We attempted our first thesis committee meeting last week.

My committee consists of Dr. Ahktar (NIPSOM, Bangaldesh), Dr. Hugh Davies (UBC), Dr. Paul Demers (UBC), and Dr. Tim Takaro (SFU). A lot of emails fly back and forth before a meeting like this can be arranged, not only due to the time difference, but also differences in available technology. We decided on using Webex, an online meeting centre which allows any number of people to get together for conferences, using an internet connection and a phone number to call into. The latter proved to be the more difficult challenge. In preparation for the meeting, I did a practice run using Skype but the static was bad and I was not always able to connect. In the next attempt, we tried the WebEx Integrated VoIP option and got it to work. This option meant I did not have to call in, but just to plug a microphone into my computer while I logged onto the meeting online. Alas, although this worked during the practice run, during the real meeting, there was a huge delay in speech and apparently I sounded like I had been breathing helium for breakfast. Needless to say, we spent the first half hour toying with different options and I ended up calling in on my mobile. This was marvelous for a little while, until my credit ran out and my Canadian committee found themselves talking to Alvin of “the Chipmunks” again.

Despite the technical difficulties, we managed to discuss the main items:

• Status of Bangladeshi ethics application, and Bangladeshi translations of the consent form and questionnaire
• A two-day trip to Bogra to meet with the Civil Surgeon and see study location before field work begins in October
• Obtaining an English translation of a map of the villages in Bogra in order to plan the enrollment strategy
• Status of fume hoods available at NIPSOM and whether or not they are appropriate for working with asbestos
• Creating a case management strategy, for local physicians who may be confronted by study respondents who have asbestosis or other pnuemoconioses

Interestingly, the ethics application, reviewed by the Bangladesh Medical Research Council, cost about $15, but it has been approved. The questionnaire will be pilot tested before final changes are made and sent back to Canada. It is our intention to “back translate” the questionnaire and consent forms in Canada, from Bangla to English, to ensure the original meaning has not been lost. Zakia, my research assistant, and I will pilot test the questionnaire on two cooks at the school, as Dr. Akhtar felt they would have a similar educational level and socioeconomic status as the shipbreakers we will encounter up north.

A trip to Bogra will be arranged for next week to meet with the Civil Surgeon, Dr. Nahar. I will visit the study locations including the Mohammed Ali District hospital in Bogra where the physical examinations and x-rays are to take place. During this visit I would like to gain a better understanding about the finer details in arranging appointments, available transportation for myself as well as the study respondents, available equipment and consultation rooms, etc.

Before coming to Bangladesh, an assistant health inspector in Bogra surveyed the study location to gain a general understanding of where shipbreakers were mainly located, what sorts of tasks they performed on the yards and how long they had worked for. Maps are not something that is commonly used in Bangladesh. Even in the city, local people do not use maps and have a hard time recognizing locations on maps if you open one up. Therefore, detailed maps of my study location do not exist, but the assistant health inspector was able to write in village names on a more basic map of the area. We initially wanted to use this at the committee meeting in order to discuss an enrolment strategy, but all names had been written in Bengali script and we will have to wait for it to be translated to English before we can discuss it again.

I was a little worried about the state of the fume hoods here, the fact that HEPA filters are not available in Bangladesh, and the attitude towards “small amounts of asbestos” not being a huge health risk. I have sent pictures of the fume hoods here to Canada, and we agreed on consulting with a ventilation expert in Vancouver to decide what materials can be brought over in November when some of the committee members visit. Apparently a large tax has to be paid on this end when receiving any sort of laboratory equipment by mail, so it is preferred to have equipment brought over in person.

Finally, we would like to begin designing a “case management strategy” for the local physicians. Once we have reviewed the x-rays, we may have a diagnosis of asbestosis, or another lung disease. The study does not have a medical follow-up component so it is important to provide some guidelines we can give to local physicians. The average Bangladeshi physician is very familiar with diseases treated every day such as tuberculosis, pneumonia and bronchitis. Most are unfamiliar with asbestosis and other fibrotic diseases. How best to go about designing this is still being thought through, but hopefully my visit with Dr. Nahar in Bogra will shed some light as well.