My patient, swathed in layers of black including a cloth wrapped firmly over her lower face, was indicating the problem that had brought her to clinic today. I could not understand the words, but the actions were clear enough as she clutched almost every joint in her body one at a time.
‘And has she got a headache?’ I asked my translator.
‘Yes,’ she answered, ‘she has a headache all the time, for the last six years.’
‘And what makes it worse?’
‘It’s worse when she works.’
It took me more than two months of living and working in that rural community to begin to understand what ‘work’ meant to the women there. Two months of hearing over and over again about chronic neck, back, knee and arm pain. Two months of watching anonymous black shapes mounting impossibly steep paths with brightly coloured objects on their heads, before I realised those objects were 20-litre containers of water and that the women were carrying them uphill two or three times a day as well as working the fields, cooking the meals, baking bread and looking after their many children.
I felt embarrassed that I, supposedly open-minded and aware, could be so ignorant of how hard these people’s lives really were. We can never know what it is like to live the way they do. I finally realised how dependent we need to be on God and his guidance to have any positive impact in such communities.
One of the most ancient lands on earth, this country is also one of the world’s poorest nations, with high maternal and infant mortality. Despite this, the population is burgeoning, stretching already stretched resources further and further. Most of the illnesses we saw were due to water-borne diseases. Our medicines were only a temporary solution to deep-seated problems. Slices of modern medicine have made an impact, but sophisticated scans and the latest antibiotics do not seem the best solution. We felt like an ambulance parked firmly at the bottom of the cliff struggling to keep up with the injured fallen.
We needed to lean on God the whole time we were away. We had many questions. Why had he called us to this country when we were able to offer so little? What are the best ways to help break cycles of poverty and improve health? How does he regard their religion? How far should we conform to strict standards of dress and protocols that may identify us as members of the religion ourselves? How should we cope with our own feelings of inadequacy and sometimes of not being wanted by certain people there?
God used the time to challenge us too. Why did we need to feel useful? Why did we need to feel that we had made a difference? Although God calls us to be agents of change in a broken world, he wants to do it through us rather than have us take it all on ourselves.
This has two implications. One is that we can let God take on responsibility for the problems that are just too big for us to cope with. His power is sufficient and we can rest in that knowledge. The second implication is that any success in our work is God’s success, not ours; we should be pleased to give him the glory. God used our time in this country to teach us humility and the need to trust in his power and goodness. We are now working on the application of this lesson!
My patient, swathed in layers of black including a cloth wrapped firmly over her lower face, was indicating the problem that had brought her to clinic today. I could not understand the words, but the actions were clear enough as she clutched almost every joint in her body one at a time.
‘And has she got a headache?’ I asked my translator.
‘Yes,’ she answered, ‘she has a headache all the time, for the last six years.’
‘And what makes it worse?’
‘It’s worse when she works.’
It took me more than two months of living and working in that rural community to begin to understand what ‘work’ meant to the women there. Two months of hearing over and over again about chronic neck, back, knee and arm pain. Two months of watching anonymous black shapes mounting impossibly steep paths with brightly coloured objects on their heads, before I realised those objects were 20-litre containers of water and that the women were carrying them uphill two or three times a day as well as working the fields, cooking the meals, baking bread and looking after their many children.
I felt embarrassed that I, supposedly open-minded and aware, could be so ignorant of how hard these people’s lives really were. We can never know what it is like to live the way they do. I finally realised how dependent we need to be on God and his guidance to have any positive impact in such communities.
One of the most ancient lands on earth, this country is also one of the world’s poorest nations, with high maternal and infant mortality. Despite this, the population is burgeoning, stretching already stretched resources further and further. Most of the illnesses we saw were due to water-borne diseases. Our medicines were only a temporary solution to deep-seated problems. Slices of modern medicine have made an impact, but sophisticated scans and the latest antibiotics do not seem the best solution. We felt like an ambulance parked firmly at the bottom of the cliff struggling to keep up with the injured fallen.
We needed to lean on God the whole time we were away. We had many questions. Why had he called us to this country when we were able to offer so little? What are the best ways to help break cycles of poverty and improve health? How does he regard their religion? How far should we conform to strict standards of dress and protocols that may identify us as members of the religion ourselves? How should we cope with our own feelings of inadequacy and sometimes of not being wanted by certain people there?
God used the time to challenge us too. Why did we need to feel useful? Why did we need to feel that we had made a difference? Although God calls us to be agents of change in a broken world, he wants to do it through us rather than have us take it all on ourselves.
This has two implications. One is that we can let God take on responsibility for the problems that are just too big for us to cope with. His power is sufficient and we can rest in that knowledge. The second implication is that any success in our work is God’s success, not ours; we should be pleased to give him the glory. God used our time in this country to teach us humility and the need to trust in his power and goodness. We are now working on the application of this lesson!
My patient, swathed in layers of black including a cloth wrapped firmly over her lower face, was indicating the problem that had brought her to clinic today. I could not understand the words, but the actions were clear enough as she clutched almost every joint in her body one at a time.
‘And has she got a headache?’ I asked my translator.
‘Yes,’ she answered, ‘she has a headache all the time, for the last six years.’
‘And what makes it worse?’
‘It’s worse when she works.’
It took me more than two months of living and working in that rural community to begin to understand what ‘work’ meant to the women there. Two months of hearing over and over again about chronic neck, back, knee and arm pain. Two months of watching anonymous black shapes mounting impossibly steep paths with brightly coloured objects on their heads, before I realised those objects were 20-litre containers of water and that the women were carrying them uphill two or three times a day as well as working the fields, cooking the meals, baking bread and looking after their many children.
I felt embarrassed that I, supposedly open-minded and aware, could be so ignorant of how hard these people’s lives really were. We can never know what it is like to live the way they do. I finally realised how dependent we need to be on God and his guidance to have any positive impact in such communities.
One of the most ancient lands on earth, this country is also one of the world’s poorest nations, with high maternal and infant mortality. Despite this, the population is burgeoning, stretching already stretched resources further and further. Most of the illnesses we saw were due to water-borne diseases. Our medicines were only a temporary solution to deep-seated problems. Slices of modern medicine have made an impact, but sophisticated scans and the latest antibiotics do not seem the best solution. We felt like an ambulance parked firmly at the bottom of the cliff struggling to keep up with the injured fallen.
We needed to lean on God the whole time we were away. We had many questions. Why had he called us to this country when we were able to offer so little? What are the best ways to help break cycles of poverty and improve health? How does he regard their religion? How far should we conform to strict standards of dress and protocols that may identify us as members of the religion ourselves? How should we cope with our own feelings of inadequacy and sometimes of not being wanted by certain people there?
God used the time to challenge us too. Why did we need to feel useful? Why did we need to feel that we had made a difference? Although God calls us to be agents of change in a broken world, he wants to do it through us rather than have us take it all on ourselves.
This has two implications. One is that we can let God take on responsibility for the problems that are just too big for us to cope with. His power is sufficient and we can rest in that knowledge. The second implication is that any success in our work is God’s success, not ours; we should be pleased to give him the glory. God used our time in this country to teach us humility and the need to trust in his power and goodness. We are now working on the application of this lesson!
My patient, swathed in layers of black including a cloth wrapped firmly over her lower face, was indicating the problem that had brought her to clinic today. I could not understand the words, but the actions were clear enough as she clutched almost every joint in her body one at a time.
‘And has she got a headache?’ I asked my translator.
‘Yes,’ she answered, ‘she has a headache all the time, for the last six years.’
‘And what makes it worse?’
‘It’s worse when she works.’
It took me more than two months of living and working in that rural community to begin to understand what ‘work’ meant to the women there. Two months of hearing over and over again about chronic neck, back, knee and arm pain. Two months of watching anonymous black shapes mounting impossibly steep paths with brightly coloured objects on their heads, before I realised those objects were 20-litre containers of water and that the women were carrying them uphill two or three times a day as well as working the fields, cooking the meals, baking bread and looking after their many children.
I felt embarrassed that I, supposedly open-minded and aware, could be so ignorant of how hard these people’s lives really were. We can never know what it is like to live the way they do. I finally realised how dependent we need to be on God and his guidance to have any positive impact in such communities.
One of the most ancient lands on earth, this country is also one of the world’s poorest nations, with high maternal and infant mortality. Despite this, the population is burgeoning, stretching already stretched resources further and further. Most of the illnesses we saw were due to water-borne diseases. Our medicines were only a temporary solution to deep-seated problems. Slices of modern medicine have made an impact, but sophisticated scans and the latest antibiotics do not seem the best solution. We felt like an ambulance parked firmly at the bottom of the cliff struggling to keep up with the injured fallen.
We needed to lean on God the whole time we were away. We had many questions. Why had he called us to this country when we were able to offer so little? What are the best ways to help break cycles of poverty and improve health? How does he regard their religion? How far should we conform to strict standards of dress and protocols that may identify us as members of the religion ourselves? How should we cope with our own feelings of inadequacy and sometimes of not being wanted by certain people there?
God used the time to challenge us too. Why did we need to feel useful? Why did we need to feel that we had made a difference? Although God calls us to be agents of change in a broken world, he wants to do it through us rather than have us take it all on ourselves.
This has two implications. One is that we can let God take on responsibility for the problems that are just too big for us to cope with. His power is sufficient and we can rest in that knowledge. The second implication is that any success in our work is God’s success, not ours; we should be pleased to give him the glory. God used our time in this country to teach us humility and the need to trust in his power and goodness. We are now working on the application of this lesson!
My patient, swathed in layers of black including a cloth wrapped firmly over her lower face, was indicating the problem that had brought her to clinic today. I could not understand the words, but the actions were clear enough as she clutched almost every joint in her body one at a time.
'And has she got a headache?' I asked my translator.
'Yes,' she answered, 'she has a headache all the time, for the last six years.'
'And what makes it worse?'
'It's worse when she works.'
It took me more than two months of living and working in that rural community to begin to understand what 'work' meant to the women there. Two months of hearing over and over again about chronic neck, back, knee and arm pain. Two months of watching anonymous black shapes mounting impossibly steep paths with brightly coloured objects on their heads, before I realised those objects were 20-litre containers of water and that the women were carrying them uphill two or three times a day as well as working the fields, cooking the meals, baking bread and looking after their many children.
I felt embarrassed that I, supposedly open-minded and aware, could be so ignorant of how hard these people's lives really were. We can never know what it is like to live the way they do. I finally realised how dependent we need to be on God and his guidance to have any positive impact in such communities.
One of the most ancient lands on earth, this country is also one of the world's poorest nations, with high maternal and infant mortality. Despite this, the population is burgeoning, stretching already stretched resources further and further. Most of the illnesses we saw were due to water-borne diseases. Our medicines were only a temporary solution to deep-seated problems. Slices of modern medicine have made an impact, but sophisticated scans and the latest antibiotics do not seem the best solution. We felt like an ambulance parked firmly at the bottom of the cliff struggling to keep up with the injured fallen.
We needed to lean on God the whole time we were away. We had many questions. Why had he called us to this country when we were able to offer so little? What are the best ways to help break cycles of poverty and improve health? How does he regard their religion? How far should we conform to strict standards of dress and protocols that may identify us as members of the religion ourselves? How should we cope with our own feelings of inadequacy and sometimes of not being wanted by certain people there?
God used the time to challenge us too. Why did we need to feel useful? Why did we need to feel that we had made a difference? Although God calls us to be agents of change in a broken world, he wants to do it through us rather than have us take it all on ourselves.
This has two implications. One is that we can let God take on responsibility for the problems that are just too big for us to cope with. His power is sufficient and we can rest in that knowledge. The second implication is that any success in our work is God's success, not ours; we should be pleased to give him the glory. God used our time in this country to teach us humility and the need to trust in his power and goodness. We are now working on the application of this lesson!
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?
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?
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.
