DHAKA COMMUNITY HOSPITAL/DCH-HARVARD ARSENIC PROJECT

Final Thoughts by Christopher Shim

General Reflections, Minor Criticisms:

When I left Harvard in February of 2001 I was a mess - unsure of myself, disoriented and discouraged, I sought to take time off from school for reassessment and reevaluation. Never did I think to travel to Bangladesh of all places, but having rested in Seattle, and ironically feeling more restless, I casually emailed Professor Wilson to ask if he had any suggestions for work and travel - and with one remark and this professor's gracious help, the course of my life was forever changed. Less than a month later I was in another plane, leaving Seattle on April 7 with little more than an address and the assurance that someone would meet me at Zia International Airport in Dhaka, Bangladesh. I had no real idea what to expect.

I've been back in Seattle for about two weeks now, recovering from a nasty flu (probably fatigue induced) and generally trying to get back into my normal routine. Prompted by Professor Zaman's request for an informal evaluation, and also to share with my benefactors/facilitators Professors Wilson and Christiani, I felt it appropriate to share some thoughts and reflections about my experiences and what I learned in Bangladesh.

Life in Bangladesh was a surreal, thought-provoking and perspective-filled series of experiences - it's difficult to express, really. I basically divided my time between shadowing doctors at Dhaka Community Hospital (DCH) and helping out with the DCH-Harvard Arsenic Project, following the Bangladeshi doctors into the villages to test the water and collect blood samples from the locals (further details in my daily reports). To my understanding, the problem with arsenic-contaminated water started back in the 1970's when UNICEF, in one of its most ambitious projects, dug millions of tubewells in Bangladesh with the promise to rid Bangladesh of diarrheal diseases like cholera and dysentery. It worked - partially - but in their haste/negligence, UNICEF didn't realize that there were high levels of arsenic in the groundwater, which is naturally abundant (for some reason) in eastern India and Bangladesh. The result some 20+ years later is one of the worst cases of mass-poisoning in history - estimates range from 30 to 60 million people suffering from arsenic poisoning. It takes around 5-15 years of exposure (depending on the concentration) to develop skin lesions, organ damage and in the worst cases, cancer. Seeing the results of this first-hand (DCH has been at the forefront of local efforts to fight the ignorance/disease), seeing the work of some local WHO/World Bank folk and just living in a South-Asian country for two months (and a Muslim one at that) - well, it's all made me rethink a lot of my naive notions about the UN/US. I'm realizing that while the intentions of those working in international organizations may be pure, it's people like me - naive and brash political scientists and physicians - who grow up, "try to help" and often do more harm than good in the name of humanitarianism.

But if there's been any tangible benefit to this experience, it's that I certainly know what international health/development really means. Kenya did it for me a bit, but Bangladesh was a much more intense learning experience (mostly because it's was a relatively solo adventure - I was not surrounded/insulated by seven fellow American students as I was in Kenya). I've realized first-hand that when one talks about service/medicine/overseas work, it's not some kind of slick, romantic ideal, "Indiana Jones with a stethoscope" deal - it's sweaty, often boring; unrewarding and frustrating at times. (Professor Zaman, if I can explain some of those minor frustrations - I was a bit overwhelmed at times by the hospitality shown to me. On the whole, my experience was very positive - I hope that fact has been reflected in my daily reports - and the attention devoted to me was both flattering and humbling. However, my only real criticism is that I was often taken aback by people's friendliness. As a person of Asian descent, I can begin to understand the kind of hospitality characteristic of Bangladeshi culture, but the American in me was simply overwhelmed by the constant greeting, friendly acts and kind words of "when you go, I feel (miss?) you" and notes of "I love you." Quite honestly, there were a few times when, tired, dirty and hungry, I was approached by some member of the DCH staff for a discussion and I had to bite my tongue and remain patient, polite and friendly, even though I could've cared less at the time. Don't get me wrong - on the whole, the kindness shown to me was simply amazing, and the willingness of people to explain things to me and just chat about life was a real blessing, but there were many times I felt overwhelmed by the gawking and attention).

However, I am fortunate - I really do think it's better that I know these aspects of service - yes, even overly friendly people! - because I know now what I'm talking about when I say "I want to serve in the medical field overseas." Sure, of course, I've got a lot to learn about life, but in this regards at least, I'm no longer (so much) the bright-eyed and bushy-tailed freshman who had all sorts of vainly ambitious and horribly misguided notions about becoming the Korean Albert Schweitzer.

If I may share further, I've also been thinking about what it means "to serve." I must admit (maybe it's just because I've been relatively alone to brood and journal for the past three months) that I've had, well, a feeling of meaninglessness...especially in Bangladesh, seeing all the money and resources pouring into the country, all these people from all over the world trying to do something and accomplishing very little (this goes along with what I said about the UN before). As a political scientist, it's been belittling to realize that I've been learning nothing but theory, really. What do I know that can actually help people? For seven weeks in Bangladesh I was an observer to the most extreme forms of poverty and malnutrition in the "homes" that lined the railroad as I walked to and from work each day. The living conditions were simply apalling - seeing how the poorest of the poor lived was honestly overwhelming, numbing. But what could I to help? It was frustrating to realize that while I could discuss Plato and Mill, tell you all about catalytic hydrogenation on a double bond, and even converse relatively well in Spanish, I hadn't really learned a single thing at Harvard that could do anything to help these people. It was, and continues to be, discouraging.

However, it has been the basis for my renewed inspiration to continue with the pre-medical sciences and go to medical school - so I actually can learn something useful and help people on one of the more basic levels of human need - a need that knows no language or cultural barrier. Shadowing the staff at DCH taught me more about medicine and patient care at a large community hospital in a developing country and observing the DCH-Harvard staff at work, I experienced first-hand how arsenic is mass-poisoning the people of Bangladesh and West Bengal and have begun the process of understanding just how complex the causes and solutions are.

Additionally, many of my naive thoughts about international organizations have been dispelled; more than ever I am convinced that the real hope for countries all over the world is not more bureaucracy and UN/US intervention, but for local groups and local people to stand up for their respective countries.

In the end, however, I realize that I have been nothing more than a two month baby-sitting obligation - I didn't really do anything nor make a positive difference - but having lived for the past two months in a south-Asian country, and a Muslim one at that, and having experienced life both in the capital city and in the village, I believe I have a deeper understanding of and richer appreciation for the people and culture of Bangladesh. And that alone has made time from Harvard worthwhile.