Trouble in Paradise
Bali is often thought of as a tropical paradise – palm fringed beaches, beautiful sunsets and balmy evenings. While this is all true, there is a darker side to Bali.
This week we feature a newsletter produced by midwife extraordinaire Ibu Robin Lim who works tirelessly to provide care for families in Bali. A large part of her work is focused in Aceh (pronounced Ah-Chay) – an Indonesian province that has experienced years of fighting, and is now trying to pick up the pieces after being devastated by the 2004 tsunami.
Robin operates the only birthing center in South East Asia and provides free or low cost care to local families. She has kindly given us permission to include her March/April 2009 newsletter below. At the end of the newsletter you will find information on how you can help the amazing work that Robin and others are doing to help the women and children of Bali and Aceh.
Bali is a small island that mainly farms rice and supports itself with the tourist dollar. People in Bali mostly practice a form of Hinduism. The maternal mortality rate in Bali is 718 deaths per 100,000 births with nearly half these deaths being caused by postpartum hemorrhage, largely due to malnutrition. Aceh is on the island of Sumatra. There have been ongoing conflicts there for many years. The two main religions practiced are Islam and Christianity.
Bumi Sehat is entirely funded by donations and all work is carried out by volunteers. Robin told us that it is the small donors that make a huge difference and enable Bumi Sehat to continue operating. If you can help, please do, in any small way possible. Send your thoughts to Robin and her team who work in difficult conditions to make birth safe for families that have so little.
Bumi Sehat Aceh Field Report – March/April 2009
by Ibu Robin Lim
The people of Aceh wake to a huge pink sky, and they look toward the sea. The sea, that forever looking backward in history, has been the people’s source of sustenance. The sea they harvested giving them work and the poetry of food, it has been their art, their life.
They look at the calm sea today and they remember the day of betrayal, of salty tears, December 26th 2004. At just about 8 a.m. an earthquake measuring 9.3 on the Richter scale struck. It was a terrible earthquake, but the people of Aceh had long lived with the shaking of their Sumatran foundations.
Then the sea betrayed them, a Tsunami. Not one wave but many, growing bigger and blacker and filled with all the churned broken belongings of modern life. Roiling with police cars, sheets of metal and glass, hunks of cement, furniture, animals still trapped in their cages, people, people who were quickly becoming corpses, by the hundreds of thousands.
They look at the calm sea today and they remember the day of betrayal, of salty tears… Not one wave but many, growing bigger and blacker and filled with all the churned broken belongings of modern life.
By sunset, when the waters began to finally recede the rebel nation of Aceh, that had faced the hardships of generations of civil war, was diminished beyond recognition.
Villages lost 30%, 50%, 70%, 90% of their citizens. But it would be a long time before they would know the extent of their loss. On the eve of Dec. 26th, 2004 the survivors were thirsty. They were looking for their children, their spouses, their mothers and fathers. They were naked, but for the mud. They were itchy. The night was coming and they wondered; would there be more waves?
Beginning in the first few weeks of the aftermath of the Tsunami, Bumi Sehat has maintained a clinic for the survivors. We came to Samatiga with a team from IDEP and WALHI foundations. We stretched tarps over bamboo and began to see patients. We worked with our sister NGOs to establish water supply, dig pit toilets, usurp tents for people living in the open, some of Team Bumi, my own grown children, recovered bodies.
Today in the 4th year of what we hopefully call “recovery” and pray is truly “healing,” Bumi Sehat maintains and operates a beautiful proper free clinic for the people of Aceh. The beautiful land a gift from “Paula”, the clinic facility built and furnished by the generosity of Rotary S.E. Asia and Ubud, and currently maintained with operational funds from Direct Relief International plus generous help from smaller donors, friends and family all over the world, is busy and lively and lit with the warm dependable power of the sun, (thank you solar energy).
For the first two years following the Tsunami I spent more time in Aceh than I did at home with my family. Team Bumi Sehat Bali galvanized itself to maintain it’s beautiful growing services in Bali, while logistically supporting their team members going to the dangerous geologically and politically unstable disaster zone, that had once been the proud, jeweled coastline of Aceh. It was a hard time of desperately treating Tsunami wounds that would not heal. We fought a war with malaria, dengue fever, unidentified skin conditions unique to the thousands of patients we saw, who had been swept away in the violent stinking Tsunami water. We delivered babies, because that is What Bumi Sehat does best.
Slowly over the months and years we moved from tents and tarp clinic to a rumbia roofed hut with four rooms, built by the IDEP/WALHI team from trees felled by the Tsunami. Eventually IDEP found funding to build us a wooden clinic in Gampong Cot, in view of the sea, very close to the epicenter of the disaster. Finally Dear “Paula” purchased enough land for Bumi Sehat, and the Rotary brought in the miracle, a proper earthquake resistant clinic. Over 12,000 grieving Tsunami survivors live within walking distance of Bumi Sehat’s clinic, many more borrow vehicles and come in groups from great distances, traveling hours, seeking kind, clean, free, conscientious medical care. Dr. Eman, Nurses Liman and Bankit, Midwives Mega, Liza and Sumi, supported by a beautiful team, live and work on site, contributing significantly to the healing of Aceh.
When the small propeller plane my husband Wil and I take to come “home” to Aceh lands on the Meulaboh airstrip, I choke back tears. Ijal and Eti, faithful team members who themselves survived the Tsunami, are waiting. “Ibu Robin, a mother in labor is waiting for you at the clinic.”
We travel over a road that was once a moonscape and wonder at how smooth it has become, thanks to International Aid. The trip back to the clinic was once 2½ to 3 hours, today we arrive in 45 minutes. Meliza is in labor with her first child. By dinnertime she has had a lovely waterbirth. The smiling midwives, working with traditional midwife Ibu Juariah, settle Miliza and her tiny baby daughter into a clean bed to breastfeed. The extended family will spend the night. Our cooks bring plates filled to feed them all.
That evening, over simple spicy rice and fish dinner, the staff speaks of how the conflict in Aceh has settled since the peace treaty in 2006. There is no sound of gunfire in the distance, yet there have been “incidents” recently, reminders that war is always a threat the Acehnese live with. Thunder rolls in and it begins to rain as it can only rain in Sumatra, huge rain with drops the size of pennies. Even the clinic ducks are running for cover.
By 2 a.m. we midwives are called out to the village of Pinem. Ibu Asya is the traditional village midwife in attendance. She is worried as Ita Ristani, having her 5th baby at home is not doing so well. Something feels wrong.
I know she will not stay with us long. I lay down beside Ita, with the baby between us. An hour and 47 minutes after her birth, Ita tells me, “Ibu Robin, Fitri is cold.” I listen, there is no longer a heartbeat. We cry together as the sun rises, it is so pink and purple, we all feel bruised by this morning.
The Bumi midwives recognize this mom and hope that her due dates were wrong, as she would be having this child 9 weeks early. Ita’s other four children are hiding in the next room of the wooden house, dimly lit with a kerosene lantern, newspaper is stuffed in the cracks between boards to keep out the wind. Ita’s husband is walking in the yard, littered with trash, smoking a nipa cigarette.
Ita moans, with a whoosh a salty amniotic sea breaks loose and in that one push the tiny baby is washed out of her mother. It is too soon. I scoop her up and she cries weakly as I lay her on her mother’s now concave belly. This Baby’s tiny hands and feet have no creases, she is far too premature, Allah has not had time to draw the lines of her fate. We call the father and ask him to sing the prayer songs of Islam to his tiny daughter. He gives her the name, Fitri, her tiny heart is slowing. We gently explain this to the parents. I wonder, if this child had been born in a modern hospital with a neonatal unit, would she have a chance? My wondering can’t change the fact that we are here, in a wooden house, where the family will eat cold rice and dried fish in the morning. Transporting this baby to the hospital in Meulaboh would be of no use at all.
Ita tries to breastfeed but the baby who has no reflexes, we make a hot water bottle to keep Baby warm. I know she will not stay with us long. I lay down beside Ita, with the baby between us. An hour and 47 minutes after her birth, Ita tells me, “Ibu Robin, Fitri is cold.” I listen, there is no longer a heartbeat. We cry together as the sun rises, it is so pink and purple, we all feel bruised by this morning.
The day is filled with clinic duties. A man in his 80s has been picked up by our ambulance, he has been unable to eat for nearly three weeks without vomiting. He is dehydrated, Max our new medic volunteer from “Leap Now” puts in an IV line with Liman.
The ambulance also picks up a 17 year old girl, who looks like she is glowing with health, but she has had headaches and nausea and fainting spells. Her blood pressure jumps from 100/80 when she is conscious to 130/90 when she passes out, a mystery. We admit her.
3 a.m. March 5th the midwives are called out by village midwife Sadhia. We arrive quickly at the home of Fitri, who has had prenatal care with us, and has attended the pregnancy education and exercise classes held weekly at Bumi Sehat.
Fitri lives in the concrete swamp getto that was once the fair city of Kuala Bubon. The little cement houses, built with relief funds, teeter on stilts, with rows of others, surrounded by the wetlands created by the Tsunami. Just at dawn a little daughter is born, robust and healthy. Allhamdullilah!
Saturday March 7th – Yanti, the 17 year old patient, has another seizure. When conventional attempts to stop the convulsions were unsuccessful, we were able to stabilize the girl with acupuncture, thanks to hand phone contact with Dr. Bobbi in Bali, who guided us through the lifesaving procedure. Dr. Eman is very excited to witness natural medicine work in an emergency. In the late afternoon the eleven elder “Bidan Gampong”, village midwives, practicing in the area are gathered. Some came by foot, others rode with family by motorbike, some we picked up in the Bumi Automobile. Mimi, only days from her due date, has made them a noodle feast with vegetables from our garden, and the kitchen staff has made seaweed cakes. The women are excited. We open the meeting with prayers and gratitude. Stories unfold of how afraid these women have been. Some of them have been called too late, to find young mothers had died. These midwives have not been to school, they have no paper degrees, what they have is a lifetime of service and experience, and knowledge passed down from generations of baby-catching grandmothers. They are needed and trusted, honored in their communities for the spiritual authority to greet new life, they have the secret prayers. Typically the medical authorities disapprove of these traditional practitioners, and blame them when there is a birth tragedy. Until Bumi Sehat came to Samatiga, Aceh, they had no one to help them. Typically a Bidan Gampong is called early in labor, she stays quietly, squatting on her little wooden bench, chewing betel nut, gently massaging the laboring woman. When the baby comes she wipes the tiny face and helps the wee one to the breast. She will stay three days with the family, to cook and wash the laundry by hand and clean and look after the new mother and baby. If she does not stay, all the work may fall to the newly postpartum woman, this cannot be allowed. For this she is paid the equivalent of $1.50 to $3.00.
Two years ago a woman bled to death shortly after birthing her 4th baby. Her husband had not called for help until it was too late. The traditional midwife arrived quickly, and the mother had lost consciousness. Having no phone she sent a neighbor boy on bicycle to Bumi Sehat to get help.
Our ambulance arrived within minutes but the mother had perished. This death galvanized the Traditional Village Midwives to work closely with Bumi Sehat.
Today, due to the generosity of our donors, we have 11 members of “Ikatan Bidan Gampong Bumi Sehat, Aceh, Indonesia” (the Society of Bumi Sehat Village Midwives of Aceh, Indonesia). Each one of them has a hand phone (mobile phone), provided by Bumi Sehat, and has been taught how to use it. Monthly, Bumi Sehat provides their pulsa phone minutes(credit for making calls on a mobile phone), so they can always call for help. We meet regularly for capacity building workshops in hemorrhage prevention and control, breastfeeding start-up, we share the art and science of midwifery together. About half of the laboring women come with their chosen Bidan Gampong to the Bumi Clinic to birth. The rest call us to assist in their births in the huts and houses.
Our Village Midwives have requested a few things from Bumi Sehat’s donors… They need reading glasses, flashlights, new stainless steel instruments and bowls and Newton scales to weigh the babies. And, they want t-shirts with the Bumi Logo that say; “Ikatan Bidan Gampong Bumi Sehat, Aceh, Indonesia”. I assured them that our donors would be proud to help out. As for me, I am in awe, this is perhaps our most astonishing program, to hold hands with these women is an honor. To have their trust is revolutionary and lifesaving.
I have meet with midwifery students sponsored by Bumi donors, Yenni and Dahlia, in 1½ years they will be finished with their studies. At that time they will join the Bumi Sehat midwifery team. We are so proud of them and of our donors for making these miracles of education for Tsumani survivors possible.
Fauzan, age 22, is from the devastated village of Kuala Bubon. He survived the Tsunami hanging on to the dream of becoming a school teacher. His father has suffered a stroke and can no longer support Fauzan’s education. Fauzan has been working as a raft fisherman while going to school. He has only 1½ years left to get his teaching degree. Hearing the story, our Leap Now volunteer, Max, has decided with his friends to sponsor Fauzan, so he will not drop out.
Bumi Sehat has been criticized for not having an “exit strategy” for the clinic in Aceh. To be honest, if we exit here, the people of Aceh will not be able to find adequate funding to keep this quality of health care going. Exiting would mean abandonment, the staff would disperse, as they would need to find paying work. The medicines would run out and the buildings would fall to ruin.
While meeting with our staff here in Aceh, they timidly asked if Bumi Sehat was planning to keep the clinic project alive, I told them, “Honestly, I don’t have an exit strategy.” translator Mimi and Dr. Eman burst into tears of joy. This team is amazing. Each visit to the sight is a delight, as the vegetable gardens are bigger and better. the fruit trees are growing, the buildings and vehicles are well maintained. The patients fill out evaluation forms, praising the services here.
Chemene of Flow Fund purchased more fruit trees and plants for the clinic, as did Wil and I. Nurse Liman spends his entire day off, working hard in the garden, with Adi planting and nurturing the flowers and trees. Imagine how happy it feels to wake at dawn to find my midwives planting vegetables with the drivers and the gardening team, I jumped up to join them! Each team member takes pride in every aspect of life here. The vision and mission; to serve as a healing team, providing hygienic, professional, loving, effective medical services, protect safe motherhood and significantly contribute to infant survival, while setting an example of environmental consciousness, in a land so ravaged by grief, is held in the hearts of every Bumi Sehat team member.
As I write this I must stop… to help a village midwife turn a breech baby. Success, the mother was crying, as she had been told at the hospital that she must have a cesarean birth. She left smiling, with Perfect Prenatal vitamins and a head-down baby – Allhumdulilah!
Mimi, our dear translator spent three days and nights in labor. Another mom comes in and has her second baby very quickly. Her first had been born at Bumi Sehat in the early days following the Tsunami, when our clinic was but a shack.
Finally Mimi’s courage and determination pay off, she and Liman have a beautiful daughter born at Bumi Sehat. They named her Talitha Nadif Halilah Wijaya. I felt like my time in Aceh was complete… I had delivered the baby of my loyal staff, this baby is like a granddaughter to me.
The day and night of the Full Moon in March 2009 brought 8 new babies into the world at Bumi Sehat Bali! We are busy indeed. In early January two Bumi Sehat families who had lost children, just the previous year, due to birth defects, had perfectly healthy babies, born on the same day. How they celebrated together with smiles and hugs!
I must tell you all the story of Ibu Yudi and Pak Mulyono, they married across religions, Christian and Muslim, so their families have rejected them. We met them struggling with one child and pregnant with twins.
We were told there that she had sold the baby to another island. The nurse said, “You are poor and stupid, best we found a rich family to take that baby. Your kind will just make more anyway.” Pak Mulyono was in shock, “What can I do, go home and tell my wife I lost her baby, because I am poor?” he sobbed.
Each Christmas my husband Wil and I bring a carload of food to the slums in Sanur. This helps the Christians there, refugees from hard lives on other islands, have food to celebrate their own holiday. This December, while delivering the food and gifts we saw Mulyono, looking very sad. “How are the babies?” I asked him. “Why did we not see you at Bumi Sehat?” He cried when he answered, “I have no motorbike, and no phone, the night Yudi went into labor I was too shy to wake the neighbors to ask to borrow their hand phone to get a ride to Bumi Sehat (it is quite far). So we walked in labor, (more than two kilometers) to a midwife. The babies were quickly born, two boys.” I hugged him in congratulations. “The story is not happy,” he continued, “The midwife charged us over 7,000,000 rupiah” (about US$640 – more than a year’s salary for Pak Mulyono. Had they called Bumi Sehat we would have picked them up in the van, and the birth services would have been free.) “We had no money to pay, our church gave the midwife 2½ million rupiah, but she said it was not enough (had they gone to an expensive hospital and had a cesarean birth, the price would have been less, this was extortion). She kept one of our babies, until I can pay off the balance.”
Wil and I immediately went with Pak Mulyono to the midwife’s practice. We were told there that she had sold the baby to another island. The nurse said, “You are poor and stupid, best we found a rich family to take that baby. Your kind will just make more anyway.” Pak Mulyono was in shock, “What can I do, go home and tell my wife I lost her baby, because I am poor?” he sobbed.
With the help of Raihan, an Acehnese friend who is familiar with human rights issues, we made contact with PBHI Legal Aid attorneys. Meanwhile the midwife appeared at Yudi and Mulyono’s shack with a corrupt policeman, threatening them. It was a three week long battle, complete with newspaper coverage in two languages. Two weeks after the New Year, the family was reunited with their baby. Because the boys are identical twins, the midwife was not able to steal another baby (oh yes – this does happen) and replace the child who by now had been separated from his parents for three months. This Baby, though thinner looks just like his twin brother.
This happy ending does not cancel the sad fact that all too often, families cannot take their babies home after birth, until they pay the bill in full. This is one good reason to have a project like Bumi Sehat. There are days and nights when it is just plain hard to do the work of Bumi Sehat; receiving the babies, helping the sick and injured, providing educations, navigating customs to bring in our vitamins, looking after recycling, education, and environmental projects, keeping a huge staff on two distant islands happy and well fed, and raising the funds to keep it all afloat… but this past Christmas Season, as we fought to reunite this family, it all came into focus for me. We are providing services so needed and appreciated. When I say “WE” I mean all of us, the midwives, nurses, doctors, housekeepers, cooks, gardeners, teachers, volunteers, administrators, drivers, and YES, donors. We hold hands to make miracles in health, education and environmental protection happen, day by day. If we make this world a little bit kinder, if we relieve just a wee bit of suffering, we have succeeded as a team.
I ask and I beg our donors & sponsors, you are our loving friends and family… to remain partners in this vision and mission. Please, stay with Team Bumi Sehat, we need you desperately to keep this work going, both in Bali and in Aceh.
In Gratitude…. Om Shanti, Allhumdulilah, Blessings…
How is Childbirth International involved?
Childbirth International has supported charitable groups working in developing countries since we were first founded 10 years ago. Many of these groups operate without any government funding. We have provided scholarships for students in developing countries who are working with women and children from local villages. We are currently exploring ways that we can become more involved in the training and support of birth supporters in Indonesia and other countries in South East Asia. A number of Childbirth International students and graduates have spent time at Bumi Sehat as volunteers.
If you would like to learn more about Bumi Sehat and support them in their efforts, visit their website at www.bumisehat.org.
Childbirth International is a truly diverse international training organization. With students in 75 countries, from every corner of the globe, we celebrate the differences, similarities and uniqueness of each culture, religion and race. Providing the most comprehensive and flexible training available for birth professionals you can truly make a difference within your community.
Childbirth International offers training programs for Birth Doulas, Postpartum Doulas, Childbirth Educators and Breastfeeding Counselors. We also have an advanced training course available for birth professionals to help you build and grow your business.