Kimang Buleng

Yesterday I joined a group from the hospital on a motorbike excursion to the top of one of the nearby mountains (Kimang Buleng). Ten of us altogether made the rather steep ascent with only one puncture (a rarity as most tyres here are long past their best and the quality is rubbish to start with so you never have to go more than about two miles without passing a "tambal ban" or tyre repair place).

On  the way, we had to pull off to the side of the road to make room for someone who was moving house (literally) !

This morning the working week kicked off with a meeting in the hospital which was a followup to the complaints workshop and survey that I wrote about some time ago. Today's meeting consisted of a  few speeches (as usual) and the public signing of a promise by hospital management, department heads and local government officials to make some very specific changes, many of which I suspect will be difficult to implement as they will involve spending money, a resource which is in very short supply. However, it's interesting to see how a country which is tied up in miles and miles of red tape still has institutions which adopt a very inclusive and open system of trying to deal with their problems. This is largely down to the enthusiasm of the hospital director, Dr. Asep, who engages lots of stakeholders in the wider community about decisions in the hospital.

Here Marlena, one of the finance team (renowned for her voice, she belts out Celine Dion numbers at weddings !) formally reads the complaints, promise and recommendations while the Bupati (regent) on the far left and Dr. Asep listen in.

 Next, Dr. Asep takes the stage and outlines the hospital management's response (using the analogy of a large ship for the hospital !).

 

 

 

Following this, the promise and recommendation is formally signed by representatives from the hospital, local government, Department of Health and other stakeholders.

 

While Dr. Harlin and Dr. Mario look on and enjoy themselves...

       

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..

Surveys, snorkels and spuds

It seems like a while since I've updated here so greetings to all of you in recession land. At the level I am working at, Indonesia is fairly recession proof – as one person said to me last weekend "when you don't have very much, you have little to lose". People here, as in most developing countries, generally live a hand to mouth existence with little by way of luxury or treats.

Since my last post, I spent two days (last Friday & Saturday) attending a workshop in the hospital which focused on complaints from the local community. This was quite a progressive idea and is a good example of the proactive style of the hospital director. The workshop, which was facilitated by GTZ, the German aid agency, had about 80 participants representing various stakeholders – former patients and their families, outpatient clinic clients, clients of the laboratory and blood transfusion service, etc. One of the activities of the workshop was an exercise in actual gathering complaints from those attending and the principal outcome was the compilation of a draft survey for monitoring future satisfaction levels.

It was very interesting to see the very genuine complaints and concerns that former patients and their families raised – here are some examples :

• Lack of personnel available – no doctor or nurse in attendance in various clinics and departments.
  
• Punctuality – late arrival of doctors for clinics
  
• Corruption – security guards seeking bribes of money or cigarettes for allowing visitors in outside official visiting hours
  
• Poor hygiene – smelly beds, dirty toilets, mosquitoes
  
• Lack of communication to patients
  
• Nursing staff busy texting on their mobile phones instead of looking after patients
  

Does any of this sound familiar ?

After the mental strain involved in trying to keep up with this for two days (and believe me, it was a struggle) it was great to have day off on Sunday. As I've mentioned before, Maumere is the home for a number of volunteers working in various different VSO programmes so there is a good social network available. Last weekend was the occasion of Jo Marie's last weekend in Maumere as her placement ends this week. Jo Marie has been here for three years (most placements are for two years but she extended for a further year so is almost a native now) and she is returning home to the Philippines for a month's holiday before starting work with GTZ in East Timor. To mark her departure, she arranged a day trip to Pulau Babi (Pig Island) so early on Sunday morning, we saddled up and rode about 60kms north east of Maumere to Darat Pantai, near Talibura where Pak Karno, a colleague from Jo's workplace lives. Karno had arranged for a local boatman to take us to the beach on the island where we enjoyed some fine snorkelling and a great BBQ on the beach with some fish Jo bought en route. On the way back home after our day in the sun, there was the most amazing pink sunset. This volunteering in developing countries really is a tough life, you know....

After the weekend, Peter (my housemate) and I decided that the lack of any visible progress on the housing front was no reason to put off embarking on some self catering forever and we took the plunge and purchased a stove (cost about Rp180,000 = €13). Household kitchens here are generally basic in the extreme with a stove (usually kerosene but sometimes gas if you can afford it), a rice cooker (if the household is fortunate enough to have electricity) and a collection of bowls, buckets and utensils (usually no sink). We bought an oil stove, oil and some bowls and tonight (Tuesday) had our first home cooked meal at home. We decided to mark the occasion by going western (lunch had been gado-gado) and so the menu for the first meal was sautéd potatoes and fried eggs... not exactly a typical Indonesian evening meal.