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.

LAMB NEWS – JULY 4TH, 2010

This newsletter is simply a report about one of our community chaplains.

One day earlier this year the chaplain was on his way to one of the LAMB community clinics when he saw a large crowd gathered at one of the intersections. He stopped and tried to see what had caused people to stop. In the middle of the crowd was a man. He was in a bad condition, had long, unwashed hair, dirty finger nails and torn clothes. He seemed to be mentally ill and did not speak clearly. The chaplain saw a big wound on his shoulder, which looked infected.

In his heart the chaplain felt that God gave him courage to help this man. He asked the crowd ‘Where does he come from? What happened? Has he eaten?’ No one could answer his questions. ‘Does someone have water and soap? The chaplain asked. The people didn’t seem to know what to make of his questions. No one wanted to touch the man or even come closer.

The chaplain gave some people money to get soap. And after some time a lady brought a bucket of water. The chaplain and some others washed the man from top to toe.

And then it was amazing: someone got a barber to cut the person’s hair and trim his beard, another brought a nice pair of trousers and yet another a Punjabi shirt. The fingernails were cleaned and cut and after a short while one could hardly recognize the man.

The people asked the chaplain ‘Why do you do this? Is he a relative of yours?’ ‘No’, said the chaplain, ‘I just know that this man is God’s creation. God loves him. God wants us to see people through his eyes and he wants us to help those in need’. And he quoted verses from the Qur’an and the Bible. Everybody was listening.

Later the chaplain got some medicine from a pharmacy for the man, while one of the onlookers took the man into his house to feed him.

The chaplain was still beaming, when he came back to tell us this story.

This could have happened in many countries around the world. It is reported here, just to show another of the differences that LAMB is trying to make.

LAMB NEWS - MAY 21ST, 2010

LAMB NEWS – MAY 21ST, 2010

Apologies for missing two monthly newsletters. It has been a bit busy at LAMB.

The full rainy season is getting close – the more than 5 months of dry season came to an end with a bang a month or so ago. Huge spectacular thunderstorms over three nights, and very high winds killed about 150 people across a narrow strip of India and Bangladesh. LAMB was lucky. Serious damage was limited to our telephone system hit by lightning – about US$ 3,000 worth of damage

The hospital is mainly fine, but we are now without a general surgeon. The LAMB surgeon for the past 6 years – an outstanding surgeon, and also a great Christian teacher and mentor with a long life of missionary service behind him – is back in the US . We still have consultants for Caesareans and gynaecological operations, but the broad range of work that the general surgeon did – including such things as appendectomies, burns treatment and skin grafts, cleft lip and palate repairs, amputations and tumor removals – we cannot do. LAMB has been in this position before, but it is obviously not welcome. We are looking urgently both for short term cover and for a long term replacement.

Last month we had a big consultation session with representatives from communities that LAMB serves. Clearly they think that we are very competent – they would like us to build a Medical School to train doctors (which is truthfully way beyond us) - but they also gave us some ideas for non-medical improvements. What we have been doing, and will continue for a while yet, is to try and reduce registration waiting times, provide more seating, provide more information and help, and generally make their time at the hospital less hassle. LAMB is already quite good, but we know we can do better.

The Training Centre – freshly painted – is now overflowing with trainees, and two rooms in another building are now also in use for trainee accommodation. A very large proportion of the training at LAMB is maternity focused, and the huge need within Bangladesh can be judged by the fact that less than one in five births takes place with a trained person in attendance. With this great need, it is easy to understand why there is a lot of encouragement for LAMB to build a third floor on the Training Centre.

LAMB seems to be becoming a little better known. An article about LAMB, written by a medical student who came to LAMB for experience last year, has been published in the DFID (the UK equivalent of USAID) development magazine. One of the donors to the LAMB disability program has also asked for an article for their annual review. LAMB also now seems to be increasingly a potential partner for work programs because of the Training Centre, the research unit, and the community and hospital programs. We wait and see how far these interests develop, but it is a very active time.

This newsletter started with an apology for missing monthly newsletters. What has been keeping us busy? The hospital has been very busy. The Training Centre is overflowing. For the Community Health and Development Program we have needed to submit two - new for us - project proposals. We are developing plans for a Nurse Training Institute, for an extra floor on top of the Training Centre, and for a new housing block. The school is pursuing registration under the Bangladesh Government system. At the same time, we are finding out information for a major look at the future.

And at the same time as trying to serve the people better in all the above ways, we are also very actively looking afresh at what we should be doing as a Christian organization. We have been blessed with lots of talent and support and we feel we should be making best use of all that we have been provided.

LAMB NEWS – MARCH 21ST, 2010

February at LAMB was just like January – really busy.

At the hospital, the number of out-patients was more than 20% higher than a year earlier, already higher than the year before. The number of in-patients was 15% higher than a year ago.

These may not sound like great differences, but with the hospital staff already well loaded it has been really stretching their work. For the first time for a long time we had all beds full and even at times patients on trolleys.

Looking at it positively – it seems we are doing the work we have been called to do. The doctors and nurses report ‘we are seeing a lot of very sick patients’.

The large Community Health part of LAMB works in a different way than the hospital. Its activities are funded by different international donors whose programs match the work where LAMB is skilled, and that fit LAMB’s own focus on the poor and on health. Some programs go on for many years; some can be only for one, two or three years. Therefore submitting applications to carry out work is becoming a normal part of life for the Community program. In February we were busy preparing two preliminary applications. In the past one application per year would have been typical, so in February we were very busy.

One of the applications is for a fairly small job - an advisory consultancy only - but it could lead to much larger work. The other proposal involves working in the remote char/ riverine areas of northwest Bangladesh. Life is very difficult for the very many people in these areas – difficult to get to and from because of the river system and floods, and so very poor.

As always, we are not the only applicants to carry out the work, and so we now wait patiently to see if we get beyond the preliminary application stage.

Back on the LAMB site the Training Centre continues at full load, and adding to the challenges of managing this, we are trying to repaint the building. This requires quite a bit of organization and shuffling around. We are using better quality paint, hopefully to get long life. Repainting the hospital in this way two years ago seems to have been very successful.

I mentioned last month that we have started a campaign to remind us to work in the ways that God would have us work. This month was the first of the Values – Caring and Compassionate. As well as posters all around LAMB there have been discussions in small teams everywhere across LAMB to see how they apply in our kind of work – whether it be nursing, training or finance.

For those Christians who pray for LAMB, I would ask you in your prayers to remember some very, very busy people here, and give thanks that we do seem to be able to make a difference

LAMB NEWS – FEBRUARY 14TH, 2010

January was a really busy time for all at LAMB.

The hospital was unusually full – for no obvious reason, although more babies were being born than typical for the time of year, and the paediatrics unit was unusually busy. We were also short of two doctors, out of a normal level of about 22, and that added to the already busy on-call duty for all the doctors.

The Training Centre was at full load. The MIS-Research Department was very busy carrying out the first phase of a potential nutrition trial, and the Community program was supporting this. The school is now well into the first year that we have had a Class 10 grade, taking UK ‘O-level’ exams. This not only requires more staff, but also more highly trained staff. It is a particular challenge to get good English-speaking science teachers at the higher level.

One highlight for the month was the result of a fund raising challenge by the husband of doctor that came from the Netherlands to work at LAMB for 6 months, (and has stayed 8). To raise money for two purposes – the Poor Fund, and for the separation of conjoined twins born at LAMB about 6 months ago – he cycled 500 km/ 300 miles across the north of Bangladesh. With no arrangements made, other than start and finish points, and speaking no Bangla, this 2 week journey through the villages and tracks of Bangladesh was remarkable. He saw Bangladesh in a way that not many people have – certainly not non-Bangladeshis. The funds raised were more than € 35,000 - nearly US$ 50,000.

Another highlight of January was the introduction of Staff Values. Even though we are a Christian organization, sometimes we fail to treat each other and 3^rd parties as well as we should. The Staff Values program – started off with posters everywhere - is to help us to work in better ways.

The five staff values, not in any special order, are Equal respect for all people, Caring and compassionate, Teamwork, Quality, and Honesty and integrity. The Values are obviously completely consistent with Christian values, but are also values found in well run organizations.

We are now looking at ourselves in other ways too, to try and see how others see us. We are starting to get an up-to-date measure of how we compare against other health services in Bangladesh. Visits to other clinics and hospitals have started. Even though there are a huge number of gaps in the health services in Bangladesh – the enormity of trying to reach every village area is difficult to imagine - the quality of some facilities are much higher than we had thought, even some of those focused on the poor. We will be continuing this looking outside to try and learn.

For those who pray for LAMB and its work, most appropriate for this month would be that the Staff Values program may make a positive difference.

LAMB NEWS – 18TH JANUARY 2010

Very Best Wishes for 2010

The past month has seen several annual celebration times at LAMB, including Victory Day, Christmas, and (western) New Year.

We had a full day program for Victory Day - celebrating the end of the Liberation War for Bangladesh in 1971. It went from flag-raising early in the morning right through to a big home-grown entertainment show in the late afternoon.

Christmas was not just a time for Christian staff, but was as always a time when all staff get together. The Staff Christmas Service in some ways seems more real here than for many readers of this news update. Live sheep – used as blood donors for the laboratory for culture growth – help to make the nativity play real. The life in the villages around us makes it easier to imagine Christ being born in a stable, (so long as we ignore the mobile phones that are common).

We celebrated western New Year well – but Bengali New Year is always the biggest one.

There were a couple of step changes in LAMB’s work in December – one program ending, one starting. After more than ten years providing micro-credit for women’s groups, LAMB has (successfully) handed over its activities to a local NGO. Bangladesh now has a number of very large competing micro-credit organizations, and LAMB chose to withdraw rather than grow into what is becoming a very commercial activity.

As a step up, we have started test work for a potential new program on nutrition supplements. There is a very large problem of underweight children, leading to underweight mothers, and hence many maternity problems we see at LAMB. The trial looks at the practicality of adding high nutrition content to normal food for pregnant women, new mothers and their infants. We hope that longer term it may be possible to reduce some of the problems that come to the hospital. We shall know in about 4 months whether or not a full nutrition trial will go ahead.

For this newsletter it seems worth giving a few facts and figures which help understand the problems the area around LAMB faces. LAMB is in a real rural location – there are rice fields all around - and yet in this area less than 20 miles square, (32 km square), there are well over a million people.

According to official statistics, the literacy rate excluding children below 7 years was less than 30% just 5 years ago. All areas were below the national average. Half the population is less than 18 years old. The average real age for marriage of girls is below 15 years old. These few simple facts show some of the problems to be overcome.

For those of you who support LAMB in prayer, we ask your support in 2010 as we continue to focus on our mission in a changing world.