How are you? I am fine.

The human body is a strange machine. Its proclivity for habit and rhythm is what keeps its day-to-day functioning on track. We’re all creatures of routine for a reason. One of the strongest and most disruptive-when-disrupted rhythms is that of sleep. And I’m a guy who LOVES his sleep. But during this fifth trip to Bangladesh, I again find myself wide awake. The rhythm is off. Something is not clicking. Awake. Again. So, there I was in Cox’s Bazaar, looking out a window at 3:30 am and wondering what was waiting out there in the dark.

Everything is pitch black and there is a strange calmness to it. But this darkness, in particular, is hiding something. It’s a convenient mask for the human suffering it conceals. Everything looks the same. There are no mansions, no slums, no Mercedes Benzs, no rickshaws. There is just darkness. The sights and sounds I witnessed today are in my head and there’s no covering it up, no drowning it out. Somewhere out there a short distance away, there are a million refugees sleeping on the ground beneath makeshift tents with nowhere to call home. This is the second time I have been to the Rohingya refugee camp yet I realized that I have not fully processed the first visit, I doubt I ever will. 

We departed from Dhaka, leaving the rest of the team to teach an important obstetrics course. Teaching someone how to perform safe labour and delivery practices is a legacy piece that will live far beyond Team Broken Earth. They will now be able to treat postpartum hemorrhage and save a life. The power of education through medicine has become such an important part of what we do.  

What’s different about this trip to the Rohingya refugee camp than the last? Well, this time we are helping to provide clinical support. Also, this time Allison is with me. Brenda, a seasoned Broken Earth nurse, and Jennifer O’Dea, a pediatrician, also join.  

We piled into a van at sunrise and left the hotel for the two-hour drive to the camp from Cox Bazaar. The van’s seasoned shocks felt every bump. We travelled along a beach road where the tall trees are lush and provided a much-needed canopy for the drive in the bright sun. We make a sudden sharp left turn through a small village. Children of various ages are playing in the streets, one kicking a homemade soccer ball while nearby parents give chase, probably trying to get them to do chores. People were heading to work, peddlers were opening their packs and setting up shop on the side of the dirt road that’s lined by fences, watershed areas and fields filled with rice paddies.     

The road is made of flattened dried mud which has recently seen rain, followed by heavy traffic and has created a combination of an obstacle course and a rollercoaster. My head hit the ceiling of the van as we glided over several unexpected moguls.     

As we travelled, I was readying myself for the sights and sounds, and the suddenness of the appearance of 1.2 million people in the middle of nowhere. 

I knew what was coming. I knew what to expect. But it was no less shocking despite the benefit of my past experience. The bright green hills give way to clear cut lands with millions of tents and makeshift homes as far as the eye can see.   

The van turned into the camp and the road throughout is better than the road we just travelled on. I thought to myself as I did the first time, this is not a camp, this is something permanent.  

The sun beat down on the dirt road as we travelled through grid roads, and our host explains the camp has been divided into sections, blocks, and subblocks. My thoughts drifted home for a second and I thought of Mark and his love of Legos. My heart sank a little with guilt.  

Since the last time I was here, the huts and tents looked sturdier and reinforced. Instead of tin roofs, many are covered with palm branches and cloth. There is no official labor in the camp, no official source of employment, yet there is a robust market area with goods and services not much different than some of the towns we have passed through to get here. From the corner of my eye, I catch glimpse of a barbershop. There has to be goods and services like this now that they have been here for 2 years. I am still confused as to the currency of it all.

The van moved slower now, and our host explained the real issues that exist. Basic things like identity. These are a people with no home, no nationality. They lack the basic sense of place and belonging. They live in Bangladesh but out of necessity. They are not Bangladesh citizens. Think about that many people with no identity. What happens to law and order? They are not from Bangladesh, and the government here does not want to be responsible for administering justice or punishing crimes. The Bangladesh army keeps the basic rule, but that’s not policing. They are there to keep the peace, not enforce laws.

Think a step further: what happens if you die there? Who issues the death certificate? Who is responsible for your remains? There are no graveyards, no means of proper, dignified disposal of remains. These are complex troubling questions that the government has been forced to deal with over the last two years.

An even bigger issue is the birth rate. Our host told us that 40% of women of child-bearing age are pregnant and in the last two years there have been almost 200,000 live births in the camp. Allison and I looked at each other in disbelief at that statistic. That’s almost the population of St. John’s created in the confines of this camp in just two years. Two hundred thousand babies born with no identity. Born into a gray area. The camps are Rohingya but they were born in the controversial Rakhine area of Myanmar. These children have no nationality, no birthrights, no home. I’ve got to understand this. I started asking. Our host reminded us that Myanmar never recognized the Rohingya anyway. They would have all been born in their homeland without identities too. It’s an impossible situation.

The van stopped at a curve in the road. We exited and were immediately faced with both the heat and the pungent smell of humanity living in such close quarters. It’s a scent so strong it burns the nose and stings the back of your throat. It’s a combination of sewer, sweat, and decay. The smell was made extra bold from the wall of 40-degree heat.   

The clinic was located just off a main street. We departed on foot and crossed a small provisional bridge. Kids were playing nearby and there was a sense of people doing daily tasks as we passed them. Normal seems like the wrong term, none of this is normal, but there seemed to be a routine. 

The clinic was composed of wooden and tin walls with a thatched roof supported by a combination of bamboo and sheet metal. As we approached the waiting area, we noticed it was divided into two sections: one for women and one for men. The women’s side is jammed packed with different coloured saris. The children have collected close to their mothers, moving even closer as we approached.

Inside it was dark and hotter than outside. There was natural light from three windows that don’t seem to generate a breeze. There’s a communal waiting area, also used for community health teaching, and two examination rooms. There were some quick introductions and we were off to the races and seeing patients, side by side with the local doctors. The volume was high and quick. The order, patience, and respect throughout the line was impressive. 

There were far more women and children than men. At least 3 to 1. They were almost all suffering from anemia and were malnourished. Our host was not exaggerating about the pregnancy rates as we see a steady flow of women hand in hand with young children. Many of the children were born within the last two years. There are posters on every wall of the temporary shelter, dirtied and well used. They are new but have the appearance of being up for decades, I guess the whole place does. Here, almost all the births are done at home, in the tents, and on the dirt floors. The posters serve the basic need of showing the signs and symptoms of the many bad things that can happen during pregnancy. There are a lot of illustrations as these posters were specifically designed for an illiterate population.

The local doctor that Allison is paired with has calm and empathetic demeanour with a big smile.  She is unflustered and professional in her care. She reminds me of my sister, Rebecca. She sits at a desk with an open window directly behind her cut from the sheet metal. It provides some sunlight as well as a much-needed breeze. There’s a view of some young boys playing in the camp, surrounded by a field and sewage. I’m trying to not get in the way as there were no orthopedic cases, and she smiles at me politely allowing me to sit on an examination table and observe her and Allison work. She became more trusting of Allison and more open to her skills with each additional patient seen.

As the day proceeds, one woman came in wearing the traditional Rohingya dress with her face fully covered. She’s holding an infant. The covering makes it tough to guess her age, but her eyes are deep and dark. She fixated on me, and I get lost in her stare. That old saying of the eyes being the windows to the soul proves true. But I never thought that it goes both ways. It felt like she is looking deep inside me. I’m locked in and cannot break away. I lose any sense of the heat and the scents. Time stood still. There was a connection and an instant level of trust.

Through the questions answered, I found out that she is 19 years old. This is her second child. This one is under two and was born in the camp. The child is not exactly unwell but has had a cough and sore throat for days with a mild fever. The child is quite cooperative. As Allison examined the child’s ears, I asked some gentle questions about her life and what it was like before.  Through the translator, she describes a peaceful life with land, order, and a home in Myanmar that was suddenly ripped from her. “It has all been taken,” she says. She was forced to make the pilgrimage, leaving behind several dead family members that couldn’t even be buried. 

She was speaking rapidly and there was no need for a translator to convey her emotions. I am picturing her at 17 years of age with a baby on her hip running for her life into the unknown. The thought is distracting. It is a kick in the guts thinking about how when we close our eyes, we both dream. But the difference is her dreams have real, harsh boundaries. I try to think about where I was, what I was doing when I was 17. Nothing could be recalled.

I was locked in on her eyes. I’m fixated on wondering what she must dream about. Home, I suspect. The moment is broken when I hear from the window a little boy’s voice say in clear but accented English “how are you? I am fine!” I turned and smiled as he is framed in the window like a picture from National Geographic. The doctor explains that there is an educational hut around the corner where they teach kids the alphabet and some basic English. He was smiling from ear to ear. It was clear these are the only English words he knows but he says them with such confidence.  

Other boys quickly gathered, as they took a break from their soccer game and came to the window. Smiling and laughing, being boys. Teasing us with their “Hello! Goodbye!” and “I am fine!” parroted phrases. I apologize to the young physician as they must be here because we, the foreigners, were here. She speaks with them each by name. She tells us that they actually come every day around this time, to the window to say hi and make her laugh. Both Allison and I smiled at the sweet gesture.

The scene was interrupted by the clinic staff who wanted to show me a satellite clinic. Brenda and I leave Allison and Jennifer at the clinic and as I walked to the van, I felt with every heated step on the dessert dry dirt path, a sense of real distance with Allison. Of course, it was safe, and she will be safe, but my heart beat a little faster. Allison is tough and doesn’t need back up. It’s not about that. But I wasn’t sure what it was.

We drove through the camp and the subblock, then walked for ages through a winding dirt path that’s one person wide. It’s lined by tents and trenches of stagnate water (well, what I hope is water). The heat intensifies as we hike through the twisting map and make our way up a hill of loose stairs made of sandbags embedded haphazardly into the earth. They are clearly well used, and the sides of the bags have been eroded. Sand seeped out with each step.  

When we reached the top, there was a small ten by ten open-sided canopy with orange walls. It covers a desk and a local medical assistant in much-needed shade. He was diligently taking blood pressures, triaging and treating patients. It has a true field medicine feel. After observing him for 20 minutes, we were told that we are at the center of a subblock and the leader of this particular subblock would like to speak with me. It turns out there are leaders of each of the subblocks that then report to the larger block and in turn to the camp. Order amongst chaos.  

The man approached with a reserved smile and shook my hand. It strikes me how tall he is. I am not a tall man, which my kids remind me of frequently, but I am generally tall by Bangladesh metrics. This man had a good 4 inches on me. He is thin with a tight beard and is dressed neatly in a North American style t-shirt with the traditional Muslim white skullcap, a topi, and a traditional wrap-style garment. He walks straight with his head held high and has a firm shake.  Our eyes locked. This time though it seemed to be a one-way window and I was looking into his soul.  There was a heaviness, a sadness, an anger to his eyes, like those I imagine from a combat veteran.  These eyes have seen more than any man should.  

We began by chatting about the camp and about the health facilities. I tried my best through the interpreter to keep it light and casual, but there is nothing light or casual about this place. I began to ask him about his journey and how he got here. His eyes grow deeper and darker, almost lost. He says he had thirteen acres of land, cattle, and a small shop. Within a few short hours, he made a decision to leave it all with his family and flee. They burnt his land as he was leaving, and he lost fifteen members of his extended family on the journey. They drowned as they were frantically crossing a raging river to the other side to safety, to Bangladesh. He paused, his eyes seemed angry and then lost again. When I asked him what he would like to do or where he would like to be, he responds in a few pained words. The translator says that he simply wants to go home. 

Fifteen family members gone. I had no words. I realized in my own ignorance that there are no good answers to the questions I’m asking him. He fled tragedy. He lives in a controlled chaos. His future is a question mark. I stumble a bit in my words but I try to keep the conversation going. He told us that it is too unsafe to go home. His eyes loosen their edge and there is fear there now. He is afraid for his life. The chaos here, the small dirt tents, the streams of sewer and stagnate water is safer than the alternative. Safer than a home that no longer exists.

The sun was on its way past the high point now and we needed to make our way back to the medical clinic. We needed to be out of the camp by 3:30. I thank the man for his story and wished him the best of luck. I regretted it as it came out of my mouth. How empty. How vacant. Best of luck.  What was I thinking? I thought about him the entire ride back.

Back at the clinic, we distributed some much need medicines and medical supplies from Canada. We were treated to a community health lecture where women were invited in and given basic hygiene and pregnancy instructions followed by prepackaged meals. In the distance through the window cut in the tin and bamboo, the boys who were teasing us had returned to playing soccer. There was a feeling of normalness and comfort like the sun finding its way through the small holes in the thatched roof.

It was time to leave. As we were driving over the hills towards the exit of the camp, the view of the endless tents was as upsetting as it was spectacular. How the hell did this happen? Best of luck, I keep thinking. I feel sick.

The idea of fleeing in the middle of the night with a few possessions, kids in your arms, it just seems unfathomable. I caught myself before I got too far down the rabbit hole of negativity though. The mass of issues is overwhelming, and even though this never makes the news at home anymore, not everyone has turned their back and forgotten. The people of Bangladesh, the doctors and nurses in the clinic, the local NGOs, they did not ask for this, they were never planning for this, but here they are, day after day, week after week, up to their necks in illness, disease, lawlessness and helplessness, doing their level best to make it work. I think of the boy in the window. I looked over at Allison and smile. “How are you? I am fine.” I said and we both laughed. 

Back at the hotel, the orange sky quickly faded to black. Took my mood with it. I guess I was still having a hard time processing it all. I thought the second trip would be easier. It has proven to be quite the opposite. The first trip was overwhelming with the size, the scale, the overall sites and sounds. This trip has been overwhelming with the humanity of it.

It’s getting darker now even as the moon is drawing a slight reflection on the ocean and the town below my window. I wake multiple times throughout the night, tossing turning. I get up several times. How dark must it be in the camp? In those well-worn tents?

Darkest. We can’t live like that. None of us can. We push through knowing that the light is coming eventually, no matter how dark and for how long. God I hope so. I just want to sleep. Maybe dream about summers in Holyrood with the family. In the morning, maybe this all won’t seem so heavy. “Best of luck,” I tell the window. The moonlight long faded.

Returning to Dhaka lifts my spirits. As it has many times before, just watching the hard work of Team Broken Earth is the medicine I need in the moment. The women’s health course was a success and there’s already talk of the next phase being organized. There’s even been time enough for a half-day of free care for the extreme poor in a downtown hospital. 500 patients were seen. 5 surgeries conducted. Watching Jen Mercer perform a c-section lifted me more. A brand-new human, seconds old, a baby girl. A clean slate. All the hope and innocence. All hope and dreams. I think of my own kids. I think of the kids in the camp, I hope they dream big and change the world. I am fine. I. Am. Fine.