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2016 Bangladesh Visit

posted Aug 10, 2016, 7:43 PM by Thabit Pulak   [ updated Aug 15, 2016, 7:28 PM ]

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. 

Shadowing the neurosurgeon, whose name was Dr. Milad, was quite an awesome experience for me. The surgery I had the chance to watch was of a 9-year-old girl’s tumor removal, which was deep inside her brain. This was a more difficult surgery that had to be carefully performed since the patient was so young. In addition, the tumor was buried quite deep into her brain, so the surgery had an additional level of complexity. I had never seen a brain surgery before, so simply seeing the skull being opened was a crazy experience for me. I was surprised to realize that I wasn’t scared at all, and was rather amazed at what was inside. This was probably a good thing, as if I want to be a doctor, I should be able to tolerate the sight of the human body being cut open. After the initial incision to the head was made, the skull was sawed down very carefully in the front, and a small piece was taken out. Underneath it was, lo and behold, the brain! 

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. 


 

 

 

 

 

2015 Fundraiser for Arsenic Water Filters

posted Jul 1, 2015, 10:12 PM by Thabit Pulak   [ updated Jul 1, 2015, 10:34 PM ]

The first custom-designed arsenic water filter built from my manufacturing shop in Bangladesh.
Ever since I was in high school, I've been actively working in the effort to help being forth an affordable solution to those millions of people in Bangladesh, and the world affected by arsenic water poisoning. 
The single biggest problem that has hindered progress with fighting arsenic water contamination was not the lack of appropriate water filters, but rather, the expense associated with such filters. For about 3 years, ever since my freshman year, I was involved in the research phase. My filter prototype eventually became more and more mature, after presenting to various science fairs and meeting various scientific mentors, including the administrator of the EPA. I was urged by many to work towards not only testing these filters out in the world, but to also keep a goal to eventually implement these filters in areas of need. 

I had founded iKormi, a non-profit organization to help underprivileged people, such as those that lack safe access to drinking water.  Last summer, I went to Bangladesh with a small amount of funds, and started up my first water filter manufacturing facility. It was difficult to start - with the help of countless people, we had to find out the appropriate places to get local labor and local materials to come together in one area for manufacturing the filters. By the end of the month, I had a functional facility, which by the time I had left for the United States that month, built 5 arsenic water filters. Throughout the year, while beginning studies at Duke for my freshman year, I periodically checked in those working in the organization in Bangladesh - progress was slow, but steady. The facility in Bangladesh was building about 10 filters a month in the beginning months that I had left. These filters were then distributed to local villages in Bangladesh, such as in Alampur, and Rajapur. A few of the filters were also distributed to hospitals and schools in underserved areas that had identified need. You can see more about my experiences in Bangladesh here: http://www.thabitpulak.com/in-the-news/mytriptobangladeshsummerof2014


As the second semester came around the corner, I got some really good news - a larger non-profit organization, called the Sabrina Memorial Foundation (SMF) - wanted to partner with us to help with it's aims. The organization was also targeted around serving underprivileged people, but in more areas, such as in ed
ucation and vocational training. I was asked to lead the Clean Water department of their organization. I came to realize just how great this relationship was-  with the help of the more experienced people working in the SMF, the production and distribution of filters could be more
widely scaled up. 
As this summer came up and school just finished, we hit the ground running. The Sabrina Memorial Foundation and I hosted a series of fundraisers in various mosques and community centers. We ran a total of 4 fundraisers, located in Allen, Plano, Richardson, and Irving, Texas. I've never had much experience with fundraisers, especially on a larger scale, so this was a great learning 
experience.(LEFT IMAGE: Fundraiser at Plano) I was incredibly surprised by the turnout we got - hundreds of people donated to our cause. I had brought a prototype model 
of my filter to the fundraising booth, and many curious people asked me about it. In a span of 4 fundraisers, we raised over $10,000 for the water project, and even more for the rest of the projects that the SMF was conducting. After my experience with working with these fundraisers, I realized that if you are working for a well-intentioned cause, people will always give you support. With the money raised, I have intentions to work to significantly scale up the production of water filters. And it is had already begun to happen - the manufacturing facility for the last two months, has increased capacity to built up to 50-60 filters a month on average.  (RIGHT IMAGE: Assembly of outlet pipes for 26 arsenic water filters)



Fundraising to work to implement these filters isn't the final goal, however. Since my freshman year at Duke, I had started research work underneath the supervision of Dr. Schaad and Dr. Deshusses of the Civil Engineering department. I wanted to continue the research behind the water filters to work on enhancing various aspects of them, such as the possibility to being able to reduce the size and weight, which would cut costs even further. I have high hopes that I will be able to learn a lot from the professors' expertise, and be able to bring further improvements and innovations from within the lab, to ultimately affecting and benefiting lives of people.




Final Day of Shadowing

posted Jun 24, 2015, 5:54 PM by Thabit Pulak   [ updated Jun 24, 2015, 5:58 PM ]

The final day had come - I couldn't believe it came so quickly. As I drove towards
 Dr. Nguyen's clinic, I thought it would be cool to take a picture of it while in the car, since this is the sight that I had seen everyday I came for shadowing (and presumably the sight everyone in the clinic saw as they came to work eve
ryday). It was pretty rainy - but the picture turned out alright!

I greeted Dr. Nguyen, and soon after, we got started with our daily slew of patients. Of the patients I saw this day, one of them was a patient I saw from the first day I shadowed - he was a man with a swollen foot, as a result of a car accident. He came back for a checkup, and to show Dr. Nguyen a problem with his arm (turned out to be psoriasis, a type of dryskin disease). Dr. Nguyen had told me that he liked his job because of being able to get to know patients on a personal level, and seeing them periodically throughout the months - and for the first time, I got to see that in play. I already had known what this man had gone through, and thus when I was seeing him again, it was a different experience this time, as I had already known a little about him. Most of Dr. Nguyen's patients have been with him for a long time, so I imagined that it was pretty awesome, since technically, m
ost of his patients have become his friends. 

Another remarkable thing I saw on my last day was a elderly married couple who were long term patients of Dr. Nguyen's, and had since moved away from the area. They had made a 4 hour drive just to see Dr. Nguyen for their checkups - that to me was amazing. However, I must say that this wasn't the first time I saw people drive long distances to see Dr. Nguyen - on the average, I'd see at least 2-3 people a day who had driven over an hour for their checkups. These people must truly like the service they are getting, and it makes me happy to see such a degree of trust between the doctor and patients, in a time where such a relationship is decidedly rare and being negatively scrutinized in nationwide politics. 
Ultimately, the day flew by, and soon it was time to leave for the last time. Even though I technically didn't do anything except follow Dr. Nguyen around (that is, after all, the definition of shadowing), it never got boring. My trusty "Duke" notebook was becoming filled with my observations from each day - and as I look back and I read them, I can vividly remember many of those patients that I met. As the days went on, I found myself looking forward to the next week.  But the final day had finally come - I couldn't actually believe it had come so quickly. The route to come here in the mornings was beginning to be familiar to me, and
 something I had built into my schedule. Yes, I was 
nowhere near being an employee of Addison Internal Medicine, but being there for just 4 full days, I had felt almost like I worked there. Allthe nurses and doctors that work alongside Dr. Nguyen are so friendly, and easy going. I think the image of medicine, and those involved within, has an image of being somewhat "stale" and "dull", but I saw just the opposite. The people who worked in Dr. Nguyen's office were incredibly intelligent and professional people, but they also were socially vibrant, and do many things outside of their job in medicine. I noticed how everyone maintains a relatively informal atmosphere with each other, but manage to get their share of work complete to still manage the clinic and patients in a professional and efficient manner. This is a place where I'd love to work, and be a part of.

realized that the purpose of me shadowing Dr. Nguyen was being fulfilled - I came 
to do this because I wanted to see whether medicine was right for me. So is it? Dr. Nguyen's clinic was the
first shadowing experience I had in primary care, and my shadowing experience in Bangladesh of a cardiologist was my first shadowing experience in the field of surgery (Click here to read about my experiences shadowing in the Ibrahim Cardiac Center) - both had exposed  me to the different aspects of patient treatment and care. In both instances, my mind had always been captivated by what was going on in all times. However, I am so glad I got to shadow Dr. Nguyen's practice, as I realized that considering my personality, I would thrive in the social environment that is presented in primary care. The daily social interactions with staff and patients, and the overall friendly atmosphere was something I really liked. It is definitely to early to understand what specific field of medicine I'd like to go into - however, I did gain from these experiences that I would love to be a physician. I realize that with me saying this, I've got a long road ahead of me - but after seeing and experiencing what I did in the last few weeks, it's a goal I am more than willing to put the work and effort into making come true.

It's been a nice run - I'll always remember this experience as my first shadowing experience in the United States, and it definitely will be my most memorable one by far ;) This blog post concludes my series on my shadowing experience with Dr. Nguyen. If you haven't read them already, here are the links to my first day of shadowing (1st day ) and the second and third day, which I combined in another post (2nd and 3rd day). 

Last Day at Dr. Nguyen's Office



Shadowing Dr. Nguyen, Day 2 and 3

posted Jun 16, 2015, 9:23 PM by Thabit Pulak   [ updated Jun 16, 2015, 9:27 PM ]

As some of my experiences between the two days share similarities, I decided to combine my experiences from Day 2 and 3 into one post. During my first day of shadowing, I was especially interested in the fact that every patient that came to Dr. Nguyen was different - not only in the conditions and ailments they suffered from, but each of their stories and their backgrounds. This trend was no different the second day - and this cemented the fact in my head that it is pretty difficult to get "bored" as a physician - you are faced with something new everyday. 

I saw, especially on the second day, that alongside other ailments most of the patients had, a large number of them suffered from depression. Dr. Nguyen, being the insightful doctor he is, didn't hesitate to ask the patients what was bothering them. Despite me having seen this on the first day, I was still nonetheless pleasantly surprised at how genuinely the patients opened up the doctor, and told him their troubles - ranging from a rough time finding a job, to troubles within the home, to close relatives passing away. One of the most touching cases I saw that day was of a middle-aged woman whose father passed away just a few weeks earlier. Her mother had always been ill, but soon after her father's death, her mother became mentally deranged to an extremely high degree. The woman tearfully talked about how things suddenly cascaded one upon the other. On top of it all, the woman's son was leaving for college. She felt all alone. The woman described her story in such depth that I was feeling the pain that she was. I checked the time - it was over 40 minutes - but there was no rush from Dr. Nguyen. This woman needed to open up to someone. I was glad that the doctor took the time to listen to her worries. When she got up to leave, I felt a bit better - she basically had no one left at home, but she at least had someone she could count on to listen to her worries. She also wished me good luck in my medical ambitions, to which I thanked her. 

What is striking about these patients that are depressed it that it is definitely not outwardly obvious. That woman whose father passed away didn't seem any different than any other patient until she walked in the room, and started talking to Dr. Nguyen, and crying thereafter. Another example was of a younger gentleman who was in for a followup.He seemed outwardly ok - but I later found out , as he was talking to Dr. Nguyen, that he was on antidepressants. He was a younger man, who had been through financial difficulty, and had spent a long time looking for a job. That day however, he was talking excitedly - he had finally found a job. He proudly described how he moved in on his own to a new apartment - his joy made me smile. I silently wished that his good fortune be forever lasting, and that he wouldn't be needing those antidepressants any longer.  (PICTURE: DR.NGUYEN)

Another thing I learned during shadowing was that age isn't at all indicative of the well-being of an individual. Many patients I've seen walking in the office were just in their mid-forties, and were already suffering from heart disease, high blood pressure, and pain and sores. On the other side of the spectrum, I saw older people in their 60s or even 70s being in much better shape. In fact, on the third day of shadowing, I came across an elderly, 79-year old gentleman who came in for a pain in his back. When I saw his profile on the computer, I anticipated him to be extremely frail, judging from my own perceptions of what a 79-year old would look like. When he walked in the office, I had a double take - the man was wearing tennis shoes and shirt with gym shorts. He hoped on to the patient bed, with the agility that might even excel mine, given that I had probably gained like 15 pounds in my freshman year of college. It turned out that his back pain wasn't from some muscular stress due to age or anything, but rather that he had played an intense weekend of tennis, and hadn't hydrated enough, and thus sedimentary deposits in his kidneys might have started to cause pain. Dr. Nguyen simply recommended him to hydrate very well, and the problem would be solved. As the man left, I told him how I wanted to be just like him in when I turned to his age. He simply laughed, and wished me well. As the day went on, I was just amazed at this man's physique. He could physically rival people in their late 20s easily. He made me feel that I needed to hit the gym much more...man I've been slacking.

However, 2 patients later,  a 76 year old man was up next. I saw the complete opposite of what I had just witnessed earlier from that limber 79-year old tennis player. This gentlemen was extremely frail - his movements were slow and pronounced. He slowly got up the patient bed, and gently put down what I thought was a lunch bag beside him. His skin was generously aged . To be fair, this is what I exactly had in mind when I thought of a 76 year old patient, but after seeing the 79 year old patient, I was truly stunned at the differences. To top it off, the frail 76 year old gentleman used to be a doctor! 

There definitely was striking differences in well being between patients, regardless of age. While life style habits and choices can change one's well-being, genetics do have a role in it as well, as Dr. Nguyen was saying. It seemed like a cruel game that some people with great genetics could seemingly overcome things like high-blood pressure and aging. I truly hope that someday, gene therapy can advance to a degree where people can be in charge of their own destiny, and squeeze out the maximum well-being in their lives. 

On the third day of shadowing, I stayed until 5, which was the clinic's closing time (before I left earlier to pick up my sister from school, which had since closed for the summer). As I packed up, I voiced my amazement of that 79 year old tennis player. Everyone of the doctors fondly talked of him. Dr. Murphy (one of the 2 other doctors that work alongside Dr. Nguyen at the Addison Internal Clinic) told me that the man came in for "injuries and problems that affect 25 year olds, not 79 year olds". In my head, I made a silent wish once again, to age just as nicely as this guy. 

This marked the end of the 3rd day of shadowing. There was only 1 more day left -as I left the clinic for my car, I couldn't help but feel a bit sad. I still remember coming in Dr. Nguyen's office on the first day, that 27th of May morning. I was pretty nervous, but I was warmly invited in, and one of the nurses, Elizabeth, sat me down beside her. And over the next 2 days, I got to know her, and the rest of the office, including the other doctors - Dr. Murphy, and Dr. Ton (pictured on the left). My time shadowing Dr. Nguyen had been enjoyable thus far - and I look forward to the 4th day to see what is in store! 

Dr. Nguyen Shadowing Notes- Day 2 and 3








Shadowing Dr. Nguyen, MD - Day 1

posted Jun 2, 2015, 6:41 PM by Thabit Pulak

I've been back home for the summer, after my freshman year at Duke. As a prospective pre-medicine student, I wanted to get some more immersion into the field of medicine. My personal physician, Dr. Nguyen, had told me during an earlier checkup, that I would be able to have the opportunity to shadow him if I wanted to in the future - and now I felt the time had come! I called the office, and I was surprised by how amiable and friendly the office manager (Christy) was in scheduling my appointment. It was arranged that I would follow around Dr. Nguyen on his patient's appointments on Wednesdays, from 8:00 am in the morning to 3:30 pm, when I would have to leave to pickup my sister from school. This would continue for 4 Wednesdays, so a total of 30 hours. There weren't any stressing rules - just come on time, wearing slacks and a tie. I was definitely excited - I've never had the opportunity to shadow a doctor in the United States! Moreover, I was in particular, excited to shadow Dr. Nguyen, because I got to experience being his patient, as well as my father, and both of us really like him. It would be cool to see the behind the scenes to what exactly an internal medicine doctor does for his patients. 

Due to traffic, I had arrived just barely by 8:00 am, despite leaving my home about 20 minutes earlier than I ordinarily would have for the distance (the GPS said it would take only 20 minutes to
 arrive - it took me 40!). As I arrived in the office, I was greeted by the receptionist, who then took me out to the back, where I was told to wait for Dr. Nguyen to come. I was surprised, as he was apparently already with his first patient! 

Soon afterwards, I saw Dr. Nguyen come out of the patient's room, and I met with him. He gave me a basic overview of the patients he was going to see for that day - there were a bit over 20 he was going to see that day. The computer sorted each of the patients by appointment time, and had detailed info on the patients' histories, from their first to most recent appointments. I was surprised by the array of conditions that patients had- ranging from diabetes, to obesity, to arthritis, to high blood pressure. I even met a patient suffering from ALS (also known as Lou Gehrig's disease) - this was the one which social media did the "ice bucket" challenge for to raise awareness - and now for the first time, I met a patient with the condition!

I took a notebook with me and noted down observations from every patient I encountered. As I was following Dr. Nguyen from patient to patient, I was surprised on a number of things I observed. Initially, I was worried that patients would perhaps object to me being in the room with Dr. Nguyen (and I'd totally understand!). However, the vast majority of patients seemed to have deep trust in Dr. Nguyen. As he would tell them "This is Thabit - he is a student at Duke studying pre medicine, and today he is shadowing me to get a first hand look at how I work with patients" - or something along the lines of that - most of the patients agreed to me being in the room.
As I was in the rooms, the patients seemed to be immediately comfortable with Dr. Nguyen - and I saw why. Dr. Nguyen, despite having over 2,000 unique patients per year in his clinic, he takes the time to get to actually KNOW the patient, as in, the patient's life. Many of us might view our doctors as people who spit out prescriptions, after telling them the symptoms we are being affected by - thus effectively making the relationship between the doctor and patient somewhat of a stale, perfunctory relationship. However, as I saw Dr. Nguyen greet each of his patients, he seemed to know something about each one, and took a genuine interest in following up on various events affecting his patient's lives. For example, I recalled he asked a parent about how her son was doing, and she delighted talked of her son's success in some athletic event, to which Dr. Nguyen seemed equally as happy, and then proceeded to talk about her other family members. To him, his patients were friends, who simply were ill, not just some anonymous patient with a disease. 

Just after a few patient visits, I realized just how much time had flown by - it seemed while inside the room, time would move extremely fast, because by the time we went to the next patient, he/she would already be waiting in the next room for us. I realized one thing while doing this - unless you love your job as a doctor, you will be simply stressed. There is definitely a lot going on - patients will come in one after the other. There's pretty much no time to relax or take a break asides from lunch time. However, by Dr. Nguyen taking the extra time to get to know his patients, and  while also maintaining quite friendly relations with all of his employees, seemed to thoroughly enjoy his job. 

Soon it was time to pick up my sister from school - I had wanted to stay until the end (5:00 is when the clinic closed), as I had learned so much, and had enjoyed my time following around Dr. Nguyen. There wasn't a moment in which I was "bored" - because every patient was different. And , the patients weren't  simply just walking disease cases - they all had a story, as Dr. Nguyen told me - a story that is waiting to be revealed, if you simply ask and take the time to get to know them. As I left the clinic, I was already looking forward to shadowing Dr. Nguyen next Wednesday (June 3rd!) 


Dr. Nguyen Shadowing Notes - Day 1



My freshman experience at Duke - looking back

posted May 17, 2015, 2:35 PM by Thabit Pulak   [ updated May 17, 2015, 10:18 PM ]

My first year at Duke is officially over. I've been at home for a bit over a week now (came back on the 2nd of May). Looking back at my experience at Duke, I can conclude overall that it was a great one - it has been quite a transformative year for me. Never had I been away from home for such long periods of time. Initially, it was quite overwhelming to adjust (to some degree, I still am adjusting!) - but through meeting with the active, and passionate student body and the professors, I was able to gradually ease in, and better take advantage of what Duke had to offer. Despite me being a freshman, Duke afforded me many opportunities to get engaged in interesting activities on campus! Taking a look back at the year, here are the main things which I have been engaged with on campus as a freshman! 



Research Independent Study on Developing a Compact Arsenic Water Filter 


One of the highlights of the opportunities I've had as a freshman at Duke was to be able to pursue my own research independent study in a lab that I wanted to work in. I was so surprised at how receptive the Duke professors were to having me be able to work and follow through with my research proposal. I wanted to build upon my research concerning the affordable water filters I've been working on in Bangladesh. Currently, there is a filter manufacturing plant overseas which makes filters and distributes them to local rural villagers in need. After starting up the manufacturing, I've learned a number of things which need to be further improved to certain barriers to implementation - such as size and weight . The current filters , despite being lighter and more compact than existing filters before my research, were STILL too heavy and could benefit from being smaller. I wanted to look into ways of making such filters smaller and lighter, by experimenting with how much sand I can removed to still ensure the functionality of the filter remained by replacing the lost sand with fine sari cloth (a 100% cotton cloth ) at the nozzle of the filter. 
I started this independent study around February of second semester. The project is still a work in progress - I over the semester, I was involved in project design and then bringing in the relevant materials that were necessary to build the filters. At the end of this semester, I've managed to build 6 filter shells of different sizes. The filter bodies are made of a translucent PVC so as to be able to see the contents inside the filter. Next semester, I intend on adding various types of filter media into the filter bodies in varying amounts to determine the effectiveness of various medias, such as sand, sand with iron, sand with sari cloth, sand with sari cloth coated with antibacterial ionic silver , and sand with modified calcium carbonate. These are the plans I have in place to move forward with next semester. Hopefully all goes well! I am definitely looking forward to it. 

Duke Independent Research - Spring 2015







Alspaugh Dorm House Council Officer


One of the first things I got involved in when I arrived at Duke was to run for my house council of my dorm (named Alspaugh). I decided to do so because in just a short amount of time, I quickly loved the environment, and made many friends. I just feel that Alspaugh had a unique environment amongst all the other freshman dorms, where pretty much everyone in the dorm knew each other - which made the place feel like a second home. Our house council accomplished many things - from hosting food gatherings such as dorm barbecues, to celebratory events, such as cookout milkshakes in honor of Duke's NCAA win, the house council made Alspaugh an even more awesome dorm. Perhaps the highlight of 
what house council has done is to initiate the building of the Alspaugh Dorm Bench. Our dorm was the first dorm to build a bench by a a few months - and none of the benches that were built afterwards matched the unique character of our bench. The bright purple color was a daring one to use, but one that ultimately stood out pretty nicely.

I wanted to spend even more time in house council next year,  after seeing the impact it made on my dorm freshman year. As a result, I am now Vice President of the House Council for the dorm I will be living in next year as the sophomore (the dorm's name is called Few-Pride Rock). I am looking forward to it!





Paid Writer for the Duke Undergraduate Research Blog



Being a writer for the Duke Undergraduate Research Blog was the first job I've had since coming on campus. I actually applied for the job during the summer before freshman year. It seemed like an interesting job - basically blogging about science events around campus. It was somewhat of time commitment, as it required one to attend the science events (which, being a freshman on East Campus, often required you to go to West Campus), and then come back to write the article. As a result, I wasn't quite an engaged in writing articles during my second semester. I plan on recommitting to this job as a sophomore. For those interested, here is the link you can access to see my writings:  http://sites.duke.edu/dukeresearch?s=thabit+pulak








Campaign for Class President


Back in senior year of high school, I ran for Senior Class President , and I was surprised to find out that I won. This was after 3 years of running for class president, and losing every time. Below, you can see the video I used as my main campaign:



As a freshman in college just beginning to know people, I knew my chances at winning class president were pretty slim, just as it was in high school when I was a freshman. The chances were even more slim especially since I hadn't picked a running mate for vice president. Infact, out of the total of 8 presidential candidates, I was the only one without a vice presidential running mate - in retrospect, it was something I should have considered doing. I ultimately ended up losing the election. My campaigning didn't contain much "substance" or a so-called campaign "platform" - mostly everyone knows that the class president is in charge of a very small array of duties, and not in any position of "real" power. I wanted to run for class president mainly because if I were to help bring change on campus, I can use my position as a way of representing my class when talking to figures of power. Thus, the campaigning was done in a fairly humored approach - but the underlying message was serious nonetheless. As I've always loved the Terminator from a  young age, and looked up to it as a role model in many things, I centered my campaign around that. Here's my main campaign video for Duke Class President: 



Although I've lost this year, rest assured, that I'll be back again for next year ;)







Hult Prize Competition at Boston, Massachussetts 


Upon coming to Duke, I was exposed to the entrepreneurship scene by taking a class called "Social Innovations". Every wee
k, various entrepreuneurs would come to our class to talk about their experiences in how they started up their own businesses and social enterprises. Later, I found out about the Hult Prize, which was a competition in which college and graduate students every year come up with innovative business ideas to combat some type of a world problem. This year's problem to solve was Early Childhood Education. A few friends and I made a team and attempted to compete within Duke for a bid to the national competition - but we ended up losing to a graduate student team. We thought all was lost, but we ended up applying directly to the national competition, bypassing the university. Over 30,000 teams applied though this method, and surprisingly , we got through, and were amongst the 100 teams picked to compete in the United States national fair! 

The Duke institute for social entrepreneurship paid for our travel expenses to Boston, Massachussets to where the competition was being held. I opted to visit MIT and stay with a friend there. The next day was the competition - it was quite an experience! Most of the competitors were far older than we were - ranging from MBA to PhD students, whereas we were an all freshman team. When we presented our project in front of the judges. We got surprisingly great feedback. We thought we had a good chance - but alas, it became fairly apparent that other teams came extremely well prepared - we ended up losing to a graduate student team consisting of MBA candidates. They rightfully deserved the win. Even though we lost, I was so glad to have had the opportunity to come to compete in this prestigious competition. Meeting the motivated people and learning of the innovative ideas that such people had to change the world were really inspirational to me. I hope to return to the competition next year, having learned from our experiences this year!








The Conclusion of Freshman Year 


Freshman year was quite a transformative year for me. It marked the first time I was away from home for extended amounts of time, and had pretty much full autonomy of what I did both in and out of the classroom. I am grateful to have the chance to attend a prestigious institution like Duke- the friends and teachers I've met here are some of the brightest, yet most humble people I've met in my life so far! The last day of my freshman year at Duke before I left for home was both a happy and a sad day. As I stared at my now empty dorm room where I have had so many memories, I was wrestling two
 different thoughts. I missed my family and friends back at Texas, whom I grew up with and developed as a person, so I was happy to be able to finally see them again after so long- but at the same time, it was
difficult to leave my wonderful friends I've made at Duke. 

As I was leaving, a group of my closest friends helped me with my bags, and walked me to the waiting Uber van - and before I parted , we took a group selfie. That final picture was a great way to symbolize the end of my freshman year journey, and the transistory period to even more wonderful things to come in future years. 








2014 Bangladesh Visit, Part 2 of 2 - Implementation of Lalon Water Filter

posted Dec 22, 2014, 10:39 PM by Thabit Pulak   [ updated Dec 26, 2014, 7:14 PM ]

It's been 2 years since I last came to Bangladesh. This particular visit brought forth the most important developments ever to iKormi as an organization. Taking what we have learned from our last visit, new improvements were made to the filter design, and now, our primary focus was to start up a manufacturing process in Bangladesh, using local materials. It’s been a little late for me to write this blog, however, as I am now a college student attending Duke University. I have many pictures, so using them, I have written this post, giving an overview of this year’s Bangladesh visit. You can view the post for my 2012 Bangladesh visit here: http://www.thabitpulak.com/in-the-news/visittobangladesh




Arrival in Dhaka


My family and I arrived at the Dhaka airport with excitement, if not a bit tired. After all, it was the end of over a 24 hour journey. We went to claim our luggage, and proceeded to exit the airport. However, this time, we were stopped. Apparently, one of our luggage pieces attracted some suspicion- it was the water filter. We had brought a prototype water filter from the US to work on replicating in Bangladesh. The sheer size of the package illicited some unwanted attention. We were instructed to open it. The shape of the filter resembled something in the shape of a big bong, and I sensed the agents being very suspicious of the product. I quickly got out my research journal to show the customs agents that this indeed was, an affordable water filter aimed to help others. This prototype was very important, as it would be the cornerstone of our efforts this summer to get production started. Needless to say, we were quite relieved when the filter was given the green signal.

I stayed in  Dhaka for 4 days, during which I had the opportunity to shadow in Bangladesh's premier heart center, the Ibrahim Cardiac Center. I wrote about my experiences in part 1 of my 2014 Summer in Bangladesh here: http://www.thabitpulak.com/in-the-news/2014bangladeshvisitpart1-ibrahimcardiaccentershadowing 



Presenting the plan



After 4 days of staying in Dhaka, we took a bus to go to Kushtia, where my grandparents and extended relatives lived. This was also where most of my work with water filtration was based. It was important for us to begin the work with the water filter by 

me presenting to local people of authority. I had the chance to meet with a local water engineer , who also happened to be the head of the water infrastructure in Kushtia, Bangladesh (where we we

re working). He was a prominent member of the Poroshoba (the equivalent of a local parliament). He voiced his support for our proposed plans to expand the water filtration work into a practical stage. I was also able to get in touch with even higher end officials in Bangladesh. 

Meeting with a top level political official in Bangladesh

In fact, I was lucky to be able to meet

Mr. Mahababul Alam, who was the former General Secretary of Bangladesh (the equivalent of Vice President) , and is now an acting head of Parliament. He also voiced his support fo the water filtration work, and invited me to the parliament the next time we came near the area!


A visit to the past


From my last visit to Bangladesh two years ago (link was provided in the beginning of this story) , we dropped off the first prototype of our water filter.  We gave it to a family in Bangladesh located in Rajapur, a village in Kushtia. Sumayyah, a girl from the family, helped us throughout the process of implementing the filter in her household. She became a member of iKormi, our non profit organization. She also helped us navigate the rest of Rajapur, which was an area heavily affected by various forms of water contamination, especially arsenic.  After we left Bangladesh, the prototype was still in use. Sumayyah periodically gave us updates on the filter's performance, which was critical in helping us make improvements to the filter's design back in the United States. We learned that the filter, while it had its merits, it also had lots of weaknesses. For one, its flow rate had significantly slowed down after a few months of usage. It was also quite fragile, in that the base actually fractured and had to be repaired later. Taking these occurrences into notice, the design of another, much more improved second prototype filter design was made.


By now, the filter at Sumayyah's home had ceased to operate, due to the restrictive flow rate. I wanted to go back to the home, check it out. Getting back into an electric auto -rickshaw, we made the trip to the village, battling through rough unpaved roads. Finally arriving at the home, it was amazing to see how much had changed since the last time we left. The roads, while still rough, had been improved . And Sumayyah's home had a new member - Sumayyah had recently been married, and given birth to a baby boy! Walking inside the household, I saw the SONO water filter, which we gave to Sumayyah's family alongside the prototype. Directly beside the filter was the prototype. I looked at it for a few moments - beneath the cobwebs that now entangled the filter , it still was quite a beautiful design. Most of us agreed that it was definitely a significant step forward from the bulky 3-bucket setup of the SONO filter. A feeling of excitement came over me- our new design would not only retain the aesthetic refinement of the old filter, but it would functionally outperform it in every metric. In a week or two, Sumayyah would hopefully have a copy of our newly designed filter in her home,  I thought.


Preparations for manufacturing


It was time to get my manufacturing plans on the road. The new filter design was based off a light-weight PVC outer shell. We located a nearby industry called BRB Cables. This company isIn the BRB Cable industries warehouse known for manufacturing a wide variety of products, but our interest in the company stemmed from their plastics manufacturing capacity. We visited the company to see what types of PVC pipes they manufactured. Soon, the perfect pipe was found that matched the prototype design I built back in the US. It had a 10 inch diameter, and was sold in bulk in long lengths. We ordered a few of them. In addition, we hired a BRB employee to come with us to our workspace to help manufacture the filters from the PVC pipe. We were fortunate to not only have the support of donors back in the US, but also of the Sabrina Memorial Foundation (SMF), who gave us a few

Transportation of the empty PVC pipe shells from the BRB Cables via Rickshaw "van"

thousand dollars to start up our work. The SMF is a non profit organization based in Bangladesh which has wide-arching aims in a variety of areas, ranging from providing affordable education in rural areas , to providing healthcare to the poor. My work with affordable water filtration in Bangladesh was this inline with their health work, and thus our partnership was established. The Rickshaw "van"


The PVC pipes were soon arranged to be shipped. A traditional "van" was to deliver the pipes. Don't let the name fool you though - it's not really a van, so to speak . It is basically a pedal-operated rickshaw that is modified to carry cargo instead of passengers, and thus has a flatbed cargo area, resembling the loading bay of a truck, or "van". A foreigner might view this to be quite low tech, but however, it was quite efficient. The pipes showed up to our doorstep just within an hour of ordering. Try doing that with Amazon ;)



Manufacturing


Over the next few days, we were making final modifications to our design for the new filter.

Our engineer custom-welding the external pipe to the water filter (made of PVC pipe)

Some things were changed - most of them were actually improvements to the design that we initially designed back in the United States. For example, the external pipe which led purified water away from the filter to the user was much more simplified.It initially consisted of multiple pipes fitted with joints, but in Bangladesh, it turned out that we could make a single custom pipe that was "heat-shaped" into the design.

Cutting a long PVC pipe to make not filter-sized segments

This would not only reduce the maintenance of the filter and chance for break-down, but also it would cut down the overall costs of the filter. It turned out that making a custom diffuser (to slow the flow of water) was cheaper than simply using a porous basket of some sort (which is what we used in the US). I was amazed at the incredible resourcefulness of Bangladesh in general - making a custom-anything would cost tons of money in the US, and in some cases, would probably be impossible.

Top diffuser lid, custom crafter for this filter


With our design plans finalized, work was quickly started. The long PVC pipes that were brought from the BRB cables industries was cut into precise 4 foot lengths to make the body of the filter.Our hired engineer then 

worked to make the diffusers, and the external pipe. 

To finish the filter off, we added a "cap". The finished product was quite beautiful - a sleek, slender pipe, with a green outpipe, and redcap. The colors matched the Bangladesh Flag, which is mostly green, with a red dot in the middle. Of course, the body would probably be smoothed down to get rid of the spots that came on it during manufacturing, but it was still quite a sight :)







But the work wasn't yet done. This was just the shell of the filter- the inner media wasn't yet prepared. I had ordered a large shipment of locally available "Sylhet Sand" to be used in the filters. This was a type of sand which had very small grains, which would physically "trap" various pathogens and bacterias (this concept comes from Biosand filtration technology, which was originally designed by CAWST, founded by David Manz. More on this can be found here: Cleaned sand, ready to put in filtershttp://www.cawst.org/en/resources/biosand-filter)  . The sand also had a very high natural content of iron, which would remove arsenic from the water. Our filter would be the first of its kind to be implemented in Bangladesh with such a design. We hired as few local residents to help clean the sand to get rid of excess dirt to prevent clogging up of the filter. Very soon, the work was done.


With the sand matter ready , and the filter shell also complete, it was time to load the sand into the filter. With the help of a few iKormi volunteers, we began to load the first filter. As our filter incorporated many of the concepts of the Biosand filter, we followed some guidelines set forth by CAWST, the organization which originally developed the Biosand filter. Essentially, you don't want to "dump" the sand inside the filter - that would clog up the water flow, since the sand would be so packed together. Instead, the filter should be initially about a third with water, and then sand would slowly be poured in. As the sand is poured in, another person would "swirl" the

Swirling the sand
IKormi volunteer Shojib helping to swirl the sand while loading the filter
water, so the sand would land in the filter softly. Ultimately, the sand needs to not be packed together, but rather be somewhat "suspended" in the middle of the filter, due to the water keeping the particles in motion. Despite this being our first time loading the filter, it took us a surprisingly short 45 minutes to finish loading the filter. The filter was done. We all took a sigh of relief - it was pretty tiring. It was also a humbling moment - it took a full month's worth of work - including preparing, designing, and arranging for materials and workers, to all come together, to make this filter. It definitely wasn't as easy as it looked. 
Water being test-run through water filter


But of course, the defining moment hadn't yet come - we needed to run a batch of water through the filter, to see if the flow rate was right. One of the volunteers, Kanak, came with a batch of water from the outdoor water well. I dumped the bucket on top of the diffuser, and then we all waited in anticipation. Sure enough, the water started trickling out of the filter output pipe. It was Looking at the clean water form the filtera steady, and strong flow rate. We measured it to be about 800 ml per minute - a great output. I then dipped a glass cup inside the bucket which was collecting the purified water, and looked at it. It was crystal clear. Everyone was amazed -

the input water from the water well was heavily iron-contaminated, which lent to an orange-ish color when observed in a drinking glass. Simply running it through this filter, and seeing the iron being removed was quite a sight. Although we still had some work to do - this filter had to be run with arsenic water and tested from removal, and also some bacterial tests had yet to be done with contaminated samples, the initial results were definitely promising.



Final Meeting


My month's stay was at an end - there was only 1 day left before I had to leave Kushtia for Dhaka (where the airport was) after our first batch of filters were made. In Dhaka, I would spend one more day before we were to fly out back to the United States.


Meeting with members to facilitate continuing this work
It was fitting to have a meeting with the iKormi members present that night, shortly after we made our first water filter. We sat in a circle, reflecting on our experiences that month, working together to make the product happen. The significance of this month was huge- we were able to successfully start-up a water filter manufacturing process, using local materials. Such a process would prove to be a very sustainable way to distribute water filters throughout Bangladesh.


We discussed our next steps - we still had a long way to go before we start marketing such filters to Bangladesh in a large scale. We planned for our initial batch of filters to go to various 

households in Rajapur, where we would distribute them to households that drank from highly-contaminated arsenic wells, or had high incidence of bacterial contamination. We would provide the first filter to Sumayyah's family, who by now, were very skilled and adept at providing us vital information on how the filters worked. 

As the filters are distributed, iKormi volunteers will periodically visit the field sites to test filter samples for arsenic and bacterial contamination, such as from E. Coli. As I would be in the United States, we all arranged for a consistent stream of communication between Bangladesh and the US. This would take the form of bi-weekly meetings via Skype.


We concluded the meeting with our good-wishes to one-another, and final words. It was a solemn moment - one that signified the amazing things to come, but also the sadness of leaving such a great community.



Time in Dhaka- Meeting with Dr. Munshi Mahbub


Our head office in Dhaka, BangladeshWe boarded a bus to Dhaka, where after 1 day, my family and I was going to board a plane back
to the US. However, in our time at Dhaka, we were extremely fortunate to have the support of one of the Advocate Lawyers of the Supreme Court in Bangladesh

With board members in Bangladesh. His name was Dr. Mushi Mahbub. He

heard of the work that we were doing, and was very supportive of it, and was eager to help us in any way he could. We realized that his expertise with the corporate and nonprofit law in Bangladesh would be of great help to us, and thus we included him as part of iKormi, functioning as our executive secretary. We discussed with him the process of trademarking our water filter. He pointed us in the right direction on our next steps, which we duly noted. And then, the most unexpected show of generosity came when he offered us his office as being the representative headquarters of iKormi. This was big news, as getting such an office in Dhaka, Bangladesh was incredibly difficult, amidst high costs, and limited space. We thanked him for his incredible show of support. He wished us all the best for our travels back home.



Leaving home, for home


My grandparents came to Dhaka to see me off, as did my uncles, Shojib and Kanak. My cousins, Shiam, and Samin, also came. A surprise person to come was my friend Casey Meeting with another Duke student at the airportWilliams, who was a recent alum of Duke University (where I study). He was in Bangladesh as part of a year-long study on climate change, funded by the university. I thanked Casey for coming so far to see me, and after we conversed for a few minutes, we bade farewell.


 And then came the the hardest part of my travels to Bangladesh - saying goodbye to my family. Our flight time was fast approaching, and we knew that we had to eventually walk towards the security check to catch our flight. Many hugs and kisses were exchanged, amidst tearful displays of goodbyes. I, being a manly 18 years old, tried, but failed to keep the tears in. We promised to keep in touch - we all had Facebook, right?  


As my family and I passed through the security check of the airport , we turned around to wave goodbye to our family, who now stood as small specs amidst a crowd of other people waving goodbye to their family members as well. We waved until they saw us, and with their final waves, we slowly turned towards the terminal, and walked towards our gate. We were leaving home, for home.




Selected Photos from the Summer of 2014 in Bangladesh Trip


Summer of 2014 in Bangladesh




2014 Bangladesh visit, Part 1 of 2 - Ibrahim Cardiac Center Shadowing

posted Aug 18, 2014, 7:29 PM by Thabit Pulak   [ updated Dec 23, 2014, 3:02 PM ]

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.

I was initially stunned – the chest was literally sawed open with something resembling a small circular electric saw. Seeing the chest being cut open in such a raw fashion was eye-opening. As time passed on however, I started to realize, open-heart surgery was as much of an art as it also requires pure skill, but much of the moves were “raw”, as in tying something up with wire, or pulling  something out, and  injecting more salt/saline into the body.  The previous procedures of angioplasty and angiograms were much more “subtle” and seemingly sophisticalted procedures, as they had to work underneath the skin, and yet reach the heart without damaging anything on the outside.

 

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

I inferred that their diets were filled with fatty junk foods. Such surgeries also reminded me just how fragile life actually is – once some part of our body goes wrong, all the energy/money of the world can’t quite safe it.

 

 

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!

High School Graduation

posted Jun 9, 2014, 10:24 PM by Thabit Pulak   [ updated Jun 10, 2014, 3:59 PM ]

On June 8th, I officially graduated from Richardson High School. It was a big day for me, and it marked the transition to the next chapter of my life to Duke University. As senior class president, I given the honor to give a speech at the graduation. It can be viewed at this link, or viewed below. Jump to 1:58 for my speech! Thabit's Graduation Speech

Two days before the graduation, on June 6th, my awesome parents threw an amazing graduation party for me! It consisted of many events engaging our local community, such as a talent show, and many short speeches. The performers in the show included my sister (Deemah Pulak) and her classmate Anisha, and others, such as  Jawad, Tahmid, Arissa, Aisha, and my youngest sister, Jana. Deemah and Anisha were the main moderators of the event. In general, all the guests loved the party, and I enjoyed meeting with family (my cousins from Chicago came!) and friends. Among my friends was Riley Testut, who was the developer of GBA4iOS, a gameboy emulator for the iPhone, which gained over 10 million downloads! I loved meeting all these people, and the food at the party sealed the deal on having a great night! Below is a photo album of the event, check it out!




Thabit Pulak Graduation Speech

Thabit Richardson High School Graduation

Thabit's Graduation Party - June 6th @ Hyatt Place


2014 Intel Science Talent Search- Finalist!

posted Jun 5, 2014, 12:52 PM by Thabit Pulak

It's been a while since I've updated my page, but I was selected as an Intel Science Talent Search Finalist near the end of January! Me, alongside 39 other finalists, traveled to Washington D.C to present our research to a panel of scientists and influential members of the public. Best of all, we got to meet President Obama at the Whitehouse! It was an amazing time. In addition, we all got $7,500! Check out the photo of me with the President below!

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