2014 Bangladesh visit, Part 1 of 2 - Ibrahim Cardiac Center Shadowing
Post date: Aug 19, 2014 2:29:42 AM
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 loca
tion 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!