LAMB

LAMB NEWS – AUGUST 16TH, 2011

2011-08-16T20:48:00.005+06:00

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

2011-06-17T16:34:00.008+06:00

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

2011-04-05T22:34:00.006+06:00

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

2011-02-07T09:55:00.010+06:00

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

2010-12-27T14:27:00.007+06:00

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

2010-11-15T22:38:00.003+06:00

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

2010-08-20T14:37:00.009+06:00

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

2010-07-04T11:38:00.004+06:00

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

2010-07-03T14:50:00.003+06:00

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.

2010-03-23T21:47:00.003+06:00

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

2010-02-19T22:45:00.005+06:00

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

2010-01-23T22:03:00.003+06:00

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.

LAMB NEWS – DECEMBER 8TH, 2009

2009-12-13T22:21:00.001+07:00

For us at LAMB, this past month has been a time with a lot of feel-good things. The lovely dry winter season has arrived, with temperatures of about 20^oC in the daytime and 10^oC at night. Nationally, and for LAMB except for the hospital and community clinic services, it has been a holiday time, as the majority Muslim community celebrates the example of sacrifice. At LAMB, the small US community seemed to expand hugely to celebrate Thanksgiving – we all had a lot to give thanks for. Around us, the second rice crop of the year is almost all safely gathered in. And LAMB itself now feels in a much more secure position than it did only 3 months ago.

The hospital for a couple of weeks has been very quiet. This is normal at Eid holiday time, but this year Eid also coincided with one of the rice harvests. The reaping, the threshing, and the gleaning of fields, is all by hand, and so even in this densely populated land, much of the population is very busy. Those not in the fields, or busy with the threshing, or at rice mills, may be involved in the transport of rice or straw. Rickshaws and trucks are all busy. At LAMB, baby deliveries keep happening, but beyond that, if a health problem can wait, it waits.

While the hospital has been quiet, other parts of LAMB have been very busy.

The Training Centre is at full stretch. Almost all of the training at the moment is related to maternity, with training ranging from 6 months for Community Midwives down to 10 days for Basic Emergency Obstetric Care. There is a huge demand for skilled birth attendants in the country, and their availability is essential if Bangladesh is going to be able to lower the rate of deaths for mothers giving birth. This is one of the global Millennium goals. Maternal deaths in areas where LAMB works are less than half of those in the country overall.

An indication of the increasing importance of the Training Centre is that the Head of Training has just been appointed as a Director. As such, she is one of the executive team with overall responsibilities for LAMB day to day management. The Director team of nine is made up of five Bangladeshis/ four expatriates, and, looking at it another way, five women/ four men.

As a sign of things getting better, LAMB is recruiting new staff again. This is linked to the trial phase of a new project in the MIS-Research Department area and is related to nutrition and heath. At this stage the work is only for a short term contract, but if the project moves to the second phase then staff will be employed for 5 years. The approximately 30 staff involved are mainly out in the community, but a small number are in the MIS-Research Department itself.

The recently started program to realign the foot or feet of children born with club foot is going very well. The program at LAMB uses the Ponseti Method and involves children first wearing plaster casts, around five casts over several weeks, gradually straightening the foot. The children then progress to wearing braces at night for the next 4-5 years to gradually embed the new alignment. The first children treated at LAMB are already out of their plaster casts – with straightened feet – it is marvelous to see them.

For this club foot realignment program, LAMB is supported by ‘Walk for Life’, an organization founded only this year. LAMB has been involved right from its conception, and is helping the national spread of the program. Walk for Life has already make remarkable progress in quickly getting the program introduced in several districts of Bangladesh. The LAMB therapist was away with them for nearly two weeks, both demonstrating techniques, and involved in discussions with the Ministry and with orthopaedic specialists.

With all these developments, as with many others at LAMB, we never stop being amazed at all the people and resources which God has provided to enable us to continue working.

LAMB NEWS – NOVEMBER 6TH, 2009

2009-11-14T18:12:00.001+07:00

How things can change in a couple of months. In September, although in the community and the hospital the normal care continued as always, inside LAMB it was tougher times. Big projects were coming to an end, there was a growing financial hole, and there was a small cut back in the number of staff.

Now, at the start of November, there is one (big for us) project which looks highly probable to be approved, and may start almost immediately. One or two other projects look very promising. We also received one very kind, large, collective donation, and people from different countries have also sprung into action for support. There is tremendous energy around to overcome what was a worrying time for the short and longer term.

For people of faith – not only Christian – a prayer day across all departments and a prayer month for senior staff have really helped.

Another very visible change in the past couple of months has been in the Training Centre, where the quiet month or so is now over and everyone is very, very busy. We now typically have about 50 trainees in residence at the Centre, and more space would be useful. The quality of the LAMB courses is considered very high, and there is a huge need in the country for the particularly maternity related training that we are strong in. Hence both for government staff and staff from NGOs, large and small, we are getting booked up well into the future. An upwards extension of the Training Centre is one of our current dreams.

Another change from a couple of months ago is that seasonally we are into a very pleasant time of year. Bangladesh has six seasons, and we are now into ‘late autumn’, with winter to follow. The worst of the humidity has gone, and daytimes tend to be sunny warm and dry. Night-times the temperatures fall, which is also very pleasant – except for some of the poor, but perhaps more of that in a later newsletter. It is likely that we shall have (almost) no rain for the next four months or so. Little streams and even little rivers dry up, and the big rivers dramatically shrink.

All the good and big things happening in the past couple have months have happily covered over ‘small problems’. The LAMB email system was very sick for most of a couple of weeks, with two problems elsewhere being the main reasons. LAMB – like very many organisations – has come to depend on email, particularly being located where we are. So loss of email contact – now our main link to the outside world, except for locally – is a big extra problem. Happily, things are mainly back to normal.

We also had some unexpected delays for a while in getting entry approvals for some volunteers from overseas, both for the school and the hospital. For those coming, who in some cases had already given up their job at home, the uncertainty was a bit worrying. Here, the existing staff were eagerly awaiting their arrival, and rotas had to be changed and even more work taken on. Happily in this area too, approvals have come through, and more help is here or on the way. Despite occasional problems, LAMB has been very well supported with approvals, despite the considerable number of short term volunteers and long term expatriates who come.

This past couple of months has therefore been one which has brought new hope and cheerfulness, and we give thanks for this and for all that has been provided.

LAMB NEWS – SEPTEMBER 10TH, 2009

2009-09-11T22:44:00.001+07:00

Greetings again from LAMB.

Here at LAMB, ‘baby season’ has arrived again – at just about the normal time of year. From end of August/ beginning of September, for a period of about 6 weeks, the number of babies being born at the hospital always seems to rise by about 25%. So, it is a very busy time – really hard work - for the already busy midwives and obstetricians. Some weeks on average 13 babies are being born in the hospital every day – compared to 7 per day or even less in quieter times. The maternity ward has overflowed into other wards, and the hospital beds are filling up.

It is not just the midwives and obstetricians that are busy, since many of the babies often have problems through being underweight or other sicknesses related to their environment. So the paediatricians too are very much occupied.

The Training Centre is also back in full swing, after a few weeks of relative quiet when the trainers could do some updating of their courses. It is now fully loaded for the next 6 months. The biggest demand by far is for training related to maternity. In general the training courses are not for qualified midwives, but rather are for lower levels of skill. The situation in Bangladesh is such that even providing a fairly limited level of delivery skills can make a big step up in saving lives compared to the current alternative, which is very often a family member or local untrained woman. It is a good feeling to be part of this big improvement for Bangladesh.

At the Hospital site, this has been a less happy week. Because of the financial situation, 15 out 370 non-field staff have been told that they are being laid off. A few are long-serving. There are several reasons for this action. The first is that because of a Government voucher scheme to encourage free care for pregnant women at Government facilities, the number of in-patients to LAMB has dropped, and is now below the number in 2006 when we expanded the hospital. Our costs have gone up faster than our income, in particular salaries and the Poor Fund subsidies to poor patients. Two large grants for work in the community have come to an end, with no other work yet to follow – although there are good possibilities in sight. And lastly, because of the global financial problems, and the fall in the value of the UK pound, there is a decline in the income we receive from overseas.

We are also taking other measures, including converting a separate area of one of the larger wards into an area without full nursing, for patients ready for discharge. We will still be able to bring the area back into full nursing use fairly quickly if so needed, and in the case of emergencies can staff it through extra working, but it will lower our costs in the meantime.

We hope that out of adversity will come strength for LAMB, but for those who will leave this is very difficult. So we would be very grateful for your prayers for them, and that we are doing the right things.

LAMB NEWS – AUGUST 6TH, 2009

2009-08-31T08:15:00.002+07:00

Greetings once more from LAMB. This is a time when we are looking very much to see where God wishes us to work, but first in this newsletter a bit of an explanation about what is happening.

Here in Bangladesh as in many countries, the weather makes a big difference to life. Now in monsoon season here, we have been reminded of the realities.

At its simplest, we see the number of patients coming to LAMB Hospital drops a lot when it is planting season, as now. The same will happen at harvesting time – since both planting and harvesting, and the gleaning that follows, are all completely manual. Planting and harvesting, twice per year in this region, take priority over almost anything – good health can wait.

With the monsoon, in one of our community areas, maybe less than 20 miles from LAMB, the clinic which in the dry season is a pleasant walk or rickshaw ride from the road and a bamboo bridge, is now already extremely difficult to get to and by a long round about route, because of flooding and the fast flowing river. It is easy to understand why common the commonly used term here for such areas is ‘a remote area’, despite seeming physically close to help.

But there are more difficult places. In the past month, LAMB has been asked by two international organizations if we would be interested in setting up health systems in new areas much further away from LAMB. For one, we are told that much of the district is under water for 6 months of the year. For the other area, two of our Directors visited to understand the challenge of getting healthcare to the communities. From the road in a fairly remote spot, it’s a good long walk, then a 30 minute small boat journey across the big wide river to one of the small islands. On this island alone there is a village of 5,000 people – and all the islands are similar. Life for these people is very tough, and if the river floods high and all the island goes under water, then it gets tougher. They have no real money, even to travel by boat, so they need healthcare to come to them. But in emergencies it is very difficult. People would live elsewhere if they could but it is a small country with 150 million people, so there is little choice for land. It is easy to see why mothers, and babies, die in childbirth at much higher rates than in more developed countries.

We wait and see if these are places are where God leads us to work.

Trying to do God’s will is a normal way of life for LAMB. It is sometimes easy though to get sidetracked into ‘interesting areas’ of work. In these, we no doubt do good, but are they what we are here for. There is now new effort both by management and the LAMB Board to refresh the focus on those areas that we believe we are here for – health and justice, and focusing on the disadvantaged, in particular women, children, and the poorest of the poor. As we look afresh at the direction that LAMB overall should be heading, we keep needing to be reminded - and fortunately there are many who will remind us - of what we are here for.

LAMB NEWS – JULY 5TH, 2009

2009-07-23T14:15:00.002+07:00

Greetings from LAMB.

Here at LAMB the monsoon season is with us. That doesn’t mean it rains all the time, but we do have some very long, heavy downpours. It is all part of the annual cycle, and is in truth a blessing – even if for the community outside of LAMB, roads and paths become mud walks. The thunder and lightning which is often a problem at this time of year has so far done no damage to LAMB.

As is often said, times of adversity are often times when new growth starts. That is how it feels at LAMB at the moment. We are being challenged by big funded projects coming to completion, the world financial woes, and a reduced number of patients because of a Government voucher scheme.

But it is extremely pleasing to see the energy, fresh thinking and action now under way. Senior managers in particular are proving to be leaders indeed – getting out and about to find where we can help in the future, looking at the things we do to find ways of doing things better, and then actually making the changes. Simple examples are in making the hospital more patient friendly by setting up an information desk – using existing staff; looking at fairly simple changes to the out-patient clinic so that we can increase the numbers of Training Centre students able to get practical experience at any one time; and at the community clinics publicizing their services better so that community members know what help they can get.

At the big scale, senior managers are now all active talking with other organizations for whom we do work to see what else we might do for them. In truth, LAMB’s high quality reputation is very helpful to us in that.

For us serving here, we often never know in depth the effect that we are having on others through demonstrating God’s love. Sometimes the results come in less direct ways. A US citizen who was at LAMB for a few weeks recently has since commented that she had not previously seen Christians putting their faith into action as at LAMB. After her time here, she wanted to start reading the Bible and exploring her Christian beliefs

We pray that we will continue to be a positive influence in God’s world
And lastly, attached is a photo from the session last month when 30 children had their feet put in plaster as the first stage of repairing their club feet. They will wear the plasters – in this heat and humidity – for maybe 5 weeks, and then wear shoe braces, for a short while all day, and then at night for 4-6 years. A big commitment, but it is a proper cure, low cost, and enables the children to lead a fully normal life thereafter.

LAMB NEWS – JUNE 6TH, 2009

2009-07-23T14:07:00.001+07:00

Greetings from LAMB.
In our part of Bangladesh, we escape the damage of cyclones which hit near the coast. The first rice crop of the year has been harvested, and the fields are full of stubble. The villagers are busy with the straw and grain. Although sometimes a bit troublesome, rains and higher temperatures are starting to be with us, a blessing for this country where so many people depend on agriculture.
At LAMB, it is a time where extra good things seem to be happening for children with disabilities. A generous and enthusiastic Australian businessman has set under way a program in Bangladesh, starting at LAMB, to tackle the problem for children born with club feet. It is using a non-surgical method developed in the 1950s by Dr. Ponseti of Iowa, but only more recently becoming widely accepted.
With the help of another organization which focuses on people with disabilities, LAMB will now also be able to increase its production of assistive devices. Usually – at LAMB – made of wood, these are items of equipment which help the mobility of children (and adults) with disabilities.
We also have the good news of a small grant from a UK charity which will help us with the work to get children with disabilities integrated better into society.
As usual, we have good news of short and long term Christian workers coming to LAMB. Although the most common image is of doctors, teachers and those trained in Bible studies, the support from young, but experienced specialists in such areas as Finance and Epidemiology are making a huge difference to the effectiveness of LAMB’s research and accounting. For them, to see God’s work in this very different environment is a mutual blessing.
This month, we are not without challenges. We would very much appreciate your prayers that God will grant us the wisdom and creativity to find ways to adjust for the future. The number of in-patients at the hospital has fallen by a tenth, as has the number of ante-natal visits and the number of babies being born. This is because in one of the areas from which LAMB patients traditionally come, the Government has started a voucher scheme providing free care, so patients are going to Government hospitals. Although their approach to care is different, if the scheme encourages people to seek care who otherwise would not, and so saves lives and misery, then it is a good thing.For LAMB, we pray for wisdom in how to manage the modest change in the short term, but more importantly to see into the long term as to how we may best be used to bring about God’s vision.

Bangladesh : Rural Life

2009-05-02T13:33:00.001+06:00

The following was reported by LAMB’s General Surgeon in April 2009. It warms the heart and gives an insight into life in the villages of Bangladesh:

“I was asked to see five year old little boy with a draining sinus from the middle of his back and a collapse of the vertebra giving him an extremely pronounced hunch back. He was unable to walk because of weakness. But he always had the most delightful grin on his face.

The very poised young lady sitting beside him identified herself as his sister.

Parents? Both dead.

Who took care of this little boy? She did. And also a nine year old brother.

How old was she? Fifteen.

How did she manage? Worked as a maid whenever she could get work. But also had help from neighbors for food from time to time. Wow!

The next day the little boy was playing on the hospital porch outside the pediatric ward with three or four ladies sitting around. Who were these women? The neighbors. How wonderful to have such supportive neighbors!!! “

LAMB Hospital 25th Anniversary

2009-03-08T11:16:00.018+06:00

Just before winter, 7th November 2008 was a bright day with the most comfortable weather Bangladesh can offer. Just repainted, LAMB Hospital was glowing. Around the hospital and around the site there were decorations, big collages of photographs and information, and lots and lots of people.

7th November 2008 was a day for celebrating - celebrating all that LAMB Hospital has achieved in its 25 years of service - and a bit of dreaming about the years to come.

The day started with LAMB staff gathered in the Hospital Outpatients area for devotions and thanksgiving. Then hundreds of the staff and their families paraded around the LAMB compound and out into the lanes around LAMB playing music and dancing with banners-festoons. These were just the start.

Under a canvas roof, the main morning session started with recitations from holy books and then moved onto speeches of many types. Some speeches referred back to the late 1960s, when the idea for LAMB Hospital was first conceived, some followed through the history, and some referred to the LAMB of today, and the work it does and its people. Nineteen speeches in all, yet the time flew by for the audience of 500 guests and staff be cause of the variety and energy.

Gary Hafvenstein had who came all the way from USA, representing the World Mission Prayer League founders of LAMB, noted that “Today we celebrate 25 years. But, the birth of LAMB goes back many years earlier. And it was not birthed by man. Rather, I believe that LAMB was born out of love flowing from the heart of God, a love for the world, a love for Bangladesh and her people. And it is the love of God that motivates the work even today at LAMB.”

Representing the Board of today, Ms. Elisabeth Blanc, praised Lamb's leadership as a model for the country in that its first desire is to please God and serve Him through the work at Lamb, without aspirations for a personal career or personal financial gain.

Representatives from partners, donors, and local government praised LAMB for its work and its achievements and recommended it as a fine example for others working in the field.

The session closed with LAMB chairman, Richard Waddell’s speech commending the green shoots of growth at LAMB followed by the surprise cutting of a HUGE cake with 25 candles .

Lunch was a massive exercise – feeding nearly fourteen hundred people. Much to the relief of LAMB it went remarkably smoothly.

More than a thousand gathered in LAMB compound field for the afternoon. The afternoon session was the main fun part, with lots of performances – mainly humorous – by LAMB staff and their children. FOUR AND A HALF HOURS of fun and talent – and yet there were still more than 600 people sitting and standing as the day was brought to a close.

It was a great day at LAMB, like nothing before, with so many people contributing so much energy and creativeness (and preparation).

“25 years of service” is what LAMB Hospital has been about. LAMB Hospital has proved that “Quality Healthcare for the Poor Is POSSIBLE”. LAMB hospital has indeed become a part of the community as a “Friend In Need”.