Gardening

25 January 2009

About 17:00 I decided that despite the rain I would try to burn my garden rubbish. I managed to break off some of the rattan which was not too wet and using a bit of my paper and a lot of blowing I managed to get the garden rubbish burning. I then started to pull more of the dead rattan off the bushes. Some of my neighbours were out and commented on my tidying the garden; then one said I really should use a parang (chopper) – I said I did not have one and an order was sent out for one; which came along with a pembatu (maid) to use it. She cut back all the big rattan bush, quite a bit of the small bush and then all the other bushes as well. The later was a bit of a shame as I actually wanted to keep them. At the same time another couple of neighbours were sweeping up leaves in front of their house and used my fire to burn them. It really felt as if I was part of the community and was nice as the conservation group would have been starting to burn at the same time. Two of the very young children were playing on my porch and wandered into my house much to the concern of their mother. I said it did not matter but she went to sit by my door to prevent them doing it again. Once the tidying had been finished at about 18:45 I sat with her and showed he pictures of Steve and Sonya and explained when they would visit and how long I was here. The fire continued to burn for a long time and flared up in the wind for several days more.

Nurses Meeting

21 January 2009

I was told there would be a meeting at 10:00 today with the ward managers and I did not want to miss it so stayed in the office. It happened at 12:00. Ibu Ani - Head Nurse chaired the meeting and all the ward managers and other senior nurses and midwives were in attendance. Ibu Ani outlined the new incentive agreement but said in return nurses were expected to be more professional. The white uniform had to be worn on Saturday to Wednesday, local jackets made from ikat could be worn on Thursday but only with black skirts or trousers and own clothes day remained on Friday but no jeans and preferably with polo shirts. Caps and name badges were to be worn with the uniform. There was some concern about nurses having enough uniforms but otherwise this was well received. Ellen had moved near to me to whisper the outline of discussion but I was able to write her a note outlining what I had understood. I also followed the next topic which was over the role of the nursing assistant – Ibu Ani made it very clear that nurses were not to let the assistants do professional roles eg blood pressures, care of infusion, administering medicines. There was more questioning of this / justification why it was done at present. Ibu Ani then asked for my suggestions on improved professionalism – talk about being put on the spot. I did my best to explain about informal teaching through case studies and feedback when staff went on courses. There was again a lot of discussion but when I checked my understanding with Ellen after the meeting she confirmed all areas had agreed to do this with maternity leading as they already did it. The final area of discussion was what role Ellen should have – there were lots of suggestions made but in the end there was no agreement so the view was things should remain as they are if Dr Rina will support this. We were served with cake and water during the meeting. I was pleased with how much of the meeting I actually followed and Ellen seemed impressed.

Over the rest of the week I attended meetings on VIP and childrens ward when the information was cascaded and by the end of the week had a more indepth understanding of what was being agreed.

Second Christmas

15 January 2009

Well I have been in Indonesia for 3 months now, almost 1/6th of the way through my time out here – John and I celebrating the fact we are managing to do more than just surviving by cooking sausages, pasta, pesto and cheese and following it with Cadbury’s chocolate, English coffee and a brandy (well fire water marketed as Indonesian brandy). A very expensive meal but we need to treat ourselves from time to time rice, fish and vegetables does get a bit boring after a few months. Earlier in the day I had been to the post office to check if there was mail. I was told there were 2 parcels for John – there were actually 8 and 1 for me; so I sent John a text to say today was our 2nd Christmas. We had so many lovely things - the wait was worth it.

Rain

11 January 2009

We are now getting rain most days and there is quite a bit of wind. I often have to take refuge in shops as I walk too and from Baa. When ever it rains the approach to my neighbours house gets flooded and when there is a lot of rain the water rises as far as mine but as I have a very high front step it is a long way off flooding into the house. I invariably have to paddle through some water to get too and from the house.

The well has filled up and is almost at the same level as the ground. Unfortunately due to the heavy rain the water is a bit murky but does for washing and cleaning.

Technical Visit

9 January 2009

As I was back in Kupang and if I had gone straight back to Rote would only manage 4.5 hours work this week I decided to visit RSUD Kupang - Rumah Sakit Umum Daerah - District General Hospital. This is where our patients go if they agree to be transferred for more specialist treatment. The hospital has 324 beds and 400 nurses. There are about 200 out patients and 150 A&E visits per day. They had a neonatal unit and high care baby unit – although there are incubators they have not got ventilators and realistically can only expect babies of 37 weeks gestation or more to survive. The nurses here were giving total care to the babies. There are children’s wards based on the class of the patient, delivery and maternity wards. There are adult surgical and medical wards. There are two a VIP pavilions with 17 rooms that had a waiting list of 15 patients – I was shown the room of a patient from Rote – it was very nice and far superior to our VIP rooms. They have a large polyclinic which appeared to include a nurse led TB treatment clinic. There is a haemodialysis unit treating 10 patients a day 6 days a week. The A&E was busy and they have a brand new ITU, HDU and theatre complex. I only visited the ITU – this would have done justice to any Western hospital. We met up with Sam for lunch. I went back to the nursing department via the medical records where I was given copies of all the nursing assessment forms. I was invited back to do a longer technical visit with collegues from RSUD Baa.

Dog Bite

4 January 2009

For the last couple of weeks all the dogs on the island have been particularly highly strung - not sure if it is the wind, rain or mating season to blame. Today was absolutely beautiful so I set off to explore and found my way to the beach on the other side of Baa. Idyllic other than for a dog which launched an unprovoked attach on me. As a result of which I had an unscheduled three day trip to Bali to have rabies booster vaccinations. I took the opportunity to raid the VSO exchange library and brought back a lot of books and DVDs for us all. I went shopping for John and Ellen I also brought some luxuries for me like cheese and Cadburys chocolate - well I have now spent almost all my allowance so good job I have a good stock of food.

Of course it was not that straight forward. I did not have much cash and the new ATM at the bank was out of order. To withdraw cash otherwise takes about 3 hours so I had to borrow some money from John to get me to Bali. The ferry was later than normal so I only just made the flight - thanks in part to the rapid driving of Imo the taxi driver I use.

New Year

31 December 2008

Well our New Year was a lot quiter than Christmas. I was up at 05:00 to go with the doctors to the local market to get food for this evening before we went into work.

In the evening we went round to the house of two of the female doctors - the one I almost moved into. The fish and later the bananas were cooked on a BBQ outside the back door in the shelter of the porch as it was raining. It was an excellent spread.

During the evning we watched a DVD of Mama Mia - it was in English with English sub titles. It was quite clear that the text had been translated into Bahasa Indonesian and then back into English as often the sub titles bore no resemblance to the dialogue.

It was Justine's birthday on 1 January so rather than celebrating the New Year we were singing happy birthday and she was blowing ot her candles.

Christmas

24 December 2008

Well after a difficult 10 hour journey from Kupang our guests Sam and Jo arrived for Christmas bearing food, alcohol and kerosene - we would have been pleased to see them even without the merchandise! They will both stay at my home - cosy.

25 December 2008

John came over with some of his presents – he had some decorations including lights. It took three of us to put them up – the effect is great really, feels festive. He also had a chocolate selection box which was put into the fridge for later. Justine - a doctor who works in a remote PUSKESMAS - Pusat Kesehatan Masyarakat - healthcentre - came over about 10:00 and we put together the food for our BBQ. It was nearly 11:00 when we set off to walk down town. We were about half way down when a bemo came past and we were able to get a lift. When we got to town and tried to pay and it was declined with a 'Selamat Hari Natal' - Happy Christmas. Brought some drinks then walked towards the far end of Baa. Found some sweetcorn husks and collected these as kindling. Round the bend out of Baa we walked through some grounds and dropped down onto the beach. There was a lot of debris on the beach and not much shade. Walked quite a long way and round a slight outcrop and found a cleaner bit of the beach with a tree for shade and fantastic views. I laid the fire whilst the others cleared an area in the shade and put out the sheet to sit on it. The fire went really well and then we started to cook the food, sausages, aubergine with pepper, oregano and fish. Had bread and tomato sauce to go with it. Then we had banana and chocolate cooked over the fire. We were outside a house on the beach and had an audience of children throughout the day. The owner of the house came out and took photographs of us on his mobile phone. When we started to cook he brought over some corrugated iron to put over the flames to then put our tinfoil on. Then when we started eating he brought out a bucket of water and a bar of soap. The weather was wonderful, sunny with a breeze off the sea. We had a couple of paddles and lazed about. As the heat started to go out of the day about 16:30 we started to walk back we had only been back on the road a short while when a bemo came past and we squeezed on board. The music was particularly load which made it very difficult to hear when my dad then ran me when we were halfway back up the hill. We had coffee and cake when we got back to the house. During the late afternoon and evening we all had phone calls from family, Sonya and Gordon both phoned me. Then after a wash we went out for a meal – unfortunately Queen Steak House was closed – despite having made a reservation, so we had a roast chicken take out from the local rumah makan - restuarant; although this is a rather grand title for it. John went back to his house for the meal as the family had invited him specifically. Whilst he was away Ibu Dese – sister from the childrens ward came round with her family. When John returned we had some drinks and then Justine came back and we played cards. She went home about 12:00 and then Sam brought out some fireworks and sparklers which they had great fun setting them off. It was well past 02:00 when we went to bed having all agreed it has been an excellent Christmas day.


28 December 2008

Well after another couple of leasurly days and late nights Jo caught the ferry home. Jude had invited the rest of us down to his house to watch the sunset and eat with him. We had mushroom and asparagus soup, king fish filets, battered squid rings with onion sauce and spicy pickled squid rings followed by lychee blancmange and bananas. It was an excellent meal and Jude was on good form. It was gone 21:00 when we set off to walk back up the hill but had only gone a short distance when the doctors pulled up and gave us a lift.

Well Sam leaves in the morning and we will have to start to settle back into routine island life.

Party, Party, Party

15 - 24 December

In the run up to Christmas there have been lots of parties. Each clinical area has had a lunchtime celebration. The staff all provide some food and then everyone associated with the area is invited. There are speaches and prayers then everyone eats. The staff also participate in a gift lottery - all buying and wrap a gift - which is given a number and numbers are then drawn.

I also went to a party at the house of Ellen's minister. There was a terrace of houses with a temporary covered area erected outside it, with rows of seats. Ellen went to sit at the back but one of the church elders wanted Ellen to sit at the front with me – she compromised by moving to the third row. There was a fancy arch of flashing lights and artificial flowers on the porch one of the houses was playing host to the sound system and another two were being used to cook – one of these was used later to serve the buffet. We were given a printed order of service and I recognised most of the hymns so the hour service was more meaningful that the previous one I attended. At one point children held candles and gave a short speech, lit a candle and then handed their original candle to an elder who went up and lit a second candle. I was one of those ‘special’ guests approached to light a candle – absolute nightmare as I could not see any left but the lad gestured with his head for me. There were more speeches after the service then the food was served. There were spot prizes taped under some chairs and then raffles for presents for helpers and widows.

I also went to a volley ball match between a team from Ibu Ani's church and one of nurses. It was great fun and very competative with the coaches getting very annimated. As you can see everyone wanted their photograph taken after the match. It took place no more than a 10 minute walk from the hospital but one of the nurses insisted on giving me a lift both ways on her motorbike.

Kupang

12 - 14 December 2008

I took advantage of the local holiday on Saturday for the Bupati elections to have a long weekend in Kupang. We are not sure when the weather will deteriate and make the ferry crossing unpleasant or worse non existant. I wanted to buy in some utensils and staple food stuffs to ensure I can have a varied diet over the next couple of months. Kupang is a grey city. I stayed at Sam's - which is just down the hill from the supermarket. I made five trips over the weekend.

On Saturday night a large group of volunteers and other NGOs congregated at Dinnia's house for a party - celebrating her leaving Kupang and Andrea's birthday. This is the VSO contingent. Maleja. Susan. Me. Jacque. Dinnia and Jude.

Boarding House is Open for Business

11 December 2008


Today saw the arrival of what we hope will be the first of many visitors. Rich is a university friend of John's who teaches English in Korea. He had the choice of John’s floor or my spare room and chose my spare room – even after he had met me! I go out for a bit and they go out at different times so we still all have our own space but also spend some time together – it is refreshing to have some different topics of conversation – although he is also into football. He will be with us until 22 December.

Jude a Fellow VSO Volunteer on Rote

6 December 2008

John went to Kupang this weekend and I caught up with Jude the other VSO volunteer on the island. He is a Filipino who has been here for about 14 months. He works in the DINKES - Dinas Kesehatan - Health Department. He had been away when we first visited the island and busy for our first week here this time. His room is at the top of the tallest house in Baa and has marvelous views. He can see what is on sale in the market without going outside, check on the ferry's arrival and watch the sun set.

He made me so welcome and he started to fill me in on which were the best shops and who to buy fish and vegetables from in the market.

On Sunday I ventured to church for the first time - I did not follow much but was made very welcome.

Work

24 November 2008

Well I am out here to work so though I ought to let you know what my daily work routine is about. We do a 6 day week, 08:00 - 14:00 Monday – Thursday, 08:00 - 11:00 Friday and 08:00 -12:30 Saturday. My desk is in a large shared office - which with flash looks so clean! There is one power source and one computer - I however have my laptop and we just use multiple adaptors to get electricity to everything that needs it.

Each day I go round the wards with Ibu Ellen the matron for the wards. These are VIP, paediatrics and general adult wards; these is also the maternity department and A&E. During my first two weeks the busiest the wards have been is 10 patients but outpatients was very quiet due to the rain - it makes travel from remote areas almost impossible and locally very unpleasant. I am meant to just be observing practice, practicing my language skills and finding out how the organisation works. However Ibu Ellen asks my advise about the patients each day and on a coupld of occassions I have found I have had to make suggestions for the sake of the patients. I am doing a lot of reading and spending time translating documents to try to understand what is happening. It is going to be a long time before I understand the paper trails - especially those associated with charges.

At the end of a hard day we relax - some more than others!

New Home?

18 November 2008

Well we made it to Rote this morning and eventually to the hospital. The island will soon be voting for the Bupati - the head of the local regency government. Today there was a rally for supporters of one of the opposition parties. It seemed as if every lorry on the island had been commondered to carry supporters to a rally in the centre of Baa - we were trying to travel the other dierection and failed.

We discovered the housing arrangements we though we were coming to had fallen through. I should have been sharing with two doctors but the access to water there was so poor they were struggling with 2 of them in the house and did not feel it would work with a third person as well needing to wash etc. John and I therefore had to move into the other sparsely furnished 2 bed-roomed hospital house together. It has 2 beds, one wardrobe, one TV (which is not connected to the cable so does not work) on a small cupboard, a desk, fridge, two folding chairs and kerosene stove. It does have a porch with two wall on which we can sit out. Unfortunately it gets the full afternoon sun so is rather hot. It has running water for about 2 hours a day but the well is almost immediately outside so water is relatively easily available at all times. The hospital staff had found a room to rent in a house immediately opposite the hospital which is well furnished with sofa, table, chairs and cupboards but has shared kitchen and bathroom and no private outside space. We spent quite a bit of time deciding which we would prefer and then negotiating as we both had the same first choice but for different reasons. We then went to both saying we would move to keep the piece. We however managed to have a very sensible discussion about it and eventually it was decided that John would move. We have a spare room and we will accommodate whose ever guests visit here. The house will be my home but our house - to give John a bolt hole if needed and access to football once the TV cable is sorted. Although the hospital staff had done some cleaning areas like the kitchen sink still needed a lot of work. The big ratan bush in the front garden was decimated by hatchet and fire.

My Fellow Volunteers

10 November 2008

Our last week all together in Bali and I realise I still have not told you any thing else about the other member of our group.

Sam is a great guy who is very generous and would do anything for you - as long as he remembered. He has only ever lost his passport twice. He managed to leave his laptop in the hotel reception in Kupang and had it held to ransom. Here his foot is in a bucket of water as he managed to stand on a spent sparkler and burnt the bottom of his foot. He is however very knowledgeable about computers but not a bore with it - useful friend to know. He is an excellent linguist and has made us laugh a lot during lessons. He is working in the medical records /IT departments at the hospital in Kupang.

Dorothea - Doro or Thea - has overcome her apprehension about riding a motorbike despite burning her leg on the exhaust on her second day of training here. She is quite with a wicked sense of humour and I really enjoy talking with her. Unlike the rest of us she is only on a 12 month placement and will be based in the VSO office in Bali developing a database to match disabled people to job vacancies.

John is thankfully more serious and sensible than I am and will try to curb my more risky persuits. He is a football fanatic and follows Blackburn Rovers. He also likes watching a lot of films. So seemingly not much common ground for conversation - however we seem to be able to chat for hours. he enjoys analysing situations and is very astute. He has several feminine characteristis which with my masculine charactersitics mean we should be able to rub along quite well together on Rote.

Back in Bali

2 November 2008

Well I am back in Bali for two weeks to compete the last of our in Country training and language lessons. Will also take the opportunity to do shopping for all those things that are either difficult to get or expensive on Rote.

There were two things that struck me on my return. One being the smell;and not in a bad way. Bali is a predominently Hindu island and offerings are put out twice a day. Each home, office and shop will have at least one temple where the offerings will be made in addition offerings are put in cars, on motorbikes, in the street outside buildings - well almost anywhere. The smell from the flowers and the incense sticks that are burnt can be quite over powering.

The other thing I noticed was the difference in the traffic. The volume of traffic in Denpasar is so much greater than in Rote or even Kupang and because the roads are better the speeds are much greater. It is not jsut the volume though but the unpredictability of traffic - although a few things are certain. If an indicator is on it means the bulb still works. If there is a space someone will go into it. Expect the unexpected because it will happen.

First Visit to Rote

26 October - 2 November 2008

Sunday saw us flying out to Kupang with our partners and Dinnia - very convenient as yet again my luggage was over weight; I will leave most of it on the island. We had to stay over night in Kupang as the feryy leaves at 08:00 in the morning. We managed to catch up with Sam whilst we were there.

On Monday we caught the new fast ferry to Rote – only 2 hours once it gets going; we were only 40 minutes late leaving. We are seeing the island at its’ brownest as the rains are due to start any day now yet it was still beautiful. It is hillier than I had anticipated so with the intense heat I may have to rethink my plan to get a bicycle. We dined in a restuarant with the magnificent view before being taken to the hospital to meet our collegues and to have the grand tour.

I am finding it hard to find the right words to describe the hospital. It is relatively new and has lots of building work going on. The A&E is being extended, an ITU is being built and a rehabilitation ward refurbished. There are beds for 48 in patients and an out patient facility with 4 examination rooms. They have an X-ray facility, laboratory, pharmacy and kitchen. There are also 2 ambulances. There are 50 nurses/midwives, 6 doctors - but no specialists and a dentist along with lots of support staff.

There is limited running water in the wards, many of the beds do not have mattresses and what there are leave a lot to be desired as they have no plastic covers, the range of equipment is very, very limited. They do have a few packs of sterile gloves and once these have been used they are then washed and reused when the nurse or doctor needs to protect themselves. A&E is not very busy – Friday saw the most patients – 15. The inpatient wards were more like crèches with more of the nurses' children in them than patients - due to lack of child care provision. The most inpatients last week was 7 and one day there were none. The malaria and dengue season will start with the rains so this may see a change in level of patients. All inpatients seem to get a drip – what ever their condition and caring for this and doing observations appears to be the only direct contact nurses have with patients. They do however keep amazingly detailed records. I accompanied Ellen on the daily ‘matrons’ round – we spoke to the staff read the patient records then went to see the patients – I was expected to ask relevant questions to the patients. Ellen would then want to know how we cared for similar patient in the UK. I am trying emphasise the similarities as I know they are not going to be able to offer half the interventions we do.

We stayed down the hill in a hotel in central Baa - the main town on the island. As you can see the main shopping street is not very busy but despite this has a one-way system.

During the week the doctors took us to a couple of beaches on the island to get a flavour for the real beauty it has to offer. Ths included a visit to Nembrala the West coast tourist 'resort' on the island. The area attracts dedicated surfers during the dry season but the main hotel was closing up that week prior to the rains. The manager invited us to used the sea water swimming pool and we saw the most amazing sun set. The picture at the start of my blog was taken here.

We also started to experince what life on Rote was going to be like - power cut are a regular part of life. We were lucky the hotel had a generator so we could sit outside to read by the light of a single bulb.

John and I have been offered a 2 bed roomed house in the hospital compound. I have also been offered the opportunity to share a house with two of the female junior doctors. I think I will probably choose the second option as it will give us a spare room for visitors, give us separate identities and make seeing each other a treat rather than an irritation. It also means if it does not work out living that closely with Indonesians I can move to the other house whilst we sort out an alternative.

On Saturday we travelled back to Kupang prior to our flight back to Bali on Sunday.

First VSO Beach Games

25 October 2008

This week Bali including Sanur had been host to the First Asian beach games. Anne the Country Director decided that VSO could add an international element to this by holding their own games on Saturday afternoon. Dorothea, John and I joined staff and their families on the beach. (Sam had already left for his placement visit.)

The games started with towel volley balloon. A team consisted of 4 players and 2 towels. The aim was to toss a water filled balloon out of the towel over the net and the other side had to catch it in one of their towels. John, Dorothea, one of the husbands and I were in the winning team. I managed to get a little wet. The next game involved threading raffia through your clothes and then through the next persons etc until the whole team was threaded together – my team just came second. The final game involved having plastic beakers tied onto our heads and then the first one was filled with water and this had to be emptied into the second etc. Again the team I was in came second amidst a lot of joviality and most of us were very wet. We then all sat down to a picnic made up of bits that everyone had brought; it was a very pleasant afternoon and a great way to get to know the staff a bit better.

Employer Conference

22 - 24 October 2008

On Wednesday afternoon we were taken to a rather nice hotel, with hot water, flushing toilets and two swimming pools. Here we had a three day workshop where we met and worked with representatives of our new workplaces. The first evening the table was set out for us to meet our new partners in an 'informal' setting.

Dr Rina who is head of support services and Ellen the matron for the wards came from the hospital in Baa. We had to interview each other in Indonesian and then introduce our partner to the rest of the group in Indonesian. There were lots of sessions where we either worked with our partner or the partners and volunteers worked as 2 groups. This was about developing trust, cooperation and understanding. John and Dr Rina one the competative session and received their price from Tjeed another volunteer who facilitated the event. Everything was translated so if an English speaker lead a session it was translated into Bahasa Indonesian and visa versa.

Thursday night we all went bowling – the partners were a little apprehensive as they had never bowled but everyone had a great time and it again elped ot break down barriers. Ellen has a bigger English vocabulary than I do Indonesian but her grammar is about on par with mine. All four of us volunteers were complimented on our level of Indonesian – apparently we are more confident than most groups at this stage.

On the last afternoon John and I sat down with Dr Rina and Ellen with Dinnia the VSO programme manager to go over the hospital's expectations of us and to discuss the practicalities of our visit to Rote next week. We rounded off by writting important things on each others backs and posing for a group photograph. The commitment I have made in volunteering is starting to feel real at last.