Even though by the time you read this, Easter has passed, I still want to show you the Easter celebration that we had here. Here are my pictures....
At church there was a well attended service where we celebrated that Jesus rose from the dead. As you can see, the church was packed and people even sat outside. Because it is now rather warm a “roof” was put up to provide shade.
You can always find lots of shoes outside the door. In Bangladesh it is the custom to remove your shoes when entering a house and this also applies to the church. There is always a collection of shoes at the door. After such a well attended church service, it can be a challenge to find your own shoes.
Of course, on Easter you dress in your finest. Before the service, 2 of the short termers and my housemate came to ask me for help in putting on their sari. You could say, I put on 4 sari’s that morning.....
We end our Easter celebration with a meal together. As you can see, the guests are seated at tables in a temporary tent and eat with their right hand.
Here you see where the food is served. In the background, you see the rice stacked high on banana leaves. And this photo was taken after the first half of the people had eaten. So you can imagine how much rice is being eaten!
In the afternoon, we had tea with our help. Here you see her 3 daughters and another 2 guests. This is the kitchen, where they use wood or dried leaves as fuel to cook with. The living room and bedroom are not in the picture.
A few months ago Antje's parents visited in Bangladesh. Antje's mother made a movie report of the trip. You can also read about the visit in the blog posts of November and December 2013.
This week we celebrated the 43rd anniversary of the independence of Bangladesh. Actually we celebrate independence twice every year. The 26th of March is the day when Bangladesh itself became independent of Pakistan. After that there was a bloody war which ended on 16th December, on that day we celebrate victory day. The day begins with children’s games. This year at 11 am everyone in the whole country sang at the same time the national anthem. This was an attempt at breaking the record for the Guinness Book of Records. I must confess I don’t really know if the record was actually broken or not.
In the afternoon there was a cultural program arranged for the children, with singing and dancing. It’s quite noticeable how much people are very taken up with the bloody side of the independence war. Even in the dances this violent side is portrayed again and again. On the other hand it’s nice to see how much energy people put into the cultural education of their children.
Dancers. The costumes have the national flag design round their middle.
Waiting for their turn.
Last week we have been trying to cope with the change from nice warm weather to very hot weather. It’s up to 30 degrees in my living room. The humidity is not too high, and so as long as I don’t move about too fast, I can cope fine. In the evening and at night it cools off a bit, which is pleasant. On the other hand it’s only going to get warmer in the next two months, and in particular, more humid. As a kind of comfort we can already see little mangos in the trees. The reward for getting down to work here in the hottest season of the year.
As far as my work goes, things are pretty much back to normal. In total my predecessor operated on 27 children with cleft lip and/or cleft palate and so far the results are good. The last two weeks it got suddenly more busy and my operating list was full but not too full. Last week I saw two patients who I’d operated on last year for different types of cancer, which in both patients has recurred. Not completely unexpected since we can’t offer the normal follow-up treatment of chemo- or radiotherapy, but nevertheless very disappointing. Another situation which made me ask myself whether what I’d done had been good enough. In both cases I finally came to the conclusion that my surgery was good, and that there are just limits to what care I can really provide.
Last week was the annual general meeting of our church. A gathering about what went well, about what was not so good, and what can be improved. Lunch was included. One of the good things about eating with your hand is that you don’t need any cutlery so it’s so much easier to eat with your plate on your lap…
I just realized it’s March already and that I didn’t write on my blog in February. It’s about time that changed!
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.
Since I wrote in my last webblog about political unrest, the last few weeks were almost anticlimactic. Election day, January 5th, was very unsettling with a lot of violence, and people expected the violence to continue. That didn’t happen.
The ruling party claims that free and honest elections were held. Since opposition parties boycotted the elections, the ruling party won with an overwhelming majority. Opposition parties thus have no seats in parliament and no official vote. I had expected them to start large scale protests, but the last few weeks have been very quiet without strikes or transport blockades. So life has continued as usual. People can travel once again to the hospital and it has become busier again in the clinic. It seems that nobody dares to believe that it will stay like this and people make plans for as long as it is quiet.
The past month-and-a-half has been pretty cold, though not as cold as last winter, now with minimum temperatures around 11°C (50°F). Often it is misty all day and damp. Days when the sun manages to come out are pretty nice. Right now, I’m enjoying a cup of tea in the sunshine and I think it is about 20°C (70°F). Over the next month, it will become warmer very quickly and halfway March we will have forgotted that it was ever cold…
Last month one of my housemates returned to the US, and now I have the larger room in our house. I furnished and arranged this room with much pleasure, and I enjoy the extra space. In the next few months I will add new bookcases and a small couch. An extra bonus is a small balcony with a door to my room. I had been able to use this balcony before, but now that I don’t have to go through someone else’s room it is much more convenient.
Last week workers started to plant rice again. The fields that I see from my window, were flooded more or less overnight (the little straw house below contains an electrical waterpump), and the last 2 days rice has been planted. If you look close, you’ll see that the rest of the land is still very dry. The first rains are not expected till March.
Next month my predecessor will come to Bangladesh for a few weeks. He will perform surgery especially for kids with cleft lip or palate, but I look forward to consulting with him about a number of issues I ran into. It will be good to hear how he would treat certain patients, and to adjust my own protocols accordingly.
Today there’s a ‘mela’, which is a market or fair, for the staffs of the community and development program. They expect about 1000 people for games and exhibits in which various branches of the work are being displayed. That took a lot of work, as you’ll see in this picture.
The tent was built especially for this fair.
The various stands and exhibits in which the projects are displayed.
An imitation village, with rice plants and a pond with real fish.
Explanation of the chain of care with community clinics and the hospital for referrals.
While I’m writing, polling day in Bangladesh is coming to an end. In many ways it’s been a pretty depressing day because of the fact that it’s an election that the ruling party has gone through with despite it being blocked from the start by the opposition. The unrest has manifested itself over the last two months in increasing road blocks and strikes. In recent weeks it’s got so bad that all travel has become difficult and we’ve been advised only to travel if it’s absolutely essential. For me it means I can’t take the short holiday I’d planned in for after Christmas.
Christmas and New Year’s Eve were great times of celebration. There were several get-togethers with different people from overseas involved in the work here and there was a Christmas celebration in the church that ended with a huge rice meal for 750 people! On Christmas day itself even the sun was shining so it really wasn’t too cold at all.
At work we also had all kinds of celebrations. A Christmas celebration in the outpatients with a birthday cake for Jesus, a Christmas do for the nurses in which we told the Christmas story, and also a party for all the doctors. In addition to all of these, there was also a celebration for all staff members involving a challenge: for each department to come up with a traditional song about any part of Christmas. Everyone had put lots of work into preparing. There has always been a kind of happy competitive spirit between the departments at Christmas and this was plain to see.
Shepherds with real sheep
For me the New Year celebrations matter less, and here even more so because people aren’t really used to staying up until midnight. So although there was a party with a bonfire, by midnight one and all were tucked up in bed; me too. On New Year’s Day there was another service with a moderate meal afterwards.
So we’re back at work as normal, apart from the restrictions caused by blocked roads so people are finding it very difficult to get to hospital. Today the hospital functioned as if it were Sunday because of the elections. The political turmoil really affected us directly when the first wounded arrived from confrontations out there. The first was a man knifed by the opposition because he wanted to vote. Soon followed victims of a standoff between the opposition and police. It’s still not clear if today’s protests are over yet. The opposition won’t accept the results of the polling, whatever they are. No simple solution.
So as to round off this update on a more optimistic note, here are a couple of photos of Nondita, a 7-year-old girl who was badly burned a few years ago when her clothes caught fire. She had scarring of her neck and of both armpits. Two operations later and she was discharged with a pretty good return of movement of both arms. Her face has also wonderfully changed!
My parents have left again. We had a good time together, and I think that they were able to get a reasonably complete picture of my life in Bangladesh. Because of the political unrest, I accompanied them to Dhaka to say farewell, and they arrived safe and well in the Netherlands. I am grateful that our travels together had no difficulties. Even with transportation blockades, the trains pretty much stayed on schedule, and travelling to and from the various train stations was also without problems.
Today, I’m travelling once again without my parents - on the way back to LAMP Hospital - and immediately caught a train with more than 6 hours delay! And I’m still not there...
My parents with me in my living room.
My room.
My mom had a great time following me through the hospital and taking pictures. In the coming few updates, I will share some of the pictures she took.
Hospital.
Doctor visit.
Consult, discussion with the mother about treatment options for the boy; we decided to wait it out a little while longer.
In the coming weeks, life resumes it’s normal pace. At first it will be busy with surgeries, but we are quite concerned whether patients can make their way to the hospital with all the transportation blockades. We shall see.
In the next week, we will celebrate St. Nicolas with some Dutch people and then prepare ourselves for the Christmas celebrations. It is of course a feast for Christians who are a minority here, so we always try to explain people what Christmas is all about.
My parents have come to visit me! That is a good reason to do some traveling in Bangladesh. After picking my parents up from the airport in Dhaka, we traveled to Mymensingh--a city about 130 kilometers north of Dhaka. We visited a project there.
We traveled by train and the following pictures show life in and around the railroad. A great thing about traveling with my parents is that they see things that I don't--meaning what they see as unusual have become normal for me.
Here you see my father waiting for the train. The train was reasonably on time--only a half hour late!
This train is going to the center of Dhaka. The people sitting on the roof do not have to pay for a ticket. Unfortunately accidents happen regularly as people climb up and get down.
As the train stops along the way, so do the snack vendors! There are many people that earn money by selling snacks. Notice the right arm of the man selling popcorn.
Here I am bargaining over the cost of our ride in a battery powered autoriksja that will bring us from the train station to the project
Buying groceries for breakfast.
Yesterday, after a long train ride, we were back in LAMB hospital. It was good to be back. At the moment there is quite a bit of political unrest in the country. That is because of the upcoming election. The government and the opposing party(s) are not able to agree on how the elections should be organized. This means that traveling has more risks. Until now trains have always been safe, but that is changing. Last week the railroads in the north were sabotaged. Our train was a little late but without further incident. Traveling from one station to another was more difficult than usual, but still possible.
For the next 2 weeks my parents will be here at the hospital with me. Then I will bring them back to the airport. Till that time I will be working at the hospital. Right now it is not as busy because a gynecologist from England is here doing surgery on women that continuously loose urine. I do other surgery so that she can help as many patients as possible. This helps me and gives me more time and energy for my parents.
It’s been a quiet week at the hospital because two celebrations have been taking place: the Hindu festival Durga Puja and the Islamic Festival of Sacrifice Qurbani Eid. Quite understandable that nobody wanted an operation planned just before the festivities began, so I didn't have much to do for a week.
Even so, yesterday a 5 day old baby was brought in with a congenital abnormality consisting of non-development of the anus. I was pretty shocked to hear that the family had been turned away from their local hospital in Rangpur, a teaching hospital, because there hadn't been a surgeon available. If you’re not wealthy enough to be able to afford a private clinic, your options are limited. Our hospital is always open during festivals, and luckily enough the family knew how to get to us. Today we operated on the child and constructed a stoma. Later, I’ll reconstruct an anus and then close the stoma. It’s in times like these that I'm thankful for the year’s paediatric surgery I did before coming out here. Thanks to this year I had had the chance to observe these kinds of operations at least once before taking on the challenge by myself.
It’s really been quite funny recently to hear the different ways in which people address me. By the title they use I can take a pretty good guess as to their background. Most people are not spoken to by name. Some kind of relational word takes its place: somebody is your ‘older sister’, or your ‘sister in law’ (if the relationship is with the partner), or your aunt etc. I'm often addressed as older sister (didi for Hindus and Christians and appa for Muslims). People who have worked in or for international organisations call me ‘sister’. Those who choose to address me with particular respect use ‘madam’. The title which always makes me smile a little is ‘sir’. Often the case for folk who haven’t had much education and work in the fields.
Most people, including patients, are quite curious about my life here. The first question is usually ‘How many children do you have?’ Or ‘Does your family live here too?’ They find it very difficult to understand that an adult woman like me hasn't got a family. The persistent questions about whether I've got a husband or not are sometimes quite irritating. Particularly because it’s hard to explain why in the west we don’t have arranged marriages, but instead go ourselves to find a spouse. Recently, in one such conversation about my lack of family, a patient asked me ‘So I suppose you don’t have a Dhulabhai?’ (husband of older sister). An indirect way of asking if I, like her older sister, also didn't have a husband.
Next week it’ll be work as normal. The weather over the last few weeks has started to cool down. Last week it was even as cold as 25 degrees in the evenings. Today back up to 30 degrees, so enough time to adjust. Really nice that at last it’s not so terribly hot at night.
September is almost over and that means that I have been in Bangladesh for 1 year. This time last year I was in language school in the capital city of Dhaka.
When I think back over this past year I realize that much has happened. I see that I am able to cope better with the fact that I am the only surgeon here. This responsibility does not weigh so heavily on me now. I know better what I can and can not do. Or maybe I can better say, I know better what I am willing to do and not to do here in this hospital.
I like living in the community of people that are involved in the hospital and with the project. I would like to have more friendships with the Bengali people, but I think that I need to give this more time to develop.
Last weekend there was a wedding. One of our junior doctors and the daughter of someone in the project were married. Weddings here are always grand with lots of pomp and splendor--especially for the bride.
And of course a wedding means dressing up in our finest clothes and taking pictures! You can see my two house mates--Hannah and Rebecca--in the picture below.
And then also this past year there has been another development! As you can see in the picture I wear glasses now while operating!
Pictured below is Shapla, a 5 year old girl. She needed surgery because a leech (bloodsucker) had found its way into her vagina. Unfortunately the leech didn't stop there but moved further into her abdominal cavity. Fortunately she recovered quickly after the operation to remove the leech. This picture was taken just before she went home. You notice her very short hair. Here it is quite normal, that girls until age 9 have their heads shaved regularly. To the best of my knowledge this has to do with getting rid of lice.
Sunset during a walk in the neighbourhood.
