RIP Arthur 6 months 1 day

3 February 2010

After an illness of only 5 days Arthur Leopold Christian died in VIP ward at 14:30. He was the only child of the principle pharmacist who lives in the mess opposite my house. Her husband had been home for some time but had only gone away again to work last Friday – leaving a healthy son. Arthur is thought to have died of aspiration pneumonia; but we have no post mortem facilities here. The hearse took his body immediately to his father’s family home the other side of Baa.

 

As I was going out to eat one of the other neighbours came over to tell me I would be collected later to go to the house for prayers. I was very touched that I was seen as part of the wider hospital family and it was just assumed I would want to go. About 20:00 a group of us set out on motorbikes. At the house Arthur was laying on a double bed sized dais surrounded by drapes. With the immediate family around him. There were prayers and the rest of us were sat around outside the house but with chairs angled to see in through the door and window. After this we had cake and coffee before filing in to pay our respects.

 

5 February 2010

Today was the funeral and again it was just assumed I would go. Desi came round to tell me the service was 15:00 and that was the real time so we would be leaving at 14:30 sharp not jam karet – literally rubber time – which means anything up to an hour after the time stated. Just about everyone from the hospital went and transportation was a logistical nightmare with helmets and motorbikes being borrowed from anyone and everyone. The service was again at the house with us all sat outside under tarpaulin which kept the worst of the sun off. At the end of the service the coffin was finally shut up – this was rather traumatic as the mother her sister-in-law had to be pulled away to allow it to happen. The funeral procession then moved to the top of the garden where the family members were buried and Arthur was interned. As I am sure you can understand I did not take any photographs although the number of flashes from mobile phones indicated that it would have probably been quite OK. As we had cake and water the male members of the family filled in the hole with stones and then concrete.

 

7 February 2010

The final formal act of morning was a requiem mass this evening. The grave had been built up and decorated with what looks like crushed coloured glass. Lots of candles were being lit and being put on and around it. This time the service was followed by a large spread of food. However since then there has been a candle lit each evening outside the families room at the hospital. They are yet to come back but colleagues have been in a removed all Arthur’s things.

 

Work

With my date for leaving rapidly approaching I am finding work spilling over into leisure time as I try to finish all the things I have set myself to do. I have now had two meetings with the hospital director, head of nursing, ward and department managers having a final check through Standard Operating Procedures (SOPs) and getting them authorised by the hospital director. I decided to group the SOPs and to concentrate of finishing all those in one section at a time. So far we have had 24 approved covering, observations, catheters, nasogastric tubes and infusions. There are another 15 covering medication ready to be presented. I am trying to finish the group on infection control but this is very challenging due to the limited resources the hospital has available. These will all be bound in a book before I leave. I have also been working on the audit tools and have agreed a programme of audit and review for all 61 SOPs we have identified.

I submitted a grant proposal before Christmas and was successful in securing 10 million Rupiah which has been spent on books. These will provide reference material for the remaining SOPs as well as many other aspects of patient care. We have bought 98 books that will support all the departments in the hospital not just nursing. I have found the majority of staff have a great thirst for knowledge and have been looking through all my resources even through the majority are in English and anything I provide in Bahasa Indonesia is read from cover to cover.

Kamar Mandi

20 January 2010

It has been relatively cool recently as we have had a lot of rain – 5 days with hardly a break in the rain of more than an hour and significant winds. This has made the process of washing a little less pleasant than normal. This made me realise I had not described the kamar mandi (washing room) on my blog. Basically by kamar mandi consists of a small tiled room where most of the tiles assist the water to drain towards the drainage hole, unfortunately there are a few tiles that defy the system and part of the floor is always wet. There is a squat toilet and a bak mandi (a large trough which is filled with water from the tap). The bak has to be drained and cleaned every three days before the mosquito larvae grow big enough to turn into mosquitoes. Every time I am going away I have to remember to empty the bak and all other stores of water to prevent the house being full of mosquitoes on my return. Unfortunately there is a reserve of water in the toilet so there is always a small rise in mosquito numbers when I have been away.

To mandi (wash) you scoop cold water out of the bak mandi using a gayung (see photo) and throw it over yourself. Sadly I did not record the noise emitted by Chris the first time he did this – I think Sonya did very well to remain smiling for the camera.

Malaria

12 January 2010

I had been suffering with a headache for a couple of days but so had John so had not really thought anything of it. However as the day progressed I began to feel really lousy and my temperature went up so I wandered along to UGD (the A&E department) to ask for a blood test. They knew exactly where to find the lab technician as her friends work on maternity so rang her there and arranged for her to meet me at the lab. There were no patients on maternity so the two midwives came along as well. I had my blood smear taken then we all wandered into the lab and sat around on the benches talking whilst the slide was processed. As I had unfortunately suspected it came back positive for malaria falciparum. VSO provides us with a self treatment pack so I went straight back to the house and after reading the instructions started my 60 hours of treatment.

I do feel slightly hard done by as I have been taking my malaria prophylaxis every day, I use lotion containing 50% DEET every evening, wear long trousers and sleep under a net yet still get malaria. At least it was fairly mild.

Exchange of Presents

All the wards have a gathering sometime around Christmas to exchange gifts. Last year I was invited to the events but not invited to participate in the exchange. This year all the areas where I had been based asked me to participate. Gifts had to be to the value of 25,000Rp and wrapped, they were then allocated a number and then after prayers we all picked a piece of paper from a bowl and took the appropriate numbered gift away. After this there was some form of meal provided. Purchasing the gifts was a little challenging as none of the shops have any prices displayed so I was having to take intelligent guesses as to the value of things, in the end I asked the shop keeper in one shop I used early on for most of my household equipment for ideas at that price and had a good selection to choose from. I really did not need the clock and bowls I acquired but was delighted to be invited so had decided to take part.

Abdurrahman Wahid

Sometime over New Year Abdurrahman Wahid died aged 69 years. Wahid, or Gus Dur as he was also known, was part of a prominent and politically active Muslim family. He initially worked as a teacher and rose to be a headmaster before receiving a scholarship to study in Cairo then later studied in Baghdad and Holland. He returned to Indonesia in 1971 and worked as a journalist. In the late 1970s he became actively involved in Nahdlatul Ulama (NU) Indonesia’s largest Muslim organisation that his grandfather had founded becoming chairman in 1984. Following the fall of President Suharto in 1998 he formed the National Awakening Party (PKB) and was officially declared a presidential candidate in February 1999; being declared president in October of that year; even though his party had lost the parliamentary elections. He was seen as a reformer and democrat but the transition to democracy was not easy. He did curb the influence of the military, released political prisoners and liberalisation of Chinese culture an religious expression. The coalition began to turn against him and ultimately his presidency collapsed following unproved allegations of corruption. He was impeached in July 2001 and replaced by his deputy, Magawati Sukarnoputri.

All public buildings were flying flags at half mast for many days and several private residencies erected flag poles specifically for this.

Natural Resources

Rote has some of the most beautiful and peaceful beaches I have ever been on but they are under treat from sand extraction. My travels over the holiday period lead me to realise how much this is happening. I had been aware of a sign in Nembrala saying that sand extraction was prohibited and had seen occasional evidence of extraction before but as I toured around it was a frequesnt occurrence. On one beach I discovered the level had been reduced by almost 2 meters and piles of sand were waiting collection.

The hills are also being eroded for their stone and there are several quarries around the island.

The stone is then delivered to individual homes where people sit and with a hammer reduce large slabs to small stones.