LAMB NEWS – AUGUST 16TH, 2011

Greetings from LAMB, where the monsoon season is helping to keep things cool - relatively. It is raining most days now, but often only at night. Although Bangladesh is the land of rivers and floods, a lot of rain is needed in most places to keep the below-ground water levels high, since so much water is taken for irrigation or people’s use

At LAMB, as-well established work continues – in clinics, in the hospital, in training, in community development – work on child nutrition is increasing.

Levels of malnutrition in Bangladesh are still amongst the highest in the world. According to a 2007 national survey, by 23 months of age nearly 50% of children are stunted and 41% are underweight. 15% of women of reproductive age are of short stature – less than 145 cm/ 4 ft 9 inches.

Stunting from malnutrition is a permanent missed opportunity for acquiring intelligence and better health. Vital organs never fully develop during childhood. It matters for all the individuals, and the loss of productivity and the health costs are also a big loss to the nation.

There is a “window of opportunity ”from conception to 24 months old for the highest impact in reducing death and disease and avoiding irreversible harm through malnutrition.

LAMB is involved with two research projects focusing totally on nutrition during this critical period, which covers pregnancy, the breastfeeding mother, and then other nutrition for the young child.

One of the research programs in which LAMB is involved, sponsored by the Gates Foundation, looks at how best to improve the knowledge of mothers on feeding. More than half of mothers in Bangladesh abandon breast feeding before 2 months, whereas recommended practice is 6 months. Most mothers report not knowing what are the best foods and how much very young children should eat.

The other research program, sponsored by USAID, focuses on food supplements in which are embedded key vitamins and minerals. The study is not only about measuring the benefits to the children of the supplement supply, but also to check the practicalities and economics for rural families.

LAMB is involved in these projects because we have a strong network of community teams across a fairly broad area, with expertise in health work and data provision, plus an existing research team as the basis for larger work. Although the benefits will take much longer to appear than some of LAMB’s other preventative work – antenatal clinics for example – it is all part of one of our objectives, to improve the health of those most in need – in particular women, children and the poorest of the poor.

This is one of the reasons that we are here as a Christian organisation, able to make a real difference to those in need.

LAMB NEWS – JUNE 17TH, 2011

Regular readers of this newsletter will have heard a number of times how busy LAMB is. These past couple of months things have taken a new leap forward in this way.

The reason we have become so much busier - at least for a little while - links to new projects. Three have started in the past three months.


The biggest, which we are just starting, is for a United Nations organization. It is probably only for 15 months, but means we have to recruit 280 new staff during just a few weeks, a very large step up from LAMB’s existing staff number of about 700. The project is trying to reduce mother and child deaths in this area through encouraging community members to follow better health practices, to use established health care facilities, and through improving the system of health care provision. Although Bangladesh has made very good progress towards the Millennium Goals to reduce mother and child deaths, the levels are still very high.

The other two projects started are both research related, although being implemented with the participation of LAMB community staff. A two year project supported by the Gates Foundation, looks at what are the most effective and cost-effective techniques to persuade mothers to provide their babies and young children with the best possible nutrition, within their budget. The other short project looks at the how decisions are made by poor families facing difficult choices. For poor families there are serious choices between survival or longer term benefits.

We are very privileged to have been entrusted with these projects. Our challenge now is to do them, and do them well, so that there really are good benefits from the work.

Other parts of LAMB are on-going busy. The number of patients coming to the hospital still continues to rise, and some departments are stretched to the limit. For the Training Centre, as I write, the number of resident trainees again means overflow into temporary accommodation.

LAMB has also during the past months been able to provide additional support to the Christian community in the area. 25 pastors from churches across a wide area came to LAMB for two days of training. The focus was on helping them to see how to broaden their ministry, not only caring for their churches and their members, but for a broader role for their churches in the community

For those of you who pray for LAMB, there are two requests. One if for the fortitude and wisdom to handle this period of being very stretched across more or less all parts of LAMB. The second is for stability in the country since times of disturbance almost inevitably hit hardest on the poor.

LAMB NEWS – APRIL 5TH, 2011

At LAMB we are very fortunate to get a lot of people from overseas who come to stay for weeks or months to support LAMB. Over the past 12 months these include

• Teachers and education experts
• Obstetricians/ gynaecologists
• Surgeons and anaesthetists
• Physicians and paediatricians
• A psychiatrist and a counselor
• A speech therapist, nurse, radiographer, laboratory expert
• Medical students
• An epidemiologist and an accountant

We also get overseas visitors who come for a few days, most commonly from LAMB support groups. For them, it is a chance to see the realities of the area where we work, and to see for themselves what LAMB does so that they can tell people back home.

All these exposures to the wider world are invaluable for what is done by LAMB. It helps to keep us all – Bangladeshi and expatriate – aware of current standards and practices internationally. Although we do not have the facilities or the funds to have the most advanced equipment, and our priorities are in any case different, nevertheless there are still many things that help us to improve and develop.

Having visitors from outside sometimes also helps to remind those every day working here of the many positives that happen. It is very easy to get lost in the practicalities and problems of day to day work, and not see the eventual end results on peoples’ lives.

Like most hospitals, we do not have the resources to follow up on what happens to the majority of patients when they leave the hospital after treatment. In the community also, we see the statistics about lower rates of mothers being lost in childbirth, and lower rates of child deaths. But it takes time to see the human meaning of these.

Some of what is seen is unhappiness and sorrow. It is very hard for the hospital staff who see so many cases come to the hospital far too late – whether because of lack of understanding, trying alternative treatment first, fear of costs because the family has no funds, difficulties of transport, or simply other priorities. It is hard seeing young girls and women coming in damaged by abortions; to see children and adults come with disabilities which could easily have been overcome if treated earlier. It is frustrating when family members will not allow life-saving treatment, or, through fear or whatever reason, will not help by donating blood.


But there are many, many cases which show what can be done with a little. Imagine the relief for a family where the father has two club feet, and his son was born the same, but with paid-for low cost treatment at LAMB now has two normal angle feet. He will wear braces at night for a while yet, but that is a small thing in his total life. Imagine the delight for a young mother who could go home after 2 months treatment paid for by a church for serious burns. (Burns happen often here because of open fires and saris). Both of these cases had very supportive families, and for the staff at LAMB it was one of those real pleasures.



Imagine the difference living in villages on river islands where there is no access to healthcare. And then someone on the island is trained enough to help organise basic health care, and with a mobile phone can consult on matters which look more important. Imagine the pleasure for a little boy whose muscles are wasting, but almost every day for weeks was carried around the LAMB compound by one of the visitors from overseas.

When we stand back and look at what is being done, with not so much considering the number of people affected, then those who visit and see, and help, and point out the good things being done, are great motivation for the staff here.

These things are far from being LAMB doing things on its own. We are just God’s pair of hands. Without people and organizations who fund the work, we could not do it. But, when we look we are able to see the changes in people’s lives – and not just the patients.

LAMB NEWS – FEBRUARY 7TH, 2011

Winter is on its way out, here at LAMB. We are up to lovely sunny days of around 22ºC/ 72ºF, and nights of 15ºC/ 60ºF, and not too humid.

Only a month ago though it was the usual very cold period by local standards, down to 6ºC/ 43ºF. Many people don’t have clothes for the cold, and some suffer seriously. So LAMB was involved in the provision and distribution of blankets and warm clothes. Nice to note was that some individual staff members – Bangladeshi and expatriate - on their own initiative arranged extra supplies.

A reflection on poverty is that sometimes those who have blankets sell their much needed blanket because food is a greater priority.

So, welcome back warm weather.

LAMB’s community activities have since January 1st taken another step forward. This is via a three year project on Disaster Risk Reduction – minimizing the damage done to communities by flooding and by drought. There are several new things for LAMB about this work. The first is that it will actively involve working with churches out in the community areas so that they may take on a more supportive role in their communities. Secondly it is taking us into another of Bangladesh’s 64 Districts, Lalmonirhat, which starts about 25 miles (40 km) from LAMB. In some ways this may not sound far, but rural travel is not always easy and even to the main town in the area takes about 2.5 hours from LAMB. To villages it takes much longer – even without floods. Thirdly, disaster preparedness work as a speciality is new for us, but working with communities and passing on skills is an established expertise for LAMB and we now have trained specialists in disaster preparedness.



We note that for our community work, LAMB is usually working as an arm of larger international partners, some Christian, some not. We recognize that without their overall support and funding we would not be able to work

Back at the main LAMB site, things have been busy as always. At the Hospital, another surgical camp was held for women suffering from an obstetric fistula, (typically damage caused by delay in giving birth). We were fortunate to have a visit by another expert gynaecologist, and financial support to make it possible. Another 15 women were operated on – in this case including some from much further away than is normal for LAMB Hospital, since most of those suffering in the moderately close region have already been seen. Bangladesh still has many thousands of sufferers, so a lot more work is needed.

Also at LAMB site, there has been a change in the way we organise the disability related activities. The activities such as club foot realignment work, therapy, and therapy training for ongoing rehabilitation at the site have now been connected directly into the hospital. All the care of the hospital is more easily available for the affected children. It will also allow the hospital to have better access to the therapy skills in the rehabilitation unit.

At the School, for the last five months of 2010 both the School Director and the Headmaster had to be away. (It was not planned that way). Very pleasing for all at the school was that things continued to run well, and it was a good learning opportunity (if busy and challenging) for all involved.

Lastly, to close on a cheery note, there seem to have been a lot of visitors to LAMB in recent times, and it is very nice to hear that people still have good things to say about LAMB and the way things are done – and ideas about what else could be done.

If you would like to pray for the work that is done here, then a particular request would be the new areas for community work and for the churches with whom we will work.

LAMB NEWS – DECEMBER 26TH, 2010

VERY BEST WISHES FOR 2011

We are still celebrating Christmas and what it means, here at LAMB. As in previous years, we have big red illuminated stars on all the buildings, visible from quite a distance in this flat land. The big stars show the way to Christ. We also have lots of other decorations in the hospital this year. They of course brighten up lives and are fun, but in this environment they do also remind people that we are Christian.

There’s lots that could be written about this month, but this newsletter focuses on what is happening out in the community areas of LAMB and on some research to be done.

One of the things that LAMB has done for quite a number of years for the towns and villages round about is to operate clinics and safe delivery units, (where babies are born). Each of the 28 clinics/ SDUs covers communities of about 30,000 people, so not small.

Until a year ago, LAMB has been very much responsible for running all the clinics. Although it has always been the intent to hand over clinic management to the communities themselves, this really started gathering momentum a couple of years ago.

More or less exactly one year ago, seven of the clinics were registered with the Government as official separate organizations. So, for the past year they have been starting to run really under their own steam, with LAMB there to help rather than manage. This month has been the time for all the first Annual General Meetings of these clinics/ SDUs, and the reports on how things are going. On average there were about 100 people at each AGM, with more men than women at some AGMs, and more women than men at others.


Although it is early days, and many things can still go wrong, these first AGMs have all been a great pleasure to see, with lots of wise and perceptive questions and comments from attendees. The clinic organizations in all the seven areas have done a great job in getting funding commitments from their communities, and there really has been a switch in power from LAMB to the communities. If this continues to work, then it is much more sustainable for the long term than LAMB running the clinics, since it does not rely on overseas donations. It felt like a great gift in the last days up to Christmas.


In other parts of LAMB too there has been a lot of activity. In particular in the (Information) Research unit. It now seems almost certain that we will be doing at least one new activity in 2011, and one other activity that can be completed more fully.

The work that we will complete involves recording for all the households in the relevant areas summarized information about the family ‘wealth’ and income. (Wealth in our local context definitely does not mean the households are rich !). This information can then be linked to the health problems of the family members, and we can start to get a better picture of where extra care and attention is really needed. This kind of information also feeds into national and international understanding of the health problems in poor communities, and what might be done about it.

The new activity is also health focused research, but not in our normal way. It looks at how people in the villages make decisions, in particular when they have a dilemma to choose between two both necessary things. For LAMB, our concern is how people make such decisions related to health, taking into account their various cultural backgrounds.

Now as 2011 approaches, here at LAMB we continue to look forward to the future, and the challenges and promises it brings. We will continue to try to serve in the way that God would have us serve.

We wish you all a very Happy New Year.

LAMB NEWS – NOVEMBER 15TH, 2010

Apologies for a 2 months gap.

As you may have gathered from recent newsletters, there is a lot going on at LAMB. And things seem to be getting even busier.

Some things are not direct work for the local community. For example, earlier this month LAMB helped organize a 3-day conference at LAMB for 12 Christian organizations doing community work in Bangladesh. The objective was for us to set up a network together and help each other. It was a real success.

Later this month we expect to be holding our second Medical Students conference. At the first conference a couple of years ago, there were more than 40 medical students of differing religions, seeing and listening about a caring approach for medicine, and caring for the poor. They have been asking that we hold more similar conferences.

Also since the last newsletter, by invitation a LAMB expert presented at an international Maternal Health conference in India. We were also very pleased that one of our Directors was invited to be part of the Bangladesh delegation to the very important Third World Lausanne Congress on Christian mission in Cape Town.

Back here at LAMB, all the normal work goes on. In future newsletters I hope that we can give some small glimpses of the difference the hospital makes to individuals, to results from all the community teams, etc.

On the bigger scale, starting properly in January, we will be working with churches across a fairly broad area to help them act as catalysts in their village communities to help cope better in times of disasters. In part of our area, floods are an annual ‘disaster’. And, in surprising contrast, not very far away in another part of our area insufficient water is becoming the big problem. Irrigation is crucial for having enough food to survive. Both problems are being worsened by climate change effects. As you can imagine, the work in these areas is very much focused on the poor, consistent with where we believe we are called to work. Working through churches on this scale is not something we have done before, but want to do, to help them build an outward looking vision putting their faith in action.

An area of concern that we have at the moment is the funding of the Rehabilitation Unit. We are (gratefully) able to carry out surgery to repair cleft lips and cleft palates, non-surgical correction of club feet, and to make many kinds of assistive devices such as wheel chairs, and tailor-made walkers and chairs. The work we would like to continue, but for which part of the funding has ended, is for other disabled children. The children and a parent can spend up to a week at LAMB Rehab Centre to be assessed and the parent(s) trained in the therapy. Thereafter, in our community work areas, there are monthly clinics where checks are made on the children, refresher therapy training given, and parents are simply able to get together and share common experiences.


This is not an area that is easy to fund because parents are not usually able to pay, and because the need just goes on for ever. It is not as if there is a nice simple cure that we do and everything is OK. But there is a big need, and it is not one which is a priority for mainstream society and government.

I wrote earlier about the growing shortage of doctors – at the same time as growing patient numbers. We took a fairly big step and increased doctors’ salaries, and it looks like for now our problems are much reduced. It has been very stressful on the doctors we have, and so we are glad to be getting back to a more reasonable (but still very busy) workload and number of night on-calls.

Thank you as always for your various kinds of support.

LAMB NEWS – AUGUST 10TH, 2010

Even though it is a peaceful country, Bangladesh has many, many people who miss out on the provisions taken as natural in much of the world - education for children, medical care, a secure home ….

LAMB has now started working with one of the most disadvantaged groups in Bangladesh – those people living on the islands in the middle of the big rivers of Bangladesh. We are working to help provide health and medical services to people on the river islands in the Jamuna River, (in India, known as Brahmaputra), where about a million people live.

The river islands of Bangladesh are special. They appear and they disappear. Really they are just sandbanks, and can last months or years, depending on how the river makes up its mind at the time.

That the river can foil mans’ best intent was clear on one of the chars (river islands) visited last week, where in an attempt to improve life for those in the surrounding group of chars, the Government had built a 3 storey school/ flood safety centre. In the middle of the island, more than half a mile from the river when it was built a few years ago, the building is now a few feet from the edge of the river and will certainly collapse into the river – this year, very soon is probable.
The same happens regularly with people’s houses. They are always looking for a new bit of sandbank to appear on which they can – at least for a while - grow rice, or jute. But it is a precarious existence. For months of the year their individual houses are surrounded by (or are flooded by) the river.


The trained medical care being provided mainly consists of a visit every 2 weeks by a paramedic, although on each reasonable size island (say 1,000 population), there is also a ‘slightly trained’ helper. A visit once per two weeks by someone whose drug list is only of 28 basic non-doctor-prescription items, may not sound much, but compared to what was available before it is a real step up. Typically about 30 patients attend the clinic, including antenatal and postnatal care, but there are also group training sessions on health and maternity care. The paramedic also refers serious cases to the mainland – with for a trial period the boat costs being paid (for some) by an overseas Government.

Parents are the same as everywhere else in the world – worried about their children’s health. How can a bad squint be overcome – medically easy, but how? A small boy needing surgery stands patiently while the inspection visit LAMB doctors examine him on their look around the facilities, How to get surgery?

LAMB’s role is to provide the technical expertise in community health to help local organizations set up and provide the service. For LAMB as an organization this is a new experience -where we are the overall experts rather than the local provider of services. It helps us to pass on our learning.

But we too are learning - and not only to be thankful for all the blessings that we as individuals have.

As Christians, this really is one of those times where we are trying to make a difference to those in need through using the talents that we have been given.