MONSOON!!!!!!

Ok so before I even get to the exciting medical stuff from today I have to remember to mention that I got to experience rain here in Bangladesh. That may seem like the most trivial thing but it hasn't rained once since i've been here, and I dont remember it ever raining on any of the other trips I've taken to Bangladesh. Also--this country experiences tropical weather, so when it rains...it RAINS! And today it not only rained quite a lot but we had some "shila brishti" or as we americans call it, HAIL!!! When I actually had the guts to leave the house later this afternoon the roads had collected about 6 inches of rain in some places...now imagine what it might be like during the actual rainy season!! I was so excited I called my mom who then told me a cute little story about how when her and her 6 sisters and 2 brothers (just emphasizing the sheer size of my family) were young they used to collect the hail in plastic bottles...in case the power went out and they couldn't make ice! Now every time it hails she thinks of that...the things we take for granted in the U.S. huh?

Interesting day at work today....started with morning rounds, had a patient who was admitted overnight with abdominal distension and bloody stools. Upon physical examination a very faint mass could be felt in the middle right area of the belly. The child would sleep for a few hours then wake up and cry, pulling her knees in towards her chest. She was too young to really verbalize that she was in pain but it seemed to be quite obvuious. The diagnosis considered at the time was intussusception--which is basically when part of the intestine telescopes within itself, this causes obstruction which leads to belly distension and may cause perforation, sepsis and death if not treated right away. One of the main physical findings that books always discuss is the "currant jelly" stool which is basically stool mixed with mucous and blood...I've only read about currant jelly stool, i didn't actually know what the heck it looked like before today....and furthermore I vaguely recall someone on my peds rotation mentioning that it is rarely even seen and the remainder of the clinical exam and history will dictate the diagnosis. WELLLLLL...today while the digital rectal exam was performed on this patient, out came some currant jelly stool..and it really does look exactly like it sounds. PICTURES TO FOLLOW LATER I PROMISE.

I also went down to the Emergency room today just to check it out. I spent a few hours there and have now realized just a few things. The scope of emergency medicine in this hospital is extremely limited. There is no residency for it here and the ER itself is split up into sections--the medical management section, the surgical management section and the poison section. It doesn't seem like each section communicates with each other. I decided by method of "eenie meenie miney moe" to hang out in the surgical ER area. Boy was it my lucky day. Three out four patients I got to see today were stab wounds from "mara mari" (fighting) out in the street somewhere. I dont know where the weapons were from or what the cuase of the fight was but there was quite a bit of blood shed in the ER Operating room. Being the eager little bear that I am I asked if I could partake in suturing up these slashed patients..and of course, as always the answer was "YES!" I only had time to sew up one particular patient, the worst of the three. His stab wound was about a foot wide and through most of the muscle in his thigh. First things first I injected the area with some local anesthetic meanwhile putting massive pressure on the bleeding...as the 40+ year old man cried and jerked around...mission accomplished then on to the next step, as quickly as possible clean the area ( hydrogen peroxide was use which basically sizzled in the wound area and I almost fainted just thinking of how horribly painful that must be) I then tied off the three bleeding vessels..slowly but surely, sutured the muslces, then fascia then the skin..DONE! Let it be known that I actually hated being in the OR during my surgery rotation mostly b/c I didn't get to do much..here I got my hands dirty in every single case I was involved in--trust me when I tell you there is no better way of learning than by doing. Oh..by the time I was sewing the muscle together the patient was completely passed out snoring..and receiving his second unit of blood. FUN DAY!

After my busy morning I had a lively discussion with an array of medical students from Dhaka Medical College regarding the positive aspects of their program here and the positive aspects of our program at Drexel. We also came to the conclusion that there should be a central site that both Drexel and DMC students can access and interact with each other, exchanging information and ideas regarding all aspects of medicine--this was another purpuse of my trip here and starting this rotation. What good are any of us on our own in the U.S. or in Bangladesh or anywhere? There are so many people immigrating to the U.S. from all over the world, we need to make the effort to understand their medical system and the illnesses that effect the people of those countries. It is time for the people of this world to stop building walls and start building bridges.

Special treat tomorrow: BRAC institute of Public Health!