My assignment in Dhaka coincided with the end of the monsoon season. As far as the temperatures were concerned, they were initially a continuation of the Munich summer, but due to the frequent rainfall, the humidity was often over 90%, which required a lot of sweat. I couldn’t get used to the unbelievable littering and the chaotic traffic conditions. Although I soon gained confidence in the driving skills of the Bangladeshis, a certain mistrust remained in view of the “moving junk” and the daily newspaper reports about traffic accidents. In addition, the journey to and from the ambulances in the slums often took a lot of time.
many many skin diseases
During the six weeks of my stay, I treated a total of around 850 patients, and my colleague treated a similar number. There could have been more on some days, but the frequent rainfall and especially the Eid ul-Adha festival resulted in a noticeable drop in patient numbers. Anyone who had managed to get hold of one of the coveted bus or train tickets had traveled to their home town to celebrate the Islamic festival of sacrifice with their relatives. The city was deserted for a week. Around 15% of our patients were children under the age of five. The most common complaints from their parents were “cough and cold” and diarrhea. Almost all the children were underweight, yet I only saw one child with marasmus. In Dhaka, the government programs against malnutrition seem to work reasonably well.
In addition to chronic diseases such as COPD, hypertension and diabetes, the older patients had a conspicuous number of skin diseases. The diagnosis of the frequent scabies was not a major problem, but for the remaining dermatoses, Dr. Heino Hügel’s offer of teledermatological diagnostics was a great help. Cases that I sent him by e-mail around 6 p.m. local time were answered by him the same evening with a detailed opinion and a treatment suggestion. Many thanks to Dr. Hügel for his great help!
Many adult patients described pain in various parts of the body, a condition that can only be described as “all body pain”. Despite a thorough physical examination, hardly anything tangible was found, so there was no choice but to continue the pain therapy of my predecessors.
Antibiotic resistance is widespread
Treatment failures were observed relatively frequently in the treatment of infections. Extremely high resistance rates are described in the literature for Bangladesh. This is certainly a consequence of the overly careless use of antibiotics. On the one hand, treatment is always “blind”, as pathogen diagnostics and resistance testing are completely unknown, and on the other hand, common antibiotics are freely available at relatively low prices. Many patients first turn to one of the countless pharmacies for advice. If they consult a local colleague, the prescription usually contains one or two antibiotics, regardless of the symptoms – antibiotic resistance is almost inevitable. Azithromycin and cefixime are popular.
To shed some light on the situation, I collected 39 bacteriological samples together with my colleague – urine, ear and wound swabs – took them home and analyzed them. I was able to isolate a total of 152 different germs and test them against antibiotics. Three MRSA were found in the 13 wound swabs and one multi-resistant Klebsielle and one multi-resistant E. coli (3MRGN) in the urine samples. In 18 further isolates, multiple resistance to common oral antibiotics (e.g. to ciprofloxacin + cotrimoxazole + ampicillin) led to a significant increase in the level of antibiotic resistance and thus to a restriction of treatment options. Although the small number of samples does not allow a comprehensive statement to be made, the results provide an indication that the literature data with resistance rates of between 70% and 90% cannot be confirmed, at least in our patients.
We received an invitation from the embassy to celebrate the Day of German Unity. Over cheese spaetzle and – oh wonder – draught beer, we had interesting conversations with the ambassador Dr. Prinz, the embassy staff and business people. The interest in the work of the German Doctors is apparently great and the appreciation impressive.
Treatment under police protection
The last week of my stay was overshadowed by disturbing events. As a result of two dubious murders of foreigners, we were quickly placed under police protection by order of the government. In practice, this meant that we could only drive to our places of work with a police escort.
We were sure to attract the attention of all passers-by. More drastic was the fact that we were no longer allowed to leave our apartment on Manda Road unaccompanied. This meant we could no longer enjoy the wonderful excursions into the greenery at the end of Manda Road, where a green model city is to be built one day. And the walks along Manda Road and Mugda Road with their many stores, picturesque photo opportunities and spontaneous conversations with passers-by were also no longer possible.
