Brainstorming for the future

 

Welcome to the ICU here at Dhaka Medical. It was an interesting morning. Here's a brief run down of what I observed and learned:

-there are twenty beds and they are always full

-there's no method of performing dialysis at the bedside

-bronchoscopy (camera to look into the lungs) has to be done in the OT(operating theatre=operating room), there's no mobile cart (transport of critically ill patients can be dangerous)

-guillan-barre syndrome is a common diagnosis, it's too costly to administer some of the disease modifying agents (IV immunoglobulin or plasma exchange) and physical rehab is hard to come by, it's done by family members 

-the arterial blood gas(sample of blood from an artery which quickly is analyzed and gives levels of oxygen and carbon dioxode among other things)  analyzers are non functional throughout the majority of the year

-the portable cxr machine is available, the films are hard to read bc they are still old school films and sometimes the cassettes (to capture the film) run out 

 

-the monitors are often missing parts 

-there are ventilators and they DO work...

 

The need for further training in ventilator management along with how best to utilize the resources that do exist is low lying fruit. It is a whole other thing to just provide missing resources without a plan for sustainability. How to balance this issue is what strikes me as one of the biggest challenges.

*all images were taken with permission of staff and surrounding family 

Eye opening morning!

 

Today I observed the care of a critical patient in the ICU. The patient's blood pressure was dropping, oxygen saturation was dropping rapidly. The physician very skillfully placed a central line and administered the proper medications and fluids. The patient is a trauma victim, a young college student who came in the night before. He came with a brain bleed which was evacuated but he continues to be in grave shape. In the evaluation of such a sick patient having the ultrasound at the bedside would have been really helpful. He could not undergo a CT survey of his injuries bc of cost and availability limitations. Is he bleeding somewhere in the belly or around the heart or does he have a blood clot? All questions we can address with the ultrasound. 

So with this in mind we forge forward with the details of the sessions. Here is the planning committee with me--we are discussing how to further recruit and organize the sessions. Checking to see if equipment is working etc. 

 

Tomorrow I will round(observe) with the ICU team and further understand the needs of the patients we seek to help.

Preparing for the next week!

So I am in Dhaka now, trying to adjust to jetlag and escape the wrath of mosquitoes. 

 

Unfortunately I've always been a very tasty target for mosquitoes but to date I haven't had any issues malaria or dengue.

In other news:

We've received a few copies of some ultrasound reading material and a few cds with PDF copies for the physicians we will be working with. Thanks to the donations from you all!

 

 Additionally we have some great news, a few more sessions will need to be scheduled as the interest level is so high. This is exciting for multiple reasons, hopefully the buy in is high and if things go well some of these other hospitals will see the need for an ultrasound and purchase one themselves. The teaching workshops will take place in both Dhaka and there will be a workshop in Sylhet as well! 

 

Tomorrow or the day after I'll be heading into Dhaka Medical College and Hospital to start preparing for the workshops themselves. This will include checking out AV equipment, checking and double checking that the computer and power point presentations will work. I'll also get a chance to round in the ICU as well! 

The ultrasound we will be using is in-country and will be in my hands by the end of next week (2/3).

Signing off for today!

Beware the blood clots!

I'm traveling from Hawaii after having spent a few days there for the Society of Critical Care Medicine conference. The plane ride there from NYC was 10-12 hours total. I am unfortunately flying the transatlantic route from Hawaii and as such I flew to LAX (5 hours) then I'll have 16 hours to Dubai and another 6 hours to Dhaka.

 

 In our line of work (pulmonary/critical care) we see a lot of blood clots in the legs(deep vein thromboses) and in the lungs(pulmonary emboli). These lead to being on blood thinners for a prolonged period of time. Certainly my exposure to patients like this is the reason I am currently wearing compression stockings, chugging tons of water, have taken an aspirin and will be doing leg exercises in my seat to try and prevent this from happening. Yes of course there is a risk but I may be overdoing it...and it leads to a reminder that we are all biased by our experiences. As I continue to think about and prepare for what's to come I have to remember that my own experiences are in a sense a limitation where I am going. There must be room for creativity, ingenuity, pliability and the ability to keep an open mind.  What we see commonly in the US is not necessarily what we will see commonly in Bangladesh. Every global health setting comes with its own personality and its own challenges!

Welcome to the official blog of the Bangladesh Ultrasound Initiative!
To those that contributed, THANK YOU! What you have done is contribute to a project that is not just a one time effort but the beginning of a long term educational intervention which is meant to be sustainable and cost effective. 

To those of you just joining the journey welcome! Below is a summary of what we have been up to!

Bangladesh is a country rich with culture yet rife with poverty. Though there are many aspects of this country that have thrived i.e. the garment industry, agriculture; still there remains a large deficit in the area of health-care delivery. There are a sub-set of hospitals which provide care to those who cannot afford private medical care. These hospitals fall under the category of a resource-limited setting. In a survey distributed by our team to one such setting we discovered that X-rays and CT scans are not readily available nor reliable. The mortality rate surely rises with the delay of diagnoses and therefore management. In such a setting we will be introducing the use of an ultrasound machine at the bedside, a mode of imaging which has been vastly integral in rapid assessment of respiratory disease, trauma patients, abdominal catastrophes, etc. 

Over the last several months with your help we have raised $11,600.00. $10,000 of this total went towards the purchase of the ultrasound machine itself along with corresponding accessories (for example the probe which is used to acquire the image). There was a small tax that was taken by the GoFundMe campaign and an added cost for safe and LEGAL shipping of the machine to Dhaka, Bangladesh. Below is an image of the model that we will be using. 

There have been many people involved in the organization of this project and its launch many of whom I will begin to name as the journey continues. These are the people who have ensured the space needed to conduct teaching workshops, and have taken the responsibility to recruit interested physicians. The excitement of our team is palpable and we are thrilled to finally get this underway!

I am embarking on an almost 36 hour journey to Dhaka starting tomorrow, 1/26/2017. I will be chronicling this entire process and hope to keep you all close as you too are a part of this already fulfilling journey towards a sustainable medical solution in a resource-limited country. 

lastly, if you would still like to donate, that is possible by clicking on the following link:

https://www.gofundme.com/BDUSInitiative 

Additional money raised will go towards ultrasound gel used to obtain ultrasonic images, sterile covers for the ultrasound, publishing fees to create copies of an ultrasound manual and towards ancillary costs of building and maintaining the teaching workshops.