It's a girl

30/12/2007

The average East Timorese woman will give birth to 7-8 children in her lifetime. Today, 25-year-old Maria Gonsalves delivered her third.

The knock on my door at 4pm brings worrying news that one of the villagers is in labour, and needs help. Gathering my equipment, I scurry over to her house, 15 minutes away from ours. I find that most of the action is apparently over. The traditional birth attendant, an alarmingly unkempt forty-something with an impressive moustache, is nonchalantly squatting outside the wooden hut. Cigarette break.
Ushered into the cramped kitchen through the gaggle of Christmas-holiday-kids, it takes me a minute or so to make out the scene in the smoky glow of the lone candle. Maria, spent and leaning against the rice sack, on a blood-soaked bamboo mat on the gravel floor. A smallish baby with biggish eyes squirming in the blood and dirt between her legs. The birth attendant has already tied and cut the umbilical cord: black cotton thread and the well-worn razor.
The pot of rice gruel boiling on the wood stove, an arm's length away, looks almost done.

Baby and mum initially seem fine, but then I discover to my horror that she's still bleeding - half an hour after the delivery, the womb has not yet contracted, the afterbirth is still inside. We immmediately put the baby to suckle (hormones stimulated by breastfeeding help stop bleeding), I attempt to show the birth attendant how to manually contract the womb and extract the afterbirth. His skepticism is thinly veiled - what is this foreign chap with the pitiful moustache going to teach him about childbirth, that he hasn't already learnt from grandma?
It takes ten anxious minutes to stop the bleeding and remove the afterbirth.

East Timor has the highest rate of pregnancy-associated deaths in Asia. Women have many children - partly to compensate for the few that will inevitably die in childhood. Most of these deliveries take place in the home, with no trained midwife, under decidedly unsterile conditions. When complications such as prolonged labour, bleeding or infection occur out of reach of health services, they are invariably severe, often fatal.

When the dust settles, Maria and husband ask me to name their baby. I'm utterly dumbfounded. Thankfully, the village chief's wife comes to my aid.
Because she was born on Sunday, 'Domingu' in Tetum, we've named her Dominga.


[Picture: Dominga at 14 days]

-raj

Weeding

22/12/2007

(See 'Digging', 21/11/2007)

We weed a lot.
It's raining almost daily now, and the damned weeds are spawning everywhere in the FAITH garden - on our eight beddings, between them, all over the path, climbing the fence, into the water pipes... and no measure of plucking appears to eradicate them, they grow right back in a day or two.
It's exasperating. I find myself wondering if we should just forget about defending the kang kong, and find a way to eat the weeds instead.
Genesis 3:17-18 "... Cursed is the ground because of you... It will produce thorns and thistles for you..." No kidding.

Weeding isn't as laborious as digging, but neither does it offer the same anaesthetic monotony. You've got to be selective about what you're uprooting, constantly mindful of collateral damage to the vegetables.
The hell-cabbages (non-scientific name) are particularly devious: they start off as baby sprouts almost indistinguishable from the tomatoes. But then they come of age one night, unfurl their vile tendrils and ravage the beddings!

About a fortnight ago, I had perfected a solution. Pulling together painstakingly studied observations on the shapes and colours of leaves, I worked out a mental diagnosis protocol for distinguishing friend from foe. Unfortunately, the first trial of The Method took about an hour to weed a single bedding.
Amandi then strolled over, shook his head and smugly showed me how real men do it: in ten minutes flat he had stomped through the entire neighbouring bed, Godzilla-like, wreaking havoc on the terrified weedery below.

I have lived with that disgrace for two weeks. But now I've just discovered that he had pulled out half the bed's tomato plants as well.
Vindicated! :)

-raj

Snake Vs. Lizard

20/12/2007

Drama that unfolded this morning.

1. Commotion in the back yard. Snake in the shed!

2. Upon closer inspection, we discover that Snake has got his fangs into Lizard, and is now in the process of strangling him.

3. But wait...! Lizard won't go down so easy, turns around and bites Snake's lower jaw.

4. Raj enters the fray. Wielding golf club. Of course.

5. Snake + Lizard dragged out into the open. Amandi waiting, parang in hand.

6. Amandi lands an almighty blow!

7. Snake mortally wounded, but still clutching onto Lizard. Determined to finish his last kill...

8. Shocking reversal! Lizard, sensing Snake weakening, shakes free and chomps down on Snake's head!

9. Wearied but victorious, Lizard limps away...

10. So in the end:

Snake - dead.

Amandi - happy.

Lizard - v. happy!


-raj

Mosquitoes and Malaria

16/12/2007

I have no doubt that several litres of my blood are now flying around Timor in the bellies of contented mosquitoes.
A confluence of factors - the rain, the temperature, the seasonal cycle - has brought us a sudden invasion of bugs, of every imaginable shape and size. But it's the mosquitoes that I most sincerely hate.
Timorese mosquitoes are not particularly large, swift or intelligent. But they descend upon you in massive waves, with a Zen-like disregard for DEET and slapping. No matter how many you squish, there always seem to be a hundred more ready to die for their cause.
Resistance is futile.

But Yudha resists anyway. Passionately.
Every night, Amandi and I respectfully evacuate the house as Yudha, canister of Baygon in hand, marches through in a murderous rage. Anything that doesn't have the grace to die quickly from the first shot is promptly drowned in insecticide.
I was initially amazed by how the fight against mosquitoes aroused such savagery in Yudha's otherwise tender soul. But it turns out that in the two years he's been in Timor, he's had malaria six times.

Not everyone has the capacity to launch such a robust counter-attack, however.
Planting season means, for the mosquitoes, many more bare-bodied, distracted men out in the fields for longer hours. And unattended children left at home to fend for themselves.
Already, I see a discernible upswing in the number of patients with malaria at our twice-a-week clinic. Most young people recover with antimalarial medicines after a week or two, with little long-term consequence except for the lost productivity on the farms. But it's the vulnerable ones - infants, pregnant women, grandparents - who suffer the more prolonged, severe, and sometimes fatal variants.

The cornerstone of malaria control in developed countries is mosquito avoidance - simply laughable here, given the overwhelming numbers. Economic factors also come into play: One well-meaning initiative to give a free mosquito net to every newborn flopped, when some enterprising Timorese figured out that sewn together, the nets make for great fishing.

How is the prevalence and impact of malaria in Vatunau solvable? I don't know. But for now, the antimalarials and I hold the line.

-raj

Winding Down

14/12/2007

December, it's planting season. Our community development work is winding down a little. Y and I are focusing on administrative odds and ends, the garden, and studying.
The rains have come, half the village have retreated to their ancestral lands in the hills south of Vatunau to plant maize and groundnuts. Over the next two months to the harvest, many will remain to weed, and to fend off the gangs of delinquent monkeys that would gleefully eat or tear through the entire plantation.
This crop is critical. There is no irrigation system, so dependence on the seasonal rain allows only two planting cycles between November and April. Vatunau lives off this harvest for the remaining half of the year.

I'm winding down too. It's been a challenge to remain awake and productive through the day. The oppressive heat and humidity is sucking the life right out of me. We haven't had electricity for a week, so midday activity grinds to a standstill as we collectively bake outdoors or marinate in sweat indoors. And if it's too hot to work in the day, it's too dark to work at night. The unholy hordes of bugs that congregate around the smallest of lights make study by candlelight an intimidating prospect.

Need... more... coffee...

-raj

Chickens Among Us

2/12/2007

Something's up with the neighbourhood chickens. They're either psychotic, possessed... or getting organized.
For the last week, they've been erupting in synchronized volleys of ear-splitting cackling every hour from midnight to 5am. It's infuriating.
But in the light of day, it's impossible to tell who the leaders of The Resistance are. They all look uniformly dumb and innocent, the way that only chickens can.

[Picture: "Who, me?" - Innocent Chicken]

We have four Nameless Chickens - Yudha refuses to christen them, for fear of engendering emotional attachment.
Codename 'Putih' (Indonesian for 'White') is the supremely cocky cock who repeatedly picks fights with longsuffering Wiro. These provocations usually end with Wiro chasing the disgraced Putih up onto the roof in a flurry of barking and feathers. Whereupon Putih pouts for a while before carrying on the insurgency by aiming droppings at Wiro from his perch.
'Hitam' ('Black') is a heartbreakingly stupid hen that needs to be chased around the bushes every morning just to be fed. Nameless Chickens #3 and #4 are singularly unremarkable souls: they spend their days in the coop, and apparently nurse no greater dreams.

Virtually every household here is home to at least one chicken: They're easy to acquire and rear, a couple of eggs a week may be the only source of protein for a family of 10, they're a traditional store of wealth. And yes, on occasion they do end up on the plate.
Should bird flu cross the border from Indonesia only a couple of hundred kilometres away, it's easy to imagine the mayhem that would result throughout rural Timor. There's very real potential for human/chicken/pig cross-infection; but any high-handed attempt to round up and cull poultry would be met with no less resistance than Herod's men in Bethlehem. Should push come to shove, I'm not at all sure that I wouldn't stand by my chickens myself.
But only if they'd let me sleep at night.

-raj

Brunei 2-8/12/2007

5/12/2007
I'm in Brunei Tuesday to Saturday to attend my high school's 10th year reunion. Staying at the home of an old classmate (thanks JW!). This'll likely be my last retreat to modern civilization before diving back into work in Timor for another five months.
Top 5 Things I have missed:
1. Hot showers.
2. The Internet!
3. Light to study by at night.
4. Electricity for my laptop.
5. Ice.

[Picture: Amandi studying by kerosene lamplight]

- raj

Alicia and Nathan

27/11/2007

We buried Alicia, age 3, today.
She had had a fever for the preceeding four days. Became severe and accompanied by shivering (convulsions?) the night before. Died early this morning. Probably malaria of the brain.
Alicia's family had not sought medical attention. Like most who live in the hills behind Vatunau, they are several hours' walk from the closest clinic - us. Before Yudha set up shop here in 2006, it would have been another two hours' trek to Liquica Hospital. The family had climbed down to the village centre this morning in order to conduct the funeral.

And to bring me their three other sick children.
Two are alright, but 1-year-old Nathan (picture) worries me. He has also had a fever for a couple of days. Looks unwell, dehydrated, temperature 39, heart beating too fast. Likely malaria too.
S, missionary from a neighbouring town, drove over and we crashed through the rain to the spartan hospital, where Nathan has been admitted. If he doesn't pull through, he will be the fourth child to die in a family of twelve.

This is not unusual. East Timor's child death rate is the highest in Asia, and one of the highest in the world. There is no single proximate cause. Poor nutrition and lack of clean water contribute to frequent and severe childhood illnesses. As do illiteracy and ignorance. The interior is inaccessible, so many kids don't get vaccinated. Poverty and an underdeveloped government health system mean many who get sick don't get medical help.
The puzzle is formidable. I'm glad to be working on at least a few of its pieces.

Back in 2004, doctor Rhodes in Kenya had told me, "The death of a child is a terrible thing. You should never get used to it."
I haven't. It still hurts me.

- raj

Digging

21/11/2007

Good God, my everything aches. Spent the morning with Y preparing the soil in our FAITH Garden, for the vegetables we're going to plant next week.

We dig a lot. Dig to loosen the soil. To remove the rocks. To build the beddings. Dig again in the beddings to remove the little rocks.
Not surprisingly, 8 years of med school and sterile doctoring in Singapore has not adequately prepared me for farming. My knees, my arms, my back - oh, my back - are profoundly sore. The dirt seems to have found its way not only under my fingernails, but embedded right into them. The blisters on my right hand are threatening to pop. I've been chewed on by unknown bugs in unmentionable places.
Genesis 3:17 "...Cursed is the ground because of you; through painful toil you will eat of it all the days of your life..." No kidding.

Why am I putting myself through this?

Three quarters of the population of Timor, and almost all of Vatunau, are subsistence farmers. What they grow, they eat; Any left over, they sell; Harvest inadequate, they starve.
The traditional practice here is slash-and-burn shifting agriculture. This may work in a small isolated community, but becomes rapidly unsustainable in a small nation with a growing population. There isn't enough unused land to go around, and vast areas lose their fertility. Solutions that more developed countries use - farm machinery and chemical fertilizers - have an initial cost far, far out of reach of the majority of Timorese.
The FAITH (Food Always In The Home) Garden method that Yudha and I are applying makes use of a relatively small area of land, a lot of labour, and natural fertilizers. It keeps the soil productive and generates a much greater yield than than the traditional method. By demonstrating and teaching this in our back yard, we aim to advance the entire village's farming efficiency.
Better farming, better crop yields and consequently better nutrition would have a far greater impact on the long-term health of Vatunau's children than ten clinics.

And that is something worth putting aside the stethoscope, and geting sore, dirty, and bitten for.

- raj