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After a general article about how to keep healthy in Bangladesh, Paola comes back to reflect with us on one particular aspect of health for expats in her hosting country. Thank you, Paola!

 

This year, Dhaka, the capital of Bangladesh, where I have been living for almost two years, has managed to drop from second least livable to least livable city in an Economist Intelligence Unit survey which studies 140 capitals each year. Okay, war-torn or exceptionally difficult places such as Kabul and Islamabad are not taken into account in the survey, but still, 140th position out of 140 is not hugely encouraging for expats who live here, or are considering moving here. Especially if they are worried about their health in Dhaka.

The ratings are based on 30 factors, across five broad categories: stability, healthcare, culture and environment, education and infrastructure. In this article, I’ll have a look at some practical aspects of health in Dhaka, which is actually, in this case, closely tied up with a huge infrastructural problem: traffic.

Dhaka has two superb state-of-the-art hospitals, and the one with the best reputation is the Apollo, which is about six kilometres north of where most expats live.

Dhaka saluteAccording to its website, ‘in April 2008, Apollo Hospitals Dhaka became the first hospital in the country to receive JCI Accreditation, an international stamp for excellence in clinical practices in patient care and safety. In June 2011, after a rigorous one-week survey process, the hospital has once again achieved full JCI re-accreditation’. Several of my friends have been patients there, and they confirm that it is indeed excellent.

The emergency services as described on the website are reassuring: ‘in case of any emergency, one call is enough to avail of our ambulance pick-up round-the-clock. Our fleet of ambulances is well-equipped and manned by trained emergency technicians and paramedics. We have Toyota and Mercedes-Benz ICU ambulances with life support equipment including ventilators. Moreover, being near the international and domestic airports, we can commute with emergency patients to-and-fro very fast from the airport to the hospital premises at times of need’.

Well, reassuring, perhaps, if you just read the website. But not if you live the reality of health in Dhaka.

Recently, I had a wake-up call. My brother-in-law, who lives in Houston, Texas, had a heart attack, his second. At the time, he was driving his car. He realized what was happening, and simply drove himself to the Accident and Emergency department of the nearest hospital. It took him just a few minutes, and he was quickly taken into care. He recovered quickly, and is fine.

When this happened, I wondered what on earth I would do if my husband were to suffer a heart attack. I suddenly realized I had never been to the hospital; I didn’t know exactly where it was. And I had actually never driven my car: for our health in Dhaka we are advised against driving as the traffic is so heavy and dangerous. Almost all expats employ a driver. I decided I had better learn, just in case. What if my driver was unavailable when I needed him?

I called him: ‘Willington, we are going to the Apollo hospital, and I’m driving’.
He looked slightly perplexed, but got into the passenger seat beside me.
‘Traffic heavy, madam’.

It’s always heavy, apart from in the middle of the night or during the Moslem Eid festivals when everyone leaves town. And I can’t determine when my husband might have a heart attack. We were going to the hospital, and we were going now.

Dhaka salute2After a few instructions on how to manipulate my automatic four-wheel-drive, I turned on the engine. Driving here is pretty aggressive: none of the ‘priorité’ business I was used to when I drove in Brussels, this is simply each man out for his own interests. So with Willington gently urging me on, I reversed out into the muddle of rickshaws, cars and potholes that constitute my street. Soon I had covered a hundred metres and reached the main road, and that’s when the fun started. A sea of taxis, cars, buses and rickshaws were gridlocked across my path.

‘Just go, Madam’, Willington said.

No way was I going to attempt to squeeze in. I got out and walked to his side of the car. ‘You drive. You get me into that line of cars’, I said.

And sure enough, miraculously, he did. We switched seats again. I inched forwards, my heart pumping as cars hooted madly around me, and vehicles skimmed within a hair’s breadth of my vehicle.

After three-quarters of an hour, we had covered two of the six kilometres of our trip. And we were stuck. Again. The most disturbing thing was that an Apollo Hospital ambulance siren was wailing ‘whee-aw, whee-aw’, behind us, just like they do in Europe. Only in Europe, the sound moves, as all the vehicles on the road manage to pull to one side, and the ambulance impressively and safely zooms past through red lights at a hundred and fifty kilometres an hour. Here there was no way out. The sound was stuck in one place, amidst the cacophony of horns. The ambulance simply had to wait till the megaknot somehow disentangled itself.

I imagined my husband in that ambulance. And cried. Then I pulled myself together, and switched places with Willington again.

‘We’re going home’, I said. ‘You drive’.
‘We not go hospital?’
‘No. Home’.

This expedition was pointless. I had to tackle this worry from another angle. Prevention. At home, I googled ‘How to Prevent a Heart Attack’, and studied all the guidelines.

Eat a healthy, balanced diet, I read. That point was already covered: we are near-obsessively careful about what we eat.
Be more physically active. That, too, was under control: we do plenty of exercise.
Give up smoking. No problem; my husband gave up the pipe ten years ago; I have never smoked.

The two tougher ones were Reduce your alcohol consumption and Keep to a healthy weight. We are working on those, although neither is a huge problem for either of us.

And then, when I was in Belgium on holiday, I attended a Red Cross First Aid course, during which I learnt about and practised CPR. I also found out what a defibrillator is, and how to use it. There are two in my husband’s office.

And now, all that is left, is to pray: pray that the heart attack simply does not happen.

Paola
Dhaka, Bangladesh
November 2012
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