I’ve already been a few days back home in Bangladesh! It’s good to be back home again, to get on with normal life and to start work again. It’s the end of Ramadan so the pace of life is now slower than usual. Fewer patients are coming to the hospital and our Muslim staff are soon going to take a couple of days of holiday.

My time in the Netherlands went well. Beforehand 4 months seemed very long, but the time went by quickly.

First, in the second week of February, I went to a medical education conference in Thailand. This is a gathering organized by an American Christian organization especially for people who work overseas and who cannot attend top up courses regularly. As well as there being an intensive program of presentations and discussion of significant issues and the most recent developments in surgery, with a focus on application in our own settings, there is also the opportunity to meet people working in similar situations.

And the conference was held at quite a luxurious resort. The overall intention is both learning and refreshment together.

I returned at the end of February directly to the Netherlands. My family were there waiting for me. It’s always really nice to know that I am welcome…

My time in the Netherlands was a good mix of discussions, meeting people, top-up learning and holiday.

Below is an impression of the talk at my church in Maastricht. As well as Maastricht, I went to a few other churches and small groups/individuals. It’s lovely that you are all so interested in my stories and that you follow in prayer and participation in my Bangladeshi work.

For my holiday, it was wonderful that I could sail for 12 days on the Eendracht. Before I left originally for Bangladesh I served as volunteer hand on this ship and I really enjoyed the experience (despite seasickness) of sailing again with old hands and new. As well as sailing on this large ship I also spent a few days with friends on a smaller boat sailing through Friesland. Lovely weather, changing winds, good friends: real holiday.

During the time in the Netherlands my youngest niece was born, much too early. She was due the following month. At birth she weighed less than 1kg and she’s still in hospital. I’m thankful that during the most anxious days after her birth I was in the country and could be there for her and the family. Her two older brothers stayed for two months with my parents. Because I also spent a lot of time there, I was able to be with them intimately. I really enjoyed getting to know them in such a close way. In the photo we are on the way to the hospital, and of course every single stone had to be climbed onto.

I was also busy updating my learning. I have to register again as surgeon in the Netherlands and in order to meet the necessary requirements I need a certain number of study points. I’ve been to different conferences and symposia as well as taken part in online sessions. Hopefully I’ll soon have accredited sufficient points to register for another 5 years.

Next week in Bangladesh things should be relatively peaceful. Tomorrow it’s Sugar Feast, the end of Ramadan. People do family things and we have a few free days as well. Nice to have time to talk with people before my tasks as surgeon and medical director come suddenly piling upon me again!

In the Netherlands and picinic with hospital staff

Written by Antje on March 12th 2017 8:32

I’ve been in the Netherlands for two weeks now. I look forward to almost 4 months of catching up with family and friends, various opportunities to speak about my work in Bangladesh, and even some time for vacation.

On the home page of this website, we’ll list the dates and locations where I will share about my work. Most of the presentations will be held during church services. On March 19, there is an afternoon meeting at my sister’s in Schoonrewoerd that will be less formal and with lots op room to ask questions.

I was a bit shocked to discover that my last blog story was nearly 3 months ago. High time to write another one before I’m overwhelmed with life in the Netherlands.

Early February, we had a picnic with hospital staff. Early in the morning, 18 busses took us to a kind of amusement park. People had a chance to admire the park, take selfies and buy cheap toys.

Everyone was dressed up for the occasion, and some still needed a make-up touch-up just before departure …

I was part of a team that helped to prepare lunch bags. The cooking had been done at night. First, the little bags needed to be filled with meat and vegetables.

Then, little cardboard boxes were filled with rice, meat, chicken legs, vegetables and a slice of cucumber. Finally, the lid was put on. We made a total 700 lunch packages …

These lunch bags were distributed in 10 minutes, and in another 30 minutes all the food was gone! I felt very content that we had all the food ready on time. Because of my help with the packages, I didn’t have much time for the amusement park, but I don’t regret that very much. When I showed up outside, I was accosted immediately by complete strangers who wanted to have a selfie with me. That can get quite annoying.

For the time being, I have left life in Bangladesh behind me. I delegated my various tasks as medical director to other people. Unfortunately I have not been able to find a surgeon to replace me in my absence. Surgical patients will be referred to other hospitals for the moment, or they will have to wait until I return. I certainly hope that the patients who know me will not get into any serious complications while I am absent.

Victory day and Christmas!

Written by Antje on December 24th 2016 17:27

On the 16th of December Bangladesh celebrates ‘victory day’. On this day the bloody 9 month independence war ended. Here in the project we celebrate this with a costume contest for the children. This is the Bangladesh version of old Holland games that everyone participates in and also a cultural program. In this program the children sing the traditional songs and dance. Here are some pictures to give you an idea of this:

Dressed in the colors of the Bangladesh flag.

The boy in the white clothes and black vest is dressed up as the ‘father of the nation’,
the leader of the independence movement..

Girls wait for their turn to dance.

A combination of different dance groups dancing together.

And then it is of course Christmas this coming Sunday. In the hospital we had our Christmas program last Monday.

The front of the hospital was decorated with ballons and a Christmas banner.

Part of the decorating team.

We celebrated Christmas by singing several songs and sharing the Christmas message. I was able to share shortly here.

Here I share how amazing it is that God chose to send a helpless baby as Saviour of the world (especially when we see how fragile a newborn baby is).

After acting out the Christmas story which included Mary, Joseph, angels, and shepherds with sheep,
we sang ‘Happy Birthday to You’ for Jesus and there was a huge birthday cake.
The medical director and surgeon was allowed to cut the cake….

For this special occasion I was dressed in a sari. Here I am with the director of our nursing school.

In addition to this celebration Christmas will be celebrated in many other places (in church, with the nurses and with the doctors), it will keep us busy!

I wish you a happy holiday season and God’s blessing for the coming year!

A week in Darjeeling

Written by Antje on December 12th 2016 22:29

Today (Friday, December 9^th) is the last day of the week’s holiday I’ve been having in Darjeeling, a city in the foothills of the Himalayas. In British colonial days it had been developed into a holiday resort especially for people to escape from the heat of Calcutta. Some spent half the year in Darjeeling. It’s beautiful here! We have a view of the mountains from the hotel where we are staying.

It took a day to get here: almost three hours from LAMB to the border between Bangladesh and India, three hours of formalities at the border and then five more hours from there to Darjeeling. Crossing the border was an experience in itself. The Brits introduced the people of this region to bureaucracy but then it got passed on and on. There were four places on the Bangladeshi side where our papers were checked and four more on the Indian side.

It was also amazing to see how quickly it went from the flat countryside of Bangladesh, like in the Netherlands, to the more hilly regions with the Himalayas in the distance.

We’ve taken it pretty easy here in Darjeeling. I’ve been out and about with my boss, his wife and his parents, who were my directors when I worked in the south of Bangladesh in 1997 and 1998. A relaxed group. On one of the days we were driven to the top of the highest hill in the area and then walked back down to our hotel. In total about 10 km with many nice views.

Yesterday we took the train to the next town. Quite an adventure because it mostly runs along the road, to the consternation of car drivers.

Shops frighteningly close to the train!

Tomorrow we’re returning home. The next two weeks will be busy with Christmas and normal work. Because I’ve been away for a week, I’m expecting a lot of patients will be waiting to see me.

Between Christmas and New Year’s Eve there’s no elective surgery, which gives the Christian members of staff the opportunity to have the time off. Work picks up again after that.

This month I also need to go to Dhaka in order to apply for an extension on my visa. It’s take quite a while before I’ll be granted it, but because my current visa expires on the 31^st December, the application has to be received before that date. It used to be possible for office staff to obtain visas for us, but now since the beginning of this year we all have to go personally and do it ourselves.

If you’ve been following the news recently: Overnight on the 14^th of November the 500 and 1000 rupee notes were declared to be no longer legal tender. It’s still very difficult for people to obtain sufficient cash. This is one of the many queues at service tills. Where there is no queue, there is nocash in the machine….

Multiculteral Thanksgiving

Written by Antje on November 29th 2016 10:47

As some of you know, last Thursday was the American holiday of Thanksgiving. I have an American house-mate, and for her this is an important feast. Thanksgiving arose as a feast of thanksgiving because the first group of immigrants from England had survived their first year in America (well, at least half of them). This happened thanks to help from the native population, and it was a festive occasion in which their first harvest was celebrated.

Here, we celebrated this holiday with our Expat and Bangladeshi neighbors. Altogether over 100 people. All important American ingredients were there: pumpkin pie, goose (to replace the turkey), and guest had been asked to bring something to eat as well. A joyful holiday to meet each other in a different context.

I made four pumpkin pies. Pumpkins are for sale at the entrance to the hospital.

The goose as 'imitation' turkey. More difficult to cut than last year's turkey!

The buffet with a large variaty of foods.

About the work in the hospital: it is quite busy, the last week with many urgent surgeries, even outside of usual working hours. That means I’m ready for a vacation.

Next week, I will go to Darjeeling for a week. It is a day’s journey from here to just across the border into India. I’ve never been there, it is at the feet of the Himalaya’s and is said to be very beautiful. I really look forward to being away for a week. Since my week’s vacation on Crete in April, I haven’t had any vacation, and I’m quite ready for it.

Workmanship

Written by Antje on October 28th 2016 21:00

This time I will begin with a homelike scene in our ‘sterilization department’. It is room where we have tea, but also where various instruments and other necessities, such as surgical gowns, are packaged to be sterilized in the autoclave. In the pictures below you see how sterile gauze is being prepared. Large pieces with about 10 layers of gauze fabric are being cut to the right size. Afterwards these bandages are folded by hand and sterilized in varying packages to be used throughout the hospital. In more extended surgery we prefer not to use these bandages because they have no leaded thread and would not be visible on X-rays if something should be left in the wound. In that case we use larger bandages of about 30x30cm with several layers sewn together which you don’t lose track of very easily.

My work as a surgeon can be challenging. There are success stories of patients that recover well after an operation. I am fairly confident that the patients would not have survived without an operation. But there are more difficult things. This week a child died the night after a big operation. Even with intensive care after the operation the child did not get better. It is frustrating and difficult to loose a child without knowing why. Especially because it is difficult to learn from the situation.

Recently I attended a girl’s first birthday party. She is the daughter of 2 of our doctors and the first birthday is always a large party. In this case a party tent was set up, the minister was asked to pray for the child and there was a gigantic birthday cake. On the one hand it is always good to see how the first year of the child’s life is celebrated, but on the other hand it is strange to have such a big party for a child that will not remember anything about it.

Sacrifice Feast

Written by Antje on September 19th 2016 19:42

Last week, we celebrated the “Sacrifice Feast”. During this feast, Muslims commemorate that Abraham prepared to sacrifice his son Ishmael to God (in the Bible, Isaak is the son being sacrificed), that God stopped this at the last moment and that Abraham sacrificed a ram instead of his son. Every year, families who can afford it sacrifice a cow or goat or even a chicken. The meat is divided in 3 parts: 1 part for the family, 1 part for the neighbors, and 1 part for the poor. This year, I had been invited by 6 people in 4 days. Every time a large rice meal with various curries…. It is very special to meet people in their home, to see how they live and to get to know them a little bit better.

Our first invitation by one of the co-workers in our rehab center for children.

Here an illustration of ‘digital’ Bangladesh, with smartphone and selfies.

This hospital was closed for one day during the Sacrifice Feast, but for the rest open as usual. It was rather quiet, because people celebrated the feast and also because didn’t expect us to be open. Many centers close for the entire week.

The picture below shows how little privacy patients get over here. The group stands around the ambulance that was to transport a patient. Every time, I am amazed at how many people think they have to say something about how to carry out the transport (and also about how small some ambulances are). By the way, these ambulances are not equipped as you would expect in the Netherlands: there is room to for a patient to be transported laying down, it often carries a cylinder with oxygen, and for the rest it’s a normal van. The driver certainly doesn’t have the medical training that you’d expect in the Netherlands from ambulance personnel….

World breastfeeding week

Written by Antje on August 28th 2016 16:25

It was world breastfeeding week at the beginning of this month. This event was marked in our hospital by a gathering with speeches, a number of songs and a drama sketch about the importance of breastfeeding for the baby and good nutrition for the mother. There is a tradition on many Bangladeshi families that the youngest daughter-in-law is the last person to be served. They are often undernourished even though these are the years when they are pregnant or breastfeeding. This year’s theme, ‘Breastfeeding: a key to sustainable development’ is therefore very much a current issue in the area where we are working.

As medical director I need to always have a talk up my sleeve ready for this kind of occasion, because I usually find myself required to contribute. Sometimes I receive advance notice, but people often take it for granted that I will have something to say so I’m not always asked beforehand.

As I wrote last time it’s the rainy season in Bangladesh. I wrote then that enough rain had fallen, but unfortunately it stopped just after that last blog. This means that people have to irrigate the fields in order to keep them moist enough. In the photo you can see how the rice is planted. The field is so wet because a diesel water pump has been used. The next photo below shows how very dry the field became as a result of too little rainfall.

Irrigation significantly puts up the price of rice on the market. Many families in our area plant rice in the rainy season for eating the whole year round. Rice grown in the dry season is more for people who have money to invest and the opportunity to take it to market. So if growing rice now demands extra costs, this pushes up the cost of rice or results in much smaller harvest yields.

With the cessation of rain it’s become quickly much warmer and more humid. It feels about 40â°C. For the last 2 weeks I’ve had constant itching from heat rash. I comfort myself with the thought that it shall become more pleasant as October begins ;-)

A favorite little patient

Written by Antje on August 3rd 2016 21:06

I wrote my last newsletter in the middle of ramadan, which now seems like a long time ago. We are now in the middle of the rainy season and in our area people are pleased with the amount of rain we have had this year. The water level in the pond on the hospital complex has risen and the rice fields are wet. Rice will be planted in the next few weeks.

My work in the hospital continues. I have a full schedule of operations and my office visits are full. In addition to this my management responsibilities require a lot of attention. I continue to remind myself that I am responsible to handle conflicts and resolve them before they escalate. (I am not sure that I am very good in doing this) I am also responsible for hiring and firing. This gives me more stress than any of my surgical duties.

Below you see a picture of my favorite little patient at the moment. Bithi is 3,5 years old. In January I operated on her for the first time because of adhesions on her right knee after a burn wound as baby. The result from this first surgery was OK, but she still could not straighten her knee completely. So I decided to make a second attempt. Unfortunately, there was a complication so that the flap I had made died and Bithi needed a skin transplant. It took a while before her wound was ready for the transplant and during that time Bithi stole my heart. Always cheerful, incredibly brave (she took off her bandage herself) and very curious.

Just when Bithi’s wound was ready for the transplant, her father threatened to put her mother out of the house if Bithi and her mother did not come home immediately. With a heavy heart, I let them leave and assured them that they could return at any time. Fortunately one of the hospital workers heard about this. She went to Bithi's home and was able to convince her father and mother to come back to the hospital. Bithi's skin transplant operation was successful and today I could release her with a straight leg! Birthi’s story has made me realize how little control Bengali women have over their own life and the life of their children. I realized a new how important the hospital workers are in getting the support of the whole community/family. This has aan important a great effect on what we try to do.

Ramadan

Written by Antje on June 29th 2016 22:53

It’s now right in the middle of the rainy season. Most days there’s a pretty heavy shower. Occasionally it rains the whole day long, but that’s quite rare here in the north. When it’s raining or just cloudy, it’s usually cooler, which is nice. But the humidity also rises. It sometimes feels like the air wraps itself round me like a warm blanket.

The rice was already harvested a few weeks ago. In preparation for the next harvest, the rice has already been sown in small fields. Next month it will be planted out.

We are counting the days to the end of Ramadan and we are more than half way there. The sugar feast (called here Eid) will be celebrated on the 6th or 7th of July. What makes things complicated is that we’ll know which of these two days it’s going to be held on, only if the new moon is or is not visible on the 5th. Particularly hard to plan free days with such uncertainty. The majority of our Bangladeshi doctors are Muslim, and will therefore want to have this day free. So we have made two different rotas for July: one with Eid on the 6th, and one with Eid on the 7th….

It’s quieter than usual in the hospital. It is difficult for patients to travel the whole day to get here if they haven’t eaten or drunk anything. It’s also hard for our Muslim staff. Not only working the whole day without eating or drinking, but also getting up in the middle of the night to pray, and eating very early in the morning before the daily fast begins again. It’s no surprise that in the second half of the month fuses are rather shorter than usual.

During Ramadan most street vendors are closed during the day or draw curtains across their displays, this is an attempt to reduce temptation as much as possible. Non-Muslims, people who are unwell and children do not have to fast.

The ending of the fast, early in the evening (Iftar), is accompanied by lots of traditional dishes. This is one of the food tents opposite our hospital. Provisions are displayed there in the afternoon so that people can buy and take them home.

This week I was invited together with a few other people to the home of one of our colleagues. Each of us received a plate filled with individually prepared snacks. We waited and watched for the first 15 minutes because you can’t eat until sunset. It is always special to be invited to share in the lives of others.

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