Hello from LAMB Hospital, Bangladesh!  It's hard to believe that I arrived here a whole week ago - it's going quickly!

First a brief overview of LAMB - it's an impressive hospital and community health system, and the hospital compound where I'm living and working is also home to an elementary school, nursing school, and midwife training program.  In communities around the hospital, LAMB has 28 clinics, including 18 safe delivery units.  The community activities include not only health related activities, but also community development and disaster preparedness.

LAMB now has more than 1000 staff – mostly Bangladeshi, but with approximately 25 foreign staff to bring additional expertise and training capacity.

I'm working in the obstetric/gynecology unit along with Bangladeshi senior doctors and residents and one Swiss physician, Dr. Ambauen, who has worked here for a number of years and heads the department.  I arrived Sunday evening and my introduction to the hospital started Monday morning with a retained placenta - 5 hours after delivering the baby at home, the patient had sustained huge postpartum hemorrhage and was in hypovolemic shock.  By noon, I found myself in the operating room again doing a C-section, and assisted a molar pregnancy D&C that afternoon.  So it was a solid start to the month here!  I was put on the call schedule as a senior doctor, which made me a bit nervous on my 3rd day in a country where they talk about "normal ecclampsia" (when mothers seize but recover without complications).  Fortunately I had a back-up in case of emergency and honestly, things went smoothly on my first call day Wednesday.  The midwives handle all low-risk cases - I'm still getting used to not knowing about all the deliveries!  Junior doctors have a range of experience from 1 month to over 2 years.  I've been working with the youngest junior doctors on suturing the fascia in the OR and doing basic growth ultrasounds.  The experienced junior doctors can handle most things themselves, but call about decision making or any complicated cases.  Many women here deliver in SDUs (safe delivery units) that are midwife-staffed.  I visited one of these this morning and was impressed with the services offered there.  If there are problems, the women are sent here to the hospital.

Friday was particularly interesting- we hosted "Fistula Camp" and operated on 7 complicated fistula cases in a single 13 hour day.  A well-known fistula surgeon flew in for the day from Dhaka and I got a crash course in assisting fistula cases.  It's mind-blowing to think of 2 million women worldwide suffering from constant leaking and the stigma that goes with fistulas, and with poor access to labor care, more women are developing these daily. It was a great learning experience to assist on these repairs, and meeting these women was a reminder of how critical it is to have access to proper intrapartum care.