Road Trip

Today I had the opportunity to travel with some of the conservation crew to one of the replanting sites in the Gunung Palong National Forest.  This is one of the two rain forests that we hope to visit while we are here and is the one closest to Sukadana.  ASRI has two prongs to its work.  The first is the clinic with the second being their efforts to reforest the areas in the rain forest which have been denuded by illegal lumbering.  They have some additional side ventures which I will write about later as well.  But these are the major foci.

ASRI has done an amazing job of working with the people here, asking they what they need and how they could work together in both of these areas.  And the ASRI  organizers are quick to say that the villagers who live on the border of the forest understand that they forest needs to be protected but due to various reasons including economic ones they often have no choice but to  participate in deforestation.  Today I learned that there is basically no legal lumber available in Indonesia.  It has all been harvested illegally.  

So there has been a system established in which villages who do not participate in cutting down trees receive a discount at the clinic and there is also a "sliding" scale for villages which have almost met the criteria etc.  Patients who come from areas where there isn't logging etc. (and they do come from far away including Pontianak where we boarded our boat) because of the high quality of medicine at the clinic...pay a higher rate.  There are forest guardians in the villages..hired staff who educate and monitor behavior regarding logging etc.

So the 6 of us traveled via van to one of the reforestation sites.  It was a bumpy, bumpy but very interesting journey.  The road was an absolute wreck having been poorly built to start with and then ruined by the palm oil trucks.  Palm oil production via "plantations"  is the latest large threat to the  rain forest issue.  Wooden houses on short stilts, small food stands with a few items, cans of gasoline for sale on little stands etc.  I haven/t seen a gasoline station since we arrived. In fact our an was refueled outside our house with the use of a funnel and a large can of fuel.

The reforestation site was in the rain forest and we could clearly see the difference in the plantings by year beginning in 2009.  There was a nursery of little plants of various species chosen for what is natural in the forest as well as what seeds they can harvest etc.  It looked much like a nursery at home although NONE of the trees were familiar.  On our walk through the growing areas we were in ferns that were over my shoulders.  

The young workers (who look about 16-18) ares studying different ways of planting to see what is most effective.  ( Little distracted right now by a bird sized cicada hanging down from the underside of our mosquito netting.  Tonight will be interesting...and not a tennis racket in sight!).  One of the current approaches is to weed an area, plant, and then ring the seedling with a piece of card board.  One of the memories will be the departure of the motorcycle loaded with circular pieces of cardboard about 3 feet high.

We did a little walking in an area of original rain forest and it was remarkably cooler..and I had to keep reminding myself that I was really there.  We would have stayed longer, but the thunder we heard during the night finally came to something and we ended up running through ferns on our way out followed by huddling under the awning of a small shop.

Lunch was picked up on the way..another smorgasbord wrapped in wax coated paper with a small scooper spoon.  On the way back and to give our bones a break, we stopped for a hot gingery, black pepper, plus at least 3 other spices drink.  Plain old hot chocolate will seem tame after this.  I should also mention that yesterday we gave in and had a cold cappuccino   One can hold out only so long.  We asked around and so far people haven't been having trouble with tourista  or at least not often.  So we gave in.  Now all available appendages are crossed.  Coffee was sold at lunch in a plastic bag with a straw  and then tied tightly around the straw.

For those of you wondering about basic life necessities...we have a helper who washes our clothes by hand (pours the water out through the spaces in the wooden floor in the wash area).  They are beautifully done and I think she may have ironed one of Jim's shirts.  She also prepares our evening meal which always rice with some kind of fish/chicken (NO pork here due to the Muslim population) and beef is very expensive and a vegetable.  Dessert (if you don't count the cookies we bought ) is fruit and those of you who know I don't like bananas will be amazed that I am eating a kind of little one.

I will attempt to send pictures tomorrow when I feel a little more secure about our internet connection.  It has been a bit variable tonight...and I know that the connection is slow and perhaps I will have better luck at the clinic.

Jim is  threatening to go to bed and it is only 8:30!  This is even worse then when we are biking.   But those roosters are early morning regular!

Love to all!

So...onward we go.

So...onward we go.  Lauri just left for a day seeing one of the original reforestation projects -- a 90 min drive or so -- that does not mean it's very far -- the roads, once you leave the main highways are something else.  And...we thought the roads in Peru were bad!!

Yesterday, I was sent, along with the newest doc, to a village that is visited monthly by the mobile clinic.  It is not a "green" village (meaning no illegal logging or burning), but it is a "blue" village, next to green, so they are making progress.  We saw only 6 patients -- apparently last year they were seeing 20-30 in a day, so not sure why the change.  The sickest yesterday was a 46yo woman with shortness of breath -- could see it as she walked in.  While I initially suspected emphysema, her loud heart murmur and huge heart quickly led us elsewhere -- what appears to be severe mitral valve insufficiency likely the result of rheumatic heart disease years ago.  they have a particularly nasty strain of strep here and lots of rheumatic heart disease and fever.  She was on no meds, so we started several and will see her back in two weeks.

The roads to and from the village were really something -- good thing we had a good driver.  For one stretch there were elevated "boardwalks" on each side of the road for the motor bikes -- apparently put there by the palm oil plantation owner.   So...I presume, they can get the workers to work.

Just this  moment saw a 56 yo man with 2-3 wk hx. of cough, weight loss, at least one episode of coughing-up blood.  His TB sputum smear is clearly positive -- Little "red snappers" everywhere.

This morning started very early with the roosters crowing about 3, followed by thunder the rest of the night, with no rain.  Then, the usual call to worship at 4:30 -- rather fitful sleep after that point.  

This AM have helped one of the docs with a needle aspiration of a thyroid -- but, was unable to get the fluid that I think is there (ultrasound suggests it).  

All for now.  Thanks, Brian, for doing the blog.  I am sure my notes seem very disconnected, and, they are.  Mostly random thoughts and observations.  Looks like, since the clinic is quiet at present, we will have our daily ed. session early.

Jim and Lauri

Sent from my iPad

First Clinic Day in Sukadana

Ok -- so today, you get two emails.  Feel free to hit the delete button.

We may have finally exceeded our comfort zone for volunteer trips!!  As Lauri said, to say our lodging is basic is a stretch.  We will send photos of the kitchen, bedroom, toilet (and shower -- such as it is), etc.  The bednet seems to allow better airflow than the mesh tent we brought, so guess we will stick with it.  The morning call to prayers may soon require the use of ear plugs for me -- Lauri already is using them.

There are four local physicians who staff this place, plus a third year Med. resident from Stanford.  So... one would wonder just why I am here.  Be that as it may, the first several patients I saw with one of the young docs included anasarka (total body swelling) in a 10 yo, probable TB in an older woman, amebic dysentery in a child and severe COPD (that patient will stay the night in one of four in-patient beds).  Later in the day, an older man (my age) with severe anemia and what looks like lymphoblastic leukemia under the microscope.  Jason, the Stanford doc, then proceeded to take a photo with his iphone through the microscope eyepiece and will send it to a friend at Stanford to evaluate -- amazing.  With fewer patients expected the other four days of clinic this week, it will be interesting to see how my time is spent.  They do remarkable medicine with very limited resources and these young "Turks" are good.

WE took a nice walk after clinic today -- found another small shop that actually had sugar and flour and larger bags of coffee (ground to fine powder).  There are no real ovens here, but they have, in some houses, a metal box that fits over the gas flame and can be used to bake -- will give it a try soon.  Also, there is no whole wheat flour so will try combining instant oatmeal with the white flour to give the bread a little substance.

Even though we are seated on the steps of the clinic at present, we still are not connected to wifi, so guess I will send this tomorrow and see what can be done to leave the system on at night -- would be nice to do some internet work in the evenings.

All for now.  Will send this in the AM

Jim and Lauri

Brief update and some pictures

It is Tuesday here in Sukadana and Jim is out with the mobile clinic.  Every morning there is a joint meeting of the staff and he was asked to go.  Another Indonesian MD will be along and I can't wait to hear what it was like.  They were loading supplies into the van as we arrived at the clinic.  And you should see the parking "lot".  It is a mass of motorbikes, the prime means of transportation here.  People take a number off the peg on the door and then file into the waiting area  and sit in rows of chairs.  Sometimes health and/or conservation education is conducted while they wait to be registered and called in.

Today I spent the morning basically observing and talking (some)  with some of the nurses.  They are very experienced in what they do and basically I feel that they are teaching me!  But they appear to like practicing their English.  One in particular does  a lot of their lab work so I was able to observe that as well.  Pat, you would find this fascinating.  He preparing to do a malaria smear and has done many many, but says that he has only definitely seen one positive.  Many times patients are treated based on symptoms and evidently she had them.  Speaking of malaria, we haven't really seen many mosquitoes but hear that will change when we are in the forests.  The cicadas (perfect opportunity to ask forgiveness for all my misspellings - the spell check doesn't seem to want to work here and I need it!)  last night were in full tilt and they made a noise that sounded really angry in addition to the general buzzing as they appeared to want to dive bomb us as we sat outside on the clinic steps hoping to connect to the internet.  BUT to not avail.  It is turned off at night to prevent others "stealing " on to it  and lightening hit recently and knocked it out for about 10 days.  This will cramp our style....so I'm taking clinic time to write.  (Jim is rather irritated....)

Lunch is cooked and served in our house and between 12 and 1 the staff walks over and the women who have arrived between 7 and 8 AM have lunch prepared.  It is always rice with some kind of topping.  And all have been good.  Yesterday Lana brought in a huge fish  - at lest 2 feet long.  It was chopped up, bones and all, and friend and then served with some kind of vegetable sauce mixture.  We have had many meals of tofu and an interesting kind of chip.  When I first heard that everyone would be coming to "our" house and there is one table, I wondered where everyone would sit.  The answer is the floor.  We ALL sit on the floor.

Tomorrow I have an opportunity to visit one of the conservation sites which I think will be fascinating and I have been told that I will also be able to visit one of the goats for widows program sites.  They are currently in the process of purchasing 150 more goats for this program.

As for the beach...the latest information is that Kinari Webb one of the founders of the clnic was stung by a box jelly fish about a year ago at this beach.  She is still affected by that sting and so basically everyone has decided not to swim there.  Her husband does, however, as he believes that the chance of it repeating is not good.  So...we shall see. At least there is most often a cool breeze there.l

Final quick story....We can truthfully call ourselves multi millionaires now.  As I think we drew most of the money out of the ATM at the airport in Pontianak.  We arrived there and needed to have most of the money we will spend while here in hand.  There are two banks in Sukadana and one only accepts Mastercard and I don't know about the other but it won't work for us.  The exchange rate is roughly 10,000 rupiah to a dollar.  Makes us feel like really big spenders when a meal is 50,000 Rupiah and that is $5.  More on the finances later.

Love to all

First Clinic Day in Sukadana

Greetings everyone!!  We had a great boat ride to Sukadana and a very interesting and tasty lunch on the way.  It took us a little while to figure out the process, which meant that we didn't get it all finished but we enjoyed every bite.  It was like a smorgasbord and you were charged by what you chose.  The river/sea was calm and the boatman whom we sat beside in the very front was skilled and we were thankful that he waited to start chain smoking until after the gas stopped leaking right below my feet.  Something must have been tightened because it stopped.  

We passed many small villages on the way along the water edge and many of the homes/businesses were built on stilts into the water.  We saw an incredible variety of boats going up and down and unfortunately a number were hauling cut lumber.  Our luggage was tied to the top of the boat and covered with a tarp and it arrived all in tact.

I do not know that I can do just in describing where we are but here goes.  I think I will start with yesterday's recap.  

We are staying in one of the clinic rental houses right across from the clinic.  It is a gross understatement to say that it is basic.  No running water, squat toilet, dishes are washed in a basin which is emptied through the boards in a wash area etc.  But we do have a fan and a good bed net.  We are sharing the house with two other men who are nurse and a driver for the clinic.  Our eating area is where the entire clinic staff eats lunch each clinic day.  Today it was great!

So, we slept quite well under the bed net until the moslum call to prayers about 4 AM followed by the contest between a number of roosters for the loudest call.  Regardless of who won, we were up at 6 and made coffee (glad we brought our camping French Press) and sitting outside watching the town wake up.  Motor bikes every where with entire families going past.  Chickens in the yard etc.  After breakfast of cornflakes! we headed out for a walk.  We had a basic map and made our way to the beach which we will love frequenting.  On the way back into town we were treated some rhombuton (fruit like lieche fruit) which is red, spiny,size of kiwi and rafter being pealed.  We then walked past mosques, temples, stores etc, and arrived at a surprisingly new hotel.  There we had a delightful interaction with the manager and a family.  I think they were impressed with my 10 words of Indonesian.  It was there that we had our first taste of a jungle fruit called Durian.  It is beige about the size of a small pineapple and spiky.  Oh yes, it stinks, stinks, stinks.  In fact the hotel in Singapore told us that we were not allowed to have one of them in our room.  At that time we didn't even know what it was.  The on the way to our hotel in Pontianak, there was a street lined with sellers of this fruit and it smelled incredibly bad.  But we had been told it was tasty.  So, at the hotel one was cut for us and we managed to get past the smell and theb managed to get it down.  The inside is a series of big seeds covered with a custard substance.  I'm not sure I need a second taste.

On the way back we basically got lost and only got back to our house through the goodness of two men on motor bikes.  They realized we were lost when we asked both of them directions and they pointed in different directions.  So we got a ride.  Seems everyone knows where the clinic is so it is great source of reference.

Last night we biked to the hotel for a sunset viewing which was spectacular.  Also...imbibing in the local beer which isn't bad, but not up to Jim and Kyle's standards.  The bikes we have been provided are basically in the worst shape possible.  Jim's doesn't have brakes and mine self shifts constantly and the seat is at the height where my knees hit the handle bars.  We will see it this can be changed.  Riding back in the dark was tricky especially since driving/riding is on the left side of the road.  I almost caused major mayham at the first intersection we came to.

The people are gracious in welcoming us and smile and wave and the kids call out "Mister" or "Miss".  One little boy was quite intrigued with Jim's IPad as we sat outside in the afternoon.  He lives next door and may be a frequent visitor.

Oh yes, there was a rousing game of badminton before we went to the hotel   Evidently badminton is a game the Indonesians did well in at the Olympics.  Jim and I weren't at that level, but a couple of the Indonesian MDs were great.  Talk about spiking a shuttle cock!  

Today the clinic is open and Jim is busily seeing the kinds of diseases he hasn't seen in years.  There was a young woman who came in dead on arrival  this AM to form a distant village  Evidently people come from far away because of the reputation of ASRI.  There are about 34 staff between the conservation staff and the clinic staff.  I will write more about the conservation end of their work, but will just let you know that it is impressive.  

I am not sure what I will be doing...but am putting all kinds of feelers out.  So far Friday I'm teaching English to the pharmacy staff.  That should prove very interesting...I'm hoping to travel to some of the distant villages, visit the schools where they do conservation and health education, and visit the conservation sites.  More on this later.

It is hotter and more humid than Ecuador and we are struggling a bit with the living accommodations and questions about how busy we will be, but the people are absolutely wonderful.  By the end of clinic time (about 60 patients today and then it drops off for the rest of the week) we will have whatever our "helper" has made for our dinner and sit on the bench outside the front door and listen to the call to prayers.  Perhaps we will see the tall young man in a white long coat and distinctive white hat walk slowly by.  Then before long it is time for our mandi.....a shower taken by pouring water over our head (it is not warm water :>) some reading and then crawl under our mosquito net.  The tent will be used later!

Love to all.  We love hearing your words.

lauri and Jim

Indonesia Jan. 24

Selamat Pagi  or Good morning everyone in Indonesian. My language level is now about 10 words.  We are in Pontianak, Indonesia and in 10 minutes will be at the dock for our 4-5 hour boat ride.  It has been a mind expanding experience beginning with the flight into the country and then going through customs.  We spent an extended period of time there as the agents went through the bag of medical things we were bringing in. Nothing of real value  but they were most concerned about the fact that we  had catheters that were out of date.  They ended up keeping some of them..didn't fully understand that they could be resterilized.  BUT they issed the depo medrol (for joint injections) and lidocaine (anesthetic) so we were happy,

We were met by Pak an Indonesian man who has basically squired us around adn thank goodness for that.  Driving here is basically a system of bumper cars all done either in cars without seat belts or on hundreds of motor bikes.  Lanes are basically suggestions with bikes passing on the right and left cutting one another off and with entire families holding on.  HOWEVER, everyone is wearing a helmet and there are basically no horns blaring.  I periodically just close my eyes as we come to roads where hundsreds (literally) of these motor bikes and cars merge.

Last night we were taken to a major shopping mall so that we could buy a few thngs i.e. a dictionary and for Pak some food.  He dropped us off at this Indonesian form of a Cosco on three floors and told us he would find us in an hour.  Again a matter of trust.  I had no idea how he would find us, but perhaps since we were the ONLY North Americans in the place and the object of much interest - but friendly smiles- he succeeded and one again to another round of bumper cars.

Breakfast this morning was a mix of Indonesian food and cereal.  And we have loved the air conditioning in this nice hotel.  This will change shortly...hot and humid ahead

Have met the newk conservation director who has wide experience and a big job ahead of him.  We are going to learn alot..and are on our way.

Love to all,

Lauri and Jim

A quick second note from Lauri this time.  We are waiting to leave for the airport and the next to last stage of our travels.   Before we leave here I wanted to share a bit  We will eventually work out who writes, but haven't as of yet.

 First of all I have been impressed by the friendliness of the people of Singapore.  They are more than willing to share their ideas of where we should go and what to see and what to eat.  They really appear proud of their city but have also told me that you still need to be careful.

Since it is the Chinese New Year a trip to China town was a must.  Red, Red everywhere.  It is a symbol of good luck.  The red lanterns hung over the outdoor market were lit last night and made a perfect red snake undulating along the way.

We were able to observe a Buddhist ceremony in a large temple.  The chanting monks totally disregarded all of the tourists.  So colorful and interesting.

Which brings me to my enjoyment of the diversity of this city.  What a collage of ethnicities...languages..appearances and dress.

The green in me also appreciates the card that we place in a card holder in our room before any of the electrically controlled features work ie the AC, lights etc.  When we leave, we take the card out and everything shuts off.  A very good thing as every huge building here appears to be lit all night long!

The food courts are amazing...just need a tutorial.

Now if I can only sleep.....my interior clock is really messed up.  They say it takes one day for every hour of time change.  Do you see any issues here?

 Love to all of you, Lauri
 Sent from my iPad

We are awaiting our flight to Pontianak after a really good lunch in the airport.  And....our first, and certainly not last, experience in practicing patience:  the line at check-in seemed short enough to us, but the young women behind the counter were in no hurry to get us through -- good thing we were there two hours early.  We have purchased the requested two liters of liquor (Bombay Sapphire gin and Gentleman Jack Tennessee whiskey.  Should make the staff happy.  We did get dinged for excess baggage -- had been warned that this was likely to happen, since we are only allowed 20kg/person and we have an entire rolling duffel with stuff for the clinic.  We are being met at the Pontianak airport by Pak Manto who will drive us to our hotel and then retrieve us in the morning and deliver us to the boat dock and the 4.5 hr fast ride to Sukadana, our home for the next 6 weeks.  As you might expect, it is hot and humid -- guess that's what we get for being on the equator.

Jim