Medical Mission Trip to Cox's Bazaar Bangladesh
By Jessica John Posko
Aloha! It's been ages seen I wrote. Been caught up with work and getting prepared for this medical mission trip. Its my first ever.
I have always wanted to help in any way I could which motivated me to join the Singapore Red Cross. I made awesome friends while volunteering with local Red Cross events. When they asked if I was able to help out in this mission to Bangladesh, I gladly said yes. When I was pursuing my Bachelor's in Nursing part-time degree with the University of Sydney-SIM a year ago, I was busy with lectures, projects and assignments after work on a daily basis. The articles and projects that were given during classes were very much relevant to me at that time as I just stepped into adult working life as a full time OT nurse with SGH. I learned so much about clinical governance, nursing laws and ethics as well as international health. It was after I graduated with a Gold Award from SIM-University of Sydney that I realised I have to put into action the invaluable knowledge I gained through my degree and my experience as an Operating theatre nurse to good use. Hence, I volunteered with the Singapore Red Cross with an aim to help as much as I can as well as learn new skills.
I wanted to help our patients coming to the mobile medical clinic, be it the Bangladesh locals or the Rohingya Refugees providing the best care possible for them to improve their health condition and prevent illnesses through proper advice and screening. I also hoped to learn from the local doctors, nurses and volunteers about the common illness seen among refugees, the drugs available to treat such conditions and other available referrals like the field hospitals around the area. Fortunately along the way, I learnt a bit of Bengali and Rohingyan language from the friendly volunteers. I also hoped to make new friends and know more about the local culture and lifestyle which i managed to do as well. I’m glad I met them and we keep in touch through social media.
Well we were informed early about the mission date and time. So I had about a month to arrange my leave with the current organisation that I'm working with. However, as I was caught up with work and other commitments, I only managed to pack the night before. At first I didn't know what to pack or expect but the weekly debriefings we had prior to departure helped me network with my teammates and they helped me alot on advising and giving me a their list of items to be packed. I mostly learned a lot from my amazing teammates as they shared their experiences, knowledge and skills on what to expect on a Mission and how to deal with certain situations as well as the do’s and don'ts during the debriefing sessions. We liased with the first team (Team 1) who went on the ground a week before our team was set to depart. Hence, we had a rough sketch on how and what to expect at the camp site as we communicated with team 1 who also advised and shared extra provisions necessary for the next team.
As this was my first time in Bangladesh, on a medical mission trip, I was mostly overwhelmed with excitement but also a tad bit nervous. Nevertheless, my teammates were an amazingly fun bunch as they helped ease my anxiety.
The moment we arrived, we were warmly greeted by Team 1 who were already on site. They shared their experiences over dinner and gave us tons of useful advice. For example, they stressed on the importance of having enough breakfast to last the day as we won't be able to have lunch at the campsite while working in the mobile clinic. They shared their knowledge on different common local drugs used for illnesses and how to talk to the Refugees with the help of the translators. It was awesome.
As we got down from the propeller and headed towards our vehicle, it felt very new to me as people were crowding the exit gate and the streets were busy with rickshaws and tom tom’s parked everywhere as drivers were waiting for people hail a ride. It was the district’s election period and so there were vans and cars with huge
speakers mounted on the vehicles’ roof that were going around promoting the election. It was certainly exciting to be see people carrying on with their daily routine as the driver drove us to our place.
When Team 2 arrived at Cox Bazar Bangladesh, we divided ourselves into 2 teams. So, my team was assigned to Camp 11 and the other to Camp 4. Our camp was located at Balukhali, along the roads of the Rohingya Refugee camp and about 20 minutes away from the Bangladesh Field Hospital and Japanese Field Hospital. The journey from our place to the Campsite itself took about 2 hours if there's no traffic jam and at most was about 3 hours to reach. Along the way to the camp, the sight of the famous Long Beach by the Bay of Bengal was
magnificent. On the first day of our mission, as the local driver drove us to the Campsite, we got stuck in a road traffic accident that involved an overturned lorry carrying a full load of Bamboos that killed a child and seriously injured 4 adults. The bamboos were used to set up camps and tents for the refugees to stay there. So we were caught under the unpredictable weather that kept changing from hot sunny day to heavy rain every 5 to 10 minutes. We expected it as it is the monsoon season.
Our mobile clinic was set up which included 3 small tents with a table & few stools. The first tent was used as a registration and triaging station where we get the patient's name, camp address, age, their weight, blood pressure and body temperature.
If the patient was having high fever or came in with open bleeding wounds, which was a common diagnosis, we prioritised them first. The second tent was our treatment tent where we did our wound dressings and necessary body examinations if needed. The third tent was used as doctor’s consultation area and drug dispensary area. As there was no ventilation inside the tents, we ensured patients were getting in line so as to not crowd around the tent. Our local doctor, Dr Ismail Hussain was passionate and disciplined and ensured patients were queuing up and there were no misunderstandings among the Refugees about who got to go in first. He would personally come out to the queue outside our triage tents every 30 minutes to make sure women and children were prioritized first. We also had our team leader, Ashik, who helped us usher in patients to queue up and alert us if anyone needed attention first.
If the patient was having high fever or came in with open bleeding wounds, which was a common diagnosis, we prioritised them first. The second tent was our treatment tent where we did our wound dressings and necessary body examinations if needed. The third tent was used as doctor’s consultation area and drug dispensary area. As there was no ventilation inside the tents, we ensured patients were getting in line so as to not crowd around the tent. Our local doctor, Dr Ismail Hussain was passionate and disciplined and ensured patients were queuing up and there were no misunderstandings among the Refugees about who got to go in first. He would personally come out to the queue outside our triage tents every 30 minutes to make sure women and children were prioritized first. We also had our team leader, Ashik, who helped us usher in patients to queue up and alert us if anyone needed attention first.
Overall, it was bittersweet and overwhelming. It was very saddening to see people living in such inhumane conditions with no basic necessities like water, food, clothes, shelter and sanitation. The locals themselves were merely getting by with what they have and yet they're willing to open their hearts to receive these Rohingyan Refugees into their homes. In our campsite, camp 11, our tents were literally set in front of a local’s house. She was kind enough to let us set up our tents for the mobile medical clinic. Along the roads we could see a very long queue for food and men carrying huge sacks of food supplied by the World Food Programme over their shoulders. The had to walk over deep muddy waters and huge pond-like puddles as the roads were so bad with their slippers. It was sad to see what they had to go through to get by everyday but I praise the amount of resilience they had to endeavour these hardships with the will to survive.
The people there are so kind and they look up to us when we arrive with our Red Cross vests on. The local volunteers would make sure the tents are set up with the necessities before we arrive and ensured the refugees queued up in line without crowding the tent. The local midwife and nurse were so patient to teach us the common drugs used locally and the workflow of the clinic. Our local doctor, Dr ismail Hussain, is so humble and friendly and he ensured we hydrated ourselves occasionally as it was very hot and the tents were stuffy with little ventilation.
On the first 2 days it was around 50 to 60 patients as it took some time for us to be familiarised with the surrounding and set up a smooth workflow. Gradually, we saw about 100 patients daily, with the maximum number of 107 patients seen at our Camp 11. They were mostly women and children. Regardless of heavy rain or scorching sun, the Refugees would come all the way from their camps, some without any footwears or umbrella on a rainy day. They were all sick and needed medication.
Since it was the monsoon season and the weather was very unpredictable, the children mostly came down with cough, flu and diarrhea. There was a Rohingyan refugee mother carrying a 1 year old child in her arms who had runny diarrhea and her cloth around the child's waist was soaked. They didn't have essential baby supplies like pampers and proper baby food which in turn makes the condition even more worse.Well, the second commonest condition we saw were skin conditions. Children had skin infections around their mouth and hands, most probably due to poor sanitation and hygiene in their homes. Eczema, shingles and fungal skin infections were prevalent among adults and teenagers. Besides that, dehydration was also common among the Refugees. Almost every patient were prescribed with 2 or 3 sachets of oral rehydration salt (ORS) to drink. We also had to administer ORS to children as they were severely dehydrated. When I offered a glass of water with ORS in it, the the little boy drank as if he had been thirsty for a very long time! It was heartbreaking to see that something as basic as water was unavailable to them.
We also saw another rare case where a 3 year old child came in with a huge swollen left eye due to an insect that has burrowed through the side of her face. I felt so helpless as there's only so much that we could do with our limited resources in the clinic. We referred her to the eye specialist at the field hospital for better treatment.
On the first day, I decided to tag alongside my team mate Yan Chew, to get familiarised with the medications as she had been on the ground working at the campsite with the local volunteers with Team 1 the week before. I helped to dispense the prescribed medications after the patient had seen our team doctor, by sitting alongside the local midwife who was very knowledgeable and well experienced in the drugs and its dosage administration. We administered salbutamol inhalers and taught the refugees on how to use it properly. My nursing knowledge on drug administration definitely helped a lot teaching them how to use it.
The local translator helped to translate how and when to take the medications in the Rohingyan language to the Refugees. Hence, we followed this workflow for the next 2 days. After that, we switched places where Guan Tain, another teammate of mine managed the drugs and I did the patient registration and triaging.
The local translator helped to translate how and when to take the medications in the Rohingyan language to the Refugees. Hence, we followed this workflow for the next 2 days. After that, we switched places where Guan Tain, another teammate of mine managed the drugs and I did the patient registration and triaging.
There was a wound case that I encountered in the clinic as well and it was our first. I was busy administering medications to the refugees in the tent and Ashik our team leader who was controlling the crowd outside called me out to see a refugee with a bleeding toe. I quickly inspected the wound and saw that it needed some cleaning and dressing. As I headed to the other tent to get the cleansing solution & dressing set, I told the local volunteers to clear the treatment room. It was a deep cut and so I cleansed the wound with some normal saline and wrapped the wound with iodine soaked gauze, bandaged it then tied a plastic bag around his foot to prevent the muddy waters from soaking the wound dressing. It reminded me of my daily cases I assisted in the Major operating theatre and I was so glad to be able to help. With Dr Cecilia’s advice, I told him to change his foot dressing at the field hospital and gave some antibiotics.
We also encountered an emergency case where an elderly man was carried to the clinic unconscious and we had to commence Cardio Pulmonary Rescucitation (CPR). However, the elderly man had already passed long before they carried him to the clinic and it was too late. It was overwhelming to see the relatives crying and wailing as they hugged the elderly man lying motionless. It must have been hard on the family on his sudden death. They carried the body away on a wooden bed frame to their village as the crowd followed behind. Although dealing with deaths in our healthcare field isn’t an uncommon sight, it definitely was a surreal experience to witness a death in a different social setting that upheld their certain culture and believes.
There are unforgettable moments there that were somewhat bittersweet and taught a little somethin about humanity.
I met with 100 year old Rohingyan refugee grandpa at the clinic while stationed at the registration and triaging tent.
He walked so slowly with his walking stick, sweat poured down his wrinkled skin as the day got hotter and he had some mild tremors. I was amazed at how his BP was at normal range at that age and his weight was also maintained well. I always try to have a mini conversation with the Refugees as I register as it gives me a better understanding of what they are going through with the help of the translator of course. I asked him what was his secret to his golden age he said perseverance and rice with a laugh. Both the translator and i laughed along.
Another memorable experience was when I had to do cold water therapy for a child who had a fever of 40 degrees celcius. I had to pour cold water over the child to reduce the fever then give her some paracetamol syrup. Over there, their main source of water was from water pumps that were connected to underground water. So, I undressed the child with the help of the mother standing beside. When I pumped the water, there was no water flowing out so I tried the second time and there's still no water. I tried the third time with all my strength only to have a very small amount flowing out. The mother who was standing beside just laughed covering her mouth with her head scarf. She signed to me that I have to put some force into pumping it. After that embarrassing moment, I put my full force into pumping the water and finally water flowed up filling up the bucket. Both of us were just laughing as I watered the girl head down. After that I gave her the paracetamol syrup and her fever came down after 20 minutes. The mother thanked me as she left. Well, at least I made her laugh. Let's just leave it at that.
Also, the debriefing sessions we had every night as a team was super fun as we all had so many things that happened at campsite everyday to share with each other and learn from it. Our team 2 members were Jasmine, Noor Azlina, Sathiaraj, Dr Cecilia Kwok, Dr Shruti Suryaprakash, Guan Tain and Yan Chew. Our leaders Ashik and Aaron are super fun people and everything was a smooth process under their care. Sathiaraj was the funniest in the group and I think I've never laughed so much in my life spending the whole week with them.
We would share our opinions on how to improve and provide better service to the refugees, the stock of medication that needed topping up, play fun games, crack jokes and chill after a long day's work. I had so much fun with my team mates and I'm truly blessed to be on my first mission trip with these people. In other words, they were like a new family that I found, only with the similar perspectives and ideas. Bingo! Hahaa
Life was hard in the camps. I knew just by looking at it. Their houses were just built into small huts, using bamboos, tent materials and wood. Rain or shine, the local people and the Refugees had to pull through and get it together to carry out their daily activities.
The most rewarding experience was when a 3 year old baby girl smiles back at me. We were literally trying to play along with the children but the children seemed emotionless with not much response. They seemed too tired and lethargic.
So being able to see at least 1 child smile back is very rewarding. I literally went “finally a baby girl is smiling” and the local volunteers laughed as they too agreed it's hard to see them smiling and playing around.
So being able to see at least 1 child smile back is very rewarding. I literally went “finally a baby girl is smiling” and the local volunteers laughed as they too agreed it's hard to see them smiling and playing around.
Another rewarding experience was when some of the refugees bless us with their words saying “may Allah bless you and your family forever” and they express their gratitude to our efforts through this clinic and they even told the local doctor and volunteers that they will be missing us once we leave. Their genuine appreciation was very rewarding.
Our daily reflections in our debriefing sessions that I had every night with the team was exciting and it was truly fun and interesting that we had the sharing session.
There were children as young as 5 who come to the clinic without their parents or guardians as they aren't around anymore and it was hard to know whether they really understand the instructions on how to take the medications given to them.
I think we are also very blessed to be living in a country with a peaceful and democratic governance alongside with different races and religion staying together harmoniously.
In other words, there's a feeling of happiness that I managed to help as much as I can towards their health, there's also a bit of anger on why such crisis is still happening in 2018 but also a bit of hope that this problem would come to end soon like they say there's always a light at the end of a tunnel.
Looking back to the first day of our mission, I was very nervous to the point that I couldn't sleep the night before we departed Singapore to Bangladesh as I didn't know what to expect or do. However, it's only a matter of time to adapt to the place and my team mates were a fun bunch that they supported me and motivated me to do better. So I think before any mission, just go with an open mind, be ready to learn and multitask and don't be afraid to talk to people.
Another thing is to always put on mosquito repellent and sunscreen whenever you're out to protect yourself. Oh, and also bring lots of instant milo packs, charcoal pills and anti-emetics because you'll never know when you would be down with stomach flu. I have a sensitive stomach and had stomach flu. I survived on milo packets and charcoal pills just for a day thanks to my team mates Noor Azlina and Yan Chew! It's always good being surrounded by awesome doctors and nurses.
It's good to have a journal with you or download the blog app in your phone. I always make it a point to record my daily life experiences there in my blog at youthdilemmas.blogspot.sg. whenever I have the time. It helps me to reflect and improve better in whatever I'm doing.
I firmly motivate and support other nurses to volunteer for missions. It's really an eye opener and by personally being on the ground and seeing how people across the world are living and going through lives beyond their hardship will completely change your perspective of life. On the other hand, you build beautiful priceless friendships with people from all walks of life who in one way or another teaches you about life. Going on missions also helps nurses to sharpen their nursing skills, gain new insights on different medical conditions and diagnosis that we rarely see in our usual work setting as well as build their confidence to deal with challenging medical phenomenon when functioning in area with limited resources.
Young nurses especially, should volunteer for such missions as they have the energy, strength and stamina to withstand harsh conditions and build their knowledge and skills.
So, now that I've been on my first mission, will I ever go on another one again?
Yes, and yes again! I believe that I should help out as much as I can to contribute towards a better life for someone. Being a medical professional, what more an Operating theatre nurse, I honestly would want to make full use of my knowledge, skills and experience by helping those who are in dire need of the very basic thing such as healthcare. There are many crisis happening all around the world and as time goes by, I only realize that it's getting worse by the day. Though I am unable to control such worldly problems from taking place, I feel that I'm doing something to ease their pain and make it a bit easier for them to go through their lives everyday although it isn't much, it's at least the best I can do to play my part in making the world a better place.
I also believe that people that we encounter in our everyday lives is nothing short of a divine circumstance. I've gained priceless friendship with people from all around the world through this mission be it through the local volunteers or doctors and nurse from the various field hospitals. There was a midwife that we met while visiting the Japanese Red Cross Field Hospital. Her name was Michi and she was very passionate and adept in ensuring the female refugees who came to the hospital to be registered had full complete health and medication history filed in. The way she explains her experience and her role on what she does was so inspiring and I strive to be like her someday. According to the head doctor of the Japanese Red Cross who leaded our hospital visit there, nurse Michi was personally requested by the Red Cross to work with them at the field hospital as she was very experienced and excellent in her work.
We also managed to visit the Norwegian Red Cross and Finnish Red Cross tents in the field hospital and i managed to catch a glimpse of the operating theatre there. It was exciting to see that they had all the necessary machines and ventilators for surgeries and even had X-ray machines available. I would definitely want to work as an operating theatre nurse here someday. It was truly inspiring to meet the doctor and nurse volunteers from all around the world who are willing to sacrifice their time and energy to help the one’s in need.
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