I was discovering I had a lot to learn in my role as teacher to my new medical colleagues in the regional hospital in Surakarta (Solo). The hospital system operated along rigid guidelines laid down by the local bureaucracy, and as in all bureaucracies, the rules were not easy to change, especially by an outsider whose presence was known to be of very short duration. Patients coming to the hospital, irrespective of their initial complaint or diagnosis, received a shot of antibiotics by the admitting nurses. This made the patients feel better, as they were now receiving powerful “Western medicine”, which our Dutch predecessors as well as our own propaganda convinced them were superior to their own folk remedies administered by the local shaman. The idea of a shaman was a new concept to me, having been brought up in our Western culture. I certainly knew about witch doctors in Africa and had a vague familiarity with the role of the shaman among our American Indian tribes, but never considered myself as someone who possessed shamanic powers, or what my words would mean to someone who looked upon me as a shaman. It wasn’t until I had further conversations with Barun, my driver as well as my translator, that it dawned on me how I was perceived by my Indonesian patients, as well as my colleagues.
In the culture in which I was now working, I was, in fact a shaman, a healer, but also one who possessed the power of life and death. This power, granted to me by my position, and the knowledge I had accumulated regarding life and disease, is a force, in and of itself. Coming from America with my powerful medicines, this right over life and death was mine, and no one was going to question me as to how I used it. The horrific idea dawned on me that when I was making rounds with the local doctors, all of whom were also considered shamans, though perhaps not as powerful as I, and I saw a patient who was jaundiced with a swollen belly and a rock-hard liver, when I declared that this person had advanced liver cancer and was likely to die in the next six months, this was not a diagnosis and a prognostication on my part. To them, I was not describing the natural course of the illness; rather, I had just condemned this man to die in 6 months. And when my prognosis had been proven accurate, it would only help consolidate the belief in my powers among those who had witnessed it. How could I have been sent so blindly into this complex culture of which I knew so little with so little preparation? I also wondered how many of my Western predecessors were aware that their words were so open to misinterpretation. Had it not been for my talks with Barun, who was rapidly becoming my teacher of his world, I likely would have remained ignorant myself.
I started to ask the local doctors with whom I was now working to share some of their experiences before coming to Solo for this program. One told me how he was sent to a leprosarium and of doing Ob-gyn there. The first Cesarean section he ever saw was one he had to perform while a student nurse read to him from a book on how to do it. “I did not find it easy,” he smiled. “How did it go?” I asked, as I reflected on my own recent OB experience in New Orleans. “Mother and daughter survived. So did the physician.” We commiserated on our mutual baptism by fire. “Spear wounds were the worst. The Javanese spear has a round, wide blade. Slices an arm off like that.” He brought his hand down sharply. “But I guess I did some good there, too.” “What makes you think so?” I asked. “Spear wounds I treat, 50% die. Spear wounds I don’t treat, 100% die.” Despite the obvious gaps in their knowledge, I became more and more impressed with the desire to serve their patients that motivated these Indonesian doctors, and that despite how little they had in terms of material possessions as well as tools with which to practice their profession, how happy each one was as a person. In the short time I had, I was determined to learn as much as possible about what made this joy of life possible. I will discuss this further in another post.
Two other American doctors were teaching at the hospital the same time I was there. One was a lean, athletic pediatrician from Seattle, who, despite the heat and humidity, would go jogging on the nearby roads, much to the puzzlement of the locals, who were not familiar with the concept of exercise just for exercise’s sake. (Their lives contained more than adequate physical exertion expended in the needs of daily living.) Like many countries in the region, infant mortality was high in Indonesia. Besides limited access to prenatal care and the usual childhood diseases, the biggest driver of this high mortality was the lack of available clean water. Most people got their water from the APC, the all-purpose canals, flowing throughout much of the country. This is where people washed their clothes, watered their animals, emptied their waste, and got their drinking water. He was on a mission to convince local mothers to breast feed their babies, rather than give them formula. Doing so would cut down significantly on infant diarrheal illness, which was the most frequent cause of death in a baby. Not only was breast feeding a healthier alternative, but much cheaper, as formula was expensive. The barrier standing in his way was the American cinema. Even in small towns, movies are a popular and relatively cheap form of entertainment, and almost all movies shown came from the USA, or other Western countries. When was the last time you saw a mother breast feed an infant in a movie? Just about never! Local women aspire to be like those beautiful creatures on the silver screen, so the concept of breast feeding had become associated with poverty and low economic status. Being a poor country in terms of wages, few women could afford to buy enough formula to feed their infants, so they would dilute the formula with – you guessed it – the water from the APC. My pediatrician colleague had been trying to organize a local group of mothers to go out and spread this message among their peers, but he described the process as being akin to pushing a boulder up the proverbial hill. (As an aside, driving into Solo, Barun smiled as he pointed at a movie poster of a half-naked woman by the side of the road, “Debbie Does Dallas.” “Do you go to porno movies?” I asked surprised. “Sure,” he says. “Everybody in Java goes to blue movies.” “What does your wife say to that?” I inquired. “She goes, too. She likes them better than me.”
The other American doctor working with me was Marjorie, a radiologist with frizzy gray hair, in her late fifties, with coke bottle glasses. She had come from Harvard on a sabbatical. She had an infectious laugh and more energy than women half her age. She specialized at the Mass General (Harvard’s premier teaching hospital) in anthropological X-rays of Egyptian mummies, and ancient bones found during excavations. She told me she once wrote a paper regarding Neanderthal man to answer the controversy if Neanderthals could speak. After performing various X-ray studies, her conclusion was that “Neanderthal man could not only speak, he could lie!” She was anxious to visit the site of Java man, recently dug up, and supposedly our oldest known human ancestor. She had an insatiable curiosity about everything, and we soon developed a friendship that was to last many years until her recent passing.
In addition to the two other American physicians, we had four ex-pat nurses working with us; two from Canada, one from Sweden, and one from Germany. One of the Canadian nurses worked with our pediatrician helping him with his breast feeding project, while the others were involved in trying to improve the antiseptic and wound care techniques of the Indonesian nurses. Our paths rarely crossed, and we lacked a physical venue for socializing. After I made rounds and had our classroom sessions, I spent my free time reading, or occasionally sharing a meal with one or more of my Indonesian counterparts. On the weekends, I would join Marjorie in exploring the cultural sites accessible nearby, about which she was a veritable fountain of information. She would hire a car and a driver, and we would head out somewhere through the jungle to fascinating destinations about which I will write in my next post.