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Boats on a river in Bangladesh

Speaking the language, learning the medical culture

Working on a global health project in Bangladesh, Stanford medical student Tasnim Ahmed learned that a familiar place can have an unfamiliar medical culture.

In Bengali, the term bideshi is used to describe a foreigner. The literal translation is "without land." This past summer, during six weeks conducting research on a global health project in Bangladesh, I heard the term often -- in reference to me.

It felt strange, as I was born in Bangladesh and lived there until I was 3. To me, Bangladesh is where I can easily blend into a crowd. Bengali was the first language I learned. I visit often to see family. I feel a sense of ownership and belonging in Bangladesh that I have not always felt in America.

When I had the opportunity to do clinical research on autism screening there, I thought it would be like visiting home.

Typically, cultural and language barriers present significant challenges for outsiders hoping to improve health care in other countries. Sometimes their expectations are shaped by a much more privileged background. I hoped that as a researcher with strong ties to Bangladesh, I wouldn't face this kind of obstacle. Yet I quickly saw evidence of my foreignness.

While recruiting patients for a study at a clinic, my quick introduction (conducted in Bengali) would almost always be answered with the question, "Are you American?" I knew my accent gave me away, but I wondered if maybe I did look out of place. This reaction from Bangladeshi patients also startled me, perhaps because I struggled to feel American for so much of my life, feeling more like a foreigner in the United States. 

At first, being labeled "American" by Bangladeshis made me feel uncomfortable -- it almost caused a mini identity crisis -- but it soon made me acutely aware of the privileges that I have grown accustomed to. In my previous trips to Bangladesh, I was always just a temporary visitor, seeing the country through the rosy lenses of vacation sunglasses.

This time, I saw the health care picture more clearly. During a visit to a Dhaka hospital's intensive care unit, I noticed that there was no hand sanitizer readily available. Pumping hand sanitizer before entering and leaving a room had become second nature to me as a medical student -- a cardinal rule for every patient encounter. The Bangladeshi doctor I was shadowing must have sensed my apprehension. She explained how a lack of funds often meant that items like hand sanitizer are sacrificed for more essential resources, such as beds or oxygen tanks. Before traveling, I was prepared to see the consequences of limited resources in a low-income country, but I hadn't considered how much I take for granted. Like hand sanitizer. 

Beyond just the differences in equipment and supplies, I was also adjusting to new dynamics. While I assumed I had checked all the boxes for cultural competency before getting to Bangladesh, I realized through working as a researcher that there was an entirely new culture of medicine that still remained foreign to me. I carried with me expectations that were formulated by American ideals -- ideals which, up until this point, I hadn't even realized were American, but assumed as universal. I was out of touch. In Bangladesh, I struggled at first to assimilate to different social norms. For example, it was very common for doctors to calm a nervous patient by recommending they say a prayer -- something that would probably be deemed inappropriate in the United States. In fact, it was something I was accustomed to seeing within my own family, but had not encountered in a professional setting. Thus, I had to learn how to adjust to a new set of rules that sometimes contradicted those with which I was indoctrinated. 

Perhaps what really struck me during this trip to Bangladesh was the realization that not everything in medicine is uniform. Sure, the science will always remain consistent from country to country, but the dynamics within hospitals, the resources available and how they're used, and the relationships between patients, doctors, and researchers can vary far more than just the language used to communicate.

Stanford Medicine Unplugged is a forum for students to chronicle their experiences in medical school. The student-penned entries appear on Scope once a week during the academic year; the entire blog series can be found in the Stanford Medicine Unplugged category

Tasnim Ahmed is a second-year medical student from Bangladesh and Queens, New York. She has a background in cognitive neuroscience and education. Her interests include global health, women's health, and embroidery (for her own health). 

Photo of a boater in Bangladesh by Tasnim Ahmed

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