During the first two weeks of November my wife, Stephanie, and I travelled with a group of 11 others to Lalitpur in India under the auspices of Mission Direct (www.missiondirect.org).  Mission Direct run a programme of two-week mission trips to 11 countries around the world from Cambodia to Dominican Republic.  These generally focus on a building project such as new housing in the favelas in Rio or building a classroom in Zimbabwe. They also though run projects centred on IT, teaching and medical teams.
Lalitpur is a city in the Uttar Pradesh district with a population of over 130,000. We went to do some work completing the new doctors’ residency and also learn more about the Harriet Benson Memorial Hospital which is run by the Emmanuel Hospital Association. The plan was for Stephanie, a GP, and Denise, a pharmacist, to spend more of their time with the professional medical staff getting an understanding of the local issues and, where appropriate, giving advice from their own experience.
Though our main task at the hospital was to complete the residency, we were also able to savour the sights, sounds and smells of the town and the surrounding countryside. One afternoon we went with the palliative care team to visit two patients. We saw the nurses spend valuable time with those at the end of their life and their families as they treated and bandaged their wounds and, with the permission of the patients, pray for them and their loved-ones.

Another visit was with the Community Health and Development Team where we saw part of their child nutrition project.  The mothers of the malnourished youngsters, 0 to 5 years, received advice on how to prepare a balanced diet and the children are checked monthly to monitor their progress. This work is supported by Tear Fund and we found the dedication of the workers involved quite inspirational.
It was whilst on that visit to the village that my veterinary heart was reawakened as we stepped from the ambulance to the smell of cattle! It seems it is the same the world over and though I had not been involved in farm work for the better part of 30 years the memories flooded back.
Due to the cow’s sacred, holy, status, it is the water buffalo which meets many of the needs of Indian population for meat, milk and leather. There are about 130 million water buffalo in the world with over 50% of those living on the sub-continent. But the cow is not useless.  Aside from being a very effective traffic calming measure on the streets of the towns and cities where any road markings seem to be present for purely decorative purposes its faecal matter does not go to waste. We know it best as a form of natural fertiliser enriching the soil without the need for added chemicals and when left as pats to dry out and remain on the pasture it creates an area unpalatable to livestock thus allowing for regeneration of the grass and encouraging biodiversity.  We saw it being used, once dried, as a fuel on fires for cooking and heating and in the construction of some ‘mud-brick’ shelters which utilise its thermal insulation properties.  It also has insect repellent qualities with smouldering cow patties keeping away mosquitoes (and also making smoked paneer [cheese] which tastes great in pasta apparently!?).
But dung is also moving with the times.
 It is being collected and used to produce biogas to generate electricity. The gas is rich in methane and is used in rural areas of India to provide a renewable and stable source of electricity.
Many uses of cow dung in folk medicine are recorded. For example, in “Vergleichende Volksmedizin” (Comparative folk medicine), second volume, by Dr. Hovoraka and Dr. Kornfeld (Strecker & Schröder, Stuttgart 1909) we read: “In case of diphtheria the patient is given cow urine to drink and he is put in wraps of cow urine and cow dung. Against wheezing and coughing as well as in cases of internal ulcers cow dung is mixed with fresh butter and this mixture, still warm, is put on the chest. In case of colic, furnace of intestine and other illness, and all complaints of abdomen that are accompanied by intense pain, the pressed-out juice of cow droppings is given to the patient.”
Thankfully medicine has moved on and many safer and more effective treatments are now available. But the services provided by the HBM Hospital are suffering from many of the stresses experienced here in the NHS. Stephanie noted the underfunding of services, the lack of doctors, the imposition of regulations and the reliance on targets to improve care. We were able to donate, thanks to the generous gifts of many of our friends and colleagues, including some from VCF, a number of items of medical equipment, including a paediatric stethoscope, blood oximeter and a blood pressure monitor. We also took a large quantity of surgical instruments which were gratefully received.  The future for the hospital is uncertain.  They would like to develop a specialist cancer treatment unit linked with their current, award-winning, palliative care service and also expand their community development projects through further collaboration with other mission partners.  We will continue to keep them in our hearts and our prayers.