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. . .