind of awkwardly, trying to figure out what to do, where to stand, whether I should join in. I noticed inside the jewelry store next to the money changer, the shopkeepers were motioning for me to come inside the store to sit. So I went in, sat with them, chatted, and they were sooo friendly and nice! They gave me a pop to have while I was sitting there but I thought it might be rude to drink it in there, so I just held onto it. I love how welcoming everyone is.

Last time at the money changer, I negotiated my exchange rate with them – they wanted to give me a lower rate for my small bills and I wouldn’t give them my passport till they gave me the same rate for all my money. Haha. Small battle won. This time around, I didn’t have any 100US bills to exchange, so they wanted to give me 68 instead of the original 70 they offered when they thought I had big bills. Another battle won because the guys liked me. Hahaha. Another thing I’ve noticed is that the guys here are very direct. One of them asked for my number and offered me his phone when I said that I didn’t have one. I obviously declined and when they asked why, I said that it was because my mom always taught me to say no when someone offered me a present (it’s true). Haha.

Tomorrow I start my first med-surg clinical day at United Hospital! I’m so excited! After clinical, I come back to school around 1430 and teach my very first class of first aid to the security guards on campus! I’m excited but also so worried! There are a number of things, actually, should I organize them based on the amount of fear or alphabetically? First, the guards barely speak English, and I barely speak Bangla, so I’m not sure if I can explain everything well enough for them to understand. Next, how am I going to demonstrate my assessments if I’m not supposed to touch people of the other gender? I’m thinking if I can’t get a female student to come as a translator, I’ll ask Musa to help me bring down the ‘Alex’ doll (mannequin, same as our Terry dolls at school) for me to demonstrate. Actually, I guess it’s mostly just those two things I’m scared about…but what if they don’t get my charm!? Without that, I’ve got nothing! I guess some can find my awkward laugh and rigid body language endearing at times. Oh well, here’s to hoping. This is what I came here to do, so I’m doing it.

On our walk home yesterday, Rhodina and I were asked by the kids who live near our flat to take their pictures. We spent a good 15-20 minutes taking pictures, I think. When we finally managed to break free, the kids came running after us with shrubbery and flowers or all shapes and sizes. We had mini gardens in both hands and didn’t have the heart to throw it away while the kids were still in plain sight. Hahaha. So cute.

Love you all, thinking of you all,

Cass Ma

Spider bites, gecko poop, and candlelit showers

Exciting news, Musa set up a computer for me at my workdesk now so I don’t have to monopolize the student’s computers as I work on my powerpoint presentations! Here’s to Musa! So I’m reading my last updates and I have to apologize for carelessness in spelling/word choice. But hey, if I can put up with power outages and showering with cockroaches, you can put up with my mistakes. J
Funnily enough, those ‘mosquito bites’ that blistered up turned out to actually be spider bites, we discovered the other night over dinner. It makes sense because not all my bites had blisters on them and I was so confused as to why those particular ones had developed them. I thought it was ironic that I was bit by one of the things I’m most scared of when I’m home in Vancouver. Let me explain….Bangladesh was something I was sooo scared of yet faced anyway. After I arrived, unconsciously in my sleep, I faced another one of my fears. And then it bit me. Multiple times. And I swelled and blistered. Haha. I think it’s safe to say who won THAT battle. (me)
The diagnostics course is coming along. Since I last posted, I have completed the first aid course for senior nursing students and compiled another one for the security guards at the school gate. That one is very very basic and they don’t speak much English, so it was a challenge making that one up. I used lots of pictures which I poached from google and tried to use as many simple words as possible. A part of me felt kind of bad doing that, borderline disrespectful, but it was how I was instructed to do so. I’ve actually got 3 first aid courses to teach aside from the one scheduled for the senior nursing students! I’m quite excited about that.
I’m starting clinical rotations on Sunday at the centre for rehabilitation for people with spinal cord injuries! I intend on going every Sunday and starting next Thursday and every subsequent one, I get to go to United Hospital to help with the med-surg students! I’m so excited. I brought scrubs and my stethoscope from home!!! I finally get to use them!
I invigilated my first exam on Tuesday – hand washing. Hehehe. We have boys and girls in the class so we had to go to the cafeteria to use their sinks cuz Corina and I didn’t want to stand in the boys washroom to watch them wash their hands.
I had to lecture some students on not completing their homework the other day. I felt horrible. They had one week to do it and then one of them was copying the terms right in front of me! Not only did they not do it, but they were copying right in front of me! And kept going after I caught them! I felt really bad for doing it and Karen’s talk about ‘not being their friend’ really became clear to me. I really hope they know that I don’t mean for it to come across as a power trip because it’s not my intention. This is adult learning, is it not? If you don’t want homework checks, you need to show me that you will do your hw on your own will, right? If you want to be an adult, you need to act like an adult. I really hope they understand where I’m coming from.
I was invited by Shehad (sp) to attend their nursing student association meeting sometime next week. I’m excited about that! I want to do a classics jeopardy/trivia game with them and I can use the telus sharpies Albert gave me as prizes! Something along the lines of what does erythro mean if erythrocyte is red blood cell and erythema means redness? So eryth would mean red. Something like that might be useful for them since they were telling me yesterday that English was very difficult for them! I’ll have to talk to him about it today. I also want to do the blood pressure stand on campus with them! Apparently in previous years the student association has set up a desk and done BMI and BP with the school, so that would be cool!
On my walks to and from school, sometimes the children in the area we live run by saying ‘HI!!!” and giving us flowers. This was one of those mornings. It is soooo cute. Who’d have thought that I would like flowers? J But it’s not just flowers, the thing that really gets me is that they grab little flowers or even twigs if they can’t find flowers. It’s just the novelty of giving something to us. That’s what I love. I think it’s adorable.
I went out to buy bananas the other day nearby and got lost on my walk home. The bananas are amazing here. They totally blow Vancouver’s bananas out of the water. They’re the little ones!! They taste like banana but then there’s a hint of sourness to them and it’s awesome!!!!!! So I got lost, and thought, ‘uh oh, I don’t even have a phone. Even if I had a phone, I wouldn’t know what number to call!!!!’ I don’t even know the house I live in!! Thank god for this one apartment building I use as a landmark to get home everyday and I oriented myself around that one.
What I’m seeing here is a sense of simplicity that astounds me. In my last trip to India, I was very moved by the poverty and felt a lot of guilt. What I’m seeing here in Bangladesh, though, is a sense of contentment and hospitality despite having bare essentials. I’m moved by it in a completely different manner. For example, when I was lost, I knew that I could cut across a field to get to the path I take home from school everyday. The field, however, was where a few families have their houses, so it felt like I was trespassing and I was sure to ask if I could walk across. Not only did they smile and waggle their heads, but one of the ladies felt compelled to walk out towards me and guide me along the walking path made of cement sacs. Something about that act really touched me. In Vancouver, how territorial can we be? Something about her was so warm and made me feel just…welcomed. Ok, that may have been really dramatic for most of you, but something about that exchange just got to me. Something about kindness knowing no differences – you don’t need to speak the same language to be kind, you don’t need to be from the same country to be kind, kindness is free. And that’s powerful, to me.
Anyway, I must apologize for not being able to load any pictures. Because Lovebug is dead, I can’t upload any pics onto any computer cuz I don’t have a card reader. Let’s all take a moment and appreciate the computer tech guys we know and love (Hen).
Love you all,
Cass Ma

Beautiful Chaos

So it seems as though I cannot post onto my blog using the school computer. My little netbook, Lovebug, has passed on (possibly only on a temporary basis!!!!!!! HENRY!?!??!!) I was quite upset, I’m not gonna lie, but as my mom always says, ‘if it’s a problem that money can fix, it’s not really a problem, is it?’ J

The past few days have been good. I’ve been given permission to revamp the diagnostics lab course! Great news! I also get to review my own pathophys and incorporate it more into the course. I’ve talked about it with Rebekah (fellow volunteer) and she says that in addition to the PBL resources I have (high/low values, what the test indicates, etc) I can get them to look up clinical manifestations as homework. Or maybe I’ll do this for them and get them to do a pathophys review session for each other. Either way, I really want them to do some form of presentation to each other so that they can practice their spoken English.

I’m almost done my first aid course. Thank god I saved all my documents on my USB key, otherwise I would’ve lost EVERYTHING that was on Lovebug (all my BCIT documents, travel documents, first aid course content, PICTURES!!!!!!!) Feels like that was the one thing I’ve done right so far. It’s so easy to know what you’ve done wrong, isn’t it, that the things you do right have an inflated sense of importance. Haha.

This weekend was so awesome. I went on a small trip with three other volunteers to the Srimangal area (the North-Eastern part of Bangladesh). We stayed at a tea resort and met a tonne of cool ppl. We left Fri morning around 0600. I went on my first rickshaw ride that morning. I have decided that Bangladesh is a beautifully chaotic country. There is so much beauty in the tea estates, in the fruit plantations, yet amongst the honking and blaring of horns on the streets, so chaotic. I’m still trying to wrap my mind around the irony of this country, or maybe even life. Haha. Dork.

My swollen mosquito bites have gone down to near normal sized. I still have a few blisters but most have subsided (thank, in large part, to me popping them) Nobody ever said that I was beautiful, the country. Nor am I glamourous. The cheap knock-off Rorschach test sweat design on my shirt will attest to that (pictures to follow when I come home).

In the trek around the tea resort we stayed at, Rhodina and I met some very friendly locals. I gave a part of my heart away to a cute little boy who followed us around the tea resort. I tried 5-layer tea (more a novelty than anything) and ate a lime another boy picked off the tree for me. J

On Sat, we went to Lowacherra forest and saw great big orb (banana) spiders, went chasing after gibbons (monkeys) off-trail and was attacked by leeches, thus causing my crocs to be filled with blood and dirt. Again, so glam. I was so scared, chasing after the gibbons, but I thought, hey, what am here to do? Now I have this great experience of going monkey chasing and getting three leeches caught on my feet (so weird). You bleed a surprising amount with each leech, I tell you!

So not without surprise, I had the big D twice this weekend. Oh well, as to be expected, surprised I made it a whole week without it! Nothing I can’t overcome and get past, though. Have yet to ‘pop a squat’, as Amy so coherently worded, in a public toilet but I feel it’s only a matter of time.

It’s been one full week and it feels like I’ve been here for so long. Time to finish off my lesson, hopefully someone will help me post this!!!



Love you all, thinking of you all

Cass Ma

Canadian Student Nurse in Bangladesh

That is the current time in Bangladesh. The past 5 days have been....shocking, to say the least. I guess this time, without my sister in a country so different from Canada, I have experienced culture shock. Maybe I've become more observant than when I was in India in 2008, or maybe my sister cushioned a lot of it last time. Either way, it's been pretty difficult the past few days. My pride doesn't like me typing that out, but this is a candid blog and I'm sure, looking back 2 years from now, I will chuckle.

Let me see. I arrived Saturday night and was EXHAUSTED. I slept quite poorly on the plane and fell asleep on my journal facedown after settling into my room, which is quite comfortable. I share a room with cockroaches (too many to name) and some friendly geckos. I shower with some cockroaches, too. The baby ones I can deal with, but the big ones still scare me. My flatmate is wonderful and has taken me to exchange money and shopping for a salwar kameez. The faculty have been very friendly and hospitable. I was so taken aback by the rickshaws and the busy-ness of the streets when I first arrived at night. The roads were shockingly busy. I'm not sure why I was so suprised by that. I swear India's streets at night were less so.

I've taken to journalling a lot. I think it's because for the first few days I was slightly confused by everything and feeling quite lost. I did, however, manage to walk to school by myself after the first 2 days( a task that sounds much easier than it actually is!!!!) The puddles are HUGE on the trek to school, and the local kids shout out 'hi! good morning!' to us as we walk by. It's quite cute. On the walk home one day, I saw some kids playing cricket in one of the vacant plots of land and if I see them playing again, I will ask to join, because I've never played before.

I've assisted in teaching a class (on Tue) and that was on mouth care and bed baths. On Wed I taught that same class independently. A shout out to all the BCIT nursing ppl - you will never know how much PBL can change you until you actually have to execute it and realize that you can execute the concept of 'chairing a meeting' in a classroom so well. Major props to BCIT for teaching me that.

I'm still quite intimidated teaching fellow nursing students. The culture's slightly different here. On my first day, Karen, the department head told me not to be humble about my skills (something that I tend to do) and not to play the 'Oh, I'm still a student, JUST like youuuuu' - another one of my strategies....another thing she said was that I could not be friends with them. I could be their friend, but they could not be my friend. Yet another hurtle to jump over for me. If you know me well, you know that I have this inherent need to be friends with everyone - weakness/strength, you decide for yourself. Therein lies two major things I have to work on but I am so thrilled. This is partly what I came here for, to see how far I can push myself, right?

I'm also supposed to be teaching this diagnostics labs course in July. When I read the course material, I FREAKED out - I honestly did. It was so in depth and I couldn't even understand much of it. But after talking to Karen, she said that I could modify it so that it is more nursing related and I can give her the proposal for her to look over. This is another huge learning point for me because I will need to teach patho in each lab test. This is huge for me because patho is one of my weak points. I'm really glad I've come here. It honestly seems like everything's happening to push me to be better, as weird as that sounds.

Anyway, I have to finish up my first aid course before I go to open lab! BCIT folk, you have no idea how lucky we are to work in a lab like ours. I will post pics soon, if I can.

Love you all, thinking of you.
Cass Ma