My first night in Solo, I must confess, was not a restful one. Like a child, I ended up sleeping with the light turned on, as I kept hearing noises I wasn’t used to, and the idea of sharing my bed with a snake or some large, biting bug was distinctly unappealing. Fatigue eventually won out over the discomfort of the heat, humidity, and my fears. I had uneasy dreams of my teaching task ahead; no doubt fueled by my apprehension of being an impostor in the role I had been given.
I woke with the morning sun on my face, and the smell of coffee wafting into my room. After washing myself by pouring ladles of water from the mindy over my head and shaving, I quickly dressed for my first introduction to the hospital and the people with whom I would be working. I wasn’t used to noodles for breakfast, but the homemade biscuits with rich butter and the strong coffee from Sumatra quickly improved my outlook on life. Barun’s jeep drove up outside just as I finished my second cup of coffee. We loaded the supplies and medicines I brought with me from the States, and drove to the regional hospital where I would be doing most of my work. The central one story building housed the administrative offices, the operating room, and a room with an old X-ray machine. The operating room was the only one in the building with air conditioning. There was also a classroom with a blackboard, and a couple dozen movable metal and wood student desks of the type found in an old high school. The hospital’s long name was stenciled on the back of each desk.
As we walk in, Barun and I are met by the hospital’s director, a woman physician wearing a long, white coat, no doubt alerted to our arrival by the sound of Barun’s jeep driving up on the gravel driveway. Along one wall behind her stand ten doctors, seven male and three female, who appear to be between their 30’s to their 50’s in age. They are to be my students during my stay in Solo. I’m younger than all the physicians present. Everyone is smiling, which is reassuring, but which I soon grow to realize is the Indonesian baseline response to life. I’ve always had problems remembering names, and unlike at home, no one here is wearing nametags. As I’m introduced to each physician with long, multisyllabic and to me unfamiliar names, I again feel overwhelmed by the task ahead of me. I present the medicines and equipment I carried with me from the States, along with Dr. Pincus’s apology for not being able to be present himself. The hospital director graciously accepts both. We then adjourn to the classroom. I introduce myself, tell everyone a little about myself and my background, and then ask each of the doctors to do the same.
I had been told that the doctors I would be working with all spoke English. Turns out, this was a gross exaggeration. All medical students are required to be proficient in English, as there are, I soon find out, no medical texts in the Indonesian languages. (I later discovered that most students studied from class notes taken during their lectures, and these notes were then copied, including any inaccuracies, and passed on to the next group of students.) While all the students could read English, their ability to speak varied widely. The doctors who were at the hospital for the six month “refresher” organized by Care-Medico had all been in practice in various villages and small towns from five to twenty years since their graduation. Thankfully Barun, who was still in the room with me, I discovered was not only my driver, but also my translator. His English seemed fairly decent, but not being a physician himself, I never knew how much of what he translated accurately represented my words.
Rather than starting off with a lecture using the teaching slides I carried with me from USC, I decided to make rounds of the patients in the hospital to see how they were receiving care, and what I could teach to help improve the process. As I write these words, I am again struck by the incredible hubris not only of myself at the time, but also of all those well-meaning people and organizations from Western countries who go to another culture and another world with the unexamined assumption that our way of doing things is automatically superior than theirs. This presumption is made worse as we have never taken the time and effort to learn what belief systems currently exist, how the culture functions, and what real needs people have. We also never examine how our own culture and actions may be detrimental to the people we are attempting to serve. I would learn some of these lessons in retrospect, but for now, I sailed forth in the callow belief that I had answers for what the Indonesians needed, and that my ways were superior to theirs.
We walked outside the main building to the patient wards. The air in the morning is still fresh and smells of ginger and frangipani. This is the livable part of the day. Patios between wards are crowded with attendants at the water pumps, washing bedpans and filling water bottles. This is the only water system in the hospital, except for the operating room and the doctors’ lounge, which has some plumbing.
The wards are like tobacco drying sheds. Long rows of springless board beds covered with lumpy pads hold the sick. Brown faces, some hopeful, some despairing, most patiently accepting their fate. Windows with open wooden shutters face out to the courtyard. The hospital provides no meal service to the patients. Families come with food in bowls to feed their sick through the open windows. Those who have no families don’t eat unless another family is generous enough to feed them. At the foot of each bed is a clipboard with a single sheet of paper with a presumptive diagnosis and showing a temperature graph. This is the entire patient chart.
We stop at a bed – compound fracture from an accident on the highway on which I came in. Beneath the bandage, the bones stick out. The patient groans. “What’s being done for him?” I inquire. “This morning we’ll take an X-ray,” says one of my new charges. Merthiolate (an antiseptic) gleams bravely but helplessly on the skin margins. “Shouldn’t the wounds be cleaned up and the fractures reduced?” I ask.
“Policy of service – X-ray first,” the doctor smiles. The others all nod their heads in agreement.
The next patient we see has a huge laceration of his thigh. “You shouldn’t worry about these wounds” says one of the doctors, seeing the look on my face. “Every patient gets pen and strep (two antibiotics).”
The patient in the adjacent bed is recovering from an appendix operation. Adjacent to her is an older man with a copious cough. I look at the chart. The diagnosis says Tuberculosis (TB).
At this point, I stop the rounds, and ask everyone to step outside on the patio, and hold an impromptu lecture on the infectious theory of disease, and why it is not a good idea to have patients with open wounds and fresh post-op patients next to ones with tuberculosis. Everyone smiles, nods their heads, and we go back inside. One of the doctors summons one of the attendants, and soon I see the TB patient being wheeled away to another building. I have an immense sense of relief and accomplishment. Not only have I potentially saved a couple of lives, but I managed to impart one of the foundational aspects of modern medicine to my charges. This feeling last until a short time later, when I’m again making bedside rounds with the team, and find another TB patient next to a post-operative one. I am both mystified and more than a little angry. “I thought we had discussed this before, and you all agreed, that it was bad care to have patients with infectious diseases next to ones who have open wounds. What’s going on?” These comments were met with a lot of nervous smiles, shuffling of feet, and people backing up against the wall. No one offered any comments. As we are leaving the ward, Barun motions me over and tells me in his soft voice, “Doctor, in my country, it is very impolite to disagree with visitors!”
Next – More health care challenges in Indonesia