Our First Overseas Adventure: Bangladesh

Because cholera is a disease with no borders, we see ourselves as an international company with global partnerships. We are proud to announce that we launched our pilot study in Bangladesh in partnerships with iccddr,b and Notre Dame University’s Global Health Program earlier this month! We sat down for a conversation with Mike Malloy, Halcyon Incubator’s Program Director, to talk about our experience in Dhaka.

M= Mike Malloy
K= Katherine Clayton
L= Lynne Cheng

M: Good morning Katherine! Good morning Lynne! It’s a pleasure to be speaking with you this morning and to learn about your trip to Bangladesh. Start us off a little bit of what you were hoping to accomplish on the recent trip to Bangladesh. If there’s one case of cholera, what happens?
K: Right. So cholera infects about 5 million people every year. We’re living in the time of the world’s largest outbreak in Yemen because of the war, over a million people have been affected. The way people get it is by consuming contaminated water or food. Within hours if they’re not treated, the patient can die from the disease. It’s dangerous, but the thing is it’s also highly treatable when someone does have medical care. It’s just about taking some really inexpensive oral rehydration salts and getting hydrated again.
L: One thing I found interesting was that the convenience store around the corner from our hotel sold rehydration tablets, right next to vitamins. So it’s a very common thing.

M: Tell me a little bit about Bangladesh. I’ve never been there, so if it’s my first time, where should I go?
K: Bangladesh is not a big tourist attraction, and it’s likely because there was a giant war in the 60’s and 70’s getting their freedom from Pakistan. But it’s a super interesting place. The people are super curious and warm. The city of Dhaka is one of largest cities in the world so it’s very vibrant! There are cars everywhere, people everywhere. The food is similar to Indian cuisines, if you like Bengali culture which is similar to Kolkata in India, it’s very transferable to Bangladesh.

M: Are there specific dishes you’d recommend?
L: I thought all the food was really delicious. Unfortunately we didn’t have any street food because I didn’t think our stomachs would handle it well. We stayed in restaurants around the hotel. We did have one free day where we explored the old city known as Old Dhaka and walked around for a couple hours and looked at how local communities cook food. We went to the markets and looked at their fresh produce and the live chickens and geese and ducks.

M: How did you get around the city? I’m assuming there aren’t scooters on the streets. What’s the transportation like?
K: We did Ubers personally, you could also use rickshaws. When we took Uber, they were all labeled as Toyota Corollas but they were never Toyota Corollas.
L: And the license plate numbers were in Bengali so we couldn’t read the license plate.
K: And whenever they called, no one spoke English, so it was super fun navigating.
L: We’d try to find a car that looked like it could be an Uber and I’d wave them down. It took us about 40 minutes to find our driver at the airport because they’d drive by and cancel. I think they also cancelled when they saw that we had US phone numbers.
M: Are the roads lined? How safe is it?
L: The lines are suggestions.
K: Traffic rules are loose suggestions. It’s more beeping to navigate where sound is coming from and to know to move out of the way.
L: There are a lot of traffic conductors but they’re fairly ineffective. It’s more about gesturing cars to stop and go but even then…

M: What’s the temperature like there?
L: Outside? It reached over a hundred and humid.

M: Who did you work with while you were in Bangladesh? Who were the partners on the ground?
L: We are partnered with icddr,b, the world’s largest cholera hospital. So that was definitely a lucky break for us. Unluckily, it’s also Ramadan, so things were closing earlier and there was less staff than there normally would be. But we saw their infectious diseases department and met with their staff and faculty. We also saw their labs which were very well stocked. It did catch me off guard that almost everyone was in sandals or open toes shoes.
K: A bit more on the lab — it was an environmental biology lab that we’re working with. Dr. Zahid is the head of the lab and I knew his PhD advisor from working in Haiti! And that lab was a lot less stocked than in Bangladesh. So this was a huge improvement.
M: And when you say “stocked”, what do you mean by that? Samples? Tests?
K: Yes, all of those things. And in Haiti when I went around, a lot of the equipment they’d show us haven’t been used in a really long time because they were broken. But in Bangladesh, everything was being actively used which was a stark difference.
M: Was that because they had more training and knew how to use the devices? 
K: I think it’s also the ability to maintain the equipment. Machines are machines, they’re all going to break down eventually. Having the resources to come in and fix it or money to buy new equipment makes a big difference.

L: The culture was so obviously deferential towards the instructor. Everyone paused working to listen to what he had to say even though the conversation was directed towards us. The students were pausing to take photos so it was clearly a big deal that we were there.
K: The reason that we got this opportunity to work with icddr,b is because we’re working with Notre Dame University’s Global Health Program which provided us with this incredible connection. We have students there now that are doing the testing for us and it’s been incredible. They’re amazing to work with and had us laughing the entire time and feeling at ease. They’re fantastic.
M: So are the students at Notre Dame or are they in Bangladesh?
K: They’re in Bangladesh, finishing their masters in Global Health and it’s part of their capstone project.

M: What hypotheses did you have going into Bangladesh? Was there anything you wanted to test for the business or with the water itself there? What did you learn?
L: For us, we wanted to prove that our device wrks in the field. We went in with an open mind because we don’t want to affect the data in any way. We simply handed the equipment over and observed and listened. We didn’t want to offer changes or suggestions until we understood their current methods. We want to change as little as possible without encroaching. We have two Notre Dame students there doing two separate things for us. Jordan is working in the lab to compare how effective and efficient the device is versus lab equipment. And we have Theresa studying user response and conducting training on using the device. They’ll be there for a total of six weeks.
K: One of the things I noticed right away was a lot of the water sources we went to were really tough to access. I think our students were giving us a heart attack getting down to the water sources — I thought they were going to fall in a couple of times. But it helped us understand how our disposable can capture water and what we can do better. So it was nice to get some immediate feedback.

M: Any additional learnings or anything unexpected?
L: Quite honestly, everything was unexpected. We came in without knowing how anything would be done. Communication was a little slow to begin and the staff preferred to meet in person before diving into details. We didn’t know where we would go to collect water, or how. I’ve shared this story a few times, but it’s still fascinating to me. If we were to collect water here (in America), we’d probably use a net or something specifically designed for the purpose. Due to limited resources, they had to be more resourceful and threw in a pair of trousers. The cloth would stop the debris and the water that filtered through the cloth is what we collected. It’s not something I would’ve thought of, but it’s so simple at the same time.
K: In a lot of water research, they call that the “Sari Method” where they get saris and fold it a bunch of times and use it for that. Same concept! I think that’s cool because it’s acting on this historical resourcefulness.

M: So what’s next? We just wrapped up the final showcase at Halcyon, you still have a few weeks in DC. Tell me what’s in the future for OmniVis?
L: We don’t want to redesign until we get the data from the pilot study. But we’re working with other partners to test in different regions and conduct longer pilots.
K: Being at Halcyon, one of the advisors here got us a great connection to do testing in Haiti in September. So that has been really cool. I’ll be making some connections in DC before we leave and this opportunity has been amazing.
M: Congrats on a great trip and I’m excited to hear more about what the future holds for OmniVis!