It’s now the end of my week off and I've almost forgotten what it’s like to be at work. The holiday went well. I had feared that I wouldn't really be able to get right away from work since for most of the time I would be here, but it worked out well because somebody has been looking after my patients for me.

Last week it’s been really cold here. For 5 days there was no sun at all and it was foggy all day with moisture dripping from the leaves. We've been chilled to the marrow, and have been gradually putting on more and more clothes including long thermals and double fleeces. I moved house to a warm country! What makes it difficult is that the houses have no central heating so they never really get warm. My house was constructed to be extra cool in the summer, so it cools very quickly. It never gets above 16 degrees now. For the last 3 days it’s been really sunny again. I’m now sitting with my computer on my lap and really enjoying the feeling of warming up.

Below are a few photos from Christmas. There’s a church on our compound which is officially Lutheran, but because people from all kinds of denominations come, through work in the hospital, it’s pretty informal really.

On Christmas Day there was a celebration service in which the children sang one of the songs (photo). We from overseas also had the opportunity to sing, and so did the Santali (indigenous tribal people).

After the service there was a rice meal for everyone: all the church members and also all the guests, hospital patients and non-Christian staff. The rest of the day was spent visiting Christians, who had prepared all kinds of nice things to eat for Christmas..

On Christmas Eve my housemates and I (photo with Christmas tree) also had a small party for all the doctors, and in the evening a party for all the foreigners without children (17 people plus some guests!). Just like in the Netherlands, celebrating Christmas means lots of food. The big difference is that unless you’re from the hospital, where quite a lot of Christians live and work, you don’t celebrate Christmas at all. For people who are not Christians although it is an official holiday, it is just another cold day.

Next week I’m back at work, and then I’ll write more about what work I’m doing.

For now, best wishes for 2013!

Harvest

Written by Antje on December 8th 2012 22:08

Winter is beginning here. Everyone thinks it is VERY cold! During the day it is between 22 and 25 degrees Celcius. But at night it cools down to 15 degrees. I am now wearing my fleece jacket and socks! But I can imagine that for the local people, who have few clothes and not enough blankets for everyone in the family, that 15 degrees is very cold. Almost daily there is mist in the morning and evening. The sun appears later in the day. Then you see people basking in the warmth of the sun! I sleep with a blanket, but otherwise it is lovely weather.

The harvest is in full swing. I took these pictures from the balcony of my house. It is easy to understand why Bangladesh is called the gold country when you see these rice fields.

As you can see harvesting is rather intense work. After harvesting the rice the kernels dry a few days in the fields before they are gathered up. Most everything is done by hand. And then the rice still has to be peeled. I don't fully understand this process. The rice is cooked briefly. The quality of the rice is determined by how many times it is cooked.

In the hospital we are also aware that it is harvest time. People are too busy to be sick and that makes things less busy than usual. However, we do see that people come later with their physical problems. People have been hospitalized with severe lung infections. Here you need to take into account that having someone in the hospital means that there are more people involved than the person hospitalized. Nurses work differently here than in the Netherlands. They do not care for the patients, but rather stick to medical tasks like distributing medicine, keeping records, putting in an IV, and more of this type of thing. The person responsible for the patient bathes him, turns him, helps him use the toilet or puts on a new urine bag.

The work here has started even though it is not extremely busy. That is not so bad! Operating has been going well. The personnel in the operation room are pretty well used to me and also the care afterwards is good. I most enjoy the patients that stay longer. There is time to get used to each other as well as building a relationship.

This is proving to be a time of growth for me. Here I do operations that a plastic surgeon or urologist would do. I need to consider—if I don't operate will the patient go to another hospital and could they do it better than I could? Some patients will be sent elsewhere and other patients I will operate on because I know that otherwise they will go home and be worse off.

First message from the hospital

Written by Antje on November 14th 2012 21:29

I’ve been in my new hospital now for two weeks and I’m beginning to get used to it. Things are partly familiar because I worked here in the past, but my responsibility has changed with my long-term stay and increased management tasks.

The hospital is open 6 days a week. Friday is our normal day off, although we’re opened then for emergencies only. As a rule, I work from Sunday through Thursday, and I run visits for in-hospital patients on Saturday. An average working day is like this: visit the ward at 8am, start surgeries at 9am until about 1pm, which is lunch time. Since I live in an apartment on the hospital compound, I walk home in 5 minutes so I can eat the meal that our help has prepared for us. In the afternoon, I do out-patient care. I mostly see people that have already been checked out by someone else who referred them to the surgeon, but occasionally a patient returns for a post-op check-up.

As far as surgery goes, I haven’t done much unusual yet. There’ve been a few inguinal hernia’s and some smaller things. This week, a few surgeries are more demanding with two cases where women leak urine after uterus surgery. During surgery, the urethra and the vagina were connected, which is an increasing problem in this country where underqualified people still perform many surgeries. The solution to this particular problem was to reconnect the urethra with the bladder. So far, the women are doing well.

My personal life is not too busy. One of my housemates left for a few weeks in the US, so for the moment we live here with the two of us. Evenings are filled with conversation, email and reading.

The weather has clearly turned to fall. The temperature during the day is great, just above 70F. It cools down in the evenings, and the day before yesterday I even went to find my fleece sweater, but it is not really cold. However, people over here think it is pretty cold, so you see them wearing all kinds of unusual combginations of scarfs, sweaters and hats.

The mainentrance to the hospital. Offices and the children’s ward are on the second floor. This photo was taken on a Hindy holiday, so it was a quiet day in the hospital.

The 'parking lot' of the hospital. People often travel down from the villages in groups on these 'vangari’s': bicycles with a flat board which can carry a few seated persons, or even a patient lying down. The drivers wait until everyone is ready for the trip back.

I'm home

Written by Antje on October 27th 2012 20:55

I’ve now been in my new home at the LAMB hospital since last Wednesday. Wednesday itself was a public holiday because of both a Hindu festival and also the yearly Muslim day of sacrifice (27^th October), so a large number of inhabitants took the opportunity to travel to their family. I too had chosen to travel on that day since the language school closed for the week and I could make myself useful at the hospital here.

Starting with Wednesday: all in all, considering that it was a very long journey, it went OK. We had tickets with reserved seats and it was a deluxe bus, and so there had been only five more tickets than seats available sold. The five men sat near the driver on the bonnet. So we really had our 2 seats to ourselves, and no chickens pecking our necks or other passengers on our laps.

But actually getting to that bus in the first place, however, is quite another story. I had actually never travelled there by bus before so I didn’t actually know from where the bus would set off in the first place. Our own driver from the Dhaka office was on holiday so we had organised another car with a driver through someone who knew someone who would be willing to take us. The bus station was on the west side of the city and we had been staying over on the east side. The roads were pretty clear, so we got off to a good start. It started to go awry when Ria, the Bengalese teenager who I was travelling with, saw a sign of the bus company we were going to travel with. She’d gone herself with the bus quite often but obviously had never taken much notice. By the time she’d seen the sign we’d already passed it, so we had to turn back (dual carriage way with a concrete central reservation, so we had to make a detour to try again). The second time past she didn’t see the signpost but the third time we managed to stop in time. With profuse thanks we got out of the car. The driver was a little irked and drove off immediately. When we asked at the office it turned out that in fact we weren’t actually at the right place at all. The building we wanted was a few kilometres further down the road. This explained why Ria hadn’t really recognised the office in the first place. I’ve now learned that you need to ask the driver to wait until you are really sure that you have arrived at the right location. Time was by now getting on and we were right close by to the place from where everyone was going to depart. The road was by now incredibly busy. But finally we managed to find an empty taxi with a very amicable driver who dropped us off at the right place and checked himself that it was so.

Eventually the bus left at 10am but it went so incredibly slowly. We were stuck in a traffic jam of mostly buses and it became obvious that although cars are very popular in the city, outside the centre of Dhaka people mostly take the bus. Over in the other lane there was also a jam of mostly trucks full of cattle. For the day of sacrifice on Saturday people in Bangladesh really do buy a cow or a goat which is slaughtered during the festival. 16 Million people live in Dhaka, of whom 80% are Muslim, so that means an incredible number of cows. We finally arrived at LAMB at 11pm (another advantage of taking this bus it that it stops right outside the entrance). A journey that had taken about five hours longer than the usual eight hours.

I’m now occupied with settling into my new home. During the festival days I’ll also work a couple of gynaecology shifts. Next week I’ll start surgical work. I’ll keep you up to date.

Traffic jam going in the opposite direction at the place where we got on the buss.

If the bus is really crowded, you can still buy a roof-space .....

Roadside maintenance on a cattle truck. I saw hundreds going towards Dhaka. The reason the photo is so sharply in focus is that we were also not moving.....

A day downtown

Written by Antje on October 14th 2012 22:21

We are half way through the month of October. This last week has been cooler. I can tell this because I sweat less at night and can sleep better. You definitely can not say it is colder--we wouldn't consider turning the ceiling fan off--but the first signs of fall are here.

Language study has been progressing steadily these last two weeks. I enjoy learning and do it without too much difficulty. This has helped make my time in Dhaka restful. I am aware that next month, when I am working, it will be quite different. So for now I am actually enjoying this rest.

This last week my housemate had guests. I went with them to Dhaka's ancient city center. The streets were quite small and it seemed like they were filled with people absolutely everywhere. We went to the 'terminal' where the riverboats are docked. These boats sail at night to the southern cities of Bangladash. In addition to these large boats, smaller boats can also be seen. The boats in the picture below are used to get to the other side of the river. One person rows about ten passengers across at once. On the other side of the river you can see the clothing industry. Clothing export accounts for 75% of Bangladesh's income.

Small river boats

Leaving the boats, we continued with our sight seeing trip. We drove through extremely narrow streets with many stores. The street was so narrow that two cars could barely pass each other. Fortunately no cars came from the opposite direction! The street was full of rickshaws, pedestrians and people carrying large bundles on their head. Goods were being loaded and unloaded everywhere. We could hardly drive through the streets, but that made it possible for us to take in all the sights!

Dhaka_oude_binnenstad_vanuit_auto_gezien_DSC00663_klein.png Driving slowly (being driven) through busy narrow streets.

Language school continues for the next week and a half. Not much else planned. The real work begins when I move to the hospital October 24. I'll keep you informed.

Language school

Written by Antje on September 28th 2012 21:37

The first two weeks I had a private tutor. Next week my lessons will be in a small class.

The last two weeks I have been busy with language study. Daily I had two hours of lessons with time afterwards to do my homework and review. I have been relieved to see that language study is going quite well. I understand the language reasonably well, can speak in sentences and also make some small talk. Telling a story is difficult.

Proof that I can write

Otherwise I am learning to read and write. I notice that even after only two short weeks things are progressing but it is still difficult. My teacher encouraged me to read the newspaper, but that wasn't as easy as I had hoped. Part of the problem is that written Bangla uses more difficult words than the spoken language. And reading in another language just doesn't go so fast! When I am reading a newspaper article with all sorts of long names of important people, it takes a while for me to figure out that these are names and not just difficult words. But practice makes perfect! This week I successfully completed my first language block and that means I am progressing!

I continue to get used to life in Dhaka. I live with a friend in her apartment. It is peaceful as well as protected. We have help with cleaning, washing and cooking (one meal a day). You could say we have a leisurely life.

I walk 15-20 minutes to get to the language school. It is unusual that someone who can afford a rickshaw walks. Along the way there are at least four rickshaws that peddle alongside me to make sure I want to walk and not ride! The rest of the way is filled with cars. As I walk further I come to a very busy road that I must cross. It is built as a four lane road, but here that means it can be used as a six lane road. Every piece of the road that is free must be used. When driving and you want to pass or turn off you just ride to the first available space and assume that all the traffic around you will let you in! And since everyone does this, it works well! Although I must admit most cars have at least one dent! In the meantime I have learned how to cross without too much difficulty. It works just like the cars drive--if there is a space and the cars are driving slowly then make a run for the open space while holding up your hand to the driver of the oncoming car. This tells him he needs to slow down! I must say it is still can be rather scarey!

After crossing I walk through a very peaceful street. This gives you an idea of the different worlds that exist at the same time here. Important people work inside their home or at the office. The rest of the people--like chauffeurs, rickshaw drivers and household help can be seen walking in the busy streets. Cars are washed and cleaned. There are make-shift stores selling tea, cookies, bread and single cigarettes. Further along the way is a blind wall where they are even cooking. You can buy a rice meal, chapaties (pancakes with vegetables) en shingara--the spicy vegetable filled pastry that I had at my farewell party. I enjoy walking through this restful street and have now even a few people that greet me. A friendly atmosphere is present here.

With regards to the weather--it is warm and humid. It has hardly rained this past week and that means that it stays warm. We count the days--until the middle of October--when it will begin to get cooler.

I have been fortunate regarding the electricity. The power goes off without notice regularly. Fortunately the buildings in my language school and the apartment where I live have generators. They make it possible for us to have at least enough electricity to keep the ceiling fans running and to have light so we don't have to sit in the darkness.

This next month my language study will be more intense. I will also be focusing on things I need to do to prepare for my work in November.

The pictures I promised

Written by Antje on September 16th 2012 19:54

Dhaka street scene with cars and rickshaws.

Note also the telephone wires.

I'm in Dhaka

Written by Antje on September 14th 2012 19:51

I’ve now been in Dhaka, the capital of Bangladesh, for two days and the sudden change will take quite some getting used to.

The last few weeks in theNetherlandswere quite relaxed. I had time to visit my brothers and sister and some friends, could spend ample time with my parents and still had time to pack my things.

The commissioning service on September 9^th was a beautiful, but also emotional service. It wasn’t until that moment that it really sunk in that I was really about to go and leave all of you behind.

My journey toDhakawent smoothly without any problems and I have been here since Wednesday morning. In the coming one and a half months I can stay with a friend inDhakaand this Sunday I start language school. The emphasis of the course will be on reading and writing.

I’m staying in a part of Dhaka that used to be the diplomatic area and was fairly quiet when I leftBangladesh12 years ago. Now almost all the detached homes have been replaced by apartment buildings and the roads are almost continually blocked by traffic jams. Mostly cars, but also CNGs (auto rickshaws - small three-wheel motorized taxis running on compressed natural gas) and bicycle rickshaws (a three-wheel vehicle with a bench in the back on which you can sit and enjoy someone else peddling the bike) thrown in. It has become a lot busier over the years. This is confirmed by statistics: in 1991 there were 6.5 million people inDhaka, but in 2011 there were 14.5 million!

The thing that hits me time and again is the contrast between poor and rich. In this relatively rich area there are people living on every bit of land that does not have a building on it. A lot of people sleep in their little store or in their rickshaw, often directly next to a large apartment building that has a guard in front of it.

I’ll try to take some pictures in the coming days and put them into this log.

Friday and Saturday are the weekend here so I will spend those days getting acquainted with some people inDhakaand recovering a little from the journey.

Countdown

Written by Antje on August 28th 2012 20:00

The countdown has started. My work at the hospital in Maastricht finished about a week ago so I can put all my energy towards my departure. Most of my time I will spend with my parents in Oosterbeek and we’ll enjoy the time we have together in this way. In addition to that the eldest daughter of my brother, who lives in Spain, is staying in the Netherlands now, so I’ll also get to spend some time with her.

In the meantime preparations continue. We have been altering some clothes that I will be wearing in Bangladesh, so that they’ll fit better. The picture gives an impression of the type of clothes I will be wearing in Bangladesh. Then there are some meetings with my sending organization, there is insurance to take care of and I need to have some vaccination boosters.

Last week I unexpectedly received an offer from friends, who also work in Bangladesh and were returning after spending a summer in the Netherlands, to take a suitcase of 30 kg with them. That was an offer too good to refuse. I had that suitcase packed in a few hours and could give it to them two days before they left.

I’m also trying to spend some days with friends and my brothers and sister. I’m enjoying spending a little bit more time with their children before leaving them and not seeing them for a longer period of time.

On Sunday September 9^th my commissioning service will be held in church and after that there will be a small party. Of course all of you are invited to come. I can imagine that the distance could be a problem to some of you but please know that you’ll be welcome if you have the opportunity. That goodbye party is really goodbye. On September 11^th I will leave for Dhaka, the capital ofBangladesh, where I will do language study in the coming one and a half months. I’ll tell you more about that when I get there.

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