Try Not to Get That Song in Your Head

Yesterday we saw one of the more annoying aspects of Bangladesh, and one of the more inspiring ones.



We started the day out with a trip to Banga Bazar for a little shopping. This is a clothing bazar in Dhaka, and consists of row upon row of shops that seems to stretch on forever. It quickly became overwhelming; fortunately there are youths who will gladly lead you to what you desire, for a small tip.

We managed to make it through the rows of jeans to the men's area, to pick out a few Deshi style shirts. The annoying part was the haggling, which fortunately Anne took charge of by virtue of her language skills. We were clearly getting the foreigner price, but the seller would not back down much. After Anne got him down to a somewhat acceptable price and we forked over the cash, he claimed he did not have change. He said he would go to another stand to get it. Suspecting that he may not come back, we followed him. He made it quite a ways, but in the end found someone to break a 200 taka note.

It seems weird to get aggravated about paying a couple dollars extra, but the principle of paying based on your nationality is supremely annoying.



The day ended with the uplifting part: a tour of International Centre for Diarrhoeal Disease Research, Bangladesh, or the ICDDR,B. This is also called "The Cholera Hospital" by locals, and is where oral rehydration solution was developed. ORS is the kind of thing we learn briefly about in med school but never hear much about the origins of it, or what an impact it has made on health care throughout the world. The ICDDR,B deals mainly with, as the name implies, diarrheal diseases, and has streamlined the care with impressive results.

We were led through the short- and long-term stay units, the "special care unit" which is similar to an ICU, a research unit where 5 clinical trials are taking place, and a nutritional care unit. This last unit was for children who were malnourished prior to their diarrheal disease, and need more care after that episode has resolved. The mothers are taught how to prepare palatable, calorie-dense meals with a few inexpensive ingredients, such as rice, lentils, sugar, and oil.

What is particularly impressive is the cost-benefit analysis they presented. They are able to quickly triage patients with mild, moderate, and severe dehydration, and treat according to severity. Mild cases recieve education about ORS. Moderate cases may receive IV fluids and go home after a few hours. Our tour guide said their cost-per-life-saved is about $15. As I work in a health care system where policy is made based on interventions with a cost-per-life-saved in the tens of thousands, I found this amazing. The tour guide also pointed out (and with a slight smirk) that getting IV fluids in the US usually involves at least $2000 in total health care resources. This left an impression on how health care is delivered in the US; we may have more resources, but we are terribly inefficient in how we distribute those resources.

More information is at http://www.icddrb.org/ (And yes, Anne has blogged about this as well)

However, their use of the British spelling "diarrhoeal" is distressing to me, as I only recently have been consistently spelling "diarrhea" correctly. That is quite embarrassing in my line of work.