War of the Roaches (Part 2) – war is declared

The cockroach mounted Mark in the early hours on the morning, perhaps mistaking his pale flesh for some mushti, a traditional Bengali sweet. Mark however, first noticed it crawling half way up his body, the cockroach’s little feet stroking his body like the brushes of a jazz drummer. Sitting bolt upright he flung the little monster half way across room into my hair, which I then knocked to floor after some frantic brushing. The cockroach scampered to safety and the rest of the night was spent by both of us interpreting each sound and movement as the impending arrival of a horde of cockroaches. As far we understood it, they had violated the uneasy truce we had; no longer would we tolerate each us others presence provided left well alone. It was war.

War of the Roaches (Part 1): a scream in the night

I awoke in the dead of night to the piercing sound of a high-pitched scream. It kicked me from my deep slumber instantaneously. What horror had come to visit? What foul entity, be it natural or supernatural, had come to torment me, perhaps to take my very life? I sprang to the light switch, never lacking in courage, so I could better confront the evil. The fluorescent glow revealed a twirling mass on Mark’s bed. I saw what I thought were too hands furiously beating the bed clothes, and the same shrill cry echoing about the bedchamber. I moved to my back foot, my courage faltering at the sight on the unholy terror. Gradually the whirling mass began to take a recognisable form. It was my friend Mark, his face anguished and tear stained and his hands still tearing at his sheets. At last I could make sense of the scream: COCKROOOAAAACH!

Singapore Slim

We are about 2 weeks into Ramadan, the holy month where Muslims fast throughout the day to purify themselves and train their minds and bodies to be good and just in the coming year. As atheists and Christians we are not expected to participate in the fasting, but living in a predominately Muslim country there are still implications on our diet. As a matter of courtesy we do not eat or drink in front of our hosts during the day.

The cafeteria where we eat most of our meals is still open, but offers a limited selection of food (even more limited than rice and curry). Now breakfast and lunch is bought in the local supermarket, Agora, and taken in our room. We’re eating a lot of fruit and drinking a lot of water, supplemented with bread and biscuits. This partially self-imposed diet has been nicknamed the Singapore Slim for reasons that I’m not entirely sure of.

The Singapore slim is a powerful weight loss diet, since in effect it involves only eating one meal a day. I’m planning to market it along similar lines to the Atkins diet. I think there’s some money to be made here. To achieve your weight loss dreams all you need to do is move to an Islamic country during Ramadan and live according to the customs of your surroundings. It is simple to use: there’s no point counting, no calculations – just dramatic weight loss that would make a supermodel convulse with envy.

Why I’m here

I suppose I should say a little about why I’m here. Ad-Din Hospital is a not for profit institution just outside of central Dhaka. The hospital provides high quality healthcare at a low price, far lower than anything else comparable in Dhaka. It does so through the excellent work and dedication of its staff and the generousity of Sheikh Mohiuddin, its Chief Executive, who regularly invests capital in the hospital.

The hospital originally started life a Save the Children nutrition centre in the 1970s. In the late 90s, as a result of changes in funding, it was no longer financially possible for Save the Children to run the nutrition centre which over the years had grown into a women and children’s hospital. At this point they entered into an agreement with the Ad-Din, who provided they met certain conditions, would be given the hospital. One of those conditions was regular inspection by a British based team. In 2005 they recommended that the hospital would benefit from the professional eye of a healthcare management consultant. Among his recommendations – hang on, where getting there – was that an NHS management trainee or two should go to Ad-Din in order to support the organisation in its development. And that, is where I come in.

Pants

I travelled light to Bangladesh, taking only those items I thought were essential (which as a molly-coddled westerner still included an mp3 player, laptop and several tins of Heinz baked beans). As such, the time quickly came when I needed to brave my first Bangladeshi shopping trip. Among other things, I needed a new towel, some shorts and underwear.

Just a few minutes from my hospital I discovered a men’s clothing store called Westec. It was a marble and stained black wood affair, something that has pretensions above itself and wouldn’t look out of place on the shabby end of Oxford Street. I wandered about the shelves picking up a towel and browsed the shirts and jeans. In the furthermost corner of the shop I spotted the boxer shorts, 195 taka (about £1.30) for three. Jackpot! Mark recommended that I buy a size bigger than normal, the average Bangladeshi being much slimmer than the average European, so I picked up a packet marked large and hurried to the counter to pay for my purchases.

It was only on returning to my room that I discovered the horror of what I had done. The boxer shorts were in fact briefs, or rather some kind of brief/knicker (brifkers? kniefs?) genetic crossbreed. They were too big to be knickers and yet there was no place to put your genitals. It was as if they were designed by and for eunuchs or castrati. Nonetheless, these facts didn’t dawn on me until much later; I was busy gagging at the colour of the brifkers. The pattern was thin stripe in the most lurid colours imaginable, pinks and peaches mingled with purples, reds and oranges looking like a fading bruise. Perhaps the eunuch who designed these monstrosities was really seeking revenge on mankind?

I’m a limited writer at the best of times, but so you can truly appreciate these pants please cross your heart and look below.

 

The only question remains did I wear them? On that topic I keep a pensive silence much like a shell shocked soldier returning home from the war.

Banger Race to Ad-Din

The disorientation I felt on leaving Zia Airport abated somewhat on the way to Ad-Din. Life was no less frantic or intrusive, but I was cocooned in the familiar surroundings of car.

Travelling by road in Dhaka can be a terrifying, exhilarating or frustrating experience, and on most occasions a combination of all three. Rickshaws, baby taxis, cars, buses and trucks compete for space where there isn’t any to be had. There is no lane discipline whatsoever. If your vehicle is small enough to fit into a gap then you can swerve from one side of the road to the other at break neck speed. If the space is too small then a little honking will make it bigger.

As far I understand it, using your horn means one of two things: I’m here, not going anywhere, so don’t hit me, or I’m here, going over there, so you’d best get out of my way. And as you can see, those two options are clearly not compatible, which explains why almost every vehicle has some kind of dent in it.

I think our driver considered Mark and my western sensibilities by keeping the ride just the right side of exhilarating. Occasionally he strayed into terrifying, but there are situations in life that only a crazy person can survive in one piece, like when a truck and bus simultaneously decide to move into a space in the middle lane that you happen to be occupying. The frequent traffic jams – it took about 45 minutes to travel the 4-5 kilometres to Ad-din hospital – are the frustrating part, but they serve a useful purpose. They allow you a little time to collect your nerves and give the drivers opportunities to test their horns.

Welcome to Dhaka

Mark and I had a smooth trip to Dhaka; getting through customs proved another matter. His visa was marked ‘Date of Expiry: 28-01-2006’, not 2007 as it should have been. The custom’s official was the first person to spot the mistake. He took a deep look at Mark, cogitated for a while and called for a more experienced colleague. 

I hoped to see an avuncular official with a kind smile and gentle eyes. Instead a stern faced man, about 5’8” with orderly demeanour and penetrating eyes, came across from the other side of the hall. Peering over his gold rimmed glasses he barked a few questions at Mark. Barely waiting for an answer he barked again, this time in Bengali into his walkie-talkie. After a nervous wait of 5 minutes a response came back over the radio. He fixed us with his glare: 

‘This is clearly ridiculous, very ridiculous.’

‘Ah, yes… Well, you see… this is what happened’ replied Mark.

‘They have made a stupid mistake. Welcome to Bangladesh. Please have your visa corrected when you return to England.’ 

With that he waved us through customs to collect and bags and on into the heat and dust of Dhaka. 

Stepping out of the air-conditioned comfort of Dhaka’s Zia Airport a wall of air, at once dense, hot, humid and thick with pollution, hits you. It rather like being smacked in the face with a wet jock strap –  or so Mark tells me. After this initial blow the sights and sounds of Dhaka begin to assert themselves. You find yourself in what appears to be a large holding cell fenced off on 3 sides with mesh and walls, with the fourth side being provided by the airport itself. Policemen guard the exits as crowds throng about pushing onto the fences. Some are begging, others are hustling, all are shouting and reaching out to you. The mass of activity numbs the brain. As an observer there is no way to absorb it all that doesn’t end in paralysis. The best option is join the great flow of life. Get moving! 

Dr Rezaul Haque, our host for the next 3 months at Ad-din hospital, emerged as our saviour from the crowd. In a few minutes we were making our way along Airport Road still trying to get our bearings in a taxi ride that was just as disorientating as Zia Airport.

Circling the plughole – a management dictionary

The graduate training scheme I’m on is designed to produce future leaders for the NHS, people who in 10-15 years will be the chief executives and financial directors of multi-million pound trusts. But if you’re gonna get to the top, you gotta know the language. With that in mind, the trainees of the London South and Eastern regions have been working on a management dictionary for the benefit of all:

 

Circling the plughole – used to describe ideas, theories, practices and so on – particularly when faddish – that are in the process of dying because they are painfully idiotic.

This phrase died out suddenly at a trainess trust when word got round that it is also, unforunately, gay slang for something entirely different. He justified his wages for year when I let that fact slip. For a laugh you may want to introduce this phrase in your work. In times of financial hardship it spreads like wildfire, and you can then sadistically deflate everyone by revealing the other meaning.

Climbing the greasy pole – working your way to the top of the NHS management hierarchy.

Turnaround – term used to mean significant financial cutbacks in an attempt to achieve financial balance.

Milkman – a person renowned for always delivering on their promises/commitments.

Does it stack? – do we make a profit/break even if we make this change to the service?

Service Review – how can we make some cutbacks (probably staff) in order to save money?

Blamestorming – sitting around in a group working out why a deadline was missed/project failed and apportioning due blame.

What it’s all about…

Every September over 100 NHS Graduate Management Trainees go on their electives leaving England for foreign shores. Some only make it as far as the Department of Health in Whitehall; others make it across the channel to Europe, North America and beyond, and few afflicted with more extreme wanderlust get as far Africa, Asia and South America.

 

This blog is a record of my elective at Ad-din Hospital, Dhaka, Bangladesh.