Amazed by the resilience of the Rohingya

Another day another incredible eye opening experience and lesson in resilience. The day started with two very sick patients in the emergency bay, one who was a year old baby boy who had a high fever and seizure overnight and the other a 65 year old female with significant shortness of breath and low oxygen levels.  The baby boy got an IV immediately and we started fluids slowly—the beauty of having a multidisciplinary team is being able to rely on colleagues for help—like the rate of fluids in a baby for instance! The adult patient seemed a bit more complex—thankfully the combination of physical exam and ultrasound was useful in figuring out what was wrong. My initial instinct was to give her fluids but once I checked her heart rate I knew right away this wasn’t so straight forward. Her heart beat irregularly and the pulse oximeter which also gives the pulse kept going from 80 to 150 confirming my suspicion that she probably has atrial fibrillation. Thankfully an EKG is available and that definitively confirmed my suspicion. Upon further examination she had evidence of pulmonary edema (water in her lungs). In the mean time the baby in the next bed was getting IV antibiotics but was still sleepy and breathing quite fast, we placed some oxygen on him and gave it some time. Circling back to my adult in distress we had given something to slow her heart rate down which did the trick and a small dose of a water pill to help her lungs. Over the next several hours our team worked diligently to monitor and treat these patients and both went home doing much better. We had all the tools we needed and it turns out it wasn’t much—we didn’t need to order a CT scan or any heavy duty testing but just remembering the basics of empiric medicine we could treat both patients to the best of our ability. 

Next the patient with the kidney infection from yesterday had returned for follow up, she was able to walk in to the clinic today without assistance she hadn’t had any fevers in the last 12 hours and her heart rate had improved dramatically. This was a huge win. While the physicians here are mostly international the ancillary staff are local and they are learning new things each day as we are also learning from them. The sustainability lies in the training of the local staff and in just a few days I have seen so much progress. 

Even just the basics of hand washing, just by a simple educational intervention now everyone has habitually been washing their hands when coming in and out of the clinic.  Education and training—the real tools to sustainability!

During a quick 10 minute break, mostly to grab a sip of water, I traded stories with my MedGlobal colleague. She said her last patient had mentioned that his vision has gone bad since he came to Bangladesh. He thought that happened because he witnessed his son being shot down in front of his eyes and afterward he cried so much his vision went bad. Meanwhile one of the female patients I saw today mentioned that her husband was in a Myanmar jail cell not sure if he was alive or dead but he was beat up and arrested on the 5 day trek over. Luckily her and her three children survived the migration and as did her brothers who are helping to take care of her now. I feel helpless hearing these stories, the cruelty that they have been subjected to. 

Their fate remains unknown but their resilience is quite clear. 

The last patient I had was a 12 year old girl. She came in stoic, mentioning that she cut her chin while pumping water from the well, she lost grip of the well handle and it slammed into her chin cutting open a 2 cm gash almost down to the bone. She didn’t cry one bit. We irrigated the wound with saline and antiseptic solution until it was as pristine as possible. The importance of this cannot be overstated as leaving any infected tissue and then suturing the wound would surely lead to infection. We then administered some lidocaine superficially and deep to numb the area prior to suturing. Again she did not cry. If this were me I probably would have at least winced if not teared up. To her this pain was likely nothing, she has been through worse and she survived. It is clear by the experience in her eyes that nothing that comes her way now is as bad as it was before. And maybe there is the silver lining, the hope that life that will be better here in Bangladesh. 

(Finished product above...I prayed for steady hands and ease of apposition so she would not have a bad scar)

And lastly..as the day came to and end I heard an inspirational story from one of the coordinators from OBAT helpers. (FYI the coordinators at MedGlobal and OBAT are nothing short of miracle workers and without them we would be rendered useless). She told me of a story of one of the Rohingya volunteers who was born in Bangladesh, his parents came in the first wave of refugees in 1994. He has been saving since 2014 to build a school and has been going to school himself as well. Just recently he has saved enough money to build this school with the help of his friends and they plan to teach Rohingya children here. Again—the resilience, the ability to re-start a life and have the motivation to help others—that is the best of humanity in the worst of circumstances.