Our winter is definitely over. This week, I stowed away my winter clothes in plastic so that they will not get mouldy later this year. It is not very hot yet, but quite nice. The afternoon temperature is 23°C (74°F), at night 18°C (64°F). It’s really very enjoyable to sit in the sun!

Right now, I’m behind my desk while the sound of crickets and frogs from the ricefield comes through the window. Rice has been planted everywhere and has begun to grow. We notice that patients have time again to come to the hospital. If it is too cold, people hardly have the energy to come, and when it is time to work the fields, all hands are needed there and nobody is available to accompany people to the hospital. It’s all a matter of priorities.

The last few weeks, I have had a guest surgeon. The surgeon that worked here for 7 years before I came, has now returned for a month to do surgery with hare lip and cleft palate. We had accumulated quite a waiting list over the last year and I had expected more patients than we would have been able to handle, but it worked out well. In this entire region, there are regular camps for this kind of surgery so half of my patients had been helped elsewhere. Fortunately, this surgeon is quite flexible and he doesn’t mind very much that I have less for him to do than expected. He will be here two more weeks before returning to his well deserved retirement.

Yesterday, I faced another dilemma that accentuated the difference between working in the Netherlands and in Bangladesh. We had a two week old baby in the hospital for the last few days, that had a problem with the belly membrane: the navel had not closed properly, but only had a thin fleece or bag over it instead of skin (the medical term is omphalocele). In the Netherlands, the diagnosis would have been made before the birth, the child would have been born in the hospital and treatment would have started immediately to get the belly contents back inside the belly and to allow the bag to dry. This baby had been born at home and came only after two weeks. There were signs of an infection and it had become impossible to get his intestines back inside his belly because they had become stuck to the bag. Moreover, it became clear that the intestines were pinched in the bag and didn’t work properly anymore. In the Netherlands, the baby would have been put in a baby incubator, here it was put up in an ordinary hospital bed. I could not do surgery because post-op care for such a small baby after anestesia is very difficult and I tried to give the intestines more room with only local anestetics. Unfortunately the baby still died this morning.

I find it quite frustrating that we do not have all the means needed to help such a little one, but then I have to remind myself how many kids with less serious illnesses like diarrhee or pneumonia can be helped for the price of baby incubator. That helps me to accept that we have to make do with the means we have.

Proof that rice is really planted by hand: footsteps in the mud.

A walk past freshly planted field in our neighborhood.