In Dhaka: The first few days

Sitting here jet-lagged and watching TV at 3 in the morning, I never realized Tim Allen and Jonathan Taylor Thomas were fluent in Hindi. Although Bangla is the language spoken in Bangladesh, most of their TV programming is Indian, and so Hindi is heard most frequently. I guess it is similar to how in Canada, we see mostly American programming. Fortunately they speak the same language as us, for the most part.

Despite a few hurdles along the way, such as my visa showing up the day before I was to leave, and typhoon Nuri delaying my arrival by a few days, I finally made it to Dhaka. Upon landing, I was greeted with a blast of humidity. It seemed to seep right through the walls of the plane even as we waited to exit. Stepping out into the hot Dhaka night, I looked around, remembering the anxiety I felt my first time landing in Dhaka back in 2006; I saw the grimy metal bars, holding off people with their hands sticking through, the chaos of taxis and sounds, but this time, I felt a certain familiarity, as if maybe I am finally starting to get used to this country.
My hotel room overlooks Gulshan lake, a murky lake with mysterious black blobs that seem to swirl up from the lake bed, and saturated with fish, although I see nobody fishing. Apparently about twice a year chemicals are dumped into the lake to cull the fish and belly-up they go, coating the surface. I was watching the pouring rain beat down onto the water, trying to work up enough nerve to get up and go to NIPSOM, the university I will be working with. It always takes a little coaxing to get myself out onto the chaotic streets, kind of like jumping into a cold pool; you know you will warm up as soon as you jump in and start swimming, but the hardest part is just getting in!

Once at NIPSOM, I found Dr. Akhtar pretty easily. My supervisor, Hugh, and I had met with him about three times during our last trip. He has a big round happy face and smiles all the time. He dies his hair with henna (this plant Indian people use to die patterns on their hands and also their hair) so it is a bright red, and he speaks with a husky, whispering voice, as if he were the godfather. When my appointed research assistant, Zakia walked into Dr. Akhtar’s office that morning, I liked her instantly. She had a friendly smile and exuded positive energy. We went off to talk about the details of the project and I found her to be sharp, awake, and to have a good sense of humour. Unfortunately she has exams until the middle of September, so Zakia and Dr. Akhtar have selected someone else to come with me to Bogra for the first few weeks.

I made a decision this time to try as hard as possible to do things the local way, and not force anything the way I am used to, “the Canadian way”. For example, when working here back in 2006 with another organization, I tried to rush social pleasantries and force instructions to get right to work. I didn’t like how slow every process had to be and I realize now I was being impatient. I would try to clear up all ambiguities by repeating things over and over again. I found in the end this didn’t work at all; no matter how much I tried to speed up meetings, they were often slower than I expected, and no matter how many times I repeated things, there were still misunderstandings. I decided this time, just to sit back, practice a little more patience, and allow things to happen the Bangladeshi way. So Dr. Akhtar led the conversation, I waited for cues to speak or change the subject, and I was happy to find, we discussed almost everything I wanted to talk about that first day.

The microscope I dragged all the way from Canada has been delivered undamaged to NIPSOM after a hair-raising CNG ride (CNG stands for compressed natural gas, and is what people call the auto-rickshaws that use this fuel); I used one hand to make sure the scope didn’t fly out, and the other to make sure I didn’t fly out! Now only one more day here in the capital and then it is off to Bogra District to begin preparations for the field work.

Project preparation

There are two components to my project in Bangladesh.

1) The major component is determining the prevalence of asbestosis and other lung diseases in migrant shipbreakers from northern Bangladesh.

2) The additional component is to train students and researchers at NIPSOM about bulk asbestos sampling and identification.

This summer has been all about preparing for both of these objectives, and with departure just over two weeks away, there is still much to do.
Asbestosis study in Bogra (in Northern Bangladesh)

• Feasibility trip for two weeks in April 2008
• Making contact with Bangladeshi partners and collaborators:
o Dr. Nurun Nahar, the Civil Surgeon of Bogra District. The Civil Surgeon is the local chief medical health officer.
o Dr. Akhtar, the head of the Department of Occupational and Environmental Health at NIPSOM, and a member of my thesis committee.
o Zakia Sultana Siddique, MBBS, a bilingual master’s of public health graduate who will accompany me to Bogra and assist me with subject enrolment, interviews and physical examinations.
• Questionnaire development
• Thesis committee meetings (Members: Dr. Hugh Davies, Dr. Paul Demers, Dr. Tim Takaro, Dr. Sk. Akhtar Ahmad)
• Application for approval from UBC Clinical Research Ethics Board

Bulk asbestos identification training

• Courses at the McCrone Research Institute in Chicago, Illinois
o Microscopical Identification of Asbestos (1608A)
o Asbestos Fiber Counting [NIOSH 582] (1616)
• Volunteered weekly at Golder Associates Ltd., at their Asbestos Environmental Health and Safety Laboratory in Surrey, BC
• Purchased a polarized light microscope along with refractive index dispersion oils to set up at NIPSOM in Bangladesh
• In the process of developing modules for bulk asbestos identification and fibre counting for NIPSOM in Bangladesh, as well as for the School of Environmental Health (SOEH) at UBC

Project Summary – Asbestosis in migrant shipbreakers from Northern Bangladesh

This study will examine the prevalence of asbestosis (and other fibrotic lung disesases) among a migrant shipbreaker population in Bogra District, Bangladesh.

“Shipbreaking” is the dismantling and recycling of obsolete vessels. In Bangladesh, this work is carried out with virtually no heavy equipment on open beaches and the labourers are often migrant workers from the impoverished regions of the north. While 97% of the ship is reusable and the industry has created thousands of jobs, the work is hazardous, putting workers at risk of acute dangers such as asphyxiation, falling debris, fires, explosions and electrocution. Chronic diseases such as lung fibroses and cancer can also occur from exposure to heavy metals, polychlorinated biphenyls (PCBs), and asbestos, which are all recognized carcinogens. Although the ships contain these hazardous substances, most work is done without adequate training or protection, and there is high potential for exposures in the shipyards.

I will undertake a study of asbestosis and general health among a migrant shipbreaker population in Bangladesh that has returned home to northern communities of Bogra District from the Southern port city of Chittagong where shipbreaking occurs. I will collaborate with the National Institute of Preventive and Social Medicine (NIPSOM), of the University of Dhaka, and health officials in Bogra District. Chest x-rays and a physical exam will be performed on 100 former and current shipbreakers. All subjects will be interviewed about their knowledge and handling of asbestos. The x-rays will be analyzed by a radiologist in North America. Ethical review will be obtained at the University of British Columbia and the Bangladesh Medical Research Council.

The field work will commence in Bangladesh in August 2008. Field work in Bogra will end in November, 2008, and the results of this study will me made available in the summer of 2009.