Traffic and rainy season
Written by Antje on August 19th 2013 21:36
The last time I wrote about ramadan. A week or so ago the ramadan was over and now we have the sugar feast (also known as Eid). Everyone gets a day off to celebrate this and we had that on Friday, our normal free day. Most of the government offices close for 5 days giving people a chance to celebrate. Everyone travels to visit family. They return to the village where they were born which usually has an aunt or uncle living there. This weekend is the weekend after Eid and we heard about very long traffic jams (90km) going towards Dhaka. This is mostly buses and no private cars. You can compare it to a Black Saturday. I have included a picture from today's newspaper.
And with the ferry it is not any better!
We have had an unusual rainy season. The rains are supposed to start in the middle of June. This year people began a month ago to irrigate the fields because there was so little rainfall. About 2 weeks ago the rain began pouring down. It has rained so much that people are concerned that the rice in the lower fields will die because of too much rain. You just can't win☺
To help you see the difference between the rainy and dry season I have included two pictures. These were both taken from my kitchen window. The top picture was taken this week. You see an unplanted piece of land belonging to the hospital. In the future houses will be built here. Close by the wall a train is coming along and behind this is a rice field. The fields with a lot of water have just been planted. The fields that look greener have the same amount of water but the rice plants are bigger and greener.
This last picture shows the difference. It was taken in March during my birthday party. You can see how dry the land was then. In the distance you can see green rice fields, but that was not because of the rain but due to the irrigation.
Ramadan
Written by Antje on July 28th 2013 15:53
It’s been a week since I came back from my holiday in Thailand. It was lovely to get completely away and relax on the beach. It was pretty hot, but much less humid than here and so very pleasant to be outside. And for the first time since I had arrived in Bangladesh I wore western clothes again, which I enjoyed very much.
The moment I returned I hit the ground running. I had planned a free day after arriving in order to unpack and prepare for work, but things turned out otherwise. It turned out that a few days earlier, a 9-year-old girl, Arjina, had been admitted with bowel obstruction. The paediatrician had tried to persuade the parents to let her be transferred to Rangpur, 2 hours away, so she could have surgery, but they couldn’t be won over. I operated on her the morning after I arrived back. She had an obstruction due to adhesions to a part of intestine which looked pretty purple. Happily she recovered very well after the procedure and was able to be discharged 4 days later. I’m glad that I’d come back a day earlier than had been expected.
It’s hospital policy in acute cases to treat first and then talk about money later. Poor people are assisted when it comes to paying the bill, but then it takes time to come to an agreement. This can take several days, so Arjina is still on the ward, 3 days after discharge. This gives me the opportunity to see for myself that she’s doing alright.
Arjina with her mother
It’s also been Ramadan for at least a week now. This means that Muslims the world over neither eat nor drink from sunrise to sunset, for the whole month. In Bangladesh 85% of the population are fasting. This includes both patients and staff in the hospital. The days are long and hot, and that that makes it difficult to fast. In addition the nights are short because people eat after the sun has gone down and also spend part of the night in prayer. During this time many people are searching for an encounter with God.
Every evening the fast is broken with extra tasty food. There are special treats prepared this month. I had to laugh when I read in the paper that the export of 5 essential products is frozen for the whole month in order to ensure that the prices in the country do not rise too much. What do you think these essential products are? Green peppers, aubergines, cucumbers, garlic and coriander!
Busy times
Written by Antje on June 26th 2013 22:20
The last few weeks have been rather busy in the hospital. This is because of a visit from a Korean urologist. He was able to operate cases that I could not do. During his visit another gynecologist and myself were responsible to see that everything was scheduled and ran smoothly. The patients needed to be selected and then we determined how the operation would be handled. In addition to this we needed to see that we had assistance during the operations. There were certain operations that I wanted to operate with the urologist so that I could see if I could do them later myself.
Several of the operations were with patients unable to control their urine. This problem can occur after a difficult delivery, but more and more we see this after a C-section or removal of the uterus. We also had 3 girls born with this problem. One girl was not allowed to go to school, another girl was able to go to school (only because of persistent asking), but must stand in the back of the classroom because otherwise the seat of her school desk would be soiled. You can imagine how life would change for these girls as well as the women if they could hold their urine.
Also during these 2 weeks my normal patients were also waiting to be helped. This means that it was even busier after the urologist's visit. Plus for the last month I also have been doing a round in gynecology. There are not enough doctors in this area and this helps to alleviate the work pressure. My first two rounds were uneventful but last week's round was dramatic. A young woman, who had given birth to a still born baby in another clinic, came with severe bleeding. Usually such severe bleeding after childbirth means a piece of the placenta stayed in the uterus. The morning I saw this young woman I thought this was the case with her. The uterus was cleaned. The bleeding stopped. In the evening she began again to bleed heavily. I tried several things (I'll spare you the details!), but eventually I had to remove the uterus to stop the bleeding. This operation saved her life but was a drastic step--no matter what country you live in. Here it is even more drastic than in the Netherlands. The position of the woman here depends on the fact that she bears children--especially sons. Because she now cannot have children her husband will divorce her. She must return to her parents and her family will support her. Another option would be that her husband takes another wife and she would be used as cheap labor. With this patient there was a small ray of hope. During her stay in the hospital the family talked about adoption. If she agrees to this then there is hope that she can live a worthwhile life.
Otherwise life here the last few weeks has been demanding and has cost me a lot of energy due to the high temperatures and humidity. In the last 3 weeks the temperature has not been below 30 degrees--even at night--with more than 70% humidity. You need to continually remind yourself to take it easy and do things slowly!
Fortunately it is almost vacation time. Another female teacher form the project and I will go to Thailand for 2 weeks. We'll go to the beach and not do much else. Hopefully my "battery will be recharged" enough to return and continue with new energy and inspiration.
Soon I'll put a short film with a tour of the hospital on the website. But first a few pictures.
Patient's wash drying
The hospital entrance
Wedding
Written by Antje on May 11th 2013 21:46
The last couple of times these web posts seem to have been a lot about celebrations.
Last weekend there was the wedding of the daughter of Rani, our home help. She completed her bachelor’s degree last year and has married a young man who also grew up like her in the local area. So they have known each other for years. But through western eyes not really what you’d say is a so-called ‘love marriage’. They have got to know one another from a sort of distance. He thought she was nice, and she didn’t really see in him anything she didn’t like. He seemed to be prepared through the years to wait until she had finished studying, but when the decision had to be made a few months ago whether they were going to tie the knot, her preference was really to go on with her studies. But finally they decided to get married. I find that it’s all a bit of a puzzle trying to work it all out, but there you are. When it came to the wedding, everyone, including the happy couple, was pleased.
The festivities got off to a start with the Bengalese version of a kind of stag party/hen night called the Gaer Holud (literally: yellow on skin). This took place in separate houses: the bride in her house and the groom in his. We went to the bride’s, about 10 minutes walk from the hospital. The bride and her sisters sat themselves down, about 2 hours later than announced in the invitation, on a raised dais, and were dabbed with kurkuma by each guest. This is a yellow powder used a lot as a seasoning which they mixed with oil. Each guest also gave a spoonful of food and a sip of water. There was also food, music and a general feeling of excitement and good fun. As guests it was also impossible to avoid getting dabbed yellow ourselves….
Despite a good shower my feet were still pretty yellow the next day…
The bride receiving a sweet morsel....
The marriage ceremony itself took place on the Friday.
Because they are a Christian couple, the marriage took place in church.
The couple with the bride’s 2 sisters, her father, her brother in law, the minister and a niece. What a contrast between the brother in law’s T-shirt and the beautiful wedding saris.
No celebration is complete without a meal. It’s about being able to tell the story later about how many people came and what you treated them to. Because we knew both the bride’s parents (our home help Rani) and the parents of the groom (his mother works in our prenatal clinic), we were treated to a lovely rice dinner on Friday and Saturday. It’s a bit like mass-production: you eat and then leave so that the next group can sit down.
And not just a small amount of rice…
Of course the couple are loaded with presents....
In between I was also busy working, and so next time I’ll write something about that.
Happy New Year!
Written by Antje on April 18th 2013 21:40
Happy New Year! Last Sunday, we celebrated that the Bengal year of 1420 started. Here’s a brief photo-impression of the day. It was a national holiday and in our project it was celebrated with a procession from the hospital grounds to some nearby project housing 500 yards away. The photo’s below show how people got ready for the procession. The text on the signs, carried by the children, reads: “Happy Bengalese New Year 1420.” Unfortunately, you can’t hear the procession music on the photo’s: percussion and wind instruments, played very loudly.
The afternoon had a cultural program where kids (and a few adults) sang and danced. De party tent in the picture if constructed from bamboo poles and fabric. They are put up in a few hours by professional party-tent-builders, that take them down even faster.
Next was a flea market where just about anything was sold, from small delicacies to clothing and toys that fall apart after an afternoon of play.
What I really liked, was all the kids in festive clothing.....
The journey to the south of the country
Written by Antje on April 9th 2013 21:20
In my previous blog, my father and I were planning to visit the project that I worked at in 1998 and 1999. This project is in the southern part of Bangladesh, an area where there is more water than in the northwest where I am now working. Because of the political unrest, it was uncertain if we could travel. But during our travels everything was quiet and we had a very good trip. It was very special to see people I hadn't seen in the last 10 years. Most of the workers (those working in security, as janitors and nurse's aids) were still the same people as when I left. I had many mixed feelings. The project has had many problems in recent years and continues to face much difficulty. We spoke often about the time when I worked there and the project was managed by a strong leader with good relationships. I was continuously asked to come back and work there, but I don't think that that would solve the problems!
One of the highlights of the trip was flying in an 8 passenger airplane that could land on water. It is amazing to see how a water landing attracts a large group of children in no time!
We also walked along the river nearby the project and watched the setting sun. I keep noticing how much I love and enjoy water. Seeing a sunset like this gives me a contented feeling for days afterwards.
I have been back in the northwest in my own project for the past 2 weeks. There was a wedding during Easter weekend. A son of the janitor was the bridegroom. It was a Hindu wedding and we were all invited.
Here is a picture of the wedding couple receiving their presents. It is the custom that the wedding couple may not look too happy on their wedding day!
Everyone brings their presents to the couple and blesses them. Then you walk through a large tent for the rice meal. During a wedding there is seldom time for a good conversation. Hospitality is measured by how many people have come and eat.
And of course we celebrated Easter. We had a lovely church service in a full church. Afterwards there was a meal for everyone from the hospital compound.
The picture shows my housemates and myself in our Easter clothes!
Birthday
Written by Antje on March 12th 2013 21:16
Already almost a month since my last update, when my first urology ‘camp’ had been just about to start – a pretty intensive week. In the end there were three visiting urologists of whom one operated and the other two assisted. In three and a half days they treated fourteen patients. Today the last patient was discharged home. I was responsible for managing the program so that the visiting surgeons were allotted the relevant patients to make the most of the time available. I also did my own ward round each morning before we operated. The operations themselves took a long time. I had originally thought that I would be able to learn how to do some of the smaller procedures (for those in the know: ‘How do you repair a hypospadias?’) but I have learned above all that it’s much more complicated than it seems. But the real benefit for me is that I can now distinguish much better which operations are simple and which are complex.
Something else: Last Saturday I turned 45. My father had decided that it would be a good opportunity to come over and visit me. Wonderful. His coming also meant that I couldn’t really ignore my birthday. In the end I had a pretty big but also relaxing celebration. I held a BBQ in the field near my house and invited all the overseas workers and about 25 Bangladeshi people – all in all about 60 people came.
It went really well (see photo): everyone came with a salad or a dessert, and someone else grilled all the meat. The weather was perfect. The afternoon had been really hot, but by the time the party began the sun was setting behind the trees and it became really pleasant. The celebration finished off nicely with a camp fire. I felt right in the centre of things but without the stress of having to organise a big party. And now of course I don’t really need to throw a party on my birthday for the next 5 whole years. :-)
Next week I’m planning to travel with my father to a project in the south of the country where I worked in 1998 and 1999. But because things here in the country have recently become rather unsettled, we are not sure if it will be safe to travel at all. At the moment we’re planning for the whole trip to go ahead, but with the proviso that we’ll need to call it off at the last minute. I’m really looking forward to seeing how the project has developed, particularly as I was involved in the opening of the hospital there. I’ll keep you updated.
Spring is here!
Written by Antje on February 16th 2013 21:05
Winter in Bangledash has officially ended. February 13 was the first day of the Bengala month Phalgun which is the beginning of spring. Several women celebrated this by wearing yellow or orange clothes. Spring weather can also be seen. Temperatures during the day are between 20 and 25 degrees and at night they go down to 20. While I am writing I hear the crickets and frogs in the fields.
In the last two weeks the land has changed dramatically from dry fields (see the lower front of the picture) into irrigated and planted rice field. I continue to be amazed that 2-3 men working manually plant these plots of land full with rice plants in an hour. There is less dust in the air. But the down side is that mosquitos love still standing water and because it is dry season they can multiply nonstop!
Regarding my work, this week wil be a rather busy one. A team of urologists is coming. We hope to operate on 25 patients. In addition to overseeing these operations, I will be responsible to make sure the surgeons are fed and housed, that the operation room personel are treated properly and that the surgeons use our hospital supplies wisely. Then of course the normal work continues. I will be wishing that I could be in 3 places at the same time!! On the other hand this is only for 4 days and then we hope to have many patients that have been helped.
The patients with burns, that I wrote about the last time, are all doing reasonably well. A 7 year old girl had healed well and was able to go home. This week I transplanted skin on 2 women and I hope and pray that the transplantation takes. If it does then they are well on the way to recovery. If it doesn't take then I will try again in a few weeks. Fortunately there are no new patients.
I'll write after the urologists leave and let you know how things went.
Work in the hospital
Written by Antje on January 26th 2013 21:06
A month has gone by since I last wrote and it is time to let you know how things are going. Even after being here for 3 months now, I am still adjusting and working on finding my way. The daily work routine is going reasonably well, but I find it difficult to determine which patients I can treat with the skills I have and knowing what my limitations are. I usually enjoy my work and receive satisfaction when patients get better.
On the other hand it is trying when the patients don't respond as well. I am the only surgeon and that means there is no one else I can ask for a second opinion. The internal medicine doctors will think with me, but I need to ask them explicitly for this. Fortunately I have a room-mate that listens to all my frustrations!
The last few weeks it has been very cold in Bangeledash and that means that people stay close to the fire. At this moment I have 5 patients with severe and large burn wounds. Their clothing caught on fire. 3 of these patients will need skin grafts. A few weeks earlier 2 patients died from their burns. I find this extremely difficult. I do not have a lot of experience with treating burn wounds and am learning to determine what the risks are and which patients have the best chance of surviving. The difficulty with burns is that we can treat them reasonably well at first, but things can take a turn for the worse if they get infected after 5 days. The first few times was that the moment when I thought things were going well. But here also I am learning.
I begin my rounds in the morning. This takes about an hour. The rest of the morning I do surgery and after lunch am in the clinic.
Here are pictures of the hospital:
This is the women's section with 21 beds in a large room. Each patient has someone with her that cares for her. Family members care for the physical needs of the patient. Nurses distribute medicine, check on the patient and do any technical services.
Rounds, the nurses here wear saris and very stiff caps.
This is the open area where patients can go outside, sit in the sun and hang up their wash.
Here in the operating room, we are putting a cast on the girl from the above picture. .She had a bone tissue infection. We operated to remove a piece of bone. The girl healed well.
Here a picture of a very special baby, Alif. He had an intestinal blockage. This was the first baby weighing less than 2 kilo that I had operated on here. The first few days after the operation he did well, but soon afterwards got worse and wasn't expected to live. We sent him home and to our amazement he got better. Another doctor from the children's department went to see him when we heard that he was still living. Here he is definitely bigger than when he was released to go home. This was an encouragement for us. And many people prayed for this baby. . .