Study Tour to RSUD Johannes Kupang

7 – 11 December 2009

I managed to secure two grants from VSO to assist the hospital in the work I have been helping them with. The first 10million Rupiah has been spent to buy 95 books to provide a library for the use of all the professions at the hospital to supplement the 30ish medical books they already had.

The second grant allowed two of the ward managers and I to spend a week at the referral hospital in Kupang. We were looking primarily at the process for ratification and implementation of standard operating procedures (SOPs) but also much wider at all the nursing documentation that is required for a hospital to gain accreditation – something RSUD Baa is working towards. We looked through lots of documents and had discussions with many of the senior nursing staff. We came away with a mountain of documents to use as templates and had the time to put our own SOPs into the approved format.

Five days travelling for a party

1 – 6 December

The number of volunteers in Indonesia continues to fall with another group leaving before Christmas. There was at least good news this week in that the Memorandum of Understanding (MOU) has finally been signed between the Indonesian Government and VSO. This means that volunteers who have been temporarily at home pending visas should be able to return at the end of January and a new intake are due to arrive at the end of February.

Festus a Kenyan volunteer who has been based in Ruteng – Flores for the last two years sent out invitations a while ago to everyone for his leaving party on 5 December. This seemed an ideal time for me to catch up with many volunteers before I also have to leave Indonesia. Flights to Ruteng are rather expensive so I decided to fly into Maumere and then travel across Flores sightseeing on route. I had to fly out of Ruteng to get back to Kupang as I was leading a study tour starting 09:00 on 7 December so there was not time to travel anywhere else for a cheaper flight.

This was a week of early starts:-

Tuesday 1 December – To Kupang

I was up early to finish packing and shutting up the house to be away 2 weeks – this includes making sure all the water reserves are emptied so I do not return to a house teaming with mosquitoes. I travelled as far as Kupang today, where I stayed with Sam.

Wednesday 2 December – To Maumere

I had to get up at 04:30 to get to the airport for my flight to Maumere. I was staying with Teresa another VSO volunteer and arrived at her house before she had eaten breakfast! I took the opportunity of a rainy day to visit RSUD Maumere and was able to talk to their head nurse and have a tour of the hospital – much bigger than Baa. In the evening four of us met up to eat and chat.

Thursday 3 December – To Moni

This was a very civilised start not waking until 06:45. A friend of Teresa’s was travelling to Bajawa in a hire car so I joined him as far as Moni. The road was generally good but very steep and winding with a few places where it was narrow due to landslides. The views were amazing. My sightseeing in Moni was also curtailed by the rain but at least I had time to do some of my studying.

Friday 4 December – To Kalimutu and Bajawa

I had arrangedto be collected from the homestay at 04:00 – yes totally insane. I had hired an ojek to take me up Kalimutu to see the three coloured crater lakes at dawn. When I had flown over these in April they had been three different colours, unfortunately at the moment two are

virtually the same colour but still fairly spectacular. There was a distinct lack of tourists and initially there were more guides, coffee and ikat sellers up at the summit than tourists. It was a clear morning and I had a good view of the sunrise. I eventually got back to the homestay in tim

e to have some breakfast before getting a bus for the next stage of my journey to Bajawa. This was about 4 hours away but we did get astop in Ende for lunch. I was to stay with friends of Teresa’s in a small village just outside Bajawa. Philip is a local our guide and in the afternoon took me round his ancestral village. The villages have two ancestor spirit homes per tribe in the cent

re of the village. The parasol – ngadhu – is the home of the male ancestor’s spirits and the miniature house – bhaga – is the home of the female ancestor’s spirits. There are also large stone slabs near the center of the village – which are used for sacrifice. The houses are arranged in two rows either side of the central

courtyard. There are high roofed thatched houses on stilts, that

have various symbols on the roofs to indicate the status of the head of the household (woman) in the government of the village. The houses with ordinary roofs are for other families.

Saturday 5 December – To Ruteng

A very civilised start at 06:00 today – Festus had made quite a lot of friends in Bajawa through water projects he had done there and two car loads of us set out on the 4 hour drive to Ruteng. Just outside Ruteng one of the party phoned a relative of his there and invited us all (10) to lunch. The meal was excellent and was served within 90 minutes of our arrival. When I complimented the wife on the food all she could do was apologise we had to wait so long for it. How many of us could prepare a meal for 15 in under two hours – which would have undoubtedly entailed a trip to the market as well? The sopi drinking started immediately after lunch with a litre swiftly disappearing. We then went to where the party was to be held as one of the group was responsible for BBQing the goat – we had to try to local Ruteng ‘gin’. We also had to deliver 25 litres of sopi which had been flavoured with cinnamon. The rest of us went to the homestay we were booked into and the drinking continued with a mixture of beer and sopi flavoured with vanilla. We did eventually go to the party to start the serious drinking and dancing.. Part way through the evening the goat was ‘served’. It was placed in a large dish with a sharp knife and you just went and hacked off what you wanted – it was excellent.

Sunday 6 December – Back to Kupang

It really was hardly worth having a room for the night as I had to be at the airport for 06:00 for my flight back to Kupang, so woken at 05:15. I did at least get breakfast three times – at homestay, on plane and at Sam’s. I then went to bed to catch up on all the sleep I had missed this week!

Police Certificate and Bureaucracy as only the Indonesians can do it

November and December 2009

As part of my clearance for another VSO placement I need to acquire a police letter of good behaviour – the nearest equivalent to the UK CRB check. I started this process at the end of October by requesting a letter from the hospital director, requesting the police letter. Once this was produced I went with one of the nurses to the main Kantor Polisi on the island to the Departmen Inteligensi where I had get every page of every identification document and immigration paper I owned copied four times along with the letter from the Direktor. I was then given three envelopes containing all this information along with copies of a letter to the Departmen Inteligensi, Kantor Polda, Kupang requesting they issue the letter of good behaviour.

This therefore involved me in an unscheduled trip to Kupang. I had hoped to go one day and return the next but no such luck. I arrived at the office about 15:00 and although the staff were still there (and due to be there until 17:00) they were not keen to process any documents that day; so after a long discussion I left to return the next morning at 09:00. All was going well, I was taken to another office and had two full sets of finger prints taken and two additional thumb prints. I then had to get 8 passport size photographs and got issues with another identification card. I then went back to the Departmen Inteligensi and as they checked through all my documents I was asked for my SKLD – a police registration card; unfortunately I had not got one. I was then told that without this I could not get the police letter and that as it was so long since I got my KITAS visa even if I had one issued there would probably be a problem in Jakarta and they would still not issue the letter. Initially I was given the blame and I felt things were turning a bit nasty. Then they put the RSUD for not taking me to be registered and for the local police for not having picked up the fact I did not have the document. They phoned both the Direktor and the local police. In the end I was told I would have to go back to Rote to get my SKLD processed. A Kupang agent that VSO use to help to facilitate the processing of our immigration papers offered to help me to sort this without a visit to Baa but that is a story that is not for publication – suffice it to say after 1.5 days of waiting I went back to Baa.

I then had to get more letters signed from the Direktor and a copy of the document permitting me to work. One of the letters had to have an official stamp costing 6,000 Rp on it. There was a delay in getting all this as Pak Suardi went to Flores for a meeting. Once I had everything I went to the Kantor Polisi again and filled out a form in duplicate – this meant hand writing it twice and had a general discussion with the staff, mostly around dancing at parties and my trips to Nembrala (both of which had been observed – well it is the Departmen Inteligensi! I was then told the person who needed to sign the SKLD letter was in a meeting and would be a long time so it was suggested I come back besok.

Besok was the day I was going to Kupang and had to leave the hospital at 10:30 to get the ferry so the driver arranged to take me to the Kantor Polisi at 08:00, he was down town at that time and had not returned at 09:00. The other driver was too busy to take me – he was washing the ambulance and then unable to take me in case the ambulance was needed. I was about to get an ojek (could not use our bike as John had gone down town on it to buy my ferry ticket) when the post delivery driver was dispatched to take me on the hospital bike. It would have to be the day that the road was shut for surfacing and we had to go on a long detour over unmade roads and fields. I had expected to be there for a long time as I knew the SKLD needed a photograph and I had not been asked for that yesterday; but I arrived and was given a letter and copies of all my documents. When I questioned it I discovered – in case you had not already guessed They just recommend to the Kantor Polda in Kupang that I am issued with an SKLD. I got back to the hospital with 15 minutes to spare before I had to go for the ferry.

When I reached Kupang I went straight to the Kantor Polda in the hope they would process the SKLD. The initial reaction was again come back besok; but when I explained I was flying to Maumere pagi-pagi besok Pak Made agreed to process the paperwork. I had a couple of very long forms to fill in the first did have an English translation but the second was in Bahasa Indonesian only. After a lot of discussion I think the upshot was that as I was leaving in February there really was not point in processing the SKLD and they would just send for my police clearance to Jakarta. I was told it could take 3 months and I was asked for a relatively high sum for postage but when I asked for a receipt the amount reduced.

Well all I have to do is wait – well so I thought! Two and a half weeks later I received a message that another letter was needed. The sponsor letter from the Direktor and to be reproduced with the address of the office in Jakarta as the too address! Now I wait again.

Photographs - or lack of them

I apologise that I have not added any photographs to the blog for a while. This time it is not due to poor internet access but due to a glitch with Blogger. I am unable to access the button to upload photographs so despite very good internet access in Maumere and Kupang several entries remain picture less. The further I get behind the harder it will be to catch up so please be patient.

Drought - What drought?

27 November 2009

Well yet again the press has got it wrong – the last four days we have had at least one rain storm a day and today we have had over six hours of rain. The ground is so dry that the water just sits on the surface until the sun comes out and evaporates it. Then it is humid as well as hot.

However, somewhere the water must be soaking into the ground as the level in our well has risen dramatically. Also the number of fish in the well has increased so a couple of the boys were fishing and managed to get a couple of small cat fish

A lot of insects have arrived long with the water. Most notably are flying ants which arrive just after dusk and make it impossible to sit outside or leave doors or windows open. The geckos are having a wonderful time eating the ants and in the morning my porch is strewn with the wings off all the ants that have been eaten over night.

Water and Sanitation

The local paper ‘The Kupang Post’ recently reported problems of inadequate water and sanitation in and around Baa. ‘The head of the Ba’a puskesmas,’ (health centre) ‘Dr Mulat Daruranto, told KP on 26/9 that of the ±4 500 houses in Lobalain Kecamatan,’ (this is the area where I live) ‘Rote Ndao Kabupaten, almost 50% lacked toilet facilities. Even in Ba’a, the capital, many houses were toilet-less. As a result, people were defecating at will in bushland and undergrowth. Dr Daruranto said that a key factor contributing to this situation was the difficulty people had obtaining clean water. This situation was adversely affecting the health of the overall environment in which people lived. “What are people to do” he said, “if they have difficulty just getting clean water, needed too for flushing toilets?” So it was the supply of water that had to be attended to as a matter of priority. Only then could attention be turned to making good the environment in which people lived.’

Drought

The local paper ‘The Kupang Post’ recently reported the impending drought in the region. ‘The Indonesian Bureau of Meteorology has announced that eastern Indonesia is about to be beset with an el Niño weather pattern. The Bureau predicts that this year’s rainy season in NTT will slip to December (instead of beginning in November as normal). Indeed a rainy season starting only in January is not ruled out. Not all parts of NTT will suffer equally serious effects, but areas prone to drought (Timor, Rote Ndao and Sumba in particular) are likely to be badly hit. In fact, many villages in Pantai Baru and West Southwest Rote (RBD), Rote Ndao Kabupaten, are even now experiencing the effects of drought, with 253 households in RBD already threatened by food shortages. To anticipate the effects of these weather patterns, all relevant government agencies and agricultural extension workers should avoid acting like firemen, i.e. hitting the road only when fires are flaring. They need to be proactive now, giving farmers the best possible advice they can on emerging weather patterns, what to plant and when, and how to avoid crop failure. Farmers must not be left to cope alone, as has often happened in the past. NTT is dubbed the “dry province”, so we should have drought prone areas clearly mapped out so that, when drought hits, we can move quickly to help areas most in need.’

From a practical perspective the level of water in my well is very low, I can only fill the bucket if it is on its side, the water is no longer deep enough for the bucket to sink into it. Even the areas of green around ponds and rivers are going brown as these areas of water are shrinking or have disappeared entirely. However we are now getting a few clouds in the sky and on Thursday there were a few seconds of rain.

Volley Ball

19 November 2009

Tonight saw the finals of the volley ball contest that has been running for about two weeks. I was invited down to watch by one of the locals and arrived at 19:00 just as the women’s final was starting. It was taking place on the volley ball court next to the football pitch and was lit by two lights. The football pitch was half full of lorries, bemos and motorbikes which had brought people to watch and round the court we were standing 6 or 7 deep with every possible vantage space around in trees and on roofs of vehicles being taken. The quality of the game improved once the teams settled down and there were some very long ‘rallys’ (well that is what it would be called n tennis). The crowd was very excited, knowledgeable and appreciative of good play. At 21:00 just as the men were warming up for their final there was listric mati – power cut – so I used this as an excuse to leave as it was very hot standing amongst so many people.

Road Works

November 2009

On several occasions I have mentioned the poor state of the roads in Indonesia and particularly on Rote. There are the unmade – never been made roads which come with the territory and then there are the unmade but used to be made roads where maintenance has lagged behind usage and finally the made but so full of holes you would be better off without the bits of tarmac. This is due to a combination of subsidence, rain /flood water damage and excessive usage particularly by trucks. The road from the hospital into Baa down the hill was a particularly bad stretch; as was the part of the road from the hospital to Busalangga the next large town - where I go to the market. This month work has been underway to resurface the road. First the really big holes were filled with rocks, then a cement like layer was put down, next came the nasty bit – a layer of small stones and finally tarmac. The majority of the work was carried out with traffic still using the road – where there was an alternative route then a one-way system was instigated so that single file traffic was allowed through the road works – otherwise it was just a matter of playing chicken with on coming vehicles. As you will see there was generally enough room for motorbikes to squeeze through but cars and trucks often had a long wait until the road was side enough for them to pass. Riding over the loose small stones was challenging – particularly after a lorry had made ruts in it. Going down the hill on loose stones is interesting particularly around the sharp bends. Walking along the road is also quite challenging as there is no longer enough room to walk beside the road and the slope is such that you have to walk quite a way onto the road and as this has caused the road to be quite a bit narrower than before you really need your wits about you particularly when walking at night. Whilst the work is in progress the journeys are more ‘exciting’ than before but once the work is complete the challenge of getting into town or to Nembrala is going to be lost.

Fishing

14 November 2009

About 18:00 I had a text message from Octo to say a group of doctors were going to go fishing tonight and did I want to join them. I had nothing else planned so decided to give it a go. About 19:30 eight of us set out for the fishing harbour. Three of them had proper fishing rods and reels the rest had to make do with line wrapped around drinks cans. It took quite a long time to get the gear set up and regularly someone would loose their weights and hooks so like fishing the world over more time was spent sorting out the tackle than actually fishing. It was a very pleasant evening as we had a sea breeze taking some of the heat out of the night. In the end more fish was used as bait than was caught by the anglers but I am not sure having fish for supper is ever the main purpose of leisure angling. We returned home sometime after midnight.

Picnic on the Beach

1 November 2009

This morning some of the nurses from the mess called round to invite me to a picnic on the beach this afternoon. I had been aware of a lot of activity outside the mess with coconuts being opened and chickens gutted but not really thought anything about it. I had been cooking pizza that morning so packed one up in my cool box to take as my contribution.

At 13:30 one of the ambulances arrived outside and we started to pile all the food on board. Then the process of shoe horning people in – not too bad when we first set off but we had various stops on route to the beach and eventually had 14 people inside. We drove for about 45 minutes before turning off the main road onto a narrow dirt track that culminated in another beautiful and deserted beach. Six other staff had come on three motorbikes so we were a big party. Just like in the UK it was the men that set about laying a fire and cooking the chickens and fish. Besides the BBQed food a bucket of rice and a large bowl of noodles had also been brought. There was a second bucket full of es campor – this is an iced drink with coconut milk as the base with condensed milk, mixed fruit and small cubes of jelly. Whist the food was prepared we all lounged around in the trees chatting.

It had originally been planned that we swam before eating but the water was too low. After eating we still had to walk a very long way into the sea before the water was deep enough to swim. None of the problems we British have in trying to get changed discretely into swimming costumes under towels – here you just walk straight into the see fully clothed and later travel home dripping wet. As it was so shallow the water was incredibly warm. When I got back to the shore, those who had not been swimming were dancing so I joined in with that as well. It was an excellent afternoon – made all the better for being able to join in conversations and no longer being the centre of attention.

Pesta

30 October 2009

Rote might not have any pubs, night clubs or actually anywhere that opens much after 20:30 but it makes up for this with parties. I have lost count of the number I have attended. A birthday, confirmation, wedding, funeral are all an excuse to hold a party. The invitation for a wedding will generally arrive just a couple of days in advance – well your diary will not have filled up yet will it?

During the day the extended family will have been very busy. Tarpaulins will have been erected in an open area outside the house – often in the road; causing it to be closed. Plastic chairs are put out in rows. An elaborate dias erected with lots of plastic flowers and flashing lights. There will be at least one large sound system erected. These will often be over 6 feet tall and almost as wide and have probably been removed from a bemo for the evening – at least at the party you are not in the confined space of a bemo so the booming base is not quite so invasive. Hugh amounts of food will also have had to be cooked.

For me the evening start by gathering with the other staff who are going to the party about 15 - 30 minutes after it was due to start. We then all pile into an ambulance and set out for which ever part of Baa the party is being held at.

On arrival at the party you give a very limp handshake to the hosts who are waiting at the gate then place an envelope of money into a box and more to sit in one of the rows of chairs. The speeches will be in full swing but eventually they will draw to a close and we get invited up to have some food – this is done in a very orderly way with each row directed, in turn, to a table of food. After the food everyone goes up to shake hands with all the important family members and then there are two options – go home or stay for the dancing and drinking.

Dances are generally quite formulated and many of them are along the Western line dancing style. However unlike in the West there are often more men dancing than women. There is also no problem with a group of men dancing together. There will be a quite dark place somewhere with a group of men drinking the local spirit - sopi. The party can easily go onto 03:00 and sometimes later than that.

Money

The local currency is Rupiah (Rp). The conversion rate whilst I have been here has varied between about 15,500 and 17,500 Rp to the pound. There are several notes in circulation - 100,000, 50,000, 20,000, 10,000, 5,000, 1,000 and a new one 2,000 that as yet I have only been given in Kupang. There are coins of 100, 200, 500 but these are rarely used. In shops if you owe less than 1,000 Rp then you are likely to get your change in sweets.

On Rote and across a lot of NTT it is very difficult to use 100,000 Rp note. The most expensive things I buy on a regular basis are a tray of 30 eggs – 31,000 Rp and pulsa – phone credit – 27,000 Rp. Text messages within Indonesia to the same network are only 110 Rp so 25,000 Rp credit goes a long way. My evening meal costs about 12,000 Rp and consists of a protein source, rice and vegetables. Fish is generally 10,000 Rp, this will either be several small fish, one medium fish or a steak from a large fish. Green vegetables will be 1,000 Rp and depending on the time of year how much you get for that money. One kg rice is 6,5000 Rp. Bensin – petrol varies markedly in price, 5,500 Rp / litre in central Baa, 6,000 Rp in rest of Baa and on main roads, up to 7,500 Rp in more remote areas. In Kupang from a petrol station it was only 4,000 Rp. Although things are generally more expensive in NTT than Bali there are far less luxury items to be tempted by so money does seem to go so much further here.

My monthly allowance from VSO is just in excess of 2,000,000 Rp – yes I have been a millionaire for over a year now! This is well in excess of the local basic wage for civil servants – although they have all sorts of schemes that add to their basic wage. Farmers and fisherman have much lower incomes. As part of the monitoring of children with malnutrition a family survey is undertaken and one family of farmers last week declared a monthly income of less than 500,000 Rp per month – they had three children.

Soe

7 – 19 October 2009

October has been a month of disappointments. The latest is that John has been told the motorbike he borrowed had to be returned to Soe – on Timor. I gallantly volunteered to take it back – well it gave me an opportunity to explore Timor that I had not yet had.

After work on Friday I set off for Panti Baru – the natural harbour where the slow ferry docks and which is used by the fast ferry when the sea is too rough to use the jetty in Baa. Panti Baru is about an hours ride from Baa along a hilly, windy but good quality road. I had always thought I should use the slow ferry at least once whilst on the island but with the ports being further out of town at both ends this was not really practical without my own transport and the savings on cost of tickets is partially offset by the extra bemo costs involved; so this was the idea opportunity. The fast ferry costs 104,000 Rp per person economy and 100,000 Rp per motorbike; the slow ferry was 110,000 Rp for motorbike and rider. The ferry is due at 13:00 but did not actually arrive until 14:45. I will admit when I saw it my heart sank – it was a rusting ex cross channel type ferry. The loading was very quick as all the motorbikes just drove on about 8 abreast and then the lorries and cars reversed on whilst we parked up. Foot passengers took their chance amongst the traffic. In the economy passenger area people stood sat and lay wherever they could find a space – although much more crowded that the fast ferry it actually felt safer as the cabin was open so in an emergency there was a good chance of getting out – which there is not out of the lower section of the fast ferry where the inadequate exits are blocked by luggage. I had been warned that the journey would take 4 hours but it actually took 4 hours 45 minutes. Once off the boat I then had to find my way to Sam’s house in the dark – I decided to follow the majority of the traffic on the basis that most people would be heading for Kupang and eventually reached a road that I knew. At Sam’s I met an ex volunteer who was back in Indonesia on holiday and discovered he lives in Stourbridge.

On Saturday morning I set off to ride to Soe about 130km. I had been assured that the way was easy to find and I was relieved to discover that this was in fact the case; with signage at almost all the junctions. The ride started off through very flat area, with a combination of lush fields and dry barren areas. It was soon possible to see the hills in the distance. The road was good quality both in terms of maintenance and visibility and I was able to do a constant 70 – 80 kph. It then proceeded up into the hills, generally the road surface remained good with occasional undulating areas, three areas there the surface had been washed away – including a bridge where the road was diverted into the dry river bed; I hope they mend it soon otherwise the road will be impassable once the rains start – and a few areas with pot holes. However the riding was not as easy as the road climbed up with steep bends. The views were magnificent and there were a lot of traditional houses and grain stores. The thatched roofs on some were quite ornate. After a rest in a hotel and lunch I set off further north on the road towards Kefa. I then headed off towards Oinlasi the road deteriorated here with lots of pot holes and stretches of unmade road but the scenery and villages were spectacular. I over took an icecream seller and when I next stopped to take a photograph a guy came past eating one. I asked him if it was enak – tasty and he said yes and stopped and chatted; he is a fish seller from Kupang who makes the trip to remote villages three or four times as week. Later on her overtook me again whilst I was stopping to drink and again chatted for a while. I did not quite make it to Oinlasi about 5 km short but my shoulders were beginning to ache and I knew I had to retrace my steps. When I got back to the main road I went on past Niki-Niki for several km. I returned to Soe just before dusk. That evening I handed the bike over to the NGO who now own it and returned by bus the next morning. I stood waiting for the bus with a group of young ojek drivers, as they were in the only spot of shade. We talked quite a bit and then they flagged down a bus for me and then evicted a passenger from the front seat so that I could sit there. It was quite unnerving as I was sat in front of the front wheels so on several hairpin bends I was over the sheer drop.

Jalan-Jalan

11 October 2009

I decided to try to explore the north of the island today – so far I have only gone south and west on the bike. I loaded up with water and food and set off on the bike. The first thing was to get some fuel. There is not a petrol station on the island but lots of kiosks and stalls sell it beside the road. The larger kiosks buy in barrels and decant the contents into various bottles and containers of 1, 2, 4 and 6 litre capacity. The smaller stalls buy the 6 litre containers and decant these to 1 and 2 litre containers. The fuel is poured into your tank via a funnel which is covered by cloth to filter out any large particles – if you are lucky the proprietor will not be smoking.

Although riding around the island much of the land is arid there are a few areas of green with crops growing. The first hour of riding was on a good quality tarmac road – by this I mean that the surface was generally in tact and that the areas of subsidence were not to extreme so that a steady 30 - 35 mph could be maintained. After that the surface deteriorated – initially with areas where the surface was broken or very bumpy but soon the tarmac ran out and I was on unpaved road but initially it had been graded so was relatively easy going but even this deteriorated and I was soon bouncing up and down and the wheels skidding around on loose stones. Progress became much slower and my shoulders began to let me know they were feeling abused. The unpleasantness of the ride was rewarded by finding an area of traditional housing.