Welcome to Papua New Guinea (PNG)

My first several days of my trip has felt like a collage of events/moments juxtaposed together, both beautiful and sad.

With feelings of nervousness and excitement my plane took off from Denver to start me on my journey to PNG. The feelings were soon replaced with awe, getting to see this incredible state I live in from a different perspective, the Rocky Mountains stretching to the horizon covered in early snow, and slowly giving way to the desert. I woke up to see the Grand Canyon pass beneath the plane, incredible even from 10,000 feet.  18 hours later found me staring out as lightning lit up the clouds and Pacific Ocean below. Another incredible display of the size of God’s creation and reminder of how small I actually am.

As my plane started it’s descent into Mt. Hagen, the mountains rose up on either side, so close that I could count the trees, until, seemingly at the final moment, the ground dropped away into the valley where Mt. Hagen lies. I met Don, one of the career missionaries here at the airport. Flying down the road towards the hospital, we fly past one stunning view after another of green foliage, looming mountains and numerous inhabitants at markets, walking along the road or swimming in the rivers. The sun set behind the mountains was dazzling and I couldn’t help feel how lucky I am to be here.

A couple hours later that evening, as we were walking through the E.D. for my tour of the hospital, we stopped to see a patient who was victim to a “chop-chop” injury, the PNG term for the unfortunately frequent machete-induced lacerations. The man had received two deep cuts, one on his right shoulder through his deltoid and down to his humerus and the other along the left side of his neck, through the lower part of his ear and down to his mastoid process. We clamped off a bleeder (small artery) in the neck and stabilized the bleeding till the surgeon could take him back for more definitive management in the O.T. (operating theater). As we were evaluating him, my preceptor leaned over and said, “Welcome to Papua New Guinea.”

The next day was my first true day in the hospital. Mornings start with rounds in the Wards, which for me this week is the Pediatric Ward. My first patient is a 6yo boy who was admitted for several days of fever, fatigue and abdominal pain. He was positive for Plasmodium falciparum and vivax and had a hemoglobin of 4 due to hemolysis from the malaria. My next two patients are kids with diarrheal illness admitted for rehydration, a common disease here in PNG. The next child is a 2 month old that had been admitted for a groin abscess. Infections of the soft tissue, tropical pyomyositis, are very common here in PNG and often present far advanced. Fortunately for this child, he had improved with an I+D and broad spectrum antibiotics.

 
The next two cases are particularly heart breaking. Across from the 2 month old was a 14yo girl with advance heart failure secondary to a cardiomyopathy of unknown origin, likely rheumatic fever vs a congenital abnormality. She was admitted for worsening shortness of breath and abdominal pain secondary to fluid accumulation. Without access to advanced pediatric care, her prognosis is poor. Even at a well run hospital like Kudjip there are critical drug access shortages, far more significant than our perpetual shortage of IV Zofran and LR in the States. The government helps supplies medications, but even so important drugs are frequently missing off the shelves. While we have IV Lasix for her now, we currently don’t have any PO Lasix to send her home with, a necessary treatment to prevent her from needing to come straight back to the hospital. Next to her is a 5yo M who suffered a severe TBI from a tree falling on top of him and who is currently in a coma with little hope of recovery. What is most difficult in these two situations is seeing the concern of the parents who are sacrificing so much to try to take care of their children in relatively hopeless circumstances. Even in the U.S. these would be difficult things to work through and treat, but here it is impossible. The boy’s family had to travel two days to get him to the hospital after his accident and likely that time factored into his current state. As in America, geography very much dictates health in PNG. The farther you are from the hospital, the more likely you are to experience the negative outcomes of infection, obstructed labor, trauma, and innumerable other health conditions.

After Wards we go to Outpatient clinic and start working through the the line of patients. We see babies, pregnant mother, chronic disease, acute illnesses and everything in between. All of the patient's in PNG carry around their health records from hospital to clinic to health outpost. This allows you to see what care they have received at other locations, something that would otherwise be impossible. In clinic it is common to see broken bones, large abscesses, complicated pregnancies, fever of unknown origin, dehydration, septic joints and more all within the space of a couple hours. The team of doctors and nurses are incredible and work together to keep everything moving.

I have felt very welcomed and brought right into the thick of things. This is already too long, thank you for reading this far if you made it :) I'm on call for the first time this weekend and will try to blog again after that experience. Keep me in your prayers as a lot of this is very new! 

Vocation

We awoke early this past Sunday morning, several minutes before the tropical winter sun emerged over the horizon. The previous week included several long days with visits to multiple sugar mills, a dairy factory, and a zoo in order to provide on-site primary care services for the employees at these various businesses. But I did not feel at all tired on this early morning. This was the start of the most anticipated day of my time in Mauritius, and like the eastern sun about to emerge from its nightly repose, I was eager to begin.

By the time the first rays of light appeared beyond the sharp peaks surrounding Mauritius's central plateau, we were on the road, using the approaching dawn as a beacon to guide our journey to the heretofore unexplored eastern side of the island. The endless cane fields, vestiges of the mercantile colonialism that defines this island's history, rippled like the surface of the ocean as the winter winds barreled across the coastal plain. We traveled along the haphazard Mauritian roads, free at this time of the usual bold pedestrians and reckless drivers overtaking other vehicles without a modicum of foresight. Coastal plain gave way to plateau. The car engine protested this modest ascent with its implacable whining, but it ultimately delivered us to the requisite elevation. Stray dogs emerged from the fields on occasion to examine the disturbance at this early hour, and they scuttled back into that rhythmic green sea when their curiosity was satisfied. After an hour of ascent, shifting gears, and sightings of several grottoes dedicated to the Virgin Mary that line so many of these meandering Mauritian roads, we arrived at l'Église de Saint-Julien, the Church of Saint Julien, where my great granduncle John Egan was pastor for the final 20 years of his life.

The parking lot was empty, as Mass was not to begin for some time. The church looked better suited for the Irish countryside with its simple gray stonemasonry, contrasting the tropical palate of yellow and white-painted concrete more typical of Mauritian churches. As an Irish relative who had also visited this church told me, this was a testament to the craftsmanship Uncle Jack had refined as a laborer in Ireland, which he applied enthusiastically to his numerous construction projects during his time here. We took several photographs of the church as parishioners began to walk in, and they sent quizzical glances our way. We walked inside, and I was taken with the simplistic beauty of the stone church. A modest altar was flanked with banners bearing messages in French and Mauritian Creole, signifying the linguistic and cultural diversity of this nation. I introduced myself to the priest, and he was thrilled to meet us. He announced our presence to the congregation, and we were greeted warmly by many of the parishioners. He ushered us to a seat near the altar, and the entrance hymn began shortly thereafter.

During Mass, the final verse of the Gospel reading caught my attention: "When he disembarked and saw the cast crowd, his heart was moved with pity for them, for they were like sheep without a shepherd; and he began to teach them many things" (Mark 6:34). At the start of his homily, the priest emphasized the importance of discerning one's vocation and following it with passion and devotion. He referenced the dedication to vocation displayed by my uncle, Father John Egan, who left his home in order to serve a community in a faraway land, to be a shepherd to a flock that needed him. After the Mass, the priest led my wife, me, and a small procession of older parishioners who knew my uncle when he was still alive into the graveyard. Some of them shared stories about my uncle, and these tales revealed a convivial, outgoing man who was dedicated to his flock and to his mission. The priest said a blessing over the grave, and in due course we found ourselves back on the road driving away from the church. 

The word vocation originates from the Latin "vocare," meaning to call. From the time

I first understood the concept of choosing a career, I have wanted to be a physician. In

this sense, it has been one of the enduring missions of my life to become a doctor and

tend to the sick. A little over one year ago, I graduated from medical school, and I thought I had realized this dream of mine. If I learned anything throughout the course of my intern year, however, it was that dedication to a vocation requires constant discipline, relentless passion, and above all, devotion. Throughout the past year, I found myself succumbing to the familiar trappings of intern year to which I had previously believed myself immune: cynicism, resentment, impatience. Hardly the virtues I hoped to espouse in my first year as a doctor. A patient interaction that occurred last week encapsulated some of the frustrations I have felt since graduating from medical school. I was working in the emergency department with Dr. Bhulah. A patient came in because he had not been feeling well for the past several weeks. He complained of increasing fatigue, thirst, hunger, and unexplained weight loss. We recognized the symptoms of new-onset diabetes, and a point-of-care test of the patient's blood sugar revealed an alarmingly high value. Dr. Bhulah recommended an overnight admission for further testing to rule out diabetic ketoacidosis and to control his blood sugar. The patient refused as he had plans to attend a birthday party later that day. Dr. Bhulah and I exhorted him to stay, citing the risks he posed to his health and safety if he declined admission. These pleas were ineffective; Dr. Bhulah prescribed some medication the patient agreed to take, and he departed from the clinic. I have had similar encounters during which patients declined indicated, even urgent, treatments and seemed inexplicably indifferent to their health. These experiences are frustrating for the physician, as I can attempt to equip my patients with the tools they need to improve their health, but I often cannot convince them to heed my advice. All of these accrued frustrations surfaced after this patient refused his treatment, a torrent of minute failures and self-perceived imperfections raging against the fragile edifice of my own ego. What to do in such a scenario? Throw up my hands in defeat? Eschew the better angels of my nature for an attitude that succumbs to gallows humor, that greets the indifference of patients with indifference of my own?

Yet—amid these little temptations to deviate from the higher path of the good physician, these enticements to give in to apathy and stray from empathy, I have the example of Uncle Jack. The example of the good shepherd. The humble servant, as some of his parishioners called him last Sunday. The tireless laborer who worked alongside his flock on numerous construction projects to rebuild churches after devastating cyclones. Who carried pipes over his shoulder on a moped up the perilous mountain road to the village of Chamarel in order to supply water to the church and school. Who did not command his flock from a position of austere authority, but who rather exuded warmth and gregariousness, who won hearts through effort, through commitment, through trust, through working side by side with those whom he served. Uncle Jack, Father John Egan, who shunned the paternalism that those in positions of power too often embrace, including physicians. Who followed his calling truly and faithfully. Who now, 54 years after his death, inspires his great grandnephew across time and space to better serve my own patients, to better realize my vocation.

This will likely be my final post from Mauritius. Mark Twain, who visited Mauritius in the 19^th century, famously wrote a description of the island he heard from a native Mauritian: “Mauritius was made first, and then heaven, heaven being copied after Mauritius.” After spending my international rotation here, I am inclined to agree with this statement. It is a beautiful country with warm, hospitable people and a fascinating, complex history. It possesses breathtaking mountains and some of the most picturesque beaches I have ever seen. I have learned a great deal during my time at La Nouvelle Clinique du Bon Pasteur, and I am grateful to Dr. Tadebois and all the other physicians at the clinic and at North Colorado Family Medicine for making this dream of mine a reality.

Below, some final photographs of my time in Mauritius. Thank you to all who have read these musings.

Photo with current pastor at St. Julien and parishioner who knew my uncle

 Uncle Jack's grave

Église de St. Julien 

 Day on the beach

 Mauritian sunset

 View from the peak of Le Pouce, iconic Mauritian peak that was hiked by Charles Darwin

 Photo with Dr. Vaulbert at Bon Pasteur, surgeon with whom I worked and who knew Uncle Jack

Au revoir, Mauritius!

Mauritian Hospitality

I wrote in a previous post about home visits for elderly patients. It was a fascinating experience, and I was grateful for the opportunity to participate. I spent an afternoon traveling throughout the village of Rose Hill with one of the general practitioners who works at Bon Pasteur visiting the homes of several elderly Mauritians. As I wrote before, the Mauritian government provides free home visits for patients over the age of 75 who meet certain criteria and free home visits for all Mauritians above the age of 90. We visited the homes of five different patients, and I was glad to be able to see a segment of Mauritian life that I would not have witnessed otherwise. One of the most noteworthy details from the day was the hospitality and warm welcome I received at each of these visits. The physician with whom I worked introduced me as a young resident doctor from the United States, and all the patients we encountered gladly welcomed me into their homes. There was not a hint of hesitation, and they were all eager to talk with me about what brought me to Mauritius and what I thought of their country. Most of the patients were dealing with the same chronic diseases that plague the elderly patients I see in Colorado: hypertension, diabetes, osteoarthritis. They were all glad to spend some time with the doctor, and they were invariably thrilled to speak with me (the feeling was mutual!).

I believe that a 5 minute home visit offers more insight into a patient's life than a 30 minute encounter in the clinic. When welcomed into someone's home, the physician is able to determine many details of that patient's life with a mere cursory glance of the parlor or living room: mobility, cleanliness, religion, important family members, and support systems. All of this was true of the patients I spoke with during my afternoon of home visits, and it helped me realize how often these important facets of a person's life do not enter the conversations I have with my patients in clinic. After I depart from Mauritius and return to Colorado, I hope to participate in additional home visits and learn more regarding the details and important components of the lives of the patients under my care.

Mauritian History and La Nouvelle Clinique du Bon Pasteur

As mentioned in the previous post, I am spending my international clinical elective in Mauritius. Mauritius is a small island located in the Indian Ocean, about 700 miles east of Madagascar. Its history, culture, and traditions are unique among the nations of the world. The first recorded human vitis to Mauritius occurred during the Middle Ages by Arab sailors; the Portuguese landed in 1507. They established a landing base for a brief period of time, but this was abandoned shortly thereafter. At the end of the 16th century, a Dutch ship landed on the east coast of the island and named it "Mauritius" after the Dutch Prince Maurice van Nassau. They established a small colony in 1638. There is no record of any permanent human settlement on the island prior to the establishment of this Dutch colony. There were, however, some famous residents prior to human settlement. Mauritius is the only place the famous Dodo bird ever lived. Sadly, less than a century after its initial contact with humans, the bird became extinct due to its lack of aversion to human interaction, its flightless nature, and the ease with which it was hunted for its meat. The Dutch abandoned Mauritius in 1710. Shortly thereafter, in 1715, the French expanded their Indian Ocean colonization efforts from nearby Réunion Island to include the now-uninhabited Mauritius, where they quickly established a sugar-producing colony. To this day, large expanses of the island are covered in sugar cane fields. The French colonial authorities and settlers brought slaves from other parts of Africa to harvest this sugar cane. In 1810, during the Napoleonic Wars, the British seized Mauritius from France, but the island's inhabitants were permitted to maintain their language and religion (hence the persistence of the French language and Roman Catholicism on the island to the present day). Slavery was abolished throughout the British Empire in 1835; in order to compensate for the shortfall in labor following slavery's abolition, British planters brought large numbers of indentured servants from India to work in the island's sugar fields. As a result of this complex colonial history, present-day Mauritius has a remarkably diverse population made up of people of European (mostly French), Créole (African and European), and Indian descent. Throughout the 20th and into the 21st centuries, there has also been steady immigration from China, leading to even more diversity. Mauritius established its independence from the United Kingdom in 1968, and it has been one of the more economically prosperous and politically stable nations in Africa following the postcolonial movement. Since independence, it has expanded and diversified its economy, shifting from a sugar-producing tropical island to a robust economy that includes sugar production, rum distillation, textile manufacturing, and thanks to its beautiful beaches and tropical locale, luxury tourism. This history has resulted in a complex, robust, diverse nation, where numerous Hindu temples line the narrow streets, the Muslim call to prayer echoes from local mosques, and grottoes dedicated to the Virgin Mary dot the tropical countryside. French and English are the official languages of the nation, but the most commonly spoken language of the people is Mauritian Creole. This is a French-based Creole that has incorporated influences from African and Indian languages. French is also widely spoken, and I have yet to meet anyone who does not know at least some French. English, however, does not appear to be spoken nearly as much as French or as Creole. The government conducts its affairs in English, and many road signs are similarly written in English, but most TV stations and newspapers are in French, and I have met some people who struggle to understand or speak English. Nearly all of the physicians with whom I have been working are fluent in all three.

Since my arrival in this fascinating country, I have been working at the Nouvelle Clinique du Bon Pasteur. It is located in Rose Hill-Beau Bassin, a large town located in northwest Mauritius. This healthcare facility was established in the 1930s by a group of Catholic nuns, the Sisters of Charity. After a time, the Sisters transferred administration of the clinic to the Roman Catholic Diocese of Port-Louis. In the early 21st century, the diocese sold the clinic to a group of private investors, among whom was Dr. François Tadebois, the current medical director of the clinic and one of the physicians with whom I have been working since my arrival.

My days at the clinic have been varied, enlightening, and exhilarating. On my first day, I was treated to a tour of the clinic by Nicolas Tadebois, son of the aforementioned François Tadebois. Nicolas is one of the clinic administrators. In Mauritius, the word "clinic" does not have the same meaning as it does in the United States. When I hear the word clinic, I think of an outpatient physician office. Here, it simply means that the facility is privately owned and operated, whereas the term "hospital" refers to the government-run facilities where patients receive care. As such, the Clinique du Bon Pasteur is much bigger and offers far more services than what a typical American "clinic" would provide. There are about 20 inpatient rooms, an emergency department, an operating theater with three separate operating rooms, a maternity ward where approximately 3 women give birth per day, and a number of physician offices for outpatient consultations. During my first week, I spent most of my time working in the emergency department, which is referred to as the "casualty" here. The standard of care provided in Mauritius is quite high, with treatments and practice founded on the same evidence we use to guide our therapies in the United States. However, the nurses and providers are necessarily much more resource-conscious here. If a patient comes in with head trauma but has no neurological findings, he or she will not receive a CT scan. Gloves are used sparingly (no need for gloves for a simple IV insertion, one nurse told me). Surgical gowns and drapes are made of cloth and reused. Physicians also seem to have more of a direct role in implementing care; they start IV lines, administer medications, and perform wound dressing changes. I find myself enjoying this increased amount of patient contact compared to medical practice in the United States. Many of the issues and complaints plaguing patients coming to the casualty are similar to those I see in Greeley: hypertensive urgency, diabetic management problems, minor injuries. However, based on my anecdotal experience in the casualty and in no way founded on any kind of large-scale observational study, I believe that the rate of postoperative and general wound infection is higher here. Many patients come to the casualty for scheduled dressing changes; some of them sustained wounds while going about their daily business, and others have postoperative wounds from routine surgeries.

I have had the privilege to witness and participate in multiple facets of Mauritian medical care over the last few weeks. I have spent time in the operating room with a brilliant, gregarious surgeon who oddly enough knew my uncle Jack Egan (Uncle Jack was his parish priest when he was a child). I have participated in community outreach with Dr. Tadebois, accompanying him to several sugar mills and poultry packing plants around the island where he provides on-site primary care for the employees of these establishments. I even had the great fortune last week to accompany one physician on a number of home visits around the community, where I received a warm welcome into the homes of some elderly Mauritians. Here, individuals aged over 75 qualify for government-sponsored home visits if they meet certain criteria, and those over 90 automatically quality for home visits. It has been a joy participating in the care of these patients, and I am very grateful to all of the providers who have taught me so much. In the coming days, I hope to spend some time on the maternity ward and observe the Mauritian perspective on labor and delivery.

À bientôt,
Tom

Below, some photos from my day touring the sugar mills with Dr. Tadebois:

Arrival in Mauritius

"I am writing this note 'standing' as I have not had time to sit down."

That is an excerpt from a handwritten letter from my great grand-uncle, Father Jack Egan, to his brother and sister-in-law, my great grandparents. It is dated September 1935, but I feel as if I could be writing those same words to my family today after the past week. Several days ago, my wife Megan and I arrived in Mauritius after a lengthy travel itinerary originating in Colorado, involving stops in New Jersey and Paris, and terminating on this small island in the Indian Ocean. It has been a tiring week, but we are grateful to have arrived at our destination safely. I am grateful beyond measure to all at North Colorado Family Medicine, my family, and everyone here in Mauritius who has made this trip possible.

When informing querying parties of my summer plans to travel to Mauritius over the past few months, I was frequently met with looks of bemusement and the common question, "Why Mauritius?" These unfortunate individuals were then met with a long, detailed explanation that involved an account of my genealogy, tales from a newlywed year spent in Ireland, and finally, the explanation that my great grand-uncle, the aforementioned Father Egan, was a priest who lived in Mauritius for approximately 30 years of his life. He died here about 50 years ago, and he is buried at the parish church of St. Julien in eastern Mauritius. Ever since I heard about Uncle Jack as a young boy from my grandmother, his tale captivated me. He seemed to be a man of great principle and devotion who was willing to move far from his home in pursuit of a greater, higher cause. He was born in rural Ireland in the early years of the 20th century. Later in life, he entered the seminary in Paris and was eventually ordained as a member of the Congregation of the Holy Spirit, a Roman Catholic order of priests. Shortly after his ordination, he was sent to preach and serve the people of Mauritius, where he would spend the rest of his days as a true man of the people. My mother recalls meeting him several times when she was a young girl and he came to visit New York, and her vague memories endorse the image of the gregarious, spirited, humble man I have encountered in the letters, documents, and stories I have gathered over the years pertaining to his character. 

I must, unfortunately, bring this post to a premature close, as the hour is growing late and I am to arise early to attend surgical cases tomorrow morning. I find my time limited these past few days, as if I have "not had time to sit down." I will end with a brief description of the past few days and what I hope to accomplish over the next several weeks. I have now spent several days working at the Clinique du Bon Pasteur, a private clinic in Rose Hill, Mauritius, where I will be completing my international clinic elective. In the few short days since I started, I have worked in the emergency department, operating theater, and with the community outreach team. I have already encountered skilled physicians who very graciously have taken the time to teach and mentor me. Over the next few weeks, I hope to explore this faraway island and learn about the practice of medicine here. I hope to learn a great deal from the physicians with whom I am working and the patients who come to the clinic seeking care. And of course, I am hoping to better understand my uncle, Father Jack Egan, to hear stories of his life from those who might have known him, and to behold the grace and resilience that enabled him to leave his home in order to serve where he was needed.

A bientôt,
Tom

Below, some photos from what Megan and I have been up to over the past week. In order:

                                   Beautiful church on the water where we attended Mass last weekend

                                        Clinique du Bon Pasteur, where I have been working

                                         Terre de Sept Couleurs, national park in Mauritius with volcanic remnants

                                        Beautiful view of the Mauritian coast

                                         



        Église de St. Augustin, one of the church construction projects Uncle Jack was involved in on the island

Bangladesh Update #4

After an incredible month, I’m headed back to Colorado now.  I finished by squeezing in a twin C-section the morning I left (and running from the OR to catch my car to the airport). 

I certainly saw a lot of unforgettable things this past month, met several doctors who quickly became role models, and gained a valuable experience in adapting to a very different obstetrics environment!  Babies really do come out the same general ways regardless of where you are.  But the amount of antenatal care is drastically less.  First trimester scans are rare and dates are generally uncertain.  The way people communicate about labor progress is different – I learned to judge effacement by centimeters instead of percentage and station by feeling the pelvis, not by cervical exam.  In fact, I gained valuable examination skills in so many areas – with little advanced testing available, physical exam is critical to making good clinical decisions.  Breech babies don’t always come out by C-section here.  In fact, transverse lie babies sometimes come out vaginally too if they’re small IUFDs (shoulder first?).  Eclamptic seizures happen.  Sometimes a patient comes in with an IV from some village clinic with who knows what prior treatment. The partograph system for plotting labor curves that I’d only witnessed in action a few times before is used in every labor here – figuring out the advantage of this system, its pitfalls, and how to use it clinically was really important!  I’m still working out the nuances of this, but as the partograph is used worldwide, I know this will be a very useful skill.  C-sections are basically the same…just with different clamps and different needles in a different operating room. I’m certainly a better surgeon after this month for having learned to be flexible with equipment.  

And there are the more general skills – learning to work with a new team that involves various levels of doctors & midwives, changing my personal patient organization system to fit the quantity and constant movement between beds, figuring out a successful communication style with my limited Bangla.  And learning to emotionally cope with tragic outcomes and higher rate of IUFDs than we would typically see in the US with all of the monitoring and testing that is able to be done.

So again – I can’t say thanks enough to the amazing LAMB team who took me in and taught me so much!  I’d certainly love to go back someday to LAMB or a similar setting, and despite the challenges, feel that my interest in going long-term to a hospital in a low-resource area overseas has been confirmed this month.  I’m looking forward to sharing more details & stories when I get back to Colorado!

I'm a few days behind updating this...I had two busy call days (Friday and Sunday) and have been putting together presentations for the past two Tuesday morning OB lectures.  So no worries, I'm really not slacking off here! 
The variety of OB cases continues to be impressive.  As an example, take my 24 hour call shift on Sunday (which was actually not my busiest call day): managed 1 breech delivery, 1 vacuum delivery, 1 set of twins, not sure how many semi-normal deliveries/inductions, one postpartum eclamptic seizure, one postpartum septic endometritis, did a D&C of a 16 week molar pregnancy (that showed up in shock with a hemoglobin of 5.0), and removed one vaginal leech (yes, that's a real problem here...leeches have no boundaries). 
The best part of the job is getting to work with the doctors here.  I've enjoyed being a part of a training program with the constant focus on good education.  Both the junior and senior doctors have welcomed me onto the team, and have all been so willing to teach me Bangladeshi obstetrics.  From laughing around the rounds table in the morning to having iftar (breaking of Ramadan fast) at their homes in the evening, they've become good friends.  Besides my interactions with patients, the staff here have given me a solid one month introduction to Bengali culture. 
I'm really looking forward to sharing cases, pictures, and experiences when I'm back in Greeley soon!