Black market beer

Another great day in Gangtok. We went up the hill to a hindu temple to see the view from there. It was raining and misty so no view. Still it was good to see the temple and the huge statue of ganesh. We also went to a Buddhist monastary where we also encountered ganesh.

The tea here is amazing as its grown nearby. We went to a tea shop and met two american tourists who were good to talk to. We went for dinmer at the same restaurant as on monday. Today we tried special chow mein which was terrible is comparison. Still, the momo were great.

We are currently back in our favourite bar which is packed and kareoke is in full swing. We are getting to know the nepali songs, but there was also creed which was strange. Its dry day here due to a hindu festival so no beer. Although the bar keeper did come up to me and say in hushed tones "I can get you beer. we hide it in a cup". I opted for a lemonade as I dont want to offend any hindu customs. It does however, explain why the rest of the patrons are drinking out of mugs.

Neil

Don't mock gangtok!

Gangtok is a superb place! It is almost like a little tibet and most of the people here are more tibetan in appearance than indian. We went to a tibetan restaurant last night and had some great dumplings (momo) which were excellent. Although we loved konica's cooking it is really pleasant to eat different things!

This morning we had a walk up to the top of the town and found a nice park and some great views into the valley. It is stunning here. Sikkim is actually geared up for tourists and even has an information centre. We got hold of a map of the city amd decided to head down to a set of falls which seemed pretty close.  After walking for 20minutes we figured that we must be going in the wrong direction so asked for help. Apparently the map we had was not at all to scale and we needed transport to get there. We got a taxi down a very bad road, each minute neil and I agreeing that we definitely could not have walked. The falls were spectacular and a tourist centre had been built around then. There were beautiful bridges and pagodas. There were even some children's play equipment including a hamster wheel. This was great fun.

We met some Scandinavian medical students today (if we see other tourists we feel compelled to talk to them). They were working for the same organisation as the students we met in kolkatta. They also had had travel plans to darjeeling ruined so it was nice to talk about where to go in gangtok.

The weather has turned though so were are hoping for it to improve before we visit the temples and monasteries near by. They have nice view points but the valley is just pure fog at the moment. Our general feeling is that sikkim is a great destination.

Where on earth is Gangtok?

So the first rule of travel in india is to be flexible! The last 2 days have been crazy but we are now sitting in a bar in gangtok  while neil and some men sing karaoke. Completely surreal!

We left Sarenga at 6 on Sunday morning and drove for an hour and a half to the station. We were driven by Surijit who has the only car in Bankura district with seatbelts. We waited in this rural station getting strange looks and getting even more hot. When the train came it was incredible to walk into an air conditioned carriage. In indian trains different men come round and sell everything that you could possibly need. Neil and I bought some books for our journey and our long awaited jhall mori (it was well worth the hype). Once in Howrah station we were met with a wall of heat. We walked to the launch and got the boat across the river. While we waited the boys playing in the river chatted to us and asked for "one photo please" (this reminded me of the children in Likhubula). Once over we headed to the beautiful victoria memorial park. This is a green haven in the middle of Kolkatta. Modern thinking young people come here on dates. That is right: unmarried men and women can actually hand hold or if particularly keen hide behind a bush or umbrella and kiss! This was a shock for us as men and women barely talk in the villages. Also inthe park we met some austrian and german medical students and an adorable family who lived in Howrah invited us for dinner. We had our photo taken with so many people, it was like we are celebrities!

We walked to a nice part of the city to get something to eat. Pretty early in our search we found a pizza hut and the need to not have rice overcame us and we succumbed. No regrets! We had a good meal in a place with ac and a working toilet. After that we got a taxi to Sealdah station. Neil describes this as "hell on earth" and "reminiscent of a refugee camp". While waiting for our train we sat on newspapers and became friends with Sardeep Hussain who was coming on our train too. He is a lawyer we was overjoyed to meet some foreigners. The train to NJP station was lovely but we spent the whole time asleep. When  we arrived, our friend Sardeep helped us to a taxi to the place buses go from. We were all set to go to Darjeeling when our taxi driver said that we would be able to get there but the hotels and shops would be closed and we should go to Gangtok instead. He convinced us and we got on a jeep going to Gangtok. This jeep did not till it was full. Full meant 11 people including the driver? To give you the picture, this was the size of jeep which in Britain would take 2 children to school.

Sitting in the back, we befriended the 2 men with us. One was Samik, the Che Guevara of the hills. He is an artist in Goa but is from Kalimpong. He is setting up an animal sanctuary in goa and is involved saving street children in the towns and taking them to Darjeeling. He was such an interesti8ng man who was very politically minded. Apparently "india is a paradox". Our other back seat friend (who I can't remember the name of but he bore an uncanny resemblance to Richard Hammond; if Richard hammond was indian!) was an engineer from Bihar. I spent some time talking with him about his relationship woes. "Women here are only interested in you for your money!"

The drive was rickety and very hot. We climbed further and further up into the mountains, it getting cooler with the altitude. When we reached the border to Sikkim, as state to the north of west bengal,  we had to deal with Indian bureaucracy. We needed a permit to enter the state. This required a passport photo, which of course we did not have. We had to pay the man half the cost of our jeep travel to photocopy our pictures, all the while holding up our fellow travelers.

Eventually we reached Gangtok, a mountain town in the beautiful, green Sikkim. It is so clean here. There is even a pedestrian precinct in the main shopping street. Our hotel is wonderfully clean and the man at reception is lovely. We are hoping for a pleasant few days in the cool of the Himalayas. We have been overcome by the friendliness of the Bengali people. So far, so good.

J x

The beyond begins

Today has been our last day in sarenga. We cannot quite get our heads around it! We did our last baby checks this morning. It is odd that just 6 weeks ago I had only done a baby check on 2 babies before! 
Much of today has been spent in reflection (as well as packing). In many ways we could not have dreamed of a better elective experience. We have learnt so much about medicine and indian culture, had the opportunity to practice skills, been able to teach, to do clinical audit, to present our findings,  to make friends, to have fellowship and  to experience first hand the lives of modern medical missionaries. We  are both feelig incredibly blessed by the time that we have spent here and are so thankful for shubhro and Elisabeth having us. Reassuringly, they are also happy to have had us.

To mark our leaving, some of the students put on a small programme of things for us. Two of the girls sang, one danced and then we all danced in the local tribal fashion. I was roped in to doing a little bit of solo scottish dancing which was fun considering there was no scottish music! Neil and I are nearly experts in indian dancing now (or just feel like we are!). It was really touching for us that the girls did this for us and as we left we were being told to come back.

Tomorrow morning we rise early and get a train (from the station 2 hours drive away) to kolkatta and in the evening we head up to darjeeling. We will hopefully enjoy some cool weather in the mountains before going to the sunderbans in the south of west bengal. After that we become stereotypical indian tourists and head to the taj mahal and then see delhi. We aren't sure how much internet access will be had in the coming 2 weeks but we shall endeavour to keep this up to date.

For any of you particularly interested in our work here in sarenga, I am sure we will be both more than happy to speak with you when we are back but until then the hospital website can be found at www.ksnhospital.worspress.com

Please continue to pray for us particularly for our safety. Thank you

J x

For you, little child

Thanks to a course of industrial strength antibiotics jenni and I have recovered from our illness and are getting back into work. We managed a full day today which was great as we are not here much longer.

We started as usual with baby checks which was good fun as we took lots of pictures for people back home. Jenni found a baby with an umbilical hernia which is something it will grow out of. My family dog has an umbilical hernia so apparently dogs dont grow out of them. After noting the diferences between baby and dog hernias we climbed the roof of the outpatient department. This is the highest part of the hospital so we got good pictures.

We went in search of food but only found disappointing chop and not the ellusive jhall mouri. The antenatal clinic was busy as ever. It was nice to reflect on how far we had come in terms of examining the patients and coming up with a plan. We found a patient had high blood pressure and swelling so we thought she had pre eclampsia. We wrote up orders for urine protein test, platelets and haemoglobin.  Elizabeth was happy with our plan and she was admitted for induction after she had the tests.

This afternoon we presented our audit on the use of episiotomy (cutting the vagina during childbirth). With 1666 patients its the biggest audit we have ever done. We found that the rates of episiotomy fell by half in the second half of the year. The hospital now has rates comparable with the uk which is very good for developing health. The episiotomies are done by nurses who dont really understand why they do them. It's a complicated decision to make and they dont really know enough. The fall in episiotomy rates is partly due to a midwife called karen who came from the UK for two weeks in february. Since her visit elizabeth has been working with the nurses encouraging them not to cut. Since then the episiotomy rate has halved. This is encouraging as it shows the impact 2 weeks can make if the person is using best practice and can teach well.

We decided to try our luck and go ahead with plans to travel to darjeeling. The civil unrest is easing now and we leave on sunday morning. Mr Baux says "it is a bold decision but I think it will pay off". We hope he is right as we dont want to get stuck without transport.

Unfortunately we have some sad news as well. The baby we mentioned in the last post died today. Though we knew it was unlikely she would live, she showed a lot of strength in her short life. Her tiny hand moved and gripped, her tiny tiny chest strained to inflate immature lungs and she even managed a feeble cry when she wanted fed. She clung to her mother all her days and was totally dependant on her for warmth and food. Though short, her life was immeasurably valuable as she was made in the image of God. When children die here I remember the french blessing we say at church and I am comforted.

"Little child, for you Christ died
For you he endured calvary
For you he rose on the third day
Even though you do not know it
So the scripture is fulfilled
'We love because he first loved us'"

Neil

Kangaroo care

Its been a quiet couple of days as jenni has been very ill with a bad worm infection. Jenni joined im solidarity with 1.5 billion of the worlds population who are infected with worms. She has had de-worming medicine and is now on the mend. Today I too have had a tummy bug but its more of a classic bengal belly and I think I am on the mend also. Konica blames my illness on too many sweetsfrom the bakery. She could well be right but they are so delicious its worth the risk.

last night shubrho taught me how to do a spinal anaesthetic. This was pretty exciting as its quite a specialised procedure. I managed to do it fine but I cant yet claim a champagne tap as there was a tiny bit of blood in the first drop.

Overnight we had a very small and very premature baby born. There isnt much that can be done for her and it is unlikely she will survive. We are trying kangaroo care which involves skin to skin contact with mother and baby. We brought some kangaroo care slings from the UK which are like a sling that holds the baby in place. Its the best way to keep a baby warm and is just as good as an incubator. 

Death and rebirth in Sarenga

So a lot has happened in the last few days but we haven't blogged due to technology issues. We have a few pictures which we can hopefully attach.

I'll start from friday when we presented our audit to the doctors at the meeting.  We were very happy with the work of our audit as it showed some promising change but lots of room for improvement. Evidence based medicine is not understood well by the doctors here. We discussed the social barriers the doctors have when trying to do the best treatment. The problem is that when a child has diarrhoea the parents stop feding them and demand iv fluids and antibiotics. These treatments are not needed and may cause harm in the majority of cases. Interestingly there was a period in our audit which had a marked increase in iv antibiotics and fluids without more patients. We raised this in the meeting but shubrho quickly dismissed it as coinidence and got us to move on. He explained afterward that the 3 weeks of poor management we described were when one particular doctor who was at the meeting was on duty. We found this quite funny but also interesting that one person can skew the results of the whole audit.

On saturday I was invited to the funeral of the mother of the builder who is employed by the hospital. Shubrho and I took the ambulance out to a wee village where the celbration was taking place. After a designated time of mourning there is a celebration feast when someone dies. Our host, the builder, greeted us dressed only in a dothi which is a peice of cloth that men wind around their waist. He had a shaved head as part of his mourning practise. The format was much the same as a wedding. There was a huge cooking operation underway when we arrived with massive pans set on bricks with a fire underneath. This was all going on in a paddy field which the builder had drained for the occasion. Despite being in a field there was a big tent which even had fans and electric lighting. The food was excellent as always and there was plenty of it.

After the meal we bumped into one of shubrhos patients, a small boy who had ashma. His toothless father invited us to his home to see the house. The house was made of mud with a thatched roof and I think their goat shed was about the same size. The family all came out to greet us and show us around. Despite being surrounded by mud, the sisters were wearing bright yellow salwar kameez with fancy shawls. I myself had white pyjamas which had bright yellow curry stains so I think I looked he part.

Also on the way back we stopped to look at the river. And all the dundee folk will love this... there was a field of jute next to us. While we were standing there a wee boy came up to us and demonstrated how he could dislocate both shoulders. We were suitably impressed with this party trick so he did it again.

On saturday the local hindus were out appeasing thesnake godess. This involves setting up a big sound system in front of the deity and having a big gathering with loud indian music. The idea is to get her to protect you from snake bites in the coming year.

Today we went to church early in the morning to see he baptism service. The service was fairly long and as it was in bengali I only pick out the odd word. After the service we formed a procession led by the church band and walked through the streets following the sounds of the tabla and harmonium. When we arrived at the pond the pastors waded in and got to work babptising 30 people. Meanwhile children were swimming round and mothers were washing clothes on the bank. This was a really special time as lots of the local community came out to watch and it was good to see the church being visible.

Neil

Independence day

Today is indian independence day, celebrating 66 years of freedom from british colonial rule. This morning the hospital put on a special service around the flag pole at the main hospital building. The nursing students we standing facing the flag in a semi circle under the shade of a tree with the nursing staff standing opposite in a little patch of shade adjacent to the hospital entrance and the doctors, lab staff, groundsmen and general onlookers standing behind then students. It was very warm this morning and the students would shuffle every so often to stay in the shade. The service itself was of a fair lengh and in bengali of course. It involved singing the national anthem, saluting the flag, some singing by a small choir of the students accompanied by a harmonium, a speech by the local minister and a prayer. Once finished we all went into the antenatal clinic where breakfast was waiting for us. This consisted of 5 fried bread type things (not like bread back home but indian bread similar to a fried tatty scone but less thick), some spicy potato and then some sweet orange and pink balls (I have no idea what these we made of but were very tasty). This was washed down with the smallest cup of sweet tea ever (the cup contained about 2 slurps). It was nice to see the unifying effect of the food on the hospital staff.

Independence day is a national holiday so no clinics were on today. It has been an extremely quiet day for medicine. We have been hoping to get some practice delivering babies but in the last few days every time we sit with a woman she has needed to go for c section. Currently there is no one even close to delivering on the ward. This has given us lots of time to collect data for our audit on births here. Currently we have information on over 1300!

Neil's sandals are karap (broken) so we went to the shoe shop to get some new ones. The largest size they had is 10 (a size smaller than neil). He is now sporting a beautiful new pair with his toes poking slightly over the sole. He can't really complain-they were less than 4 pounds. Apparently he should be able to get his old ones fixed for 30p so they are off to the cobbler tomorrow.

I've attached some pictures from independence day but also the sign from a school on the road to the hospital. We imagine that it is filled with pin ball machines!

Jx

Cross cultural medicine

The student nurses leave for a holiday on friday so before they went we thought we should have some mixing of cultures. We decided we would teach them some ceilidh dancing and they would teach us some indian moves. We got the hifi set up and waited for them all to arrive. Some were dressed in their plain clothes, salwar kameezes,others had come straight from ward duty and were in their clinical uniforms.

We started with a Gay Gordons. Neil and I demonstrated and told them to take partners. Only 2 girls came and joined us. We went through it again and another 4 came up. We tried to persuade them all that everyone takes part in a ceilidh. This did not work. Music on and away we went. Neil yelling "forwars two, three, four..." some of them really got the hang of it and we started to have a good time. More students came to the courtyard and we encouraged more to join in. Maybe one 6th of the girls were dancing now. Then the electricity went out. Not to worry: Orcadian strip the willow just needs clapping. This was hilarious. When neil and I started spinning, laughter erupted. The most haphazard dance then ensued. We thought we should try one more dance with the music back working. Again there was very poor uptake but those who danced had fun.

Now the indian dancing began. One of the girls is a very good dancer and she came out with another girl and they started to dance. I joined in trying to copy their steps. Again this was highly amusing for any on lookers. They were very patient with both neil and I. We learnt a fun dance which incorporated some chicken like moves. Arms behind your back with elbows out, flap them and then sort of peck at the ground. Good fun. Then a new track was playing and we got into a circle to try out some steps. I think I got the hang of it eventually. We are both exhausted now but we had such a good time. It has been lovely to spend time with the nursing students. Our friend jolti was disappointed to hear that we will be gone by the time they get back from their holidays (she thought we were staying till christmas!) Hopefully if we encourage some more dundee students to come over here, they will have better luck getting a proper ceilidh going.

One of the cd's that the girls brought out contained christmas tunes. We never could have imagined that we would be in west bengal dancing in an indian style to wham's last christmas! It was great fun!

See one, do one, teach one

Today we held a workshop on examining babies for the student nurses. We wanted them to be good at recording a babies vital signs as often we find every single baby has a heart rate of 140. The lesson went very well. We started with a short lecture on normal babies and then headed to the ward where we recruited two babies to demonstrate on. The students were very enthusiastic and keen to learn. One of the students, Jolti translated for us. We think they enjoyed the lesson and it was good practice teaching for us.

We are currently sitting in the dark with a candle having our dinner. The electricity which is always inconsistant has been particularly flakey today. Despite the hospital being in darkness (except mat ward which has solar panels), the loud music which has been playing since dawn is still going strong. The pounding beat and wailing vocals are relentless and insidiously annoying.

Despite having had enough indian music for a lifetime we are doing an event with the student nurses where we will teach them ceilidh dances and they will teach us traditional indian dances. This is pretty spontaneous but luckily Jenni is a ceilidh expert trained in the art of country dancing.

The title by the way is an old saying about training in medicine which no longer applies in the UK. Here however, it is indeed possible to see one, do one and teach one which is what makes learning here so fun.

Neil

Wedding ambassadors

We went to another wedding reception today. This one was extremely short notice. The groom went to Kolkata on business and came home to be told he was getting married in a weeks time! It was in a village about 6km away so we traveled in luxury indian transport: the HindustanI ambassador.

When we got there we could here music being blasted from giant speakers and walked round the corner to see people eating rice off banana leaf plates sitting on the ground under a canopy. We were ushured inside and told to sit on some chairs. We met the groom, a man with a very nice face and a broad smile, and then his cousin brought us a drink. A concoction of water, lime, salt and sugar. It tasted a bit like the rehydration drink that you take with a tummy bug: delicious. Then some sweet syrup soaked balls were brought to us on little plates. While we were eating there were little children staring at us but they were very shy and wouldn't speak.

When finished,  we were taken to the next room to meet the bride. She waa beautifully adorned and her new husband jumped up on the bed beside her, clearly thrilled at his family's choice. She looked like she was in a state of shock but we think that they will have a happy marriage because of the way the groom is. He was a very good and attentive host. We were then taken to the eating marquee.  This family was a little poorer than the last so there were no fans. The food was excellent. We had learned from the last wedding to take small amounts and to stop the servers pilling more onto your plates. The groom's uncle, an elderly man with superb english, came over to our table to make sure that we were being looked after. He brought his grandson with him, a boy of 9 who was very like his grandad. He also spoke english very well and his grandad told us he was a good singer.  We persuaded him to sing for us. A song his grandfather had composed. It was just lovely to get to know these 2 and to see the pride in the grandad. Once the eating was done we said many thank yous and left for sarenga being waved away by our new friends. When we go to weddings we are treated like guests of honour just because we are foreigners. Indian hospitality is really wonderful.

Yesterday we went cycling into the jungle yesterday. A fun mixture of tarmac and single track mud. The two biggest dangers on the roads are buses and herds of cows. Cycling with 20 cows coming towards you is particularly terrifying as it is difficult to work out the path to avoid a collision. It is a great way to see the rural villages. As we ride through the villages the children say hello or are very shy and just stand amazed at these strange white people going by. We got to see all the aspects of village life which is just great. Several of the men had green in their hair and I was convinced it was from the soap they used. I was wrong! It was something to do with a political party. When we got back to sarenga there was a brass band playing. This was also a celebration of an election. We don't really know what was going on.

J x

5th time lucky

As expected, today has been quite quiet. We had a hilarious moment this morning though. We looked in on one of the women in the mat ward (a lady recovering from an eclamptic seizure) and saw that she was covered in a sheet. She wasn't moving so we thought that she might be dead. We looked in her notes and couldn't see anything written about it. Surely their record keeping couldn't be that bad. We saw that her blood pressure had been taken just an hour before-maybe only her family noticed. We didn't want to go in and check, unsure of the cultural practices around the dead. I went to the nurse on duty and asked her what was going on, was she alive? She walked into the room with neil and I in tow and much to our surprise the woman pulled the sheet down from her head and smiled out at us! Apparently sheets are the best way to keep out the mosquitoes. 

We also had a very fast delivery this morning! The woman was pregnant for the 5th time (all girls previously of course). Within an hour of her waters breaking she was delivering! Neil just got his gloves on in time to catch the head before it was out completely!  We have been used to women having their first child taking a lot of time between getting into the labour room and the head coming out. The speed on this occasion was markedly increased! Thankfully the baby was a boy so she won't need to get pregnant again. There was even a slight cheer in the room! In the month we have been here I find myself more pleased when a boy is born than when a girl is. This is mostly due to the families reaction to the child. Last week, when a women gave birth to her 2nd girl she wailed when she was told the sex. The reason for this is that when girls marry they leave their parents home and family and become part of her husband's family. This often means moving miles away and never seeing their own families again (except when they are giving birth when their own mother is allowed to be present and look after her). The family also has to pay a dowry to the husbands family when they get married. Lots of girls can be quite expensive. Only boys get to stay with their parents forever and look after them in their old age. You can't get too attached to your female children as they will one day leave you. You will be left wondering how she is being looked after and whether her mother in law is working her too hard. Knowing that much of their daughter's life is out of their hands must be very hard. Having a boy means future security and less heartache.

Neil has a bash at surgery!

Ok so a lot of excitement just occured while I was writing this. Jenni heard a squeaking from the next room so we tentatively went to look.under the desk we found a rat in thefinal throes of death from rat poison. However when we found him he started moving around. Since he was in distress I decided to dispatch him in a swift and peaceful manner. We trapped him the waste paper basket and carried him outside. I then took a hoe and smashed it down on the poor creature cutting him in half. Unbelievibly he was still alive and was in more distress so I smashed his head a few times for good measure. We must have made a bit of noise during the excitement as Shubro and the night watchmen came to see thinking we had found a snake. The night watchmen disposed of the rat and we returned to our peaceful evening. I feel the situation has only served to strengthed my opposition to the assisted dying bill.

Anyhoo, on with the blog I was writing before I was interupted.

We just packed away the audit for the night. At 318 patients its already the biggest audit we have ever done. We are looking at rates of epesiotomy in the hospital which are way too high. We finished our audit on gastroenteritis and will present that next week. We are both very pleased with this work amd we hope it will make a difference to management. The data we are collecting at the moment is lovingly written down by sister bokkit. she sits in the office and peers at you through thick round glasses as she fills in the labour record. She can't be older than 70 but looks 100.

Its been a busy day here. We started off with usual baby checks. Some were jaundiced, some had murmers and some just looked a bit odd. All the babies need winded and we have no idea what the bengali word for winding is ( or if there even is one), so our conversation when translated is something like "after your baby eats milk you must..." and then we put the baby on our shoulders, pat his back and imitate the noise a baby makes when winded. The mothers seem to understand but are nonetheless confused and tentatively have a go themselves. Unfortunately the patients are rarely in the hospital so get a good feeding and winding routine established and mother in laws are invariably useless (at most things) at passing on their mothering skills.

I am still a bit shaken up from the rat incident so I feel it is time for dinner.

Neil

Some babies never cry

Today I learnt about another interesting aspect of Indian culture. There are strict rules on the interaction that can occur between a woman and her brother in laws. This is applicable to both the brothers of her husband and the husbands of her sisters. It is very important that she does not have her hair down when he is present. She should really cover it with a shawl or scarf if he is around. They cannot touch. Ever. Even a slight graze is forbidden.  I discovered this was the case in clinic today. A woman came in having trouble conceiving.  She had lost her first 2 pregnancies. During the first one her brother in law had touched or hit her abdomen.  Somehow this put the paternity of the pregnany into question (I don't think sex education is well done here) and she was forced to take some herbal remedy to abort the baby. She sadly miscarried the second and is now very stressed about losing another baby. Firstly, I cannot understand why the brother in law would touch her (let alone hit her) if it is unacceptable. Also the person who has suffered most from this is the woman herself. It is just so tragic that a life was taken away for what seems so trivial to me. Men often don't have to suffer from the consequences of their actions.

This morning we were putting our management of newborn baby skills into action. When examining one of the babies, neil found him to have a slow heart rate. He was also a bit cold. He had an incredible level of body control especially for such a small baby (2.4kg). When you stand him upright he can almost stand by himself! Anyway, we took him through to the nursery amd got him under a heater. His oxygen levels were also pretty low so we gave him some oxyen. His heart rate was still low and we noticed that it was quite irregular. All these things were worrying us so we gave Shubhro a call and he said to get him warm and reassess. We got him warmed up but his levels and heart rate stayed much the same. He went back to his mum and got Shubhro to come and see him later. After some reading we think that it is because he quite a low birth weight which can cause a slower heart rate than you would expect. Neil had read that exercising the baby should increase the heart rate. The one time he needed the baby to cry it wouldn't. Instead he danced it around and the heart rate came up confirming his diagnosis.

After clinic, Elisabeth and I went up to the mat ward to deliver a baby. This mother had had a previous caesarean section so she would usually have had a scheduled one a few weeks before her due date. The women here don't often come up for this earlier operation, instead waiting until their waters break or the contractions start. This is dangerous because the scar from the previous operation means there is a weakness in the wall of the uterus so the uterus can rupture at this point. In the uk they try and encourage women to have a normal delivery after they have had a c section but here there is no blood bank and they don't want to have to deal with a uterine rupture. This mother delivered normally and she was fine. It was important that we delivered her quickly to prevent too much strain on the muscle. Just yesterday another post c section lady came in too late (3 weeks after her operation date). She ruptured her uterus during the c section operation. She is doing ok but it just highlights the problem of the women not coming in when they should. She is pretty much guaranteed to rupture again if she gets pregnant. Will she come in before labour starts? Probably not.

J x

The waters have broken!

After a few days without rain it is back and coming down more than ever! We left the house at midday and the weather was fine so we left our umbrellas. Big mistake!  We had gone up to see a baby that was just new from a c section but she was breathing quicker than normal. Shubhro wanted to check to see if this was due to a heart problem or a breathing problem. To do this we measured her oxygen levels using the infrared probe that Neil had brought from the UK (an amazing 19 pounds on Amazon! ). If she responded to being given oxygen through a mask and her levels went up then we would know that her heart was ok. They did so we are reassured. She will stay with oxygen on until her breathing normalizes

After that we went and stayed with a woman in labour, monitoring the rate of her contractions and listening to the baby's heart. For a while we couldn't hear it because her bladder was full and she wouldn't pass urine so we had to put in a catheter. We have discovered that this is particularly difficult when they are close to delivering as the baby's head can stop you advancing the catheter tube. We stayed with the mum all the way through but when it came to delivery she was very tired and couldn't push well. She hadn't really eaten all day and hadn't had water in the morning. Her blood pressure had been high and was still high so we didn't want her to be pushing for too long. With every push the pressure in the brain increases which in turn increases the likelihood of seizure. Incredibly she managed to find some strength from somewhere and delivered without the need for forceps.

During this time the rain had become to pour and we heard thunder in the labour room. By the time we came out, the maternity courtyard had become a swimming pool and the ward itself was filled with water. A praying mantis had also appeared, apparently they like to come out in the rain. It crawled onto Elisabeth and caused a hilarious scene of Neil and a nurse screaming at her and Elisabeth dancing once she felt it on her back. One of the nurses knocked it off her and then proceeded to squish it to our horror. Elisabeth had very kindly brought our umbrellas so we went home for lunch (a very late one at 4!)and then headed back to the ward with some brushes to sweep out the water. We managed to get most of it out. We don't quite have Bengali thighs yet (the brushes don't have handles) but we are working on it! No electricity at the moment means that we are sitting with the candles on listening to the rain and the thunder outside. This is what a medical elective in monsoon season should be like! We have jelabes so no complaints from Neil.

We thought we would give you all a little update on some of this week's cases. Unfortunately the very premature twins died at the weekend. The lady with eclampsia from yesterday is doing much better but is quite anaemic. Her baby was still-born.

J x

Feet first

Today we have had not one but 2 breech deliveries. In the UK, babies that are feet or bottom down are delivered by c-section. It was both odd an terrifying to see a small baby foot poking out the mother's vagina. Here the risks from c section mean that it is safer for them to be delivered normally. This was the first time we had seen this happen so it was really good to see the technique used. The first one had a foot coming out when Elisabeth and Neil got there and the second was even more tricky as its feet were up by its head! Both babies are doing very well.

We've spent the majority of our day with a young mother who had had a seizure this morning. She was extremely confused because of this and couldn't understand why she was in hospital. It also made her very uncooperative. Some of her male relatives had to come in and hold her while she was examined. The nurse looking after her was extremely displeased at this. It is unheard of to have males anywhere near a labour room- this is women's business! How different from the UK where men are encouraged to be with their wives or partners and it is the doctors and medical students that are often being chased away by the midwives! We spent the day observing her and became worried when she was quite unresponsive. Trying to manage an emergency situation with nursing staff that don't speak your language is certainly a challenge.  Thankfully a strong contraction roused her and she didn't need intubated and sent to another hospital. Women with eclampsia can often temporarily lose their sight which just added to her distress. She had a catheter in for urine output monitoring and this was irritating her. Eventually we had to get her mother to sit holding her hands to prevent her pulling it out. The family seem very distressed at the situation and want reassurance that mother and baby will be fine. Unfortunately we are unable to give them any. We have stopped monitoring the baby's heart rate because it is is either very premature or has grown very poorly in the womb. This means that it probably won't be able to cope with the stress of the mum's condition and labour. The priority is to keep the mother alive. Please be praying for her.

The theatre is too hot

The theatre is way too hot. It was hot to start with, then the door broke. Now we can't use the AC and heat and humidity is ridiculous. On two occasions I have nearly passed out during C sections and Jenni also fell victim to this oppressive heat.

I found myself in theatre most of this afternoon for a lady I thought would have delivered by lunch. Her waters broke 2 days ago so this baby was due to come out. During the morning she progressed nicely and the fetal heart was sounding good. Just before lunch elizabeth found that she had stopped progressing and gave her until 3 or else do a C section. After lunch the baby was still stuck with his head in the transverse direction so we went off to theatre. This involved putting a tarpaulin over the woman to protect her from the rain and Jenni acting as the portable drip stand. I had to shout at the families waiting outside the mat ward to get out of the way as I pulled the trolley and of course they didn't. This would not happen in the uk as the labour suite would be next to the c section room and there would be a roof around.

Elizabeth started with a trial of forceps which didnt work as she couldn't rotate the head (we didn't have the special turning ones). Elizabeth pushed the baby back into the abdomen and started a very fast C section. By the time I had scrubbed she was cutting the uterus. The baby cried as soon as he arrived and seemed ok. The uterus had torn and was bleeding lots. Elizabeth took it out the abdomen and I put pressure on it to stop the bleeding while she sutured it. It was an exciting operation, but by the end I had employed a poor nurse to dab the sweat that was running through my hat and onto my face.

The mother lost a lot of blood so the husband donated his for a transfusion. The baby probably has an infection and is in the nursery getting oxygen and antibiotics. I think he will make it as he is a big sturdy baby.

When we are not sweating it out in theatre Jenni and I have been sweating it out on our wee cycles about Sarenga. We went out into the countryside to see the rice paddies. Yesterday we went to get more jelabes. Oh, and the roads are crazy here so cycling is fun. Jenni is a bit more... Indian in her cycling than I. She won't stop for anything, rings the bell constantly and even bumped a guy as he walked on the road.

Please pray for the baby that was delivered today.

Neil 

Dada, didi, cha?

We have a bit of a confession to make. Our stay here in india is not as rough as some of you may think and is in some ways quite colonial. You see we are very well looked after by Konica,  the housekeeper of Shubhro and Elisabeth.

She has worked for the different medical superintendents here since she was a child and is now in her middle age. She speaks very little english but is very keen to help us with or Bengali. She is an exceptional cook and tries very hard to make things that we like. (She knows that I like her tomato relish and neil likes chipati).

Today because Shubhro and Elisabeth are away visiting the bishop she made us some mashed potato and chicken. It was odd having food without any spice in it having gotten used to indian food. In india you never really address someone by their name instead using some other term. Konica calls neil dada or big brother and me didi or big sister. Even though she is our elder she feels she has to use a term indicating respect. This took some gettig used to. We are becoming accustomed to having lots of things done for us that we are not sure how we are going to cope without her at home. Having someone asking you if you would like tea at various points throughout the day is a true luxury!

Elisabeth says that when Shubhro became medical superintendent that she didn't feel that she needed a housekeeper but to deprive her of her income would be cruel. Konica has something that many people in the area would be lucky to have; stable employment. Much of the work is dependant on the rains and many families go hungry when there isn't work. Its a big part of indian culture that rich people employ staff to give work to those less fortunate.

In india labour is astonishingly cheap. A nurses income from the night shift is less than I spent on a box of cereal today. The grass is cut by many people with blades rather than one man and a lawnmower. To have konica as a cook seems frivilous to British people, but here it is an essential means of employment.

Jenni and Neil

Thank you

Not much to say to day except to thank all you for your prayers for our exams. Neil and I both passed. For me especially, I know that this would not have been possible without the support and faithful prayers of so many of you at home. We are so thankful for you and for your continued prayerfulness now. Please continue to ask for God's name to be known in this place, for the work of Shubhro and Elisabeth in showing the face of Christ to those in need, and for us that we may be a source of fellowship and blessing here. The more we learn of people and life here the more we can see how much these people need Christ (just like we all do). There is a hope found in Him that is so much fuller than the hope people look for in financial stability and education. We pray that it would be His hope that is found in this place.
J x

You are the SALT of the earth

This afternoon we visited part of Sarenga known as choto sarenga (little sarenga). This is part of a program called SALT which KSN hospital are trying to develop. Shubhro and Elisabeth have tried to explain to us what this is but Shubhro says that no one really knows. It involves lots of buzz phrases such as "going into the community" and "collaberation of hospital, church and community". The letters stand for various things (all of them pretty vague in meaning). For example S stands for supporting and situation.  Neil and I were very confused. Bobby (an indian- south indians have western names apparently), who works for various charity projects using a technique called Human Capacity for Response (another buzz word), is visiting trying to help get the program going. Again we don't really know what this means but I think it is humans know instinctively when things are not right so you can ask people about concerns that they can identify and work on them.

So with the unknown ahead we jumped in the back of an ambulance with 4 young people from the church and drove for 5 minutes honking at goats to get out of the way. Once out of the car we walked to a courtyard between 3 houses. Each had mud walls and a thatched roof (one also had the addition of a satellite dish!). There we split into 4 groups and went to a few of the surrounding houses and talked to some families about concerns they had about the hospital.  Then we all came back together and discussed it as one big group. Plastic seats were brought out for us to sit on and the community people sat under a veranda. It was a bit slow to start off with but eventually things got underway. It was very interesting and good to see what some of the people thought problems were. Outpatients has a bad reputation.  If you want to see a specific doctor that can be a problem. Also notes get lost. They were insitant that neil and i contributed to the discussion so we said who we were and that it was all very good for us to hear. After this we were brought some tea and biscuits. There is no way to voice a complaint in the hospital so this was a good opportunity for people to get things out in the open. Hopefully it can be taken on board and things will change for the better.

One theme that came out from discussion was that parents consider their own lives to be of poor quality and so do everything they can so their children can live better. It's a nobel thought but it's slightly depressing that peoole have no hope for their own lives and try to live through their children. It makes the church involvement in SALT understandable. Healthcare, sanitation and education may take a generation to change but hearts and lives can change in an instant. These people live and exist in the present but their hope is in the future. We are praying that the church can give them hope in the present for that is where true reality is found.

Jenni and Neil