Made in Bangladesh

…another project!!!

(ok, i’ll admit that is rather cynical sounding, but it’s becoming a standard joke that every three months we open a new project in bangladesh – the emergencies have kept us on our toes!)

quick update:  i went on leave in april, and came back to another project opening!  we carried out a food assessment in the chittagong hill tracts back in march/april, and the results came in – there was definitely a need to intervene.  so we have started up a short term nutritional intervention in the region that appears for now, to be the hardest hit by the flowering bamboo/ rat infestation (for more information, click here).

so the past month has been another flurry of activity.  6 new expats so far, with some on the way.  plumpy nut arriving on planes (a form of ‘ready to use’ food which we currently use in our feeding program in teknaf as well – sachets of a paste made with peanuts, milk, sugar and vitamins – kids love it!.  more info on ready to use foods here).  the area we are working in is not unfamiliar to us – you may recall the post from over a year ago when i was in khagrachari for the final phase of our malaria health program.  the hill tracts are a very unique region of bangladesh.   it’s very hilly, and there’s a lot of jungle (as opposed to the rest of bangladesh which is river delta/ flood plains).  malaria is a huge problem up there, which is why we had a program for so long.  until a few years back, it was a conflict region as well.

the access is difficult, not tonnes of roads, and during the rainy season the streams become rivers.  lots of hills, and jungle combine to make a lot of locations ‘walk-in’ only.  the assessment took 4 weeks simply because of the amount of time it took to reach each location!

our logistical teams are currently trying to get to set up outposts in different areas so that the medical staff can set up feeding programs.  as i mentioned, the terrain is not easy, and there’s lots of hiking involved… everyone lives in pretty small villages, and they’re pretty far apart, so we have to find a way to make sure we reach the malnourished kids.

next challenge is a food distribution (!)

so how did everyone celebrate international women’s day?  i really did not do much more than work.  but i did think about the whole ‘what does international women’s day mean to me here in bangladesh?’ and mostly, international women’s day made me think of the moms in the hospital in the refugee camp.  moms holding tiny malnourished babies.  moms who are barely past childhood.  moms that as malnourised as their babies.  when we did our nutritional survey in november, we gathered data that revealed 1/3 of households in tal camp are female headed.  as well, 1/3 of children between the ages of 6 months and 2 years are malnourished. and one more ‘IWD-appropriate’ statistic; 1/4 of pregnant and lactating women are malnourished or are at risk of malnutrition.

while i was in teknaf last month, i saw a baby that was only 1 kilo when it was born.  the baby was doing remarkably well, and had fattened up to 1.6 kilos by this point.  mom had gained some weight too, as she was 24 kilos when she came to the hospital.  she was smiling a lot and showing off her baby to the doctor who had come back from vacation, asking how soon they could leave.

some moms held babies that did nothing more than look.  they just looked up at the ceiling, up at their mom, or just out to whatever was holding their gaze in midair.  they weren’t crying to gurgling or laughing.  just looking.  the babies that just stared made me scared.  it sounds wimpy to say, but they looked so fragile, serious, and just so ‘not like babies should’.  later on, one of our staff members showed me her new baby, and it was fat and reassuring, and i realised that they sight of a malnourised baby is still so unreal to me, so very sunday morning fundraising 30 minute infomercial on tv.  instead of babies, they look like frail old men, lying there staring at you, asking for some sort of explanation.

i would talk to the moms a bit (ie. say hello and smile and use some universal sign language since we had no common spoken language).  i was thrilled at one of our hospitals, when a 13 month old girl, 1 day from being discharged and feeling goooooood, smiled up at me when i walked around.  she had big eyes naturally, not just the kind left hollow from a wasting face.  big eyes, and the start of some chubby cheeks underneath.  and she gave me a grin that revealed the new teeth arriving.  all that baby wanted to do was giggle and shove her fist in her mouth to soothe her aching gums.  but our nurses, who are constantly trying to reinforce hygiene, kept reminding mama to pull out the hand.  baby was a bit disgruntled with this, but i tried to distract her by playing peek-a-boo with my scarf.  she was SO into it!  she started using mama’s scarf to hide behind.  woot!  what a party.

then she wanted down, and showed off her hesitant steps.  i was kneeling on the ground and she toddled over to me and then collapsed onto my legs, grinning again.

so i took a seat on the floor, perched the little one on my leg, and we had a fine 10 minutes of hanging out time.  mom thought it was funny, the nurse tried to get me to not sit on the floor (the staff hate it when i sit on the floor, or on a step or anything that isn’t a chair), and this little girl just had a field day trying to climb up my hair.

so i will try to do with this story, what i do with so many others in an attempt to keep myself sane.  i will look for the silver lining, the lessons learned.  i will be proud that we are doing what we can, and treating those people who we can treat. i will forgive myself for the shock i felt when i saw the 1 kilo baby.  although to be honest, i hope the sight of a malnourished child never fails to shock me.  i hope i never normalise this.  i hope i can respond to the nightmare with compassion and action, and not shutting down, or bailing out.  It’s so easy to avert your eyes, i hope i don’t.

well before i scooted off for vacation, i did make it back to teknaf for another field visit.  this time i brought with me Leonie (see below), our WatSan from the Dhaka Emergency DTC Project (more photos coming soon!!!), and a visitor from HQ, Ms Katya, who is our Expat Support Office (lots of HRM duties)We flew to Cox’s via Chittagong and it was nearly a private jet by the end since we were the only folk going to Cox’s.  The flight attendant let me know it wasn’t the best time of year to visit, and perhaps I should delay my trip

here’s a shot of me taking my human resources responsibilities seriously.  neck massage with smelly de-stress potion.  i take care of my people!!

next we had a 2 hour car ride (much shorter than when the flight is to chittagong).  katya is a bit of a photo freak so she took lots of pics out the window of the car.  i think it was the first time she’d seen real rice paddies.. although these look a little flooded.

if you don’t see rice paddies when you look out the window you probably see this:

then finally we see the blessed sign!

(have i ever mentioned that everything here ends up water damaged somehow?  our logco came back from a field visit and the shoes he had left in the apartment had grown mold…)

so first thing… get some work done at the office.  meet with the
Project Coordinator, Administrators, and later on a meeting with all
the Expats to go over HRM/Finance things to update on
policies/procedures, and see if anything has come up (Question
Time!!!).  Then off to the house for an evening of chatting.  Fun.
Here’s a pic of the office for reference.. (and leonie waving)

For
the rest of the trip I had meetings scheduled.  Looooots of meetings.
First one, was with the office staff: mostly your logisticians,
administrators, translators, guards, cleaners and drivers.  I managed
to schedule this for the hottest part of the morning when there is no
shade.  So um, I’m not going to post photos of me melting.
But, Purpose of the meetings to discuss:
1/
MSF Principles and how they translate in our daily work (like
neutrality, impartiality and a core belief in the right to medical
assistance) – and how can we relate that to our reasons/actions here in
Bangladesh.
2/ Each of our role in helping patients (from loggies to doctors) – let’s all brainstorm those ways!
3/
How our work here is part of broader movement, and how serving the
patients and adhering to principles like neutrality and impartiality
has a worldwide impact on MSF being able to work the way we do.
4/ Annnnnnd always the question period about specific HRM/Admin/Finance policies and procedures

And
the first meeting with the office staff was good – the staff had a
great awareness of their organisation, and happily all knew how
important their place was.  I worry about non-medical staff sometimes
feeling like they aren’t important, but the storekeeper knew that he
had to keep the drug store organised and the stock cards up to date so
that the doctor wouldn’t run out of a medicine, and our beneficiary
could get treatment.  Huzzah!

The second meeting I did was with
the staff from the Feeding Centre (TFC) and the (Out-Patient) Clinic
outside Tal Camp.  Here’s a shot of some of our staff at the TFC:

This
was a good meeting too – and I was so happy when I asked our Clinic
Cleaner how she saw her role in patient service.  I was given a very
good run down on hygiene practices and the impact of poor hygiene on
health!  The guards as well knew that they played a totally important
part in facilitating the medical triage that goes on at the front gate
(done by a medical staff).  I was thrilled to see that all the staff knew
how important they are in our programs here!

I took a break from the large workshop type meetings to chat with the
Clinic and IPD (Hospital) Supervisors.  Mostly to discuss scheduling
and things… and i’m totally listening in this picture… it’s just
really hot.

these
guys do not suffer from ‘expat fear’ at all which is great, so they
totally let me know what was working, what wasn’t, and how they thought
it should be fixed. i’m happy now because i think we’ve resolved the
main issue they brought up.  huzzah!

(expat fear: the affliction
of being somewhat hesitant around these strange foreigners who show up
and like to make changes and have the potential to run amok. can be
developed after working for INGO’s where this has happened.  Often
leads to not speaking your mind when statement would contradict
presumed desires of an expat.  i don’t blame people for developing
expat fear, but i wish the causes weren’t there….)

Our Expat Midwife/Nurse Penny enjoys watching the Doctors grilling me   Beside her is our translator Sworna.

we
did a tour of the IPD which was great because I hadn’t seen it since
all of the construction was completed.  Here is the Emergency Room:

and the pharmacy

and
penny here is showing off her fabulous birthing unit, a small separate
building beside the IPD.  and no, that is not a noose, but a birthing
rope that penny had put in.  dear penny has worked around the world,
and apprently the concept of a suspended rope like this is one women
have thought of nearly everywhere!

demonstrated… (tee hee)

oh, and here’s penny showing me the real use for a bed in a birthing unit

and then a quick hi to everyone else working!

i
don’t have an exterior picture of this hospital (We met and toured the
Nayapara one) but I’ll include a shot of the Kutupalong IPD below so
you know what they basically look like from the outside:

it
is super handy to have a logisitician who is an architect by trade when
you are building new hospitals.  they will make it all very nice, while
coming in on budget (i know, the budget thing is boring to everyone
else, but i’m the finco…).  the roof is very cool – the extra venting at the top makes the ipd sooo much cooler than you’d expect in this climate.

the last two big staff meetings
were scheduled with all of the staff of the 2 IPDs.  the first one was great,
and as the staff were all less than 6 months working as well as being
seconded from the Ministry of Health, i wasn’t expecting everyone to
have too much to say about MSF… but i was wrong!  very good
discussion – and i must say they took the most advantage of the Q&A
re: finance/hrm/admin.  How does everything work and why that way!?!?
by the end, i was exhausted… but still satisfied with it all.

a couple of evenings we took advantage of the cooling temperatures and
lack of monsoony rain to wander through teknaf town.  it would be a
nice relaxing adventures if delivery trucks didn’t take up 99% of the
road and nearly crush you repeatedly.  but here we are wandering:

and here’s the local spice stall/hardware store (cumin and nails, together at last!):

it is truely a coastal city… lots of boats:

and a great sunset

and so ends another trip to our fair teknaf.

between june 4 and june 28… i managed to make three trips – the first to teknaf for 5 days (2 of which traveling), the second to bangkok to renew my visa (a hardship i know – and that was 4 days with 2 being travel – and then another trip to teknaf (2 1/2 days of travel, 1 day in the office).

i was a little tired when i got back from that last one.  2 1/2 days of travelling to get a day in the field was a bit rough – and that was the easy route!  originally i thought i’d have to stay overnight in chittagong on the way back because there was no space on the flight that left in the evening – just one on the 8 am flight (ugh).  but i went to the airport anyway, and made really big puppy dog eyes and pointed to my two colleagues who already had tickets and basically begged the counter staff to put me anywhere on the flight (i could huddle in the lavatory for 45 minutes no prob).  i offered that i wouldn’t need to eat any snacks, and i could even pass on the mango juice box they always hand out.

and 5 mins before the flight was scheduled to leave they gave me a boarding pass!!!! huzzah i cannot describe how happy i was about this.  (they didn’t make me sit in the bathroom and i got 2 mango juice boxes and a chocolate wafer bar…)  to know i could sleep in my bed (i didn’t care at this point that my bed at home was a foam mattress while the hotel likely had a real box spring), to know that i’d eat at home with my husband – ahhhh what joy.  this was thursday evening and i’d spent tuesday morning at an airport, tuesday afternoon picking up oxygen tanks in chittagong for our hospitals, tuesday afternoon/early evening driving (4 hours weeeee) and tuesday evening in a hotel near teknaf since due to getting the oxygen tanks, we were running late and we can’t drive after dark – so fun hotel night.  then wednesday morning Abu (he’s been driving for MSF for more than 10 years!) and i set off at 6 am, stopped to get about 15 boxes of medical forms we had printed up (we print up our own forms for prescriptions and lab tests at the hospitals) and off we went for 2 more hours on the road.

after all that i made it to the office in teknaf pretty much on time for work!  but everyone was quick to tell me i looked like crap.  ‘whiter than an englishwoman’ was one of the comments.  i get kinda car sick when travelling, and one consequence apparently is that all the blood leaves my face and settles in my butt (this is an assumption of where the blood goes but i like the explanation for excusing why my pants are getting tighter).

i used to think lots of travel was romantic.  i’d read job ads that said ‘travel required’ and get all giddy and excited.  now… not so much.  i love the idea and i still get excited.  but well, the harsh reality of exhaust fumes and delayed flights has taught me better.  i know, i know, i work for msf so i should really get to a good place with travel… and i have mostly.  i mean, the fear of flying i developed while in sudan seems to have gone away (huzzah huzzah!) so i no longer think i’m going to die at least 8 times per flight.  and i like going to new places.  but yeah, sometimes it’s just not as exciting as one would hope.  most of the not fun parts consists of trying to find potties and food.  it’s a lot like road trips at home actually – have to plan where to eat, where to pee.  but here it’s a tad more complicated.

like, i try really hard to make sure i don’t drink too much water before a long drive (even though it’ll be dehydrating) because the look of stress that crosses a driver’s face when i lean over and say ‘um… could we find a bathroom’ is a look of stress i don’t like to cause. and it’s so densly populated here, that there isn’t even an option of hiding behind a tree.

on the trip to khagrachari in april, it took 30 mins before the driver pulled over to a big fancy gas station and went in and negotiated with the manager to let me use his personal privy.  and the last hour of the drive to chittagong last week consisted of me trying to find the best position to sit in that wouldn’t remind me of all the coffee i had drunk before we left.  (eventually we also had to grab the half full water bottles that had been making sploching noises and stash them under luggage so i didn’t have to listen). and it’s not that i mind too much the state of the loo – it’s that other people really mind me using them!  and, well, as far as i can tell, most public facilities here are designed for men and i don’t think i could quite get away with trying to sneak into one.  so i get princess treatment which means i’ve probably done myself permanent nerve damage around my bladder, but i do get to use some of the poshest potties in bangladesh.

ta ta

at the end of april i was lucky enough to make it khagrachari just before the closure of our medical programs in the area.  this is the first of a couple of entries about that trip.

khagrachari is located in the Chittagong Hill Tracts, which is the only non-flat part of the country really, and it is so much different from the rest of bangladesh. i had been to teknaf just the week before, and in both trips i flew to the city of Chittagong and then drove to the program site. to get to teknaf (where tal camp is) i drove south, while to get to khagrachari i drove north.

at first both journeys seemed quite similar [the mad dash to the airport, the delayed flight, the bumpy airplane ride complete with betel sweets and the one hour drive through gridlocked traffic in chittagong city to get to the highway]. and even the first hour on the highway was similar. i found myself becoming convinced that bangladesh was in fact one large city with varying degrees of population density. every time i thought we were about to hit an empty stretch between towns, the spaces between houses were shorten, and the number of rickshaws would increase and suddenly there were shops and bus stops surrounding us. nearly the entire highway route to teknaf (5 hours drive) is bordered by shops and houses and livestock and rickshaws.

(And I can’t forget to mention the huge buses who feel that they should not pull over when the stop for passengers, but in fact just stop on the narrow road causing other large vehicles to swerve to the other side of the road to pass them, regardless of the presence of oncoming traffic).

on the trip to teknaf, it was only the last hour or so of the drive when there started to appear rice fields and larger plots of land with less than 90 people in site at all times.  (perhaps this was due to the fact that we were no longer on the main highway that goes to cox anymore, instead on the highway to teknaf.)

but on the drive to khagrachari, there was a point less than halfway there, where not only did the shops thin and i could see signs of the rural communities i’d heard to be quite a large portion of the population – but there also appeared to be land that was not inhabited at a density rate that dwarfed the west end.  suddenly hills rose up, and you could look at trees!  people could be seen walking along the road, on their way home from work, but it was not as claustaphobic suddenly.  suddenly, we were in the chittagong hills, where things are very different.

[and on a total side note, i love journeys where the landscape changes dramatically depending on the direction of travel. going into the hills looked so different than coming out of them out that i feel like i had two different journeys. see below for a picture of the trip out – this shot was taken just after we'd come out of the hills. you can see a rickshaw ahead and a truck full of goods (and people) coming towards... notice how it's nearly in the middle of the road]

these photos were taken by our log at ‘tal camp’, just two weeks ago - the morning after being battered by the winds and tides of a nearby cyclone.

this makeshift camp (it is not an official refugee camp) is situated between the highway from teknaf to cox bazaar and the river Naf (you can just see the highway on the right hand side of the picture below)
the camp occupies an area that is 800 metres long and between 50 and 30 metres wide

at least 7500 people live here

since the storm we’ve been trying to repair the latrines that we built a few months back that were destroyed (and flooded) in the storm.

we also run a basic health care clinic and a feeding centre for tal and surrounding residents with an average of 100 consultations a day at the clinic.  over 40 children per day attend the theraputic feeding centre.

this is tal camp.

(thanks to luca for the photos!!)

and for the press release from last march (which i posted earlier so some of you have already read it) please click here

Well here it is, the first of my long awaited field trip posts from teknaf and khagrachari. I left nearly a month ago, and sadly, I’m just getting to this post now. The past month has been a blur of field visits (2 work weeks worth) and budget fun.Honestly, I can tell you that for someone who enjoys budgets as much as myself (I know, I know, a sickness) this past month has even been enough to turn me off of numbers. Although I’m getting quite good at estimating the cost of bamboo roofs (just another one of those transferable skills you pick up working for MSF

Ok, so Teknaf. Now, technically I was supposed to leave on the Sunday, the 15th of April, in the morning and fly directly to Cox Bazaar (about an hour or so). But the airline called me on Saturday afternoon and told me that the flight had been cancelled. I’d been warned that this airline was known for canceling flights, so I took it in stride as they rebooked me for the flight to Cox on Monday morning. So leaving my knapsack empty, I went about my normal routine and wandered in to the office Sunday morning for a regular day of work.

And then they called again. Nope, Monday flight cancelled too.Would I like to fly Tuesday? At this point, the trip is starting to shrink beyond the point of usefulness. The work week in Bangladesh is Sunday through Thursday, and the last thing you want to do as a capital staff person is show up in the field and force the field expats to work with you on their weekend (they rarely get a weekend off as it is, and I’d rather they only work when it’s emergency related, not the Finco wanting a tour of the clinic). So if I flew out Tuesday morning, then I’d have Tuesday afternoon and Wednesday and I’d be flying out Thursday. I start to ponder the usefulness of this Tuesday morning flight.

But that wasn’t necessary, because they cancelled that one too. So now it is noon on Sunday and I’ve nearly decided to ride a bike to Teknaf.The clock is starting to tick since it is one of the big budget planning months and since Teknaf only has a 6 month budget, and could really use a full 12 month budget, it was really important I get out there to talk to the team. Plus they were in the process of hiring 30 new staff for the new hospitals, and again, I felt that since I was ‘HR’, I should try to be out there to help with that if needed. So I started asking people around the office what the alternative was. And then we had it!There was a flight to chittagong in 5 hours, which could meet up with the car movement the next day! Huzzah! So now, all I had to do was wrap up at the office, go home and pack, run to the shop and buy cheese and chocolate for the field team, get to the airport, fly to chittagong, sleep there, and wake up in the morning for a short car trip (4 hours) and boom… I’d be in Teknaf just past lunch on Monday. The whole trip would take just less than 24 hours. (Seriously, look on a map at the distance; it’s like going from Vancouver to the Okanagan. The bicycle plan may have saved time).

But all of this was nearly for naught. I arrived at the airport totally sweaty and gross since the power was out while I was trying to pack and I kept wavering between shoving my laptop in my knapsack (too heavy) and carrying it separately (would have to check a bag) which finally resulted in me repacking in the car (never recommended). When I finally got to the airport, I had about 15 minutes before the flight was scheduled to depart (my mother is rolling her eyes as she reads this) and so I rushed through the front door, shoved my bags on the security belt, and went off to where the woman could pat me down in the privacy of a curtained booth. As I finished up, smiling at the guard with the big gun, I glanced up at the screen and saw a flight to chittagong listed… and it was cancelled.

So in true Julia fashion I grab my bags, dash out the door, and chase after my driver who is starting to pull away. Many people watch me do this.And they are giving me a lot of space. The driver parks and comes up to me just as the information screen switches from bangla to English, and at that moment I realize it is not actually my flight that has been cancelled but another one scheduled for the same time, and if I want to check in on time, I’ve got about 5 minutes to do so. I apologize and sheepishly slink away from the chuckling driver (and observers) and reenter the airport. The men at the front wave me past the initial check, since I’ve already had my bags and person searched, but the guard waves me back – he would like for me to be rechecked. [This exchange would later provide me something to mull over while I waited for my flight – is the guard now suspicious of me? Am I going to get hauled away? I don't like to annoy men with guns.] At the desk they don’t seem concerned about my timing, but as I would soon realize, that is because the flights don’t actually leave as scheduled. Nobody actually tells you this though. You just sit in a large waiting hall, sitting, waiting, watching the clock tick past the actual departure time with no announcements, looking for people holding the same ticket as you for reassurance, and the finally a podium is set up, and people in the appropriate uniforms start taking tickets. Everyone then piles into a mini-van and off to the plane and away from Dhaka.

honestly, i swear, i am writing my adventurous field visit posts right now.  so they will be posted soon.  in small chunks, because if i did it all in one it would be 8000 lines long and no one would read it except family members who love me so much that they will read any nonsense i type out and they would end up with eye strain.  so little posts.

promise.

Today I am just a little bummed because I was supposed to get out to one of the projects on Sunday, and then the other one the week after.But I found out today, (Thursday = our Friday), that while the former finco and I did a great job checking with the projects about the timelines, we forgot to check with the staff here.So I have a meeting with the auditors and a meeting with the people who approve our visas all scheduled for next week.So, malesh, I must put off the trip for a bit. Which I know will disappoint the expat teams out there since I have promised presents of chocolates and seaweed.

But this delay may in fact be handy since I hadn’t yet purchased a shalwar kameez (traditional garments for women here) to wear in the field.While there are a few of the long shirt/ baggy trouser combinations left in the guesthouse, I have the feeling that either we’ve only had teeeeeeeeensy tiny female expats in the mission or most of the garments have been worn/laundered to exhaustion, (except for the teeeeeensy ones left in the guesthouse of course), since there are none there that come even close to fitting properly. And I think it may defeat the purpose of wearing traditional garments if they are so tight they look like they were painted on.All in all, gotta go shopping before I hit the field!! Yah!! Now if only I could find the stores…