Workshops and reports

Not a lot to report this week I'm afraid, mostly dull workshop stuff...


Since I checked in last week, I attended a two day workshop on workload calculation (really exciting stuff) which produced some predictably interesting results - the variation between departments in the hospital is huge with some producing results that suggest they are understaffed by a factor of about 50% while the results from others hint that they only need about half of the staff they currently have. Of course, any calculation such as this has many limitations in the context of a hospital given the need to be prepared for whatever emergency occurs at any time of the day or night. However, it is interesting and very encouraging to see the very participative process adopted in processes such as this in the hospital - largely, I suspect, at the instigation of the director.

Another two days were spent on the followup session to the complaints workshop that I wrote about some time ago. This was another long two days but I am encouraged by the fact that the task of keeping up with what was going on was far less arduous than the first workshop so my language skills must be improving ! Again, this was a particpative process with ward managers and department heads agreeing on solutions to the most frequent complaints (the one at the top of the list was dirty toilets...)

Also on the work front, we received the disappointing news that our application for a small grant from Australia (AUS$5000 - about €3000) was unsuccessful. Apparently, we were the next in line - they probably say that to everyone ! The grant was going to be used to help fund a Health Care Worker (HCW) Safety training programme which is one element of one of my tasks, helping to set up an Infection Control Committee.
Speaking of tasks, last week was the time for my first quarterly report. VSO has a well developed monitoring & evaluation (monev) system which monitors the effectiveness of placements and involves the completion of a report by the volunteer (in partnership with the employer) every quarter and a formal review meeting approximately every six months or so. The task of completing the report is not particularly onerous and provides a very useful formal opportunity to sit down with your employer and discuss what is working well, what is not working and what should be changed. In many cases (including mine) this leads to the original placement objectives being revised, although not significantly in my case. While this may seem strange after coming all this way, you have to remember that my placement description was written in August 2008, I saw it and accepted it in September but I didn't arrive in Maumere until April 2009 so many things have changed since the original document was written.

Outside work, no more parties to report, just another short road trip along the coast to the west of Maumere..

Moni, the hospital party and mud, glorious mud

Ok, the internet seems to be faster than usual here today so I'm going to take the opportunity to include lots of photos in this post..

After the excitement of finally getting my KITAS last Saturday, three of us from Maumere headed off to Moni in the mountains on Saturday afternoon to meet Dany, my programme manager from the VSO office in Denpasar who was here on a holiday trip for the weekend with some friends before a few meetings on Flores next week. The trip to Moni seemed much easier this time around than the last time, I think that the inside of my helmet has now adjusted somewhat to the shape of my head and I'm able to wear it for much longer periods before the discomfort becomes too much, also I'm better used to going around endless corners ion steep hills. As usual, Moni was a lovely spot – we didn't go up to the lakes this time around but chilled out (literally – Moni is about 1600m high and so much cooler than Maumere) on Saturday night.

On Sunday morning I left at about 10.30 am as I wanted to get back for the hospital party at Sao beach near Maumere. This was partly a farewell for Dr. Hendradi, an ENT specialist who is leaving the hospital soon after two years here but mainly just an excuse for a party for hospital employees and their families. There were about two hundred people there, including lots of children and plenty of party games (including one which involved transporting leeches in a glass of water...).

The first group I met on arrival was the breakaway "adult" group, engaged in a more traditional Maumere activity !

Echae McQueen, chief MC for the day :

Pak Edmon on keyboard, still going after last Thursday's wedding !

Dewa, the hospital gardener, strikes a cool pose in my sunglasses...

Okto and Igo skiing in the sand

A serious spectator..

Marlena and Ika

Igo & Okto celebrate something or other (probably the end of another bottle..)

Igo with a covering of soy sauce after one particularly messy game

Transporting leeches (well, it is a hospital after all...)

Echae rallies support

Ika

Party games

Dr. Asep always organising

Monday was a tanggal merah (literally, a red day which means it's a holiday) so the morning was spent relaxing and reading Patrick Leigh Fermor's fascinating account of a walking tour from London to Constantinople in 1933 and 1934 (sent to me all the way from Canada – thanks, Robert !). In the afternoon I headed out with Daniel, who works in the blood transfusion unit in the hospital, to explore the coastline west of Maumere and travelled about 45kms along far better roads (and flatter too) than I experienced between here and Moni. Some really spectacular scenery, with rice paddies in the foreground and mountains behind, and also some sunbathing water buffalos. My journey took me into the Kabupaten (regency) of Ende, the next one to Sikka (which is Maumere's Kabupaten).

Daniel with rice paddies in the foreground.

Flores is at the top of this map - Sikka District is the purple one towards the eastern end of the island and Maumere is on the north coast.

Cooling off..

Mud, glorious mud !

They're going to let me stay after all..

Well, this is what all the fuss was about. As of this morning, I am now the proud possessor of a shiny new KITAS (Kartu Izin Tinggal Sementara - temporary residence permit) and the subject of a massive file in the Kantor Imigrasi in Maumere. This little card neccessitated six flights, four nights hotel costs, numerous visits to the passport agent's office, a mountain of paper, a collection of official seals, a fingerprint session (my third in Indonesia) and more signatures than I can count.

The wedding season continues unabated - last Thursday I was invited to the wedding of Pak Robby, who works in the finance department of the hospital. This was a quieter affair (i.e. more sober) than the last wedding I went to but the music and dancing were quite something. Instead of a DJ, there was a real band, headlined by Pak Edmon who is the HR manager at the hospital. His talents are wasted on such mundane matters as absenteeism policies, this guy really knows how to work a crowd (aand he's also a great jazz pianist) ! The wedding was also a chance to see some colleagues from the hospital in other than their rather drab official brown uniform !

Wind and eggs

Two random thoughts :

Everybody will tell you that there are only two seasons in Indonesia : a dry one and a wet one. However, they forget about the one in between - the windy one. For the last two weeks, it has been blowing a gale most of the time. There are a number of consequences to this - dust and roof noise. The first is self explanatory, the second relates to the fact that the tin roof on our house does not seem to be held down very securely and rattles and vibrates noisily right above my head ALL NIGHT LONG.
Yesterday, I was invited to a first communion party in a village called Waigete, about 20kms from Maumere to the east. While driving there, I was following a guy on a motorbike (semi-automatic type so he didn't need to use his left hand to drive). In his left hand he held a small plastic bag containing some eggs (this is how you buy eggs here, loose in a plastic bag). After a while he got tired of holding the eggs carefully in his left hand so he leant down and very carefully worked the handles of the plastic bag over the passenger footrest on the left hand side. All this while driving at about 45 km/hr, weaving in and out of other traffic, I'm just sorry I didn't have my camera !

22 weeks later

Not that I'm counting of course, but it is quite amazing how time flies (or maybe not flies, but passes anyway). It's hard to believe that I arrived in Indonesia not able to speak a single word of Bahasa Indonesia this day 22 weeks ago and here I am, five months later, not able to speak a single word of.... I jest of course ! Language is still a problem, especially in staff meetings at the hospital but normal conversation is becoming easier and easier, especially when the person you are talking to makes some allowances ! Anyway, another week dawns in Maumere and I am STILL waiting for the wheels of bureaucracy to grind their way towards issuing my KITAS visa with no sign of an imminent result.

Last week, we had a day off on Wednesday for the presidential election. This was only Indonesia's second ever democratic presidential election (the first was in 2004) but it didn't seem to raise much excitement here at any rate (apart from the novelty of having a day off !). Next week we have another day off on Monday (for the ascension of the Prophet Mohammed) so a few of us are thinking of using the rare opportunity of having two consecutive days to visit Moni again.

Some of my readers (both of them, in fact) have asked me to write a little more about the hospital and my work. The hospital is a 200 bed unit which serves a district with a population of about 300,000 people. The current hospital opened in about 1996 as far as I can work out and replaced one which was destroyed in the earthquake and resulting tsunami of 1992. About 1500 people died in Maumere in that earthquake and many of the town's buildings were destroyed, with a total of 90,000 being left homeless in the region. According to the US Geographical Survey, the wave ran inland for about 300 metres with a height of 25 metres. The hospital has two operating theatres and carries out procedures such as hernia repairs, appendectomies, and many Caesarean sections (between 1500 and 2000 babies are born in the hospital every year). The pace of work is generally much much slower than at home – some of this is due to the language problem but even if I were completely fluent, I would still not be working at the same pace as home. A lot of time is spent on social chatting here and meetings are really something else – the discipline (or lack of it) about use of mobile phones would have any meeting chairman in the west tearing their hair out. It is seen as quite normal to sit in a meeting, and not only send and receive text messages but also to receive calls and chat away while the meeting proceeds around you. Frequently, the meeting stalls while the chairperson answers their phone too... Recently, I have been helping out with a complaints survey. About 5,000 questionnaires have been distributed to wards, outpatient departments, local health centres, etc. seeking feedback from the local community about the hospital's facilities. While the methodology is maybe a little flawed (there is a preset list of complaints and participants are asked to say "yes" or "no" to each one), the results are proving to be quite predictable. The only problem with this is that someone has to summarise all of the returned forms - anyway, I guess it's good practice for my counting in Indonesian as we enter the results on a spreadsheet. Other tasks on hand for this week are an email appeal to a number of five star hotels in Bali to ask for cast-off bedsheets and blankets and to complete my first quarterly report for VSO. This is in preparation for my first placement visit which will take place after about six months in placement but it provides a useful opportunity to have a formal discussion about how the placement has been going and maybe adjust priorities and objectives.

Appeals : as mentioned above, mobile phone usage here is very high and everybody has a HP (hand phone). However, unlike at home, these are all personally owned rather than being provided by employers and are a significant investment for their owners. Also, there is no system of upgrades after a year or two and as they are a relatively recent phenomenon, there is no big pool of old phones available. This means that when a phone gets lost or broken, buying a replacement is a very big deal indeed. I know of some people whose phones have died and they now carry around a SIM card in their wallet and use their friends' phones to send and receive messages. So, if anyone has any old phones at home (with charger) I could do with a couple of them. They will need to be unlocked from the network at home before sending but this usually can be done quite easily. If anyone can help, send me an email.

While I'm at it - another appeal, this one for me. If anyone has any old paperbacks that they don't want, pass them on to my mother and she will make up a parcel and send them out to me. There are enough English speaking volunteers here to arrange a book exchange, we just need a few more books ! I'm not too fussy about what I read so long as it's well written – just avoid ones with pink covers !

In other news – the hospital yesterday admitted its first patient with suspected swine flu. The patient is a Dutch citizen who arrived here very recently but the diagnosis is not yet confirmed.

And finally, happy birthday to my parents today (yes, they share the same birthday) !

Still not legal...

In my naivety, I thought that leaving the country last week to go to Singapore and returning to Maumere was all that was required to validate my new visa. It turns out that I was mistaken; this was only the means of switching from my previous "social and cultural" visa to a new single entry visa. After returning, I then embarked on the process of applying for my temporary residence permit. I met VSO's passport agent (Father Hubert, a local priest !) in Maumere last Wednesday immediately after returning and handed him my passport and a stack of documents so that he could start the process. Since then, I have visited his office on four further occasions with yet more bits of paper, most of which have to be signed by the hospital director as my employer. The latest visit (Monday morning) brought the news that I am to stand by and wait for a summons to be fingerprinted (for the third time since arriving in Indonesia) but that the lady who does the fingerprints was sick on Saturday so we're not sure when this will happen ! There must be only one person in the immigration office who can do fingerprinting.... As with most things in Indonesia, there are no prescribed forms to be completed for the visa application, just a bundle of miscellaneous documents certifying this, that and the other.

My burgeoning radio career has reached new heights since last week with the successful (well, adequate anyway) completion of my first solo broadcast on the newly established hospital radio MEDIKA 107 FM. Last Saturday, I was persuaded to present a one hour English language programme – the big difference between my previous SONIA FM broadcasts and this one is that there is no producer on hospital radio so it really is a solo effort ! I think it went ok, I even received one or two SMS requests during the programme so it looks like being a regular feature – one of the things about hospital radio, of course, is that the audience changes from one day to the next so the concept of regular programmes is not as important as on a local station. MEDIKA 107 FM broadcasts to the town of Maumere (about 10km range) but nobody knows that yet as the official licence has not arrived so it has only been publicised within the hospital! I suppose that makes me a pirate broadcaster....

On Saturday 4th July we "celebrated" Independence Day with Mik & Jess at their beachside house at Gading Beach, including mokehitos, a new take on the local hooch which went down very well !

This week is being interrupted by the presidential election which takes place on Wednesday 8^th July and means a day off work. The run up to the election (in Maumere at any rate) has been extremely low key compared to the hoop-la that I witnessed in Bali for the general election in March but it will be interesting to watch. Anyone I have asked expects the incumbent Susilo Bambang Yudhoyono (known as SBY and the country's first directly elected president) to be re-elected even though they all also say they won't vote for him themselves (I'm not sure how that will work). As this is only the second ever presidential election here, I think that many people are not completely au fait with the system. SBY has two opponents for office - Megawati (former president Sukarno's daughter) and Kalla (the current vice president).

Back home again

Another month begins and what I have got to report ?

Well, last Tuesday I took an English class for a friend who was away for a few days. The class consists of a group of ten year olds who are the children of, or related to, a local hotel owner. I was surprised to find that their vocabulary was better than expected – however, they had lots of problems with word order and sentence construction. From my own bitter experience, the temptation when learning a new language is to try and translate directly from your native language - this is almost always a recipe for mangling ! One example where this is particularly obvious in Indonesian is when speaking to someone older or of higher status (e.g. to a teacher, doctor or parent). In Indonesian, it would be perfectly normal (and very respectful) to address the person to whom you are speaking in the third person and refer to them as Ibu (for a lady) or Bapak (for a man). So, it is quite in order to say "has Bapak eaten yet ?" rather than the less respectful "have you eaten yet ?". However, many Indonesians when speaking English then translate this literally into English and also translate the work bapak into the literal translation "father". This resulted in an interesting conversation recently with a group of students at a local seminary who were keen to find out what I thought of Indonesia but kept asking me questions like "what does father think of the food in Maumere?". I eventually managed to explain to them that I was not a father of any sort !

On Saturday, Peter and I left home bright and early to head to the airport for our visa trip. This was a rather protracted business which involved spending four nights away from Maumere, one of which was in the bright lights of Singapore and three in Sanur (a suburb of Denpasar on Bali) on the way there and back. The time spent in Singapore was short (less than twenty four hours) but long enough to meet the passport agent twice, have a few big meals and a couple of glasses of red wine. Yesterday evening (Wednesday) we arrived back home in Maumere (writing that felt a bit weird !) and met the local passport agent who today starts the process of applying for my KITAS (temporary residence permit. This simple matter looks like it will take about a week to achieve as one of the documents needed has to be signed by the hospital director who is at a conference in Bali until the weekend. The pile of paperwork needed to support the application is very impressive and includes my CV from home (in English) and no less than fourteen photographs in three different sizes ! I can report that bureaucracy is alive and well in Indonesia....

On the work front, the last thing I did before leaving for Bali was to hit "send" on an email enclosing a completed application to an Australian foundation for a small grant to fund a project to promote Health Worker Safety. I received a quick acknowledgement saying that they've received the application and that it appears to fit their criteria so all I can do now is wait until the committee reviews applications. In the meantime, the work of gathering information on how to set up an Infection Control Committee in a "resource constrained environment" continues and I must thank all my friends, former colleagues and especially customers who have provided me with tons of useful information. One of the main priorities of the Infection Control Committee will be to establish policies and guidelines about hygiene (especially handwashing). However, one of the biggest challenges is lack of money (and therefore, equipment) so anything that requires spending money just ain't going to happen !

For instance, something as simple as a proper mop is an alien concept here – floors are mopped with water (no detergents) and a torn up bedsheet pushed around with a bamboo pole. Forget about the questionable hygiene aspects of this operation, the efficiency isn't great either as the area of the end of the bamboo pole must be only about 3 or 4cm square !