Dhaka D1

his was not the 1st visit to Suvarnabhumi airport and I had done some study before my trip. There were 6 lounges for me to choose from. On arrival of the flight, I had gone to the transit counter to confirm that my baggage had been actually transported to the relevant flight as per directed by the ground staff at KHH airport. Well, after the hazardous check-in, I felt uneasy about the trip and double confirming my baggage was just what I need.

It was a long walk to my gate and I had chosen a lounge nearby the gate. The food served was simple Thai style green curry and I had taken a small nap. I was exhausted but yet was still worried about my trip. The next challenge waiting for me was the visa on arrival. It could take up a few hours for the application. As my team mate was Taiwanese the process could be longer as they might need to get a special documentation to verified their ‘unrecognized’ passport; that was what happened in Sri Lanka.

I left the lounge early and did a small tour around the shops. There were many shops in the airport but yet most of them sold similar products. I bought some biscuit for the team and headed toward the gate.

The boarding was smooth and I had met a lady from mainland on the flight. We had a great chat exchanging view about religious and condition in Bangladesh.

On arrival at the Dhaka airport, she had led me to the visa counter and I had gotten my visa in less than 30mins.

Those information I gathered regarding visa on arrival were outdated….In the past the payment should be done after the counter accepted the papers but yet the latest procedure was pay first. I was brought to the counter and paid up the fee. With the receipt, I was redirected to the application counter and got my visa with no hazard.

However my team mates were not that lucky. MAS had arrived slight later than the Thai airway and I saw them getting down the stair entering the hall while I was 2 persons away from my visa.
I directed them to the payment counter but the queue was long then. After I got my visa, I had assisted the rest of the mates filling up their visa application form; the form that they had prefilled was outdated and not usable. When they approached the counter they were however later redirected to another police counter where they were given a verification letter for their passport. The total process had eaten up almost 3 hours for everyone to get their visa on arrival.
I had taken my time changing my USD to TAKA and gotten myself a new sim card as the sim card I pre-purchased prior the journey was non-assessable. Everything was settled after 3.5hrs of struggling in the entry area. I considered it was a smooth process. My team mate apart from the three medical staffs, were all fresh travelers with no experience.
The local missioner was waiting at the arrival hall when we exit the airport.

A small bus was chartered and we headed to the local pier for a boat ride to our destination....

the mission - start 1

The mission would start after 10 days from our Kansai trip. It was a row of shifts after my return and physically I was exhausted. To make the situation worse; I had a very bad attack of asthma due to the dust from the room while we resided in Kyoto. I had been thinking from time to time during that period about quitting the mission. It was a struggle but after praying, I had gotten no sign of telling me to step back.

The final day had come after a long shift. I managed to pack my luggage and brought everything that I could remember to do so. I did not properly listed out what I need and just packed whatever I could think of. Food should not be a problem and there was a hospital nearby where we were staying; I thought I would be good. I was still worried about my condition and did not mention anything to Ving, Xian and Yun.

Most of my team members were residing up north and opted to depart from TPE; I did not joined their lineup and was able to find myself another flight route. They had taken MAS which would be flying TPE-KUL-DAC. My flight was Thai airway which would be flying KHH-BKK-DAC. Both flight was 30min apart arriving in DAC and departing from it on return. It seems perfect for the team.

I arrived on time at the airport and proceeded to the counter hoping that I could do a early check-in and have some snack at the lounge as my late lunch.

When I approached the counter, the ground staff had referred me to the payment counter after telling me that they would need a longer time to process my check-in. I noticed that there were 1 pair of mother-daughter and another senior lady waiting beside the counter. Apparently they were in the same shoe as I did. From time to time, the mother had anxiously approached the payment counter asking for info. The KHH check-in counters for foreign flight companies were mostly outsource to local flight companies (EVA or China airline) and there would be a foreign staff to lead the operation. The payment counters were mostly manned by the staff from the foreign flight company.

The Thai-smile air ground staff who was manning the payment counter had taken our passports (4 of us ) and was busy using her LINE to communicate with her counterpart in Thailand. As I saw the rest of the passengers completing the check-in process, our check-in was still stranded at the counter.

I had asked the local ground staff about the condition and she told me that our booking with the connecting flight operated by Thai airways from BKK were good but the booking from KHH to BBK which was operated by Thaismile was no way to been seen on the computer; thence we were not able to proceed with the check in. Apparently it was a database synchronization problem. Thai airway did not update our booking to the Thaismile database. 2 hrs had passed and the flight was 40min away from departure and the Thaismile ground staff was still struggling with the LINE and the check-in terminal computer. I was hungry and tired as I did not had my lunch. The local airport staff had approached the Thaismile ground staff and telling her that they were going to closing the baggage lane but the ground staff replied firmly that she would ask them to re-open if they dare to do so….

For a moment, I thought the great one had answered my prayer and let me rest for the next 7 days peacefully in my home. It was my fantasy of course and I finally got my boarding pass after 2.5hrs waiting at the counter. I proceeded through the immigration and security check. I had no time to grab any food and headed to the gate.

While waiting for the boarding, I had a strange feeling about this trip…It was a bad start; from the planning phase to the boarding part. However every obstacle were countered and I was about to start the most perilous journey of my life. The only thing that made me felt better was that I had remembered to triple my insurance coverage just in case….

I boarded the plane waiting impatiently for my meal and drunk a few refill of soda before I had fallen asleep. It was an uneasy sleep as I knew the most difficult part of the initial journey was awaiting me when I arrived at DAC.

the mission - prelude

For the past few years I had been involving in medical mission organized by churches on a yearly basis. A promise which I intended to keep after my PCI few years ago; I however leave it to the great one to decide where my destination. The missioner serving in India had returned at the beginning of this year and I knew that a returning to India is impossible this year. I was contacted by the local assistant pastor in charging of the foreign mission earlier this year; she had told me that 3 missions would be held this year and one of the options was China which I instant stroke out from the list. Application of a visa to China is a pain of the aXX for me as I need to hand my passport to an agent and sent it to HK for application. The next option was Satun and Bangladesh. I opted for Bangladesh as I had never been to that part of the world. 5 years ago during my 1^st mission, I had chosen Bangladesh as my first choice but was redirected to Satun for some reason.

After the inquiry, everything went silent and I was a little happy that maybe the great one had wanted to move the jubilee forward a few year for me(yeah, yeah, I knew it was only year 5….). Well, after I finalized our trip to Kansai. I got contacted by one of my mission mate asking me if I wanted to do any trip this year. I told her that I had opted for Bangladesh early this year but no one had contacted me. She told me that much had happened and the asst pastor who in charge of the mission was reassigned and another new asst pastor had taken over the job. However due to various reasons, pass-over was not done properly the new kid on the bloc did not aware that I existence. The Bangladesh team was still short of physician. My ex-team mate Z (a nursing practitioner) had opted to go to Satun with a catechumen(chief resident in family medicine) and we had exchanged idea about trip for catechumen;  we both agreed that Satun is a more civilized place to go for a catechumen. Z had asked me if she could mentioned my name again to the new asst pastor in charge as the Bangladesh team is still short of medical staff and I complied.

Days later, I had gotten a call from the new asst pastor in charge C and I had accepted his invitation; I knew that there is no place for me to hide.

The Satun mission was later cancelled and Z and her friend C had joined the Bangladesh team.

always 50/50......

The 70+ y/o pt was sent over by a ambulance. He was having his breakfast and later felt dizziness and he had just laid his head over the table. The restaurant owner had help him onto his car and sent him to the local rescue ambulance. He had reached our ED 30min after the incident. He was alert and initial neurology examination had revealed left eye hemianopia but muscle power was well over both limbs. I had did a quick NIHSS evaluation and found out it was 9; just slight above the requirement for tPA therapy. The brain CT was normal and diagnosis of rt PCA infarction was made. The patient is a loner and no spouse nor child was available. His nephew was on his way and it would be more than enough time to start the tPA in 4.5hr window. However I was in a stranded condition due to delay of CT(CT was done slightly more than 25min) due to chest discomfort of patient(EKG was ordered…). If this case had made it to tPA therapy list, it would made our treatment result index ugly.(we do only a handful of cases per year and any case which failed to achieve the therapy standard would down pulled the total data of the TCPI). Well, CT did not show any hemorrhage and he was definitely a candidate. The condition had worsen as his relative would be arriving late causing another violation(tPA should be given within 1 hrs of arrival in ED).

Double violations and after I obtained all the lab data and completed the check-list, I had gone to talk to the patient for a final time explaining the risk and benefit of the therapy. He had however expressed that he would not want to take the risk of intra-craninal hemorrhage and refused the suggestion of tPA therapy. A relief for me and I had reassured him that with proper therapy and rehabilitation he would recover fine. I informed the neurologist about the situation and he was admitted to ICU.

Few days later, I met the neurologist and he told me that despite of the MRI done on next day that revealed a large area of involvement of rt PCA region, his condition had however improved.

The tPa infusion sometimes worked like a miracle and sometimes…My colleague had a bad experience where the patient did not suffered from hemorrhage but still deteriorated few days later, the case had nearly ended up in a lawsuit. I always tell my patient, the possibility of an incidence to occurred means nothing to the patient, the odds of happening is always 50/50 for any incidence to occurred; it is either yes or no. Those statistic data is only useful reference for the doctor; you never know you are the 99 or the 1….

Well, sometimes, do nothing is better than do something....

Kansai - the return

The returning journey was one of the most worrying part; initially it was typhoon Cimaron, then it was the train catching part. We would need to take the Sakurajima line from USJ to the Nishi Kujo eki and hop onto the Kansai-Airport Express train which run 2 shifts per hour. It seems simple but yet a missed might ended up with a rush situation. We woke up early and reach Nishi Kujo station in time to catch the Kansai-Airport Express. It was not a working day but the train was crowded and no seat was noted on our boarding. We were however able to secure a seat for everyone half way of the journey.

We proceeded to the airport food court and did a final food round prior to our departure. The fried noodle, curry rice and tempura were up to the standard. We proceeded to T2 after the overloaded breakfast. The kiosk check-in was unsuccessful like our last visit; the booking name and passport name was not consistent. Our name had 2 spaces separated and the booking name was noted only with 1 space. Well, it was smooth and we passed the immigration without any difficulty. The rest of the journey was uneventful…..

It was a satisfying journey for everyone.

One month later, Kansai was hit by typhoon Nabi and quite a few places we visited were wrecked.

My asthma had become worst on the day of departure and I had to return to my desk with a tight schedule while another hectic tour was waiting for me around the corner 1 week later.

Kansai...USJ

We had gone down early to the convenient store and grabbed some breakfast before we left the hotel. Out of our expectation the USJ was not packed with crowd at the entrance. We had a smooth passage and proceeded to the rides. The rides were really special and I had no regret buying the fast pass. At noon, we had our lunch at the Three Broomstick restaurant. Though the food was so so but it was a great experience having lunch in the restaurant. We bought some wands and tried out the butterbeer and pumpkin juice. A short period of raining was noted but did not disrupt our trip.

By 5pm we had finished our final ride – the Forbidden Journey at the Harry Porter World. I had never been to any similar ride like it in the past; stunning experience for everyone of us. We left the USJ by 8:30pm and waited a long queue for a seat at the rotational sushi along the walk.

The weather had helped a lot; visitors were less than expected and we enjoyed a great day in the park. After all those day of worrying, everything had proceeded accordingly. It was a tiring day for us but the challenging part was to catch our train early next morning.  

Kansai- pre-USJ

We had leaved the apartment late and took a slow walk with our baggage to Kyoto station for our ride to Osaka. It was a 1+ hr train journey and I fallen asleep during the ride as I had been disturbed by cough since our arrival. The room was filled with dust and my asthma had recurred since our arrival.

The Shin Osaka station is huge and its underground passages are just like a maze with no end. We had located some locker and stored our baggage and did a quick tour around the station surrounding. We ended up eating Okonomiyaki at one of the shopping mall. We proceeded to the USJ at around 3pm. The train station was filled with people as the local govt had announced that the train service will end early in the evening due to the typhoon. The USJ had also closed prematurely at 5pm due to the typhoon. We were lucky enough to get a seat in one of the restaurant located in the city walk mall near our hotel.

We took a walk around the pier of the Osaka bay after our dinner. From time to time, gust of wind had cruised down the walking lane; we could sensed that it would be a big one. However nothing was more striking than big crowd of customers storming the convenient store nearby the hotel for food as most of the restaurant nearby was closed and the rail service had shut down due to the typhoon.

I crossed my finger praying that the USJ would open as usual and no rain would be there to disturbed our journey.

That night was an uneasy one as the gust of wind constant shattered the building and making uncomfortable noise. Rain was also noted. I was disturbed by my wheezing and woke up early At 5am,  looking through the window, I noticed that the sky was slightly filled with dark cloud and the wind had stopped….Well, I knew that our last leg of trip would be finally materialized.