“How was it?” How in the world do I answer that question?

“How was it?”
How in the world do I answer that?

My crazy life has once again swallowed me whole. I’m back to my precious family and friends, back to my private patients and running my business, back on the road constantly for my son’s travel soccer, back to reality.

The question I am asked daily is “How was it?” Three simple words that I struggle to answer. How do I condense two weeks of a life-altering medical mission into a polite social response? The answer is… I can’t. I understand now why people say catch phrases like “It’s life changing” and “You just have to experience it yourself”. It is impossible for me to convey something so profound in a few minutes, so I end up not saying much at all. Then I feel like I’ve let people down.

Believe it or not the BIG lesson is actually very clear and concise, even though my pediatric nurse persona and my hospice nurse persona are in conflict over a few ethical questions (I’ll address those two issues in a future post). But I’m not being asked what life lesson I learned or what ethical questions were raised. People want to know “How was it?” “It” ran the emotional gamut.

There was bad…

I would be lying if I didn’t admit that it was kinda frightening. It was eerily quiet during the hartals (public strikes). But the silence was better than the loudspeaker propaganda. You didn’t have to understand the language to know that the tone was hostile and threatening. I never really felt unsafe, but the whole train/car bombing/mass protest/people being killed thing was unnerving at times.

This is what the front page of the paper looked like most days.

It didn’t give me much comfort when the hospital folks said that there was no need to worry, because the protests were going on in the front of the hospital, and we were in the back. Neither did the swarm of military helicopters I could see, or the fact that I could hear the angry shouting mob when I stepped outside the Recovery Room. We all owe a tremendous thank you to the Gulshan Lake Rotary club, the staff of the Eastern Residence Hotel, hospital security, the city police and the Bangladesh military for protecting us.

A few of our protectors.

It was heartwrenching watching families being turned away because they didn’t qualify or because they were so severe we couldn’t safely operate on them. Considering I’ve never seen a person that is unable to get medical care, it was difficult to come to terms with how their medical system works. I understand why it has to work as it does. I can not tell you the monumental respect that I have for the hospital staff, from the doctors to the cleaning ladies, that show up everyday and deal with impossible situation after impossible situation. I fully believe it would crush me. One of the local surgeons said to me, “Come here and work for 6 months and you will no longer cry.” I’ve been unabashedly crying over patients for 23 years. The day I can’t cry is the day I need to leave nursing.

EVERYTHING was recycled at Shishu including gloves and gauze.

Speaking of crying, I’m still not able to put into words having to walk away from Tonya the day before we left. I’m trying to find out what happened with her sister (the burn victim) but haven’t had any luck so far.

On to the good…

It was extraordinarily cool. How often to you get to hang out with a US Ambassador and the wonderful staffers that have dedicated their lives to bridging peace and watching over the visiting US citizens? I’ve never before been asked to a Chargé D’Affairs house for drinks. And on our last night, there was a dance troupe from New York City that happened to be performing. We were honored to be guests of the Ambassador and sit on the front row of the theater with photographers taking our pictures like we were somebody important.

Ambassador Mozena…The US Ambassador to Bangladesh.

It was bizarre feeling on display like a panda in the zoo. People would stand in front of us and stare. They were constantly taking our pictures. I had many a kid shoved at me and a picture taken before I could react. I had people walk up and touch me, my skin, my face, my hair. They didn’t worry about people’s personal space.

I gave and received a lot of hugs.

It was profound to be so readily accepted in to a country and culture so different from my own. To work side by side with people that it was difficult, if not impossible, to communicate with if there was no interpreter. To have non-cleft palate families handing me their sick babies because they believed I could some how help them. I couldn’t even explain to them my inability to help, all I could do was hug them, shake my head no, and walk away. I formed true relationships with people that I will never forget. Many of whom I call friends now.

On the ward.

Hard at work in the OR.

It was miraculous, the transformation of faces was absolutely miraculous. Somehow I ended up a small part of an incredible Alliance for Smiles team of highly skilled and amazingly humble people that selflessly dedicated two weeks of their lives to completely change the lives of these courageous children and their families. I saw children with horrible deformities look whole after surgery. The best part was that I didn’t have to leave wondering if we made a difference, because it was as plain as the beautiful new smile on their face!

Cleft palate repair. So pretty!

Now when people ask “How was it?” I still don’t have a short dramatic response to answer the question. So like everyone else, I guess I’m stuck with, “It was life changing. Everyone should experience it for themselves.” It doesn’t tell the story, but it sure is the truth.

More of Team Bangladesh

I am still here. I know I owe everyone the last 2 days of the mission, Sorry, I can’t rush it. Thank you for being patient. I promise that I will give you closure. I’ve been trying to recover physically and mentally, and I’m slowly but surely getting back to “normal.” So until then…

Here are a few more of my amazing teammates.

Tina Hollcroft… Our fearless leader.

Tina with her baby.

Tina with another of her babies. (Get the pattern?)

Here is what Tina says about herself.

Hey Trish – I am not very good about talking of myself but I will indulge you for the sake of the children and your hard work and compassion you have put into this blog. It is wonderful!!

Board member of Alliance for Smiles for how long I don’t remember, a long time.
Past President of Rotary Club of Greene and Putnam.
District 6910 international co-chair 2012-13 and chair 2013-14 (Yes, I am crazy)
Can not remember how many missions I have been on.
Third trip to Bangladesh – I love this country.
Owner of a Real estate consulting business and owner of Barefoot Mountain Farms in North Carolina – growing and harvesting Christmas trees for non-profits in the southeast (I love Christmas!!!)
Lives at Lake Oconee in Georgia with my dog Sophia Loren.
Loves the Lord and all the children in this world.

Here is what I say about Tina.

She is one of the few non-medical team members. Medical people are not always the easiest people to spend time with. Most of us have the nasty habit of talking about really gross things. It almost always has to do with body fluids, and unfortunately, it’s usually discussed while we are eating. We can’t help it. I’m not sure how she put up with us or how in the world she kept us all straight for 2 weeks. The most amazing part is that she did it all with a smile on her face.

She left Bangladesh and headed for Burma to start working on next year’s Alliance for Smiles mission. We have already received an email about signing up to join that team. I wouldn’t hesitate to volunteer for any mission that Tina was team leading.

Tina is the energizer bunny. She is one of the most remarkable women I have ever met. I will say, it would probably be a toss-up as to who cried more, Tina or myself. She has a true passion for everything she does, especially Alliance for Smiles. It would not have surprised me to find out that she had snuck some babies back home with her. They are ALL her babies. Of that, there is no doubt.

Barbara Fisher… Quartermaster

Barbara on clinic day.

Barbara keeping up with the chaos around us.

Here is what Barbara says about herself. (I’m going to condense it a bit.)

Barbara is an RN. She has been for 50 years! Wow. She has a Masters in Nursing and in Hospital Administration. She’s been everything from staff nurse to hospital Vice President.

Awards and Honors
Baxter Fellowship in Innovation in Healthcare Management–1989
Who’s Who—1994
Recipient of Rotary International Service Above Self Award

Heath care missions and programs:
American International Health Alliance—Grant Administrator for 10 year Grant in
Former Soviet Union
Mission Director for 20 plus Cleft Surgery Missions in China, Bangladesh, Philippines, Ghana, Nigeria, Zimbabwe, Cameroon, Rwanda,
Mission Director—General Healthcare missions to Mexico, Russia, Tajikistan, Kazakhstan, Turkmenistan, Georgia, Armenia, Azerbaijan, Ukraine, Togo, Romania,
Assistant Mission Director—2 Rotaplast Missions to South America

Here is what I say about Barbara.

Barbara is steady and constant. You can tell that she is a fantastic leader, just the kind of person us “non leaders” need to keep us in line and on task. She and Tina are like Thelma and Louise. She was under the weather for a good deal of the mission. I hate that not only for her, but for me. I didn’t get to know her as well as I would have liked. Despite not feeling well she still managed to get to the hospital. As you can see from above, she has done it all and is a wealth of information.

Small world, we actually worked at the same hospital in Macon, but I started there 5 years after she left.

Sue Cone… Mission Records Keeper

Sue with one of her favorite patients.

Sue cutting up with Kamal, local Rotary President.

Here is what Sue says about herself.

Retired 12/12 as Sr. VP Human Resources at Pinnacle Bank after 31 years in banking. Taught high school for 10 years. Was NEVER a secretary or typist!
Son and daughter. Granddaughter 8, grandson 10.
Hobbies include: Oil painting, gardening, travel, entertaining, cooking and grandchildren.
Affiliations: Elberton Rotary Club, Elberton Sister City board, Elberton Theater Committee, member First Methodist Church.

Here is what I say about Sue.

Sue and I were both mission newbies. We were pretty speechless the first couple of days. At clinic, she was responsible for entering all of the patient info. Not an easy task when you don’t speak the language. Not to mention many of the patients had only one name, and some didn’t know their date of birth or how old they were. Challenging is an understatement. She was also responsible for keeping up with all of the charts. I know she had many other tasks because she was always busy.

She was another non-medical person. I think it took her almost the entire 2 weeks to sort of tolerate our gross table talk. I doubt she ever got used to it. By the end of the mission, she even threw on some scrubs and watched a surgery!

Sue is the President Elect of her Rotary club. So as I was dragging my exhausted tail out of the plane and heading home to crash, she got off the plane and immediately attended PETS (Rotary’s Pres. Elect Training Seminar) on Saturday and Sunday. That absolutely blows me away. She is a better woman than I will ever be!!

Dr. Mark Fajgman…Anesthetist (that would be an anesthesiologist in the US.)

Mark assessing patients on clinic day.

Mark hard at work sleeping a kiddo.

This is what Mark has to say about himself.

Mark Fajgman, I am an Australian doctor who began his anaesthesia career in 1981. My parents migrated to Australia after WW2.
This is my 4th mission with AfS.
I am married and have 3 teenage children.
I have has worked as a paediatric anaesthetist for 25 years at the Monash Children’s
Hospital, just south east of Melbourne.

Here is what I have to say about Mark.

Mark is a character. I knew I was going to like him when he sent an email, before the mission, pointing out some different terms used by the Aussies. For example, IV= drip and OR= theatre. He ended by saying that some words are very similar, like beer and wine. I knew right then that I was going to like him.

We talked some about the differences in our country’s healthcare systems. I loved to listen to him talk. It’s always nice when someone has a more pronounced accent than me.

He is obviously a compassionate and kind person. Sometimes, as healthcare providers, we are so focused on getting a task done, that we forget that for the patients this is not routine. I saw him on more than one occasion go out of his way to ease a scared child. In my book, that makes him a really good guy!

Thanks again, for everyone’s positive feedback and kind comments! In the next few days I will continue to highlight all of the incredible members of Team Bangladesh. (Including myself, Wendy! Be patient.)

There’s no place like home… Returning to Kansas.

“Dorothy, you aren’t in Kansas anymore.” That phrase was used many times in Dhaka. I returned home yesterday after 30 exhausting hours of travel. To my life in Georgia, not Kansas, but you get the idea. I’m worn out and jet lagged, as expected. Thankfully, I’m still in one piece. At least physically. Emotionally is a different story.

Surprisingly, I find myself quoting Johnny Depp.

“You can close your eyes to the things you don’t want to see, but you can’t close your heart to the things you don’t want to feel.”

Everyone said this mission with Alliance for Smiles would be life changing. Everyone was correct. As much as I want to write about the last two days I spent in Dhaka, I can’t do it right now. It’s too raw. I know how painful it’s going to be to relive it on paper. I need a little more time to sort through the emotions so I can attempt to convey them to you. Instead, I will write about the difficulty of returning to the normalcy of everyday life.

I didn’t consider how working so closely and sharing the chaos of the last 2 weeks with people that I didn’t know would affect me. I figured I’d go, work hard, accomplish some wonderful things and come home not much different. I was wrong.

Yesterday I returned to my comfortable life. My amazing family and friends. Everything that I hold dear is just the same as when I left. I am the one who is different. Don’t get me wrong, I have no intention of giving away all my personal possessions and traveling the world with only a bag of good deeds to hand out. I do, however, see things in a much different way.

I am unexpectedly sad. I feel somewhat lost. Empty, like I’m missing something. I am no stranger to forming temporary intimate relationships under stressful circumstances with complete strangers. It does take some getting used to, but it is what all good hospice nurses do. I have learned to be a chameleon, to adapt, to be whatever people need me to be. I can be a listening ear, a comforting voice, a shoulder to cry on or a punching bag. You frequently come into the worst time in someone’s life, do whatever you can to support the patient and family and for the most part when the patient is gone, what has been a very intense relationship is over. That’s not to say I haven’t formed real and lasting relationships with families I’ve taken care of. I always have and probably always will.

My days and nights are turned around. I did sleep some last night, albeit fitfully. My dreams haunted by Shishu hospital and the faces of the children that couldn’t be helped. I threw in the towel at 5:30am. The silence of my house ringing in my ears. There was no morning call to prayer over loud speakers, no honking horns and the other noises of gridlocked traffic, no wake up call, no breakfast waiting or morning briefing.

I went to Starbucks to get coffee, then drove out to Lake Allatoona to watch the sunrise over the water. It was beautiful. Layered hues of pink, yellow, red, orange and purple. So indescribable even the Crayola Company would have trouble naming them. I thought about the simple things in life that I have always taken for granted. Set aside the fear of accidentally getting tangled up in a violent, bomb throwing mob… I can hop in my car and quietly travel 4 miles in 6-7 minutes, not 2 stressful hours with annoying, constant honking. I can clearly see a sunrise instead of gray sunlight hidden behind a blanket of pollution so thick it threatens to smother you. I am surrounded by clean, sweet smelling, green land and wide open spaces instead of piles of rotting, rancid trash strewn about overcrowded streets. I can run tap water, instead of using bottled water, on my toothbrush without fear of getting sick from bacterial contamination in the water supply. I can see innocent, light hearted children playing happily without a care in the world instead of darting dangerously through heavy traffic, risking their lives knocking on car windows begging for money that will go to God knows who.

And just like Dorothy, I am now very aware that there truly is no place like home. Be it Kansas or Georgia, we are the lucky ones.

Yesterday I Cried

Yesterday was a difficult day for me. The most difficult. This post was not easy to write.

I’ve shed tears almost every day of this mission. No surprise, that’s the norm for me. I can tear up over almost anything, but today was different. Today I cried. It was that gut wrenching, this-is-totally-unfair-and-there’s-not-a-damn-thing-I-can-do-about-it-cry. I am already a tender hearted person, but never more than when I perceive something as an injustice. I hate it when I realize, not only am I unable to save the world, I can’t even help with the situation I am facing. There is nothing more frustrating to me than feeling helpless.

One of my sweet little girls, the only one that is still here almost 2 weeks after we arrived, is Tanya.

Tanya on the right.

Tanya is not a patient. She comes to see me every day. She patiently waits until I have time to come see her. She speaks very little English. I thought she wanted nothing more than to give me hugs, hold my hand and curiously examine me. Unfortunately, I found out that this beautiful girl needed to escape the situation she was facing.

**Here is the point that I give fair warning. This is not a pretty story, and there is no happy ending ***

This much I know… Regardless of how screwed up the US healthcare system is, it is still one of the best in the world.

Tanya is at Shishu Hospital with her little sister. I’m not exactly sure how old either child is because they do not know their birth dates. Her little sister was shoved into a fire by another child. She has 3rd degree burns over approximately 40% of her body. The skin from her entire trunk, neck to groin, and thighs are burned away. In the states this type of burn can be devastating. Here it is fatal, but not immediately. They do not do skin grafts. They leave the wound open to air and the mother wipes away the dead skin with her sari. It will not heal. It is a hopeless situation. She will get an infection and she will die.

They do have a burn unit. Despite that, she has been placed in a closet outside of the unit. I have no idea why. I was taking an extra lunch over to her family, so they would have some food other than the gruel that is served each day. She had been quiet and calm the past few days. Not today. She was screaming Tanya’s name over and over. Every fiber of my being wanted to run away and not look back. I wanted to somehow drown out her voice which, I will never forget. I held myself together long enough to step in the “room,” hand over a boxed lunch, hug Tanya tightly and smile at her crying sister. I had nothing to offer, and the suffering this poor little girl was enduring absolutely broke my heart. The tears started as turned to leave. By the time I got to the break room, all I could do was continue to sob, and begin ranting to a handful of team members about the sickening unfairness of the entire situation.

The gruel that is served to patients and families.

It wasn’t until after we took a tour of the hospital that I realized, if you can’t pay for it you don’t get it. We went to the neonatal stepdown unit. In the US it would be where the premies, that are doing well, would go to feed and grow until they are big enough to go home. Here it’s where many go to die. If you can’t pay for an ICU bed, then you don’t get one. It’s as simple as that. There are no government hand outs. There are no write offs for indigent care. There are no payment plans. I then had the realization that there was a pretty good chance that Tanya’s sister was laying there in horrific pain with no pain medicine.

These are the sisters (nurses).

I took a deep breath and headed back to the burn ward. Praying the entire time, that she would not still be screaming. Mercifully she was asleep. I learned from the nurse (they are called sisters here) on the ward that she did have some pain medicine. Because of the language barrier I couldn’t tell what medication she was on. It’s probably better that I couldn’t. I’m betting it was just plain old Tylenol.

Because of the hartal and the protesters, we couldn’t leave the hospital until our Rotary hosts deemed it safe. Before I could get an interpreter to go back with me, sort out the situation, and help me find out what medicine she had, we had to quickly leave. I will go back tomorrow and see if there is anything I can do to help. Unfortunately the hospital is filled with countless situations such as this.

I ask myself, has this Alliance for Smiles mission changed me? As a nurse, not really. The care I give has been, and will always be the best that I can give, regardless of the circumstances. As a person, profoundly. The next time I start to complain about how expensive healthcare is, have to untangle an insurance billing mess, have to wait for a bit to see a doctor (have labs drawn, get an xray, etc…) or the fact that my prescriptions aren’t ready when it’s convenient for me, I will think back to this mission. I will be thankful that I was lucky enough to be born in a country that takes care of all its people, regardless of the ability or inability to pay. I will sadly think of a little girl who did nothing to deserve the horrific thing that happened to her. And I will fondly remember Tanya. A little girl, who despite all of our many differences or inability to communicate, trusted me enough to reach out for comfort.

I will never forget the day I cried. And I will hope, as I always do, that maybe, just maybe, a little something good came out of situation so senseless and tragic.

Team Bangladesh… The Players

Let me introduce a few of the players for Team Bangladesh.

David Fowler… Photographer

Fowler with one of our babies.

Here is what Fowler says about himself.

I am married to Gloria, have 5 children and 5 grandchildren. I have been a professional photographer for most of my life but was also a disc jockey for a number of years. Gloria and I owned a portrait studio in Ogallala, Ne until 2006 when we sold the business and retired.

Now, we both work part-time…Gloria as a caregiver for Home Instead Senior Care and I as a bus driver for our small city transportation system.

I am lead photographer for AfS and have been on 15 missions since my 1st to China in 2006. This is my 2nd time to Dhaka.

Here is what I say about Fowler.

There are always very few pictures of the photographer so I only have one to post. Fowler is a mess! (For those of you who aren’t from the south, a mess is a good thing.) He is a fellow Rotarian. Funny, sweet, kind and always encouraging. He reminds me so much of my dad. He’s one of those people that can make you feel like you are capable of doing anything. It obvious how much he loves his family and has shared their pictures with me. He is an excellent photographer. Fowler adds the color and with out him my stories would be dull. Thank you my friend for being my illustrator!

Dr. Sib Schepel… Plastic Surgeon

Sib hard at work.

Sib at clinic with family.

Here is what Sib says about himself.

I am a retired plastic surgeon from the Netherlands. I am an M.D. and a Ph.D.
Since my retirement I am involved in humanitairian missions for various organizations such a Rotaplast, Interplast Germany, Interplast USA, Smile Train and Rotary Doctors Netherlands.
I have participated in over 35 missions thus far in Africa, Asia and Latin America.
This is my first mission with Alliance for Smiles. I am a Rotarian since 1983. I have been married to Alice for 42 years and we have two children; our daughter Babet is a dentist and our son Wibo is an engineer with the oil company Royal Dutch Shell. We have three adorable grandchildren.

Here is what I say about Sib.

There are physicians that are technically very good and then there are sculptures. Sib is nothing short of an artist. He is the master behind 1/2 of these beautiful smiles. He takes a face which is terribly broken and within an hour or two he fixes it. The outcomes here in Bangladesh have been outstanding. Not only is he an artist, he is humble. (Believe me, not all surgeons are.) He came through the PACU and looked at a baby post op. He said, ” That work is beautiful.” He followed up with, “Oh, this is Dr. Hauge’s patient. I would not make that comment about my own work it would be bragging.” There is no need for Sib to brag. His results say it all.

Jade Brandstetter… Operating room nurse

Jade at work. Teaching the local nurses and techs how to circulate and assist.

Jade on clinic day evaluating patients.

Here is what Jade says about herself.

Nurse for 8 years.
Works at The Nebraska Medical Center.
4 years experience in OR on the general vascular transplant team.
Live in lincoln with my husband, Todd.
Just got married in August.
Enjoy spending time with family and friends.
Love doing things with my nieces and nephew.

Here is what I say about Jade.

She is the youngest member of our team. She has been to Haiti on one other mission. Jade always has a smile on her face. She is very low key, laid back, and nothing seems to stop her or bother her. Not only is she an excellent nurse, she is a patient teacher. That is clear when you watch as she works with the locals. 1/2 way through the trip, she had the Bangali OR team circulating and scrubbing in to assist the docs with the surgeries. She has been such a pleasure to work with.

Dr. Wendy Delaney… Pediatrician

I sent out an email for the team members to give me a personal/professional bio. I’m highlighting the members as they respond.

Here is what Wendy had to say.

Do I have to?? Ugh!

Here is my response and what I say about Wendy.

No girl, You don’t have to, I got you.

Wendy and Gary, the other pediatrician, consulting on all of the patients.

Wendy with a family.

Wendy is my roomy/guest blogger and a fellow Rotarian. I can tell you this about pediatricians, they do not chose that path to become rich and famous. They are underpaid and overworked. They take care of children because they truly give a damn. Wendy, like most pediatricians, has a heart of gold. To quote Forest Gump, she and I are like “peas and carrots.” If you look up the definition of ADD there will be a picture of us. We have gotten to the point we don’t even have to say much, we just know. We both have the same convoluted way of thinking. I had a very bizarre method for learning and remembering the numbers. Not many would get it and most would think I was nuts. (Admittedly that’s not far from the truth.) Wendy understood it perfectly and had the numbers down in no time with her own convoluted system.

This is Wendy’s first Alliance for Smiles mission, but she’s no stranger to serving in third world countries. She has done numerous medical missions in much worse places. She is smart, meticulous, patient, kind and tender hearted. Her profound love for her profession and her patients shows in everything she does. I count myself lucky to know her and call her my friend!

So here were just a few players for Team Bangladesh. Stay tuned, more to come…