July August September 2013 Newsletter from K.S.N. Hospital Sarenga

We returned to Sarenga on 14th July, along with Neil and Jenni, two final year medical students from Dundee University in Scotland. The photograph above is one of Shubhro’s ‘panoramic’ views of the main entrance to KSN, taken around mid-day when ‘’only mad dogs and English men go out’’, hence you can only spot one

person standing beside his bike under the tree !! Seriously though, we have been so impressed by Neil and Jenni’s ability to cope not only with heat but with all the other discomforts of living in the jungle. Here they are joining in the celebration of a wedding we were invited to in Sarenga. Neil and Jenni kept a blog while they were in India, and it makes for very interesting reading – there are so many things we have become used to, but seen for the first time…….its different. So with Neil and Jenni’s permission, some of the stories

here are just everyday things seen through their eyes.

‘’We walked down from the hospital and turned off onto a mud path past the cow tied to a tree. The path followed the side of one of the ponds in the village and was lit with strip bulbs strung up on posts. The sound of tablas grew louder as we approached and would hear the shrill register of Indian music blasting from the sound system. We were welcomed by the man from the hospital who quickly ushered us into the house. Sandals off we were led down a crowded corridor. He showed us into a room where the Bride was sitting like a deity on a shrine. She was sitting cross legged dressed in a colourful sari with lots of jewels stuck to her face. She was surrounded by flowers and the whole scene was lit by a single 1000 watt bulb. We quickly took in the scene and did lots of bowing and namashkar-ing. It was so far

very surreal. We then were invited for the food which occurred in sittings until all the guests were fed. We were in a marquee covered in colourful cloth and crammed with red garden

furniture. This meal was an impressive exercise in efficiency. Men dressed in green charged down the rows laying out banana leaf plates, water, cups and no cutlery (not needed if you have hands). The food was great and it just kept coming: chickpea, rice, chicken, mango chutney, popadoms, salad. Desert was a local rice pudding and ball of sugar thing served straight on top of any curry you hadn't finished when it arrived. You didn't have long to eat such a large volume of food as the next sitting was hungry and ready to go.’’ But we don’t want you to think Neil and Jenni spent their time here partying……….. Operating in temperature of 40 C – Neil’s account ‘’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 Elisabeth 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.’’ ( At this point in Neil’s account of emergency theatre in the monsoon, we just want to say a big thank-you again to our friends in Fullarton Parish Church in Scotland who very generously provided the money to build a proper brick cement covered path between the Maternity ward and the operating theatre. The path used to be a mud bath in the monsoon, and sometimes it could take 40 minutes to get to the theatre for an ‘’emergency’’ C-section. Neil and Jenni did not realize it but

they had it easy if the only objects to progress were people! ) Elisabeth started with a trial of forceps which didn’t work as she couldn't rotate the head (we didn't have the special turning ones). Elisabeth 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. Elisabeth 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 she received a blood 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.’’ He had a stormy entrance into this world but here he is with proud Dad a few days later.

Many saplings planted in the hospital grounds

In early July, thanks to funds raised by an ‘’open garden’’ event in Perthshire we were able to plant hundreds of teak and eucalyptus saplings in KSN. John’s garden in Scotland is wild and beautiful……..our KSN Hospital is wild and in need of control. Here is a snapshot of Johns garden (left) alongside 2 saplings recently planted in KSN (right) – can you spot the saplings among the weeds?

Neil and Jenni rename the ‘’father tree’’ ‘’Just outside the maternity ward stands the father tree. In the shade of its broad leaves the fathers of Sarenga await the birth of their

children. It can be a long wait for them so they have to fill their time somehow. They mostly pass the time sleeping, eating, chatting, showing off motorbikes and occasionally getting updates from didima (grandma ). I love this tradition as I imagine ancient tribesmen may have gathered in the shade to await their own children.’’

Fifth time lucky ! Jenni tells the story

‘’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.’’

During the time Neil and Jenni were with us they audited the episiotomy rate at KSN Hospital, and we have some interesting results from that. We are very encouraged that we have managed to bring down our episiotomy rate, as per the Government of India guidelines. Indeed Jenni and Neil contributed to this, since of the majority of their deliveries there was no cutting or suturing needed. Occasionally though, as pictured above there was a small tear that required suturing, and here is Jenni concentrating on that with Elisabeth looking on.

A night shift in maternity ward - Jenni writes ‘’In India labour is astonishingly cheap. A nurse’s 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.’’

(What Jenni says is true – our nurses work very hard round the clock for a pittance – here they are getting a patient ready to go to theatre with Sister looking a bit anxious – unbooked patient with previous Caesarean section and baby distressed, but back in the ward with a healthy baby being cared for by two of our lovely student nurses.)

The David Goodall Football Tournament By this time many of you are aware that 2014 is the Hospital Centenary year. News has spread in Sarenga that there is going to be a football tournament and everyone is already practicing hard. Folk here are almost as keen on football as cricket – in a previous letter we told you about a 14 year

old girl who presented with a large mass in her abdomen which turned out to be an ovarian tumour – thankfully benign – this lass’s main concern was when she could get back to playing football – she played for West Bengal, and she was from an interior village in the jungle. She was back practicing at six weeks after major surgery !! You can see (with the eye of faith) the boys playing in this photo are barefoot, but they will be properly kitted out for the tournament. Dr David Goodall (past Medical Superintendent of K.S.N.) is ‘till today a keen football supporter. As Prince William has recently said ‘’ Football brings people together’’’ And so we hope will be the case at the coming Tournament in January 2014 - keep practicing lads.

Neil’s thoughts on an ethical issue ‘’A 7 month old boy was in with a viral cold and cough. Interestingly, this boy needed to be resuscitated for one hour when he was born. The guidelines say that you should stop resuscitation if it is unsuccessful after 20 minutes. He was beautiful with these gorgeous big brown eyes staring at you. You could tell that he gave his mother great pleasure and joy. Unfortunately, his brain was deprived of oxygen in utero leaving him with some spasticity which suggests he has cerebral palsy. It makes you wonder whether it is morally right to stop resuscitation after 20 minutes. Yes this child will be disabled but his mum clearly loves him and wouldn't want him to have died at birth. I know in the UK the issue of inflicting disability and suffering versus allowing a child to die is pretty contentious.’’

Note – these two little ones above are not the baby referred to in the story, but they are KSN babies.

Kangaroo mother care in K.S.N.

Neil and Jenni very kindly brought out all sorts of useful things for the hospital and patients. Somebody had made ‘’kangaroo mother care shirts’’ and we can just hear some people wondering what these are. If you can imagine a baggy short sleeved shirt with the sleeves opening to the back and very long ties at the waist. Now you put it on, but before you do so, open your blouse and place a 7 inch dolly on your chest. Now get somebody to help you on with the blouse and bring the ties round to the front, then round the back and finally bring them back round the front and tie them securely – the dolly will now be sitting very snugly on your chest, and your arms will be free to do anything. You can sit, lie down, stand, walk or even run about, and the dolly will stay securely on your chest.

The WHO have suggested this method of keeping very premature infants warm in health facilities like ours which do not have an incubator. We have a very high premature delivery rate, and these tiny tots

under a kilogram in weight (less than a bag of sugar) are cared for in our nursery. With God’s help Shubhro has saved some such infants simply by keeping them warm, ensuring they are minimally handled after careful hand washing to prevent infection, and they are fed by a drip

in their arm or leg, and then a tube in their stomach until they are big enough and strong enough to suck. But some babies are just too small to survive, and sometimes for the mothers sake a baby has to be encouraged to come as was the case in our first ‘’kangaroo mother care’’ baby in KSN. This Mum’s waters had broken (that is the bag of water that the baby grows inside the womb had burst) 17 weeks too early. Initially the mother was OK herself, but then she developed a temperature, in spite of being on antibiotics, so after a discussion with the parents they agreed to allow labour to be induced. Their tiny daughter – only 710 grams cried at delivery, so she was brought to the nursery to keep her warm. Shubhro felt it was kinder to let her be with her Mum all the time, so she was laid skin to skin against her Mums chest, covered by a warmed shirt, and then snuggly tucked in using the ‘’kangaroo mother care’’ shirt. Her Mum expressed milk, and she was fed this every hour by a dropper, literally just a teaspoon at a time. She and her Mum and Dad had 5 precious days together before she slipped away – they wept together for her, but these tears have helped begin heal their sadness.

Neil takes up her story here………

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 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 dependent 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'"

Out and about in Sarenga

Neil and Jenni worked day and night with us, but also got the opportunity to go out on the cycles around the villages. One day when accompanying Shubhro, Neil writes……‘’we

bumped into one of Shubhro’s patients, a small boy who had asthma. 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.’’ The photo is actually one of Elisabeth’s on another village visit. And Jenni takes up the story further……… Yesterday we went cycling into the jungle. 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.

And Jenni prays……..Please continue to ask for God's blessings to be poured out in this place, for the work of Shubhro and Elisabeth in showing His love 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 Him (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. We could go on with more stories from Neil and Jenni, but we shall keep some of their observations for the next newsletter.

Some of the things we are thankful for

1. A small, but committed team of doctors who are working well as a team, communicating and building each other up, sincere, often exhausted but happy in their work. This is a real answer to prayer – you remember us explaining about the human resource problem, and one of our aims when we returned in 2009 being that we should build up a team of doctors and nurses who could work confidently without supervision. In the last year it has been necessary for Shubhro and Elisabeth to be away from KSN for one month out of every four, and during these periods of absence the confidence of the team remaining has grown, so that good work is being carried while we are out of station.

2. Neil and Jenni were such a blessing to us personally, but also to so many patients, staff and students – we thank them and our God for sending them to us.

3. For the ongoing work of the ‘’Us’’ team from UK and India – there is not space here, but our next newsletter will give an update of how the work of ‘’Us’’ in Sarenga is bringing the community, church and hospital together and we are learning how to go forward together – we thank you Ian, Ann and particularly Bobby for investing so much time in us, and being such an encouragement.

4. For the ongoing building and construction in Khristiya Seva Niketan, and in particular Mr Biren Mondal who leads the team of workers. We also want to thank those who have given so generously to enable all this and more……they know who they are – thank you so much.

A couple of things to pray for

We are still looking for an experienced surgeon who would be willing to train the existing team, so that if he or she has to leave then the work can go on – for the past year our surgical emergencies have had to be referred to a teaching hospital 60km away.

Pray also for wisdom in organising the 2014 KSN Centenary Celebration Programme…..for those both in the UK and India who are working hard towards this.

It has been a very busy quarter with the delivery rate rising to 7.3 per day. But we are as ever grateful to God for His faithfulness, and grateful to all of you who pray so faithfully for us. And this comes with our love

Shubhro and Elisabeth

!