A Day in the life of a “German Doctor” – My Dhaka Diary, Part 4

Aside from getting as much sightseeing in in our spare time, I primarily came to Dhaka to work!

And whatever reservations I had in the beginning, I honestly and thoroughly enjoyed my first mission as a doctor serving disadvantaged communities, and if you are in the position to help, I can only encourage you to do so. It may not be comfortable, there may be lots of challenges, but being able to help at the end of the day, was more than worth all the hardship on the way there. Any NGO posting may be different, so this post is based solely on my personal experience.  Feel free to contact me if you have any questions!

I had few expectations of Dhaka, a city of over 10 Million people, and the 7th densest populated city worldwide. It is certainly very busy all day and nightm, and was nothing like I ever experienced!

The NGO I work with

The organisation I am working with is called German Doctors. They are a smaller Non Governmental Organisation based in Germany which sends medical doctors on projects in the Global South as well as European Refugee camps to provide basic medical care. UNlike larger NGO’s like Medecins sans Frontiers, their volunteer doctors work unpaid for a relatively short period of six weeks, usually making major contribution to their travel costs, so that donations are used in the actual projects – for medicines, equipment, and local staff salaries.

Every other volunteer doctor I met was practicing back home in Germany either in employment like me, or in their own practice, but a significant number of German Doctors are retired.

The Dhaka Project

The project I am working in is called “Medical Centres for the Marginalized and Poorest of the Poor” and is one of over 100 projects run by Caritas Bangladesh, one of the top NGO’s in Bangladesh. The project runs at least three small outpatient medical centres in a relatively poor area in the suburb of Ashulia, about 30 kilometres northwest of central Dhaka. Once a green suburb full of rice paddies, it has seen significant urbanisation in recent years, from garment  and brick factories to rapid residential development.

Where I work

I work a Muslim week from Sunday to Thursday, about 8.00 to 17.00 or 18.00, in one of three medical centres, where we hold clinics on a rotation system. We are two volunteer doctors,  here for six weeks.

All our permanent staff, including one part time doctor, are Bangladeshi, and since the volunteer doctors usually don’t speak Bangladeshi, we have a translator each, who also are an immense help with administrative tasks.

Two receptionists admit all patients and take their vital signs, supported by a registered nurse. We also have a physiotherapist, who can see patients on the sport after referral.

A day in the clinic

A typical Day at the medical centre starts between 8 and 9am, when we either just saunter down to our clinic rooms or take a taxi or rickshaw to our clinics, laden with bags of supplies.We have a van, but due to the political unrest, public transport buses getting torched and stoned, I got to ride in it once. However, rickshaws are fun, nifty and much faster than the van on crowded streets and out here in the “suburbs” they are electrically powered.

By the time I turn up for work, the sun is up and already bright and warm, the noisy generators in the neighbouring garment factory would have been on for at least an hour and the office housekeeper would have brought us breakfast – pretty cushy compared to home with its 5.45 wake-up calls. Also, the sun and warm weather help around this time of the year!

The clinic opens its doors at 9, but usually we see a few patients sitting in the open-air roofed waiting area well before that. We set up our stuff, which, in my case, is quick: stethoscope, headlight, oxygen monitor, portable ultrasound… and, importantly a thermos of tea appears, and then we are ready for our first patient.

Our patients come from all walks of life. We are in a less well-to-do area even for Bangladeshi standards. Dirt roads, communal housing with shared bathrooms and some 3-10 storeyed buildings are common. But wherever we are, there is always a bazaar and small restaurants. The bazaars look lovely, with fresh fruit and veg glistening in tidy displays, and  after a while, we get recognized but various traders – some of our patients. Many garment workers also live in the area, and it is quite common for families to require double incomes to get by, but we see plenty of housewifes too. So, the most common professions in our health books, recorded by registration are “GW” for garment worker, “Small Business” , “Day Labour” and yes, we get our fair share of house wifes.

There is currently two of us plus a local doctor for some sessions. Sadly, there isn’t much interaction with the local doctor. The two of us see our own patients each but work together a lot, especially when it comes to second opinions or uncharacteristic presentation, seeing we are from two different specialties. My colleague is internal medicine, while I am a surgeon and pretty decent with all small surgical specialties, as well as some tropical medicine.

We also see many pregnant ladies for routine antenatal care, something of a steep learning curve for both of us. I use the project guidelines published by my NGO, and also Medecins sans Frontiers medical guidelines to direct my diagnostic work-up and treatment. Important thing here is to work cost-effective and make the best use of donations, and help as many people as we can with the financial means we have. Sadly, this also means no expensive diagnostic work-up, no surgery or cancer treatment on our budget – we can refer to low cost hospital but this is where it often ends, and I wish I would be staying longer to learn about the Bangladeshi health system.

Many of our patients work in the garment industry. They earn a basic salary of 8000-9000 Taka at present, which equals about 70 Euro, which is not enough to live comfortably in Bangladesh. Our patients do not have health insurance. This means if they have to see a doctor, they pay out of pocket, which can amount to a quarter to half of their monthly salary – not affordable to most. In the clinic set up by Caritas, they pay a nominal fee of 30 Taka per months including any medication from our basic list.

Morning Break

After two hours of clinic or so, in comes our housekeeper with a snack. Now, this is something I wish I could have at home! Since the housekeeper is employed primarily to keep the practice nice and provide meals and tea and snacks, she puts a lot of effort into the food – very day we enjoy copious amounts of rice with green chillies and at least two dishes and a salad. For a snack, it’s usually Chow Mein, very popular in Bangladesh, or she makes something super traditional from puffed rice called Jhal Muri. In the afternoon, she cuts up the fruit we bring from the market into bite-sized pieces.

Our patients

After a week, the most common complaints we see are epigastric burning, itching and lower back pain. When asked, about 70% of my patients complain about epigastric burning, even though no one takes alcohol and very few people smoke. This is relatively surprising as diets seem quite balanced – rice is a diet staple, green veggies are available even in the smallest markets, and so is fruit but fruit are more expensive and not everyone can afford them.

Scabies and fungal skin diseases are very common, given the hot climate and cramped living conditions – often it’s a whole family in one room with shared bathrooms in the simplest accommodations.

And then, I get problems I have never encountered in my professional career – secondary infertility, irregular periods… so in between assessing lower back pain and ruling our structural damage and checking that the epigastric issues are “just” heartburn, I get to consult the books and guidelines and try to help at my best. Some patients I refer for second opinions to services where we have agreements and where we can pay for the consultation. But sadly, in more than half of cases the specialist opinion isn’t making much sense, or the patients just ended up having further lab tests instead of an actual opinion. X-Ray services and ultrasounds on pregnancy work well, as for the rest – not so well.

Mornings tend to be the busiest – anything from 30 to 50 patients coming to see us. There were definitely more garment workers during the 12-day strike, otherwise it is relatively difficult for them to pause work to see the doctor other than in their lunch break.

I have a Bengali to English translator in the room with me. They’re lovely and usually university educated, with degrees in economics, social work or education. Not only do they translate the sometime very unspecific histories, but they are also helping with a lot of administrative tasks.

Lunch is around 13.00, and we all eat together which is wonderful and something I would love to have at home. We even have a cook and a fully fledged kitchen in each of our clinics. Food is 100% local home cooking – huge bowls of rice accompanied  by a salad and smaller bowls of curry. As a vegetarian, after telling various people several times that I am allergic to fish and meat, I always get fed very well, although I get served an awful lot of eggs. And the two foreigners always get an extra bowl of something less spicy than the rest of the team.

After lunch and a little rest, or a walk round the local market, we continue our clinic until there is no more waiting patients. Round this time of the year, with the political unrest and the garment workers strike going on, people tend to be more cautious, and not use public transport so much. On some days, we visit nurseries, also ran by Caritas, to check on the children once a month. In theory, all children should have their basic vaccinations (they are free) but that is not always the case, but sadly, we are unable to provide vaccines at this point.

And finally, come 17.00, the clinic empties out and we pack up and return to base, sometimes taking a stroll through our market and shopping for some fruit.  Dragon fruit and papayas and pineapple are good right now, plus lots of fruit we do not know – we are eating quite well with all the fruit and hour housekeepers good cooking.

How we live

Unlike most expats to Bangladesh, we live where we work, which in our case, is a less fancy suburb of Dhaka. The project, MCMPP, has rented a couple of floors in a solid multi-storey building, next to a garment factory. For Bangladesh, this is a fancy building with fancy flats, but nowhere like we know it, coming from an affluent EU country.

We have a small flat, with a small kitchen, a small dining room and a single bedroom each, equipped with a noisy ceiling fan. I also have a private bathroom, accessible via a tiny balcony, which has a Western toilet and a sink and a shower over the toilet. All rooms are tiled and the floors are very clean. Because of the factories in the vicinity, dust gets into the house constantly – our stairway and all shoes left outside the flat are coated in thick red dust. I proceed to dust everything and wash my mosquito net when I arrive, only to find everything coated with dust, even inside my cupboards, three weeks later. I keep single glazed window open most of the time to get some fresh air and to stop the room from being stifling hot at night. My bed is simple but quite comfortable – a standard issue hard pillow, some sheets, fluffy blankets (which I definitely don’t need) in the cupboard.

We have a large fridge in the hallway, a microwave and a water kettle. At least once a day there are power cuts, up to two hours, but we get some emergency electricity from a generator when this happens.

What I learned

Those who know me know that our NGO flew us back home after just three weeks in Dhaka due to the current political unrest. Elections are now set for  the 7 January, 2024, and hopefully, the country will settle down again after that, and they will send doctors to Dhaka again.

The call came very surprising, in the middle of a busy clinic, and I was pretty shell shocked to hear. I arrived on the day of a political rally, and had never seen the country without general strikes. In general, I read the English language Bangladeshi papers every day, spoke to local staff and felt quite safe in my area. I even managed to get two weekend trips in,which went without issue.

I am leaving Bangladesh hesitantly – I tried to stay, but German Doctors was pretty unambiguous in their response – leave now safely, no other option. Three weeks was just enough to get a glimpse into Bangladesh life, not enough to learn, and I feel like my job is not done here. I have been thinking of making a donation to the project as they will be working with locum doctors now, and to make some information leaflets about common ailments and simple physiotherapy while waiting to return to my regular job in a week’s time.

Most of all, what impressed me, not just at work, but everywhere I went, is how friendly the Bangladeshi people are. TOurists are still rare, and everywhere we went, we were given a good old stare, but always accompanied with a smile. People wanted to talk to us, and it’s a shame my Bengali reached a grand total of about fifty words and a few basic phrases after three weeks. Caution about riots and manic traffic aside, I felt safer than in Europe – no one’s interested in stealing your bag or mobile phone in general, on the contrary, people look out for you – some guys even helped me across busy streets! people have so little yet they want to share what they have, and they don’t see foreigners as a cash cow – they were just pleased that we came to visit.

People in our area knew of us, and we’d usually walk down our street pausing to say hello, vendors holding up our favourite fruits that we bought from them previously, people wanting to gift us fruit, tea… it was incredible. I do not know how to put it into words, and without wanting to sound condescending – people have so little and work so hard yet seemed so jolly, enjoying the smallest things. Just bringing some of that home and trying to live the way might be the biggest challenge of them all.

I will definitely apply to work in Dhaka again, despite the physical hardship (the heat, noise and dust weren’t comfy at all), despite missing my beautiful home, despite professional challenges, despite the endless epigastric burning and feeling a bit powerless to explore further due to lacking the language skills…   Even if I make just a small contribution, working for free for the disadvantaged communities may help to improve the quality of life for Dhaka’s less moneyed.