Medical / Health

Rina’s father came to the hospital about two weeks ago with bowel obstruction. He is a homeopath, and had been treating himself for a month. The family didn’t want to go to Rangpur Medical College for an operation – or rather, going to Rangpur (about 50km away) for an operation was as much within their world-view as going to the moon might be.

I tried to talk to them, but it was obvious to me that they just couldn’t cope with the level of decisionmaking required. Left to themselves, they would have taken him home to die. I was extremely tired and very busy at the time, and couldn’t give them the time and emotional energy required to talk it through so that they could make their own informed decision.

So, against all my years of experience and my better judgment, I took over and told them what to do. We tried conservative treatment for one day, with some initial success, but the next morning it was obvious that he would die without an operation. It was also a hartal (general strike), and only ambulances and bicycle rickshaws could safely use the roads.

So I continued to behave like a boro lok (a local term for an important or influential person) and sent him off with a referral letter and a LAMB medical assistant (who I simply pulled from his duties for that day), as the thought of going alone was still too much for them. I arranged for them to use the local government health complex ambulance and sent them to see Dr Murshed (the husband of one of our staff doctors) at Rangpur Medical College. I also gave them a letter for Dr Murshed asking that he make sure that they got good treatment and that I would cover all of the cost.

Rina’s father was admitted to a private clinic, and was operated on by the best surgeon in Rangpur (arranged by Murshed). The surgeon also agreed to cut his fee as they were poor. Ironically, they are not poor by the standards of the patients we see at LAMB, and they had the promise of financial support from me. Despite initial misgivings, he made a steady recovery and is due to be released today.

Discomfort I sat down the day after I sent him off to Rangpur and tried to articulate my discomfort at the whole event. I had saved a life. This isn’t an unusual experience for me as a doctor in Bangladesh. But this time it was because I had abused my position at LAMB, used my friends and contacts in Rangpur and thrown the promise of money around. In short, I had behaved in exactly the way I work to prevent people behaving here.

Rina’s father lives today not because I am a doctor, but because I am an important, powerful, connected person, and because Rina works in my house. If she had not been related to me in this way she would not have come to me for help, and her father would have died. She came to me as her ‘patron’, and I obliged by behaving like one.

And yet her father had as much right to live as the next man. Dear God, why him and not the next man?

Medical / Health

Yesterday Ruby and I went for our regular hospital visit. Once again we visited the female ward where women are dying of Aids and TB.

These thin malnourished women basically, without exaggeration, lie on their beds awaiting death. The ward has no character; just bare walls, basic beds and a dirty floor. Several kittens and their mother were playing around under the beds, oblivious to the sufferings around them. Life had just started for these kittens, with a new world to explore. These women, however, are dying in an awful and lonely place.

We continued down the ward, and there was a dead body under a dirty blanket. I thought she was sleeping or resting, but the other patients shouted that she was dead. No one was beside the dead body, no one was crying for her, no one was holding her. She had recently passed away. Ruby reminded me that a lot of these women are abandoned because they are prostitutes.

Two beds down, there is another dying woman, minutes or hours from death. Ruby said she was in a coma and her breathing was very irregular. Once again no one beside her, no one crying for her, no one holding her… only the flies on her face were keeping her company. I felt so sad and depressed; I can’t express my feelings of despair. I said to Ruby that we needed to pray! I felt this need with urgency and panic. I prayed, but words are limited; it didn’t express to God what I really felt. I touched the woman’s forehead and she was cold; I wanted to make her feel the warmth of my hand and comfort her. There was a look of hopelessness on her face. I prayed I would see her in heaven. This is surely the worst type of death to experience, being alone in your last moments on earth. I hope to see her in heaven, without pain and being loved.

Just before leaving the ward, we saw two men with a metal stretcher coming to collect the dead body. The other patients looked on. Were they thinking, ‘Am I next?’? What a way to end life.

I will never forget this day. Thank God for everything: for good health, food, clean water, family, friends, shelter, everything. I don’t understand suffering; in heaven, I’ll ask.

Valerie Dehaene, a nurse, went with Interserve England & Wales to Pune, India, for most of 2004 through Interserve’s short-term programme, On Track. Dr Ruby continues to persevere as a volunteer doctor in the red light area in Pune; please pray for her. Valerie is at present studying at All Nations Christian College, England.

Medical / Health

Yesterday Ruby and I went for our regular hospital visit. Once again we visited the female ward where women are dying of Aids and TB.

These thin malnourished women basically, without exaggeration, lie on their beds awaiting death. The ward has no character; just bare walls, basic beds and a dirty floor. Several kittens and their mother were playing around under the beds, oblivious to the sufferings around them. Life had just started for these kittens, with a new world to explore. These women, however, are dying in an awful and lonely place.

We continued down the ward, and there was a dead body under a dirty blanket. I thought she was sleeping or resting, but the other patients shouted that she was dead. No one was beside the dead body, no one was crying for her, no one was holding her. She had recently passed away. Ruby reminded me that a lot of these women are abandoned because they are prostitutes.

Two beds down, there is another dying woman, minutes or hours from death. Ruby said she was in a coma and her breathing was very irregular. Once again no one beside her, no one crying for her, no one holding her… only the flies on her face were keeping her company. I felt so sad and depressed; I can’t express my feelings of despair. I said to Ruby that we needed to pray! I felt this need with urgency and panic. I prayed, but words are limited; it didn’t express to God what I really felt. I touched the woman’s forehead and she was cold; I wanted to make her feel the warmth of my hand and comfort her. There was a look of hopelessness on her face. I prayed I would see her in heaven. This is surely the worst type of death to experience, being alone in your last moments on earth. I hope to see her in heaven, without pain and being loved.

Just before leaving the ward, we saw two men with a metal stretcher coming to collect the dead body. The other patients looked on. Were they thinking, ‘Am I next?’? What a way to end life.

I will never forget this day. Thank God for everything: for good health, food, clean water, family, friends, shelter, everything. I don’t understand suffering; in heaven, I’ll ask.

Valerie Dehaene, a nurse, went with Interserve England & Wales to Pune, India, for most of 2004 through Interserve’s short-term programme, On Track. Dr Ruby continues to persevere as a volunteer doctor in the red light area in Pune; please pray for her. Valerie is at present studying at All Nations Christian College, England.

Medical / Health

Rani Bala and her eight-month-old son Bikash are nowhere to be seen when we approach their bed on the women and children’s ward. Neither is her songi, who might have been able to explain their absence. Most mothers have a songi, a female relative, with them most of the time when they are in hospital. She cares for their basic needs, helps with their child, does their washing and provides their food. In fact, Rani does not have a songi.

A nurse goes in search of Rani and she finally enters through the curtain which divides the women’s ward from the men’s. She is tall and slim and holds herself erect. She sits on the side of her bed and places her son down on the bed for the doctors to look at. He had been admitted with a chest infection and has been treated with antibiotics. His infection is now almost better, but other things about him and his mother cause us concern. Bikash is thin, malnourished and listless. He allows examination without any resistance and Rani sits impassively by, with little care for her son – so different from most of the mothers, who cradle their children in their arms as they sit cross-legged on their beds. She answers our questions in monosyllables with an emotionless face, looking at us with big, round, sad eyes. Something is very wrong here. What is it?

What’s going on? We turn to Bikash’s notes and find out that he has been fed on formula milk from birth. This is very unusual here where breast-feeding is almost universally the norm – for financial reasons if nothing else. We find out, with some difficulty due to Rani’s unwillingness to talk, that Bikash is still fed formula milk and has some family diet – rice, dahl and so on – as well. We are dubious as to how much he has, as he weighs only just over five kilograms, way below the average for his age. We then enquire about what Rani and her child have been eating while in hospital. Feeding patients is not a hospital responsibility. Food is brought in by the patient’s family, or bought by the songi at the gate (there are several roadside cafes just outside the hospital entrance) or from the food supplied by the kitchen here. Little food had been brought in for Rani and her son during their stay, and so it was not surprising that Bikash’s weight was falling still further since admission. Had he had any food in the three days since admission? A food slip can be provided to folk such as Rani so that she can buy hospital food cheaply. We provide her with such a slip, encourage her to use it and walk away. The look in Rani’s eyes made me uneasy. What is her story?

The next day we come to Rani and Bikash’s bed and once more find it empty and we have to find them. Bikash has not gained any weight, and both he and his mother look listless. It transpires that Rani refused the hospital food. I take a nurse aside and try to find out Rani’s story – and then I understand. Rani looks to be in her mid-twenties but is, in fact, only fourteen-and-a-half years old. She was married at thirteen years and bore her son, Bikash, ten months later. Her husband has deserted her, and she has gone back to living in her father’s household; probably not a happy situation. No wonder that she is depressed.

No kind of ending We return to thinking about what can be done for Rani and her child. We find that they do not live far away but it is not in an area where the LAMB Project has clinics. Then, the doctor has an idea – perhaps Rani could bring Bikash to the Rehabilitation Centre each week for weighing and could receive help, advice and support while there. It is all we can do except encourage her to eat nourishing food and give some to Bikash. He is nearly ready for discharge as far as his chest infection is concerned, and we can’t keep him in for ever. Once again we walk away. We can do so little to help in such a situation. I feel tears welling up in my eyes.

At lunchtime I make a point of going through the ward and am encouraged to see Rani feeding Bikash with some of her food, although whether it was any more than rice I could not see. I smiled at Rani and got a hint of a smile back. How I longed to be able to tell her of the One who most certainly loved her and her son more than ever I could.

The next day, I visit the ward and go to Rani’s bed. It is empty, with no sign of Rani’s or Bikash’s belongings. I am filled with apprehension. Has she gone? I find a nurse, who tells me that Rani has discharged herself. Did she do this under compulsion, I wonder, or had she done it willingly? Was it really what she wanted? Had we been too intrusive? A sadness fills my heart. What will become of Rani and her son now? But then I realise that, though they are out of reach of LAMB for the moment, they are not out of reach of our loving heavenly Father, and I resolve to pray and trust Rani and Bikash into his hands.

Cecilia, in her early 60s, went out from her church in the UK, through Interserve’s On Track short-term programme, to the LAMB Project in rural north-west Bangladesh for four months last year to help in the setting up of a children’s nursing course in the 75-bed hospital there.