"The sea in Aceh is the exact
temperature of tears”, says Harvest, my daughter’s Godmother. Apparently one
cannot really look forward to returning to Sama Tiga, so near to the epicenter
of the 2005 tsunami. “It is like returning to purgatory.”
I have shed a few tears myself these past
years and I had been wondering if I would ever again practice what my hands do
best and my heart knows and loves - midwifery.
Trisha Anderson told me once in relation to
midwifery and, probably, life, that when you find a door there is no need to
push- it will open. The moment I decided I could go was the moment the
metaphorical door opened.
Robin Lim’s offer of a place for me in her makeshift clinic “Bumi
Sehat” by the Indonesian fishing villages off the Western coast of Sumatra,
felt like a door opening after groping around in the dark feeling only walls. I
suspect that going there will acquaint me with that little-contemplated of
human understandings - perspective.
“Until one is committed there is hesitancy,
the chance to draw back always
ineffectiveness. Concerning all
acts of initiative and creation, there is one
elementary truth, the ignorance of which kills to countless ideas and
splendid plans: that the moment one
definitely commits oneself, then providence moves too. (W.H. Murray)
And so, I commit to spend 6 weeks at Bumi
Sehat and to try and get other midwives and healers to do likewise. The only
inkling I have of what awaits me is what I have gleamed from Robins e-mails. I
am vicariously sharing her story.
Aceh Province saw 30 years of civil war
before the tsunami. It is not uncommon to hear gunshots at night. There is
community malnutrition and most women have lost a child in the first 2 years of
life. The maternal mortality always was one of the worst in the world.
80% of deaths were women and children. The
men of this area were out at sea when the tsunami struck. There is a large
homeless, jobless and traumatized male population. The people are Muslim. The
women, not prepared to venture outside the confines of their barracks area to
seek aid -not from western male relief workers and certainly not without
chaperones or headscarves- both of which were swept away. 30% of the local
midwives (Bidans) are gone. All the equipment long since rusted under the
water. No cars, no roads, no fish, no vegetables.
The networks which made the communities
flourish have vanished .The resettlement of the 15 villages is essential to the
physical and emotional survival of the people who now face generations of
displacement from ancestral lands, stuck in tent cities or army barracks
relying on relief food and sharing pit latrines with hundreds of others.
It is not that nothing has been done with
the generous donations from overseas but there are governments’ agendas and
contractors’ needs. The priorities mostly lie within the cities whose
infrastructures were leveled. Women and children in rural areas are last on the
agenda.
The clinic has a grassroots integrated
approach, based on local community participation to identify and fulfill a wide
range of needs. Robin is half Indonesian and runs a similar holistic clinic in
Bali. As an Indonesian based non-profit organization, volunteers are able to
get into areas that the Indonesian government won’t allow for other agencies
and NGOs.
Bumi Sehat is the only facility within
walking distance of 2000 survivors and many more scattered in the forest. It is
a sustainable place where 70 people a day come for medical aid. Through this
contact, the clinic staff is able to put small rag-tag communities in touch
with other agencies and NGOs .It is a safe neutral place where the most
marginalised feel comfortable to come and ask for help.
The clinic was built by male volunteers and
made from reclaimed trees felled by the tsunami. Now they are building bridges
and digging latrines and wells. Sometimes the only food available is if one of
them gets hungry enough to go out and kill something, roast it on a fire and
feed it to the clinic staff!
The clinic organized generators and street
lighting for the camps and also negotiated for an Indonesian vessel to bring to
the shore, 3000 kerosene cooking stoves and a motorcycle for the clinic. The
boat The Endless Sun however got scuttled and although 1200 stoves were rescued,
it was by a village some miles down coast. The clinic again negotiated for the
sailors, now shoeless and without passports, to get safe passage back to Bali.
As well as prenatal birth and postnatal
care, the clinic offers modern medical care, suturing wounds and anti-biotic
treatment. Malaria, the queen mother of all tropical diseases is rampant and
rapid testing, diagnosis and treatment is available as well as referral and
transport to the nearest hospital -50 miles away in Meleuboh. Malaria preventative
medicine is only 30% effective and medicine has to be bought by patients on the
streets of Meleuboh.
The rolling staff consists of volunteers
from all over the world, brought to Indonesia on tourist visas by Robin’s
lawyer in Bali. Depending on who is volunteering at the time, there is
traditional healing, aromatherapy, homeopathy, chiropractic and massage. A
local cure from the fruit of the Star Tree has been found to dramatically
reduce high blood pressure: this kind of sustainable health care gets everyone
at the clinic excited.
There is a lot of hand holding and just
listening. Counselling takes up a large part of the day. Orphans come to play;
elderly people congregate and tell stories. They tell how only 70 people
survived in the village of Lahok Bubon -saved on the mosque roof. They tell of
the pregnant woman unconscious and held afloat by holding onto the horn of a
water buffalo who went into labour that night on the roof and how - Alhumdulillah!
- Praise be to Allah! - One of the 70 survivors on the roof was a midwife!
.
Projects include the Mercy Corp’s Curriculum
for Safe Motherhood workshops for the TBA’s on cord care and neonatal tetanus
prevention. At a workshop, attended by 41 Bidans, a midwife who herself had
lost her husband and child and was 30 weeks pregnant, walked for three days to
attend. Unicef director, Scott Woolery also attended and pledged new
birth-kits. Sadly, no refrigeration exists so tetanus vaccination is not an
option. However, cord burning rather than cutting with blunt scissors in
conditions which lack running water, is a lifesaving skill.
Workshops on breastfeeding sponsored by
Catholic Relief, explain the dangers of formula feeding when there is no
potable water and liaisons with other aid agencies explaining the dangers of
passing out infant milk are ongoing.
The clinic staff is called to births with
the TBAs and share hemorrhage prevention techniques. One birthing mother had a
retained placenta which Robin peeled off inch-by-inch. The TBA had done cord
traction, severing the cord. The woman, not used to opening her legs even to
save her life, was fine and the baby healthy. The local midwife who was also
the birthing woman’s sister-in-law took the skill with her. The birthing
woman’s sister had died a year previous from the same complication.
On Halloween, Robin writes of a dehydrated,
tachycardic mum with placenta previa brought to the clinic by local TBA, Elly.
The roads were washed out by the rain and the clinic car was on the other side
of the thigh-high rushing water. Six men carried Marlinda to the car donated to
the clinic, and they made their way to Meleuboh where they were informed there
was no surgical team. Clinic staff knocked on the door of the main surgeon,
rousing him from his bed and persuaded him to organize a surgical team. Also
accomplished, a delivery from Medicine Sans Frontiers of B+ blood. All the
clinic staff happened to be O+ and Marlinda had no living relatives to donate
for her. Her husband had also died the week previous of TB.
The next day the clinic staff learned that
the midwife, Elly had not seen her husband for many months and that they had
planned on meeting in Banda Aceh and making a baby. All three of Elly’s
children were drowned in the tsunami and now she had missed her chance to make
another as the last bus had long gone. In the spirit of friendliness and
sharing that is so often found in disaster areas, a UN plane was organized to
take her out that afternoon for the special occasion.
Where labouring women make their way from rotting
overcrowded tents to the latrines by hopping on toilet seats in a monsoon sea
of mud and where there is no ultrasound, Robin finds two heartbeats. “How many
babies have you planted in your wife Pask Usman?” Robin jokes. Her assistant,
who has never attended a birth but has come all this way because she wants to
learn and help, is sent for the birth-kit and some sterile gloves. There is no
time to transport to Meleuboh - the babies are coming fast. Robin comments that
this would be a stress free birth were it not for the fact that she cannot pick
up any FHR on baby number one. She was born screaming and healthy! Baby number
two arrives 8 minutes later in the caul. They are identical twins with one
placenta and two separate amniotic sacs.
The area is regenerating and nine months on
there certainly is a baby boom. In the face of such devastation, the midwifery
model of care is so simple, so essential and so effective.
In the Bali clinic, they report that Bumi
Sehat Aceh volunteers cry easily but look ten years younger. They wear their hearts on the outside of
their bodies. Like the wound that Tolkien speaks of when Bilbo the brave
hobbit, having ventured too far from The Shire, could never find himself the
same again.
Robin’s son, who is 17, has had everything
that was true and good about him strengthened. He has gained a beautiful
maturity and a deep compassion.
The lesson appears to be ‘more love less
attitude’. To live amongst this hell on earth is to be converted to the
religion of gratitude. None of the volunteers will ever take a single moment
with a friend, lover or child for granted.
Aceh is the most broken place on earth today
and paradoxically the most healing.
Anyone who has 6 weeks to lend a hand or can donate basic supplies
please contact me on 01308-861376.
There is a list of equipment needed on my
website www.acehmidwifefund.org
You can make a donation via the website – www.acehmidwifefund.org
Or
to Lloyds bank, Bridport branch - sort code 30-91-21 - account name ‘Aceh
Midwife Fund’
Or
by post to - 1 Marsh Dairy Cottage,
Mapperton, Dorset, DT8 3NP
Blessings to all who have gifted donations
so far.
Thanks to:
Elsie Gayle and the Balsall Heath Midwives
for the W. H. Murray quote.
Jeanine Parvatti-Baker, who tragically died
recently, for the ‘religion of gratitude’ analogy
Trisha Anderson for showing me when to
“instinctively know when one is right;”
… and to Robin Lim, author of “After The Birth- A Woman’s Way To
Wellness”. The wording is hers!
Tania Berlow, January 2006