Just 4 days ago, I returned from my bi annual trip to Bangladesh. As the days are rapidly going by, and my junior year of college at Duke is about to start, it means that I should get my bi-annual blog post done too. You can view my blog posts for the 2014 and 2012 Bangladesh as well before reading this, for a bit of context of what has been going on. This trip was quite eventful, and many things got done, many people were met, and my overall development as a person was impacted. These sorts of trips always change you.

This year, we elected to take Etihad Airlines instead of Emirates to fly to Bangladesh, as tickets to Emirates ended up being hard to find for a family of 7 (my grandparents were coming with us to Bangladesh this year – they had finally secured a Visa and visited us in the States for almost 10 months, and were now going to return to Bangladesh with our family during our vacation). This meant that our stop on the way to Bangladesh was in Abu Dhabi, instead of Dubai.

We were a bit cautious as we heard that Etihad probably wasn’t nearly as good as Emirates had been (we’d never had bad experiences with Emirates). Unfortunately, our fears were confirmed, as our hiccups with Emirates started almost from the moment we set our feet inside the Dallas Fort Worth Airport, to board our 16-hour flight to Abu Dhabi. There apparently was quite a rigid policy associated with carryon size aboard the Etihad flight. We all had what we thought were “standard size” carry-ons, which worked just fine all these years, but upon approaching the Etihad counter, we saw that almost all of our carry-ons wouldn’t fit the reference size crate on the floor. We already had exceeded our allotted amount of checked baggage, so it would have costed us a hefty amount to check all of our excess carryon bags in. After shoving quite hard on the carryon bags into the metal crate, a few of them managed to sneak in, and we somehow managed to move on. It was weird to me how strict the Etihad employees were on taking on carryon that may have been 0.5 inches longer that what they required, which was already absurdly small.

The flight itself wasn’t bad. 16-hour flight upon economy class isn’t anything to write home about – but I watched a few cool movies on the flight. There’s a movie I watched called “Concussion” starring Will Smith. I had previously read reviews about the movie being rated at somewhat mediocre by critics – but I took my chance and watched it. I ended up really enjoying it – the movie is quite underrated – basically about a doctor (played by Will Smith) who found out that NFL players suffer from life-damaging concussions leaving them with mental disabilities. The NFL then fought against the findings of the doctor, since his findings would undermine the very existence of the NFL. It is quite an interesting movie, and I highly recommend this movie!

ARRIVAL IN DHAKA 

We landed safely in the Dhaka international airport – but we noticed that things were quite different. Security seemed to be much more amped up. We later found out that there was a terrorist attack (claimed to be by ISIS) in a region in Dhaka (the capital) called Gulshan, where over 20 people were killed. It saddened me to hear this, as Bangladesh was actually very immune to these types of attacks – and attack of this scale was virtually unheard of in the country. Because of this, I noticed lots of armed security guards throughout the airport.

After taking up all our luggage from the baggage claim, we noticed that one bag was missing. It turned out to be one of my bags, which contained many of my books, which I had intended to use to study for the MCAT (man…it’s crazy that I am now having to think about applying to med school already…). The books were pretty expensive, so I got worried. The workers at the baggage claim told us not to worry, and that usually lost baggage tend to turn up at the airport in the coming days after the flight. We had no choice, as it was getting late, so we left our contact details, and exited the airport to go to our flat in Dhaka. 

On the drive to our flat, I noticed just how much Dhaka had changed in just the 2 years I was gone. Lots of new overpasses were built, which seemed to have reduced traffic substantially. The quality of the roads going out of the airport were now very good, and overall, it was clear that tons of improvements to the surroundings have been done in just 2 years. Seeing such improvements reinforced my hope in this nation. 

 By the time we arrived at our flat, it was past midnight. We all settled down as soon as we could, and went to sleep, as early next morning was the departure time for our bus to Kushtia, Bangladesh, where all my relatives lived. It was also the location of our non-profit organization iKormi, where we have been working over the last 5 years to fight arsenic water poisoning via the manufacture of affordable water filters using local labor and materials. As we were going to sleep, something caught my eye – it was one of iKormi’s water filters, perched near the kitchen of the flat. After running water through it, the resulting water was sparkling clean, and tasted great. The date on the filter’s sticker indicated that the filter had been running for nearly 5 months. It was quite encouraging to see that the filter was working great without any need for any replacement parts for that period of time.

The following morning, we departed from the Dhaka flat to the bus station. We boarded our bus, chartered by the Hanif Company, and was on our way. It was quite a comfortable bus – more comfortable than any bus I’d been in even in the United States.The bus ride to Kushtia took over 6 hours, but the time flew by without incident, especially because of how comfortable the bus was. We arrived in Kushtia, and went straight to my grandparent’s home, from my mother’s side. My grandmother greeted us, and was overjoyed to see us. My grandfather, who was much more weakened than he used to be, also greeted us, when we went to his room.

Luckily for me, my grandparent’s home from my father’s side was also in Kushtia, just a mere 15 minutes’ rickshaw ride away. My uncle and aunt lived in my
grandparent’s home, so we went over there briefly to see them as well. My dad and stood on the side of the road, and stuck our hands out for a ride, and soon a traditional pedal-powered rickshaw came over, and picked us up. Or so we thought it was pedal powered. The moment the rickshaw started moving, I noticed something different. It was going much faster than I had realized 2 years ago, and the rickshaw was emitting a 

"buzzing" sound. I suddenly realized that the rickshaw was entirely electric.The rickshaw could also be pedaled, but an electric motor was hitched underneath, which had enough power to zip us through traffic.  I looked around as we were driving through town, and noticed that virtually all the "pedal" rickshaws all had these small electric motors by the rear wheels.I attached a picture of our driver, and his auto rickshaw. Quit amazing :) 

 These pedal auto rickshaws were traditionally considered to be the slowest form of transport in Bangladesh, as there already were dedicated 3 wheeled electric auto rickshaws all over Bangladesh - but now, even these pedal auto rickshaws were electric. And since these pedal-powered auto rickshaws were so light, they actually were faster than the standard, large electric auto rickshaw  I realized that Bangladesh had come a long way in this regard - and the city was not experiencing the kind of smog you'd expect in a densely populated area, since everything was electric! Below are two pictures - on the left is one of the "standard" electric auto rickshaw which is now quite popular in Bangladesh, and is capable of seating up to 9 people, as there are 3 benches within the vehicle. The green vehicle on the right is an auto rickshaw powered by compressed natural gas (CNG) - these are since being phased out in Bangladesh with the electric versions. The CNG rickshaws are still quite popular in parts of East Asia, India, and Pakistan.  

We finally arrived at my grandparent's home (from my father's side). The headquarters of iKormi was right beside their home for convenient access, so as I entered the home, I saw the dozens of filters under construction off to the side. It was amazing – I didn’t think the construction would have advanced this far. I saw the various parts of the filter in the corners of the construction place, such as many neatly labeled bags of sand, which were used as the filtration media. I also saw the many plastic diffusers waiting to be installed in the filters. Inside my grandparent’s home, there was a finished arsenic water filter which was being used by the household (at the time, my uncle, aunt, and two cousins were living there). The water filter was one of the first filters we ever built – the filter was over 2 years old. Yet the filter worked amazingly. The water well that the household used had large amounts of iron – to the point in which the red iron residues were visible even in a single cup of water, and the smell of watery iron was quite noticeable. After running the water through the filter, all traces of iron were completely eliminated, and the smell and taste of the water was much improved. My grandfather’s water well didn’t really have arsenic however, so that filter didn’t need to work to remove arsenic – but even in removing other impurities like iron, the water filter worked beautifully. It was amazing to see that the performance of the filter was so consistent over these two years, without having to replace cartridges like other types of filters would ordinarily have to do.

As it turned out, the filter was not only helping the many households in rural areas where we deployed to over the last 2 years (such as in the village Rajapur), but also was a great help to my grandparent’s household as well. Previously, the iron-rich water would have been boiled in an attempt to get rid of some of the iron-esque taste from the water. The water would then have to take some time to cool, before being drinkable. This wasn’t necessary anymore, as the filter took care of removing all the iron from the water as well as substantially improving taste. Seeing this filter, as well as the one in the Dhaka flat greatly encouraged me and reaffirmed me of the strength of these filters. 2 years ago when I came to Bangladesh to start manufacturing these filters, my biggest fear was how these filters would hold up. If these filters didn’t properly hold up, then my purpose for making these filters would start to be weak – what is the point of them? I wanted to improve upon the three greatest weaknesses of filters already in the market – the high cost, and the fragileness of the filters, as well as the need to keep replacing cartridges. I couldn’t wait to go to Rajapur to see how the other filters which had been distributed over the last two years had been holding up. From what I heard from iKormi volunteers who have followed up on those who received filters, very few units have had problems. I was hoping to see those for myself.

Trip to Chuadanga, Bangladesh

I spent a few days just relaxing between the two of my grandparent’s homes, and meeting my relatives. After a week, we all decided to visit some relatives in a neighboring town to Kushtia, called Chuadanga. Another aim of our visit would be to survey the water conditions of a rural region in Chuadanga, as it was known to us that Chuadanga was another region heavily hit by arsenic water poisoning. We rented out what people in Bangladesh call a “microbus”, which is essentially just a small van capable of seating 10-15 people. My family, as well as my grandparents and uncles, all came along for the ride. We had brought along the parts to manufacture 1 water filter in the van. Our goal was to build a water filter that my uncle living in Chuadanga could use. Once we arrived at Chuadanga, at my uncle’s home, we worked to build the water filter straight away. One of the main volunteers for iKormi, named Kanak, helped pioneer many enhancements to how to deploy the water filters into the field. He came up with an intelligent way to split all the sand which goes into the filters, into numbered bags, which go in one after the other. Because of this efficient technique, the filter took only 10 minutes to assemble onsite, and just shortly afterwards, we took one cup of water from the filter, and saw that it was sparkling clean compared to the supply water. It was refreshing to see the instant impact that something like a water filter could make. The picture below shows the clean filtered water on the left, and the dirty water that originally came from the supply line on the right. 

         Shortly afterwards, we all left the house in Chuadanga, and went back in the car to take a visit to a rural site nearby, to survey the quality of the water there. Just after driving 20 minutes away from the main city of Chuadanga, we came across a rural village. We got out of the car, and met with many of the

villagers in the area. They were all incredibly hospitable, and all offered to show us the water wells from which they drank from. Within the next 30 minutes, we took samples from the water wells of several villagers around the area, and saw that the vast majority of the water was heavily contaminated with tons of iron, and many were arsenic contaminated. The water samples were also visibly cloudy, meaning that the water had lots of sediments, and possibly other contaminant materials in there. We also stopped by a school, which was at that moment, currently in session. We saw in the middle of the courtyard of the school where all the kids were playing, was an old water well. The water well was elevated, which was quite an unusual design compared to all the normal water wells we have seen so far. It turned out that a NGO had built that well. The well was elevated to avoid arsenic contamination on the output, as often times, the concentration of arsenic could be reduced when brought out from underground and exposed to oxygen. However, at the moment, the water well was 

completely broken, and children were playing on it. I decided to take a picture of the well, via selfie. The children were all excited by our presence, and all were intent on getting in my picture. Afterwards, we talked to the school’s headmaster, who confirmed our suspicions that indeed, there was arsenic contaminated water in the area, as well as at the school. We decided that Chuadanga needed a representative to collect the names and addresses of the first batch of people who most urgently need water filters, similar to how we found a woman named Sumayyah in Rajapur, who had helped us greatly in bringing us a list of people who were in the most need for arsenic water filters. Because of Sumayyah’s cooperation, we were able to help Rajapur greatly increase their access to safe drinking water, especially amongst those who are extremely poor. We ended up finding a woman in Chuadanga who was willing to volunteer- her name was Fatima. We gave her the task of giving us a list of people in her village who were in the most need to receive water filters. We also provided her with the financial resources for the support and time she would give for this cause.

With the preliminary surveying of that region’s water supplies, we were done. We packed our stuff back into the microbus, and headed back to Kushtia. Things were going all good, until the microbus started to heavily jerk. The vehicle has already been displaying problems since the beginning of the trip to Chuadanga, but the problems were magnified on the way back to Kushtia. I suspected the clutch was giving out. Suddenly, the vehicle came to a stop, and didn’t move any further. It was directly in the middle of a busy highway road. To make things worse, there was only 10 minutes until sunset, so that made the situation very dangerous. Within minutes, a long line of cars piled behind us (it was a one laned road). We were very confused and scared on what to do. Suddenly, out of amazing good luck, a passenger bus came up from behind. The assistant on the bus walked out, and offered all of us to come on board. I was stunned at our luck – 12 people in the middle of the night managed to hitchhike onto a passing bus just like that. I later found out that is sort of behavior was customary in Bangladesh – stranded travelers in the middle of the roads were often picked up by the good will of people on passing passenger buses. It warmed my heart to see such behavior. After we got on the bus, we found out to our good fortune that the bus was headed to Kushtia by default, so we were finally able to relax. That was definitely a story that would never be forgotten.  The picture below is of a small public bus in Bangladesh, similar to the one that picked us up. These buses aren't the fanciest thing in the world, but they get the job done - and the operators are always kind enough to pick up travelers in need! 

Trip to Dhaka

Shadowing Neurosurgeon Dr. Fazle Elahi, at the National Neurological Institute

2 years ago, when I went to Bangladesh, I went to Dhaka for one week in the middle of my time in Kushtia to be able to shadow a cardiogist in the Ibrahim Cardiac Center. I did this so I could gain experience on how different types of surgeries are performed, and to be able to compare the quality of treatment in the United States to the quality of treatment in Bangladesh. You can read about my 2014 trip to Bangladesh’s shadowing experience of the cardiologists here . This time, I wanted to have an opportunity to shadow another type of surgeon in Bangladesh. My mother knew a doctor in Bangladesh who happened to be a neurosurgeon, so through that connection, I was able to have a glimpse into the life of a neurosurgeon in a Bangladeshi hospital. 

Never have I ever seen anything like it. I mean, I always knew what the brain looked like in textbooks, and the fact that all people had brains (well…actually, that is debatable), but seeing one in front of me was surreal. The brain was covered in several layers of thin membranes, which the doctors were carefully peeling away. Afterwards, the sides of the brain were carefully “pushed” aside so the doctors could take their scalpels and reach into the tumor, which was further inside the brain. Since the space to work within the skull was so small (exacerbated by the fact that the patient was only 9 years old), a sort of digital microscope was used by the doctor to be able to see what he was doing. Luckily for me, the digital microscope also projected an image onto a nearby television in the operating room, so I could see what exactly the doctor was doing. It was quite impressive that the doctor was able to maneuver such a small area and remove a tumor from something as complex as the brain. A small mistake in the hand maneuvering would probably end up in a bad situation for the patient – yet the doctor remained quite calm and at ease throughout the procedure. The nearby nurses and assistants all worked together with the doctors in an orderly manner. After 3 hours, the surgery was complete, and the patient’s skull was repaired, and the skin around it was sutured together. The finishing touches were so good that it was difficult to the naked eye to see that such a big surgery was done on this patient. The machines and all the tools were put aside, and the nurses and assistants cleaned up the operating table. The doctor did some finishing checks, ensuring the patient was ok, and then told me his job was done.

BELOW: The completion of the tumor removal surgery on the 9-year old girl

I was impressed – what I saw that day admittedly far exceeded my expectations. One wouldn’t quite imagine a surgery like this would be able to be completed in a “third-world” country. I didn’t realize that the surgery would be completed in such high-quality facilities with such highly qualified individuals. The overall surgeries were done at a standard fairly comparable to what is expected in the United States, and yet the health care costs are a fraction of what they are in the States – in some cases, the surgeries are free! The neurosurgeries were occurring at the Neurological Institute for Neuroscience in Bangladesh (NINS). NINS is actually a government institute, which meant that healthcare for some people was free, and for everyone else it was extremely affordable. Exactly half the beds in NINS were completely free, while the other half of the beds were available to patients at a cost of less than 3 dollars a day, which is extremely cheap compared to private facilities in Bangladesh (forget about facilities abroad, such as in the United States).  Such government hospital facilities in Bangladesh are quite new, but are rapidly on the raise. Right beside NINS was Bangladesh’s national Eye institute, which was a massive government facility just like NINS, offering free to affordable treatment for eye-related ailments. The interesting thing about Bangladesh’s health system was also that foreigners could come in and receive free/affordable treatment as well. I talked with the doctors, and they stated that they have received patients from other nations as well, such as India. 

BELOW: Me with Dr. Fazle Elahi who graciously allowed me the opportunity to shadow him and see the surgeries

After shadowing at NINS, I had the opportunity to also shadow a pathologist at Bangladesh’s Dental College and Hospital, whose name was Dr. Ina Rahim. Like NINS, this was also a government institute, so people

came here for nearly free treatment for dental ailments. I was interested in going to the Dental Institute’s pathology department as I was interested in seeing how they detected E.Coli in people’s urine samples. At iKormi, one of the biggest difficulties is ensuring that the filters are removing bacteria from water, such as E.Coli. Unlike testing for the presence of chemicals like arsenic, it isn’t easily possible to use a simple test kit to detect the presence of bacteria like E. Coli. I was hoping that perhaps the methodology used to test for bacteria in urine samples might be simple enough and replicable enough to use for water samples. After shadowing at the institute, I realized that the procedure to test for E.Coli in the urine sample was quite similar to established norms on how to test for E.Coli – simply smear the sample (in this case, urine) onto an agar plate, and then incubate for a day, and observe the growth. The growth is then, in the case of the urine test, subject to the “Indol” test, which basically indicates if the growth is that of E.Coli if the test returns a purple color. Overall it was an interesting experience to see this test being performed, but we will need to do a bit more research and discussion to see whether this sort of test would be feasible for us as an organization to try to implement so as to be able to do bacterial tests on our own, similar to how we perform our own arsenic detection tests.

A visit into the Hazaribagh Tanneries in Dhaka 

ABOVE: Me with the manager of the Ayub Brother's tannery which I had a chance to go inside of.

Dhaka is one of the world’s most heavily populated cities in the world, with a population of over 16 million people. It is also one of the most densely populated cities. Being a densely populated city in a developing, Dhaka has it’s fair share of struggles, such as providing clean water and electricity to all. Pollution, both air and water, is a huge problem. However, there are certain things that were happening in Dhaka that I had read about and read online which were only exacerbating the problems. One of the biggest things I had read about was the leather tanneries district in the Hazaribagh region of Dhaka.

This region in Hazaribagh is home to one of the largest leather tanneries production areas in the whole world – over 200 leather tannery facilities are crammed into this small area. In these
facilities, raw leather is transformed into processed leather, which is then exported to developed countries in Europe and the United States to be made into shoes and leather bags. Over 185,000 people live in this area, which is just over 1 square mile in size. Processing leather is very dirty business, and tons of waste is generated- most of which is quite hazardous to health. These tanneries process millions of dollars worth of leather, and then dump the waste chemicals into the drain which flows directly down to the Buriganga river, which leads to the illness of many people who live in the surroundings. In addition, there are tons of scrap leather which is thrown away after the leather is processed. The scrap leather is often thrown away in the open land or lakes nearby. I read about all this prior to coming to Bangladesh – and this time, I wanted to see it for myself. So, towards the end of my one week stay in Dhaka, we drove down to the corner of Dhaka where Hazaribagh, and asked to be able to get inside one of the tannery facilties. To our surprise, the tannery directors allowed us to see how they manufacture the leather. I was overall quite surprised with how 

orderly and quick the tannery operated, but when it came to asking how they disposed of their waste materials, the answer was just as grim as I was expecting – simply dump the chemicals down the drain leading to the river, and dump the scrap leather in the open lands nearby. I wanted to see the dumping grounds myself – so we drove just about a half mile away from the tanneries, and it was absolutely stunning to see what happened next. I walked out of the car, and saw what appeared to be a massive wasteland filled with chemicals and waste leather. As I walked closer, I saw that this wasteland was actually a huge lake, that was covered with over 5 inches of leather and chemicals from the tanneries. There was water UNDERNEATH all that! It almost seemed I stepped into a part of the world that had experienced the apocalypse. It seemed stunning to me that this region was only a mere 5-6 miles away from the heart of the city. It turns out that many people are pushing for the tanneries to be relocated away from the densely populated city to a more remote area so that the impact on the people wouldn’t be so great. As I got back in the car to leave, I was feeling a bit helpless – what could I do? There was so many pieces of scrap leather being thrown away – was there anything that could be done with that leather? It turns out that the scrap leather is just as good quality as the leather being exported – but they simply were difference sizes, not fit for export. I was trying to think maybe the leather could be put to use in some type of product which could be sold, serving both a business purpose, and helping to solve a big environmental problem affecting the health of thousands of people.

 

Dropping off water filter samples to test for bacteria at the ICCDRB ( International Centre for Diarrhoeal Disease Research, Bangladesh) in Dhaka 

In Dhaka, there was not an arsenic problem, but more of a bacterial contamination problem in the water. The

filters that we were building at iKormi, while mainly designed to fight the problem of arsenic water contamination in rural village, were also designed to remove bacteria from water as well. On our final day in Dhaka, we met with Mr. Atiq, who was a friend of my dad’s. Mr. Atiq was also one of the people who have been critical in helping iKormi keep expanding. He was one of the first people in Dhaka to take a water filter from iKormi so that he could keep track of how the filter performed there as well. His filter was in operation for over 8 months, and the filter was working great, at least when visually inspecting the water. However, for safety, Mr. Atiq was boiling the water that came out of the filter to kill bacteria in the water if there was any. Boiling water turns out to be a very common household task in Bangladesh, especially in Dhaka, where bacterial contamination of supply water is prevalent. In many households in Dhaka, people own water filters (the kind with cartridges that need to be replaced) which they pour their water through, and ALSO boil the water afterwards, because of the subpar performance of the filters. After the 8 months of usage, we wanted to see whether or not the filter that Mr. Atiq was using from iKormi was properly removing bacteria from the water. So we decided to take 4 different types of water samples, and take them down to the ICCDRB (International Centre for Diarrhoeal Disease Research, Bangladesh), where they have a water bacterial testing facility. The 4 different samples were water samples taken from 1) Supply Water, 2) Filtered Water, 3) Boiled Water, 5) Bottled Water. We all went to the ICCDRB, and gave our samples, and were given directions to come back after 5 days when the tests were complete. As my family and I were going to leave Dhaka the next day, we gave Mr. Atiq the duty to retrieve the sample results, and give them to us when we come back to Dhaka for a final time 2 weeks later when we go to the airport (coincidentially, Mr. Atiq worked as an airplane engineer at the airport, so it all works out).

 Ratifying the iKormi Constitution 

A final thing we did in Dhaka was to meet with iKormi volunteers who were in the area to confirm the iKormi constitution, which would be critical in consolidating paperwork that would confirm iKormi’s status as a registered NGO. We were very fortunate to have Dr. Munshi Mahbub, who was a Supreme Court Justice Lawyer, to be on board with iKormi’s efforts. He helped edit our constitution, and square it away for submission for iKormi’s NGO status. If you read the blog post from 2 years ago, we had met with Dr. Mahbub earlier as well to start this process. With this meeting, this process has finally ended, and hopefully within the next few months, iKormi’s status as a NGO would be solidified.

 

Return to Kushtia - Trip to Rajapur Village 

We came back to Kushtia for one last time after our 1 week trip to Dhaka. It was hard to believe that there was hardly 5 days left before we’d have to leave Kushtia again for the Dhaka International Airport, and fly all the way back home. There were still lots to do. We still hadn’t gone into Rajapur to see the conditions of our filters being deployed there. For a bit of a background of us going into Rajapur to initially start deploying arsenic water filters, I’d suggest reading my blog post from 2 years ago. We also were intending on bringing in 13 new water filters to distribute to the village along with us. Early in the morning, we had a micro-truck come in and scoop up the filters, and the rest of us got in one electric autorickshaw, and we all drove down to Rajapur. This was a huge contrast from before, where we just took one or two filters at a time with a single electric auto rickshaw. This time, we used the micro truck to fit all the 13 filters, and the auto rickshaw was left to carrying all of us to the destination. It was quite remarkable, how one small electric autorickshaw fit 9 people, and managed to pull us down the highway and into the more rough inner rural roads that led to Rajapur. In the United States, there are some much larger SUV’s which are only designed to fit 5 people, and fitting more would be considered a stretch. While we were going to Rajapur, it had suddenly started raining. We were lucky that autorickshaws had roofs, so we didn’t really get wet – however, I saw many other cars going down the road, and I was wondering whether the passengers on those cars would get wet. Many of those vehicles going down the road lacked roofs – these were basic versions of taxis, whose sole purpose were to get people from A to B, so they weren’t very fancy, so the passengers riding in the rain would usually be out of luck. However, I saw something which made me laugh, but also marvel at the smart thinking - the passengers (some 12 of them!) who were previously exposed in the back of the vehicle, were all covered by one huge plastic bag. As the car was speeding along, the plastic bag formed a ginormous bubble over all the passengers. I managed to capture a picture of one of those vehicles with the rain umbrella “bubble” pass by – hopefully you get the picture (see below!). It actually seemed pretty fun.

 

When we arrived inside Rajapur, the iKormi volunteers Shojib and Kanak who traveled with us, started to distribute the 13 water filters which we had brought in the truck. There was already a predetermined list of people receiving the filters, which was organized and given to us by Zarina, who was a doctor at the local village clinic, and the filter distribution commenced. New filters were given out, and the stickers with the owner’s names and serial numbers were fitted as well. I was proud of seeing how orderly the filters were being distributed, and how professional the process was. I also noticed that the village people all knew what iKormi was, and we were all greeted with a warm welcome.

BELOW: iKormi field operations coordinator Shojib registering the new owner to receive a water filter

ABOVE: Women carrying the filter bodies back to their homes

After distributing the water filters, we then began to visit some of the households which had first received our water filters. We went to the homes, and firstly tested the arsenic concentration of the water coming in from the original water pump. We then tested the arsenic concentration of the water leaving the filters. We went to 5 different households, and tested in this manner, and to our excitement, all the filters were performing just as well as they originally did, or even better than before, despite running for over 2 years. For example, in one home, the arsenic concentration of the water was over 500 ppb (parts per billion), and the arsenic concentration of the water after going through the filter was less than 5 ppb – virtually all the arsenic was removed! For reference, the acceptable level of arsenic in Bangladesh as designated by the government is any level below 50 ppb. 500 ppb, which is what the people were drinking before, is extremely high, and quite dangerous for the people to continually drink. Such positive results we saw in the other households – reductions from 500 ppb to 0-5 ppb were repeatedly seen. And in addition to removing arsenic, all the filters seemed to remove almost all iron from drinking water, and the resulting water looked crystal clear, and tasted great. So looking through all these results of the performance of the filters after 2 years in the field, I had even stronger faith and confidence that these filters can remain functional – as in remove contaminants from the water- without replacement parts, unlike other cartridge based filters which require a cartridge replacement every 2-3 months, and sometimes earlier depending on how dirty the input water is.

BELOW: Me and iKormi volunteer Shojib performing arsenic water tests on the water pump line of a household, and the water that came out of the filter we gave that household two years prior. The water pump can be seen in the right side of the picture. This water pump was later found by us to have over 500 ppb of arsenic, and our water filter still removed nearly 100% of arsenic, even after over 2 years of operation

 

However, in Rajapur, we did hear of a very small number of filters with leaking problems. We went to investigate such problems. We saw that most of the problems involved very slow leaks near the base. To make it easier to manufacture filters, we had built the bases to be square in shape, which contrasts in comparison the cylindrical shape of the filter body. After seeing the filters which have leaked in person, we decided that perhaps it is better to build the base of the filters rounded, so that the pressure on the base could be more evenly distributed, as opposed to being concentrated on a point of a corner of the square base, which is likely what might have led the leaks on the select filters. All of these issues were structural, which was very important, because if the issues were more “functional” (i.e the filter simply wasn’t removing arsenic), then we would have a bigger problem at hand. However, the structural problems are easily remediable, and hopefully with our round base, the problem of leaking bases would be solved.

As we were looking at filters, I caught glimpses of a few of our filters which were deployed in public spaces in Rajapur. One of the earliest filters deployed two years ago was in a community mosque, where hundreds of people pray every week. The filter, despite being visibly aged on the outside due to dust and heat, still produced crystal clear water. Even those who didn’t go to the mosque would go to the filter to retrieve clean drinking water for their personal use. I felt really happy when seeing that, and wondered just how many people had benefited from using that filter. Afterwards, we passed by the community clinic. This clinic was sponsored by the Bangladesh government, so it gives out free medication and treatment for the villagers. Inside the building was also a water filter which iKormi had distributed. Like the filter inside the mosque, the filter was still going strong and producing clean water. Just for good measure, we measured the arsenic concentration of the water before and after, and saw that the arsenic concentrations were reducing from a whopping 500 ppb to nearly 0 ppb. 

BELOW: Picture of the 2 year old filter outside of the mosque, still working great!

BELOW: Picture of filters at the Rajapur community clinic. The community doctor, Zarina, is second on the right, dressed in pink. She was valuable in giving us the names of villagers in need of water filters. 

Overall, I was happy with the progress in Rajapur. I’ve always heard from the iKormi volunteers that the arsenic water filters were working well in Rajapur, but seeing it for myself in person really gave me hope and confidence in this product. These filters really are durable, and really do help these people a lot. Testing for arsenic gave an additional measure of confidence both to us and the villagers that filters like these retain their ability to remove nearly all arsenic from water even after 2 years of continuous use without replacing any parts. 

BELOW: Me and the others (out of the frame) walking ahead of the electric auto rickshaw inside Rajapur

Return back to Dhaka for the airport - Time to leave home,

 to go home. 

Our vacation had come to an end. The Rajapur trip was the last thing we could do in Kushtia before it was time for us to leave for Dhaka again to go to the airport. I said goodbye to my grandparents, and we boarded the bus to go to Dhaka. I left Kushtia with a heavy heart, knowing that I would miss it, but I also left Kushtia quite hopeful and happy that we are making a difference, and that we can continue to make a positive difference. We entered Dhaka airport, and noticed the very different atmosphere than what it was 2 years ago. There used to be many people jam packed outside the airport saying goodbye to their relatives – now that place was barren and empty. The security regulations were so tight to the point that it was difficult for even us, the passengers, to get through. My uncle said goodbye to us at the gate, and he had to leave – 2 years ago he was allowed to enter the gate with a visitor’s pass, and relax with us at the gate until it was closer to the time we had to leave to go through security and catch the plane. Luckily inside the airport we wouldn’t be alone – Mr. Atiq, who I mentioned earlier worked at the airport as an engineer, would be there. He had always been there at the airport to see us off back to America every single time we visit Bangladesh. Mr. Atiq had told us there was some good news regarding the bacterial reports for the filters. We sat down in the airport outside of security, and reviewed the results of the bacterial tests. It turned out that the supply water of Mr. Atiq’s house contained dangerous levels of E.Coli and Coliforms. Even after boiling the water, the reports indicated that some coliforms remained. However, passing the supply water through iKormi’s filter showed absolutely “0” for E. Coli and Coliform bacteria. The bottled water also showed “0” (as expected- this was our control). These results were amazing – it proved to us that this filter was definitely capable of removing bacteria like E.Coli, even after running for many months. Another damning result was the fact that even after boiling the water, some bacterial matter remained (it was likely that such bacteria was resistant). We knew that these results would open new doors for us, and allow us to continue to fight onwards, with the quest to provide clean drinking water for all.

BELOW: The bacterial test results for the default supply water line at Mr. Atiq's home in Dhaka. Notice the E.Coli reading of "4" (Standard is 0), and the Coliforms reading of "10". 

BELOW: The bacterial test results for the water after it went through the water filter. All traces of E.Coli are gone, and general Faecal Coliforms are absent as well. 

 

I said goodbye to Mr. Atiq, and as my family and I boarded the plane, I thought of all the great memories I had in Bangladesh. We had so much promising data concerning the water filters that we didn’t have before. Armed with this data, I imagined we could move so much more forward – from being able to secure more finances to expand operations, to being able to actually launch a real for-profit filter into the middle-upper-class market in Dhaka, so as to become more financially stable and independent. There was so much to be done, and I was excited to think of what the future held. The plane took off, and that was the end of our trip to Bangladesh for 2016. I was leaving home, for home. 

 

 

 

 

 

I arrived in the late afternoon of the 18th of July in Dhaka, from Dallas, TX. Starting from the 19th morning, I had reached an agreement in which I could shadow doctors at the Ibrahim Cardiac Institute for 3 days (this institute is Bangladesh's number 1 heart center). The person who helped me come to the Institute was Dr. Sahela Nasrin, who is one of the head doctors working in the interventional cardiologist section of Ibrahim Cardiac Center. For the next 3 days, through Dr. Nasrin's guidance, I would be shadowing various doctors working in the invasive and interventional departments of the cardiac center. I had never done such shadowing before, so I was very excited!

Day 1

I was given a blue uniform that the doctors wear at the Cath Lab, so in effect, I actually looked like a doctor, minus the stethoscope around my neck. I never wore such clothes before, so, taking a selfie, I was kind of astonished. It was also an inspiring moment for me, as this was one of the things I aspired to be – a doctor- someone who could treat the ailments of others directly.

The first day was to observe procedures that take place in what is called the “Cath Lab”. Mainly, two types of procedures are done here- angiograms and angioplastys. In a smaller capacity, pacemakers are also installed, although I wasn’t able to observe such a procedure take place during my 3 day stay.  Angiograms were a way to image the heart by inserting an imaging device via a catheter inserted either in the hand, or beside the groin. The location was

 mainly dependent upon whether or not the main artery

can be located, through which the catheter will go through, and reach the heart. The first day, I observed 7 angiograms, of which 3 of them were immediately cases in which angioplasty was required, which is where stents are installed, and inflated by balloons to clear out blockages that were identified by the angiogram taken previously. I stood by Dr. Nasrin on many of these operations, and watched how she skillfully navigated the balloon into the coronary arteries of the patients. It was fascinating to see just how much finesse it took to deal with something as sophisticated as the heart!

Day 2

I was still in the Cath Lab for the second day. However, this time, I observed 6 angiograms, of which 2 became angioplasties. Sometime rather odd happened this time – during the angioplasty procedure, since the patient was on a local anesthetic, the doctor asked halfway through the procedure, whether or not the patient would like to use an “upgraded” stent to clear out his heart blockage. It struck me rather odd that such an important thing hadn’t been discussed beforehand. The advanced catheter apparently would slowly absorb into the blood vessel wall, while the other catheters r

emained in the body forever. The patient seemed like he wanted to use the advanced catheter, until he was told the price was nearly double of what the standard catheters usually cost. Afterwards, he succumbed to financial pressure, and relegated himself to decide to use the standard catheter. In my heart, a sadness started to fill as I wondered just how the patient was probably feeling at the moment. It just wasn’t right, I thought. All this stuff should have been thought out beforehand.

This brought me to my second observation about the way things worked in the Cardiac center – everything is done by near-instant payment. There’s not much of a concept of insurance or credit, so everything must be done by cash. Treatment can be easily denied if a patient is deemed uncapable of paying for treatment cost. Ibrahim Cardiac center however does charge relatively decent rates when compared to the large medical institutions in other places in the world like the United States.

Day 3

My last day in the hospital proved to be a quite interesting one. I got to witness my first ever open-heart surgery. The location was different - it was in the operating theater across the hall from the Cath lab. I had to change from my blue cath lab uniform to the brown surgical uniform. I got to get up close to the patient during the operation, standing at the base of the bed, on an elevated platform so I could see the chest.

It struck me also how young some of the open-heart patients were – many were under 50 years of age.

Conclusion of the 3 day visit

At the end of the third day, which was my last day in Dhaka before we left by bus for Kushtia (where all my relatives live).

Before I left, I was introduced to the CEO of the Cardiac institution by Dr. Nasrin. The CEO received us with a warm welcome, and he told me that if anytime I was around, that I was welcome to come in. It felt good to hear such a thing from this man.

Even though my visit to the Ibrahim Cardiac center was brief, it was definitely a great experience. Dr. Nasrin, and the rest of the staff at the Ibrahim Cardiac Center were very hospitable, and I loved to work alongside them. I look forward to coming back again in the near future!