November 2005 in Aceh

My first night "home" in Aceh was particularly heartwarming, as the
Bumi Sehat and IDEP staff had moved us to the new clinic site, just
down the road in Gampung Cot. We have more than twice the space, and
this wooden building, built from trees felled by the tsunami, is
beautiful beyond description. There is still a pressing need for more
facilities, so that we can separate the birthing women from the very
sick patients. The staff continues to sleep on the clinic floor,
which is crowded. Peter, Rene, Ida, and Jan had organized the
medicines in the treatment rooms, a gargantuan task. Ade, Christine,
Sam, Hendra, Hanafi, Cut Rachman and many Acehnese workers had
labored for months to make this space a reality. We tear up when we
pass our old clinic-shack, where the conservative estimate is that
over 12,000 people were treated, over an 8 month period. How I wish
that every IDEP and Bumi Sehat donor could walk across those wobbly
floors, lean on the crumbling walls, under the leaky palm leaf roof,
and look into the eyes of just one patient, who sought and found
healing there after the tsunami.
The road is again impassible due to repairs being done on the
bridges. With each rain it flash floods, to the point that trucks and
cars get stuck, and the passengers must wade out. And it is the
rainy season now.
It was Halloween night, "All Souls Day" and I settled in with my
book under the mozzie net, enjoying the quiet. No sooner had I dozed
off when an ambulance pulled up. Bidan (midwife) Elly from Calang,
had set out at 1:30 in the afternoon, transporting a mom in labor,
hemorrhaging with a placenta previa. It was already 8:30 pm. Rene
changed the IV, "Marlinda" the young mom was dehydrated, tachycardic
and needed to pee. Fortunately she was contracting gently, and the
bleeding was not life threatening, yet. Clearly the ambulance could
not cross the flooded riverbed. As miracles do happen, our transport
vehicle was stuck on the far side of the river. Ida and Hendra were
about to abandon it and wade home. A huge truck was nose down in the
water, blocking the remains of the road. We brought the ambulance to
one bank. Christine and Ade had gone ahead to move the traffic. Six
strong men hefted Marlinda on her stretcher, over the water, slipping
and nearly dropping her in the dunk. Ida, Midwife Elly and I held
hands, rolled up our pants and braved the thigh deep, icy, rushing
water. Hendra got us to the hospital in Meulaboh, which was only the
beginning of the evening's adventure.
The Meulaboh hospital midwives were sorry to say that no surgeon
would come until morning. This could mean that our young mother
would bleed to death in the night. At the very least it would
further compromise the baby, who was coming early as it was.
Without a cesarean birth things looked grim. Ida called a surgeon
Dr. Cahyo, whose number she happened to have in her hand phone. He
agreed to come and at least evaluate. Once he saw the situation, he
doubted that he could get a surgical team together before morning.
We prayed, the doctor made desperate calls. Finally, a team was
organized. Ida negotiated for most of the IV fluids and medication
to be donated. One more glitch, surgery could not be done with out
blood to replace Marlinda's loss. Marlinda had type B+ blood. All
of us there that night were O+. Marlinda was the soul tsunami
survivor of her blood relatives, so getting blood via family was not
possible. Once again, Ida/miracle worker, made some calls. She
contacted Eddie and Mr. Wong from Mercy Relief. Middle of the night,
and he hunted up a donor, and delivered the needed rare and precious
blood right to us in the hospital parking lot!
Marlinda and her tiny 1 kilo 700 gram baby girl are alive and
well. To add to the sadness of the story, only a week earlier the
baby's father had died of complications of TB and Filariasis
(Elephantiasis). It was nearly 2 a.m. when Ida, Henda, Midwife Elly
and I made the long trip back to our beautiful new clinic. We had to
park on the South side of the rushing water - and wade across. Ade
and Hanafi were waiting to shuttle us the rest of the way home by
motorbike. After drying off we all slept well, deliciously.
In the morning we learned the Midwife Elly had lost all three of
her small children in the Tsunami. She was stationed in Calang,
while her husband was far North in Banda Aceh. She was distressed,
and shared that they had planned to try to make a baby at Idul Fitri,
the end of the Ramadan month of fasting. She had been given a few
days off to return home to her man. Sadly, the saving of Marlinda's
life meant her planned honeymoon was cut short, in fact there would
not be time, as the bus trip from Meulaboh would be nearly two days
long, even if the roads were open. I called Mike at the UN, and
shared Elly's story. He put her on a Un flight that very day,
reuniting Elly and her husband for the first time in many months.
Marlinda's baby dropped in weight from 1 kilo 700 grams to 1 k
300 g. We continued to visit them in the hospital, She named her
baby Muliasafitri, after her deceased husband, Mulia. The last time
we visited they had been released and had gone home to Calang, the
baby, tiny, weak, but alive.
The next morning we were visited by the family of Mohamed Thori,
born at Bumi Sehat the month before into the loving hands of Anna
Rawling. He is healthy and growing. Malaria patients keep coming
in. It is raining part of nearly every day and night now. The tent
dwellers have scavenged what they can to build shacks around their
tents. There are houses of brick going up in our area, thanks to
many international NGOs but construction is slow due to the rain and
poor road conditions.
Dr. Anne Entus (PHD psychology) is here treating Bumi Sehat
patients for trauma, believe me she is busy. We have seen her help
so many people with high blood pressure, sleep and eating disorders.
One night a 25 year old deaf and dumb patient was brought in, in a
catatonic stupor. All his vitals were normal, he was cold and stiff
as a board, as if in a trance. After 20 minutes in therapy with Anne
he walked out of the clinic, to resume his life. Late the next
night, a patient was brought in by his family, with a suspected
"acute asthma attack". Upon examining him I found he just had a
terrible case of hiccups, which had begun 10 hours earlier! Again,
Dr. Anne to the rescue, the patient left without the painful hiccups
and with a smile.
Alulia, a two year old girl was brought in having fallen from her
uncle's motorbike. She suffered two deep gashes in her head. Ida
calmed her while I sutured. She is just fine now. Today she will be
coming in to have her sutures removed.
We had thought that moving the clinic would mean that attendance
would drop drastically. Well, we are averaging 45 to 60 patients per
day, unless it rains all day and all night. There are an increasing
number of pregnant women, including many who had come in for
fertility counseling months ago, to achieve pregnancy. We continue
to need vitamins. UNICEF has provided micro nutrient powder for all
the children. John Fawcett Foundation gave us combantrin, and I am
worming everyone who has symptoms.
The mosquitoes are savage out here in Gampong Cot, where the new
clinic sits, between two graveyards, swamp to the East, Ocean just
West. We struggle with the high price of gasoline to run the
generator. Our prayer is to find the financing to get set up with
solar power, as the electric lines will not be reaching us out here
anytime soon. The clinic staff is enjoying a heap of harmony. The
food is, well, not so good. Ade went out and caught a jungle foul,
roasted it for us, that was the week's culinary highlight. Bang
Hanafi goes fishing. The cooks bring food from Meulaboh, but they are
widows, and their depression is evident in the flavor of their
cooking. Seems the only really delicious food that comes our way
these days is a result of the male staff getting hungry enough to go
out and kill something, roast it on a fire, and feed it to us!
Dr. Anne Entus suffered the near rupturing of her hernia. Thanks
to cooperation between doctors from several NOGs, coordinated by
Samantha from IDEP, and the Meulaboh hospital, Anne received surgery
just in time. The UN plane then airlifted her to Medan. She is on
the mend now, home in Bali.
Dr Frank and Nicole arrived toward the end of November, to donate
a week of their time. Frank, a Dr. of Traditional Chinese Medicine
treated dozens of patients, with great success. He is already
missed. One life Dr. Frank saved was that of a young man stung by a
scorpion. His foot was bright red, hot, swollen. A red line was
traveling up his leg, and he had extreme pain. Frank applied a
Chinese medicine almost never used, toad venom, to the wound. Then
he and Ade drove the patient to the hospital in Meulaboh, to get
serum/anti venom. Because the poison was moving fast, they were
worried that the long trip on our impossibly bad road, would get them
there too late, unless the toad venom worked. Well, when they
arrived at the hospital, the patient's foot looked normal. The red
line was gone. The swelling was also gone. Pain, nearly gone.
Serum was administered 'just in case', but the patient was clearly
saved. Sometime around 2 a.m. Ade called to say that a truck had
fallen off of the last bridge on the road home to the clinic. I woke
Bang Hanafi, to go get them. Hanafi took the patient home by
motorbike. Then he finally brought Frank back to the clinic. Ade
stayed with the car, and helped get the truck out of the way so he
and some friends from the village could fix the bridge. About 5 a.m.
Ade came home, feeling very good about the night's events.
The 23rd of November I was called with Nia, my assistant, to a
birth in the barracks in Reusak. Suardani gave birth to a healthy 3
kilo girl. Her first child, a four year old boy, had been taken by
the Tsunami. That birth, in the run down barracks, where the
laboring woman had to wade out over toilet seat covers laid out to
make a path to the outhouse, was a beautiful event. We could hear
the happy sounds of Federation Red Cross, Red Crescent food packets
being distributed. We could smell the fish drying on huge plastic
tarps. We could hear the radio of the people 1/8 inch of plywood
away, in the room next door. They could hear us, laughing and
crying.
The next day I went to see Wahuidi, the young man paralyzed in a
motorbike accident. His younger brother Farizal is taking such good
care of his bedsores that they are healing beautifully. Matias is
bringing him books to read. Handicapped International has provided
him with a rolling bed, proper mattress, and gel pillow. His spirits
are good. Our translator and 'get anything and everything done'
girl, Ida… has given him hope for a quality of life that he knows
will be entirely up to him. Wahuidi is so positive - we believe he
overcome the obstacle of not ever being able to move around on his
own.
I had wanted November 24th, my 49th birthday to be quiet. I was
terribly lonely for my family, and wished just to catch up with
Wahuidi and see my friend, Ibu Elysa. Elysa and Pak Usman had two
living daughters. Yenni, and Wulan. Bella and Indah, the two
youngest, a toddler and a baby, had been torn from Yenni and Elysa's
arms by the tsunami. Now, nearly a year after the tsunami, Elysa was
expecting any minute. I was a bit concerned as her fundus was huge
and I felt baby parts all over the place. I found two heartbeats,
but said only, "Pak Usman, how many babies did your plant in your
wife?" I was not certain, and I wanted to wait to see what they next
prenatal visit proved. Since there is no ultrasound available in
Muelaboh, I did not refer them.
Well, I showed up at Elysa's house, which they share with four
families. She was feeling badly, had mild pain. I felt her pulses
and her belly and assured her that this was most likely, early labor.
I told her I would come back in about an hour, as I had to do a few
errands for the clinic, and asked her to call my hand phone should
anything come up. Well, less than an hour later Elysa called to say
her waters had released. I had just gotten through to the clinic to
have my birthkit sent out. I had my basic prenatal kit, and dashed
into Medicens Sans Frontiers to ask for some sterile gloves. Hendra
got me to Elysa's side in record time. Ade, back at the clinic in
Samatiga sent Eti, our accountant and Nicole off at top speed on the
motorbike, with the birthkit. They arrived 9 minutes before the
first baby came.
Baby number one was born 8 minutes before number two. Both girls
were born head-first. It would have been a stress free delivery for
me, but for the fact that I could get no heart tones at all on baby
number one. The birth was moving too fast to transport. Imagine my
relief when a perfectly healthy alive baby emerged. The girls are
identical, shared one placenta, separate amniotic sacs. Baby number
two was born in the caul at 2 kilos, 800 grams. Her elder sister was
3 kilograms exactly. Considering the size that her uterus had to
stretch to accommodate the twins, Elysa did not bleed that much,
though I would consider it a hemorrhage, and I did administer
pitocin. I watched her carefully. Baby number two needed some
suctioning as her airways were blocked by thick mucous, and she had
some chest retractions, which cleared up within 9 or 10 minutes.
Both girls went enthusiastically to the breast.
For Nicole this was her first time to assist at birth. What a
beautiful introduction to midwifery! I am so grateful for her
assistance. At one point I am sure we each had four arms.
We are now getting help from the Obor Berkat doctors from Java
several days per week. I was sad to find two patients with Leprosy.
We are currently seeking medication for them. It is a grave concern
of mine whenever I find yet another contagious disease in Samatiga.
The people in the tents and barracks are immune depressed from
grief, minimal sanitation, and malnutrition. They don't need
leprosy.
This year as you celebrate the birth of Christ, the tsunami
survivors will be remembering that one year ago on December 26th
2004, most of their loved ones died. One year ago they became
homeless. As the New Year dawned the tsunami survivors slept in the
rain, and wore mud to cover their bodies. Their eyes searched the
sky for help, in the way of boxes of dry noodles dropped from
helicopters. Today, a year later, they live in rotting tents and
barracks buildings with sagging floors. They survive by the kindness
of donors all over the world. They are having babies if they can.
They are happy as the tiny houses are beginning to go up.
Together, we are building bridges in the rain.

With very special thanks to Rotary, Zimmerman Foundation, Sakthi
Foundation, as well as all the ANGELS behind the scenes who are
keeping the Bumi Sehat Tsunami Relief clinic open. Your hearts move
our hands to heal.
With love and gratitude, Ibu Robin Lim