Matandoc iha Vatunau

The Naked Doctor

2008-03-31T17:54:00.000-07:00

1/4/2008

Three weeks left to the end of my term here in Timor. What I miss most about Singapore hospitals is the glorious abundance of new, inventorized, sterile plastic-wrapped equipment.

Our dinky clinic here is OK for the regular 'flus and diarrhoeas, but the squeeze comes with the small surgeries: abscesses to be poked, cuts to be stitched, wounds to be repaired.

[Do NOT poke me!]

[Post-poking.]

Greatly outgunned by the patients, I returned from the lightning trip to Singapore in Jan with a substantial armoury of dressings, syringes, IV sets... (thanks CM!)

Initially, the only anaesthetic available to me for some procedures was 'brutacaine' - 3 or 4 handy assistants holding down the shrieking patient while I sliced away. Not much more refined than a consultation with our local witch doctor. I've since got my hands on a stash of Ketamine (thanks S!) and Lignocaine (thanks G!), which have greatly decreased the pain and drama of our surgeries.

Dr. Daniel Murphy, a personal hero who's been serving in Timor for 10 years now, responding to an interviewer's question on high-end medical equipment: "You don't need all that stuff. Two hands and a heart, that's all you need. A stethoscope helps, though."

Agreed. But the syringes help too!

-raj

Saving Ballo's Bushes

2008-03-31T17:36:00.000-07:00

31/3/2008

Abel Ballo's kids shall no longer abuse the bushes. The CHEs and I built him a toilet this morning. (See 'Penitence', 20/3/2008)
Not a particularly extravagant affair: just a big hole in the ground, overlying planks with a hole, stones for squatting, a bit of zinc fashioned into a cover. But not without its technicalities. Siting needed consideration of relationship to groundwater depth, distance from living quarters, surrounding vegetation and direction of prevailing winds. And digging a 1.5-metre hole was no small task.

'How to build an effective toilet' is a question that's weighing on NGO minds across the globe. A cursory Googling brings up an astounding array of technologies and philosophies, even a World Toilet Organization.

But only half of Timor uses any form of toilet a step above the ad-hoc hole, so we're still pretty proud of our big-hole-with-a-cover.

-raj

Kakrui

2008-03-31T16:49:00.000-07:00

13/3/2008

I'm pooped. 3-hour climb to the Kakrui hills south of Vatunau this morning. Visiting homes with our volunteer Community Health Educators, five girls and one guy who've attended weekly health workshops for the last two years, and helped me run the clinic for these past five months.
We meet 6 am. Posters, flipcharts, stethoscope, a few meds. As usual, I'm the only dude geared up in boots, backpack and bottle of water. Our CHEs would bounce up Everest in their slippers and pyjamas.

The three-hour trek takes us along the river bed,

through the jungle path

and up the hills

A major adventure for me, but I'm episodically greeted by giggling kids heading the other way, daily walk to school. We arrive at the Kakrui cluster of houses, welcomed with smiles and cassava.

Brunch is followed by the main business of visiting homes. The CHEs teach basic health: nutrition, hygiene, mosquito avoidance, home treatment of children's diarrhea...

The main health problems here are still best addressed through simple education on prevention and improving living conditions. I count the time spent training and supervising our CHEs as my real legacy here in Timor - these guys will remain on the frontlines of the war against disease long after my Panadols are forgotten.

-raj

Penitence

2008-03-25T23:50:00.000-07:00

20/3/2008

I've just returned from a 5-day trip to several villages in Los Palos on the eastern tip of Timor, to visit the resident missionaries, conduct community health talks and deworm children.

Gut worms are universal in rural Timor, mainly due to poor sanitation. When one infected child defecates behind a bush, rain and groundwater flow eventually carry the worms to the community’s well – everybody’s drinking water.
The government school health programme includes mass-deworming, but many places have yet to climb on board. So our plan was to carpetbomb our villages’ 2-5-year-olds with deworming meds.

Easier said than done.
Generations of threats from bulging-eyed mothers has left Timorese children with a deep confidence that if you’re naughty, the Evil Foreigners will kidnap you, and – depending on the creativity of your mother – beat/imprison/eat you, feed you vegetables, turn you into a goat or give you injections.
Predictably, being lined up to receive deworming medicine at our hands created much holy terror.
Some children gave wary assent:

Many went ballistic:

And this guy:

survived the ordeal with deworming meds everywhere except down his throat.
Exhausting. For all involved.

But rewarding. I’m told that entire villages are now abuzz about whose kid has passed out the most worms.
Let’s just hope it wasn't behind another bush.

-raj

Deficit

2008-03-25T23:34:00.000-07:00

18/3/2008

I'm crunching statistics from the clinic records, in this last leg of my term here in Timor. An alarming 40% of the children I’ve treated are growth retarded.

Due to starvation.
Not the hollow-eyed skin-and-bones frank hunger that's familiar from TV images of '90s Ethiopia; but an insiduous, chronic lack of protein and energy foods that manifests itself in frequent illnesses and poor growth. The resulting physical and mental deficits are significant, and permanent.
Malnutrition here is rare in infants until about a year of age – when they’re abruptly displaced from the breast by a new arrival.

[Vexation]

The staples, cassava and corn, are both mostly fibre and water. So toddlers may fill their stomachs three times a day and still effectively starve.

[Breakfast/lunch/dinner: cassava, salt and chilli]

Concerned mothers stream to the clinic seeking ‘vitamins’ to fix their skinny kids, which I steadfastly refuse to dispense. The solution is upping the energy content of their meals. I’m on a campaign to encourage mothers to include a tablespoon of cooking oil in every meal.
Awkward. It’s exactly what I wouldn’t be advising back in childhood-obesity-smitten Singapore.

-raj

Ainaro district, in 10 photographs

2008-03-14T18:45:00.000-07:00

11/3/2008

Timor is gorgeous.
I've just returned from a 5-day foray into villages in the central mountain region, running mobile clinics with a team from Singapore's CEFC.

Sunrise

Girl

Backside

Flowers

Daggers

Routine

Inn

Hut

Precarious

Aftermath

-raj

Steady As She Goes

2008-02-21T18:51:00.001-08:00

14/2/2008

Things are better.
We're still wound tight. But Timor has been remarkably - almost supiciously - peaceful.
Regular updates on the radio (they've ditched the "remain calm" guy) and SMSed news clippings from friends in Singapore have made the story clearer.

From CNN.com:
[[DILI, East Timor (AP) -- East Timor declared a state of emergency Tuesday... assassination attempt Monday against President Jose Ramos-Horta and the failed attack on Prime Minister Xanana Gusmao.
The country's top fugitive, Alfredo Reinado, and one of his men were killed in the attack on the president. One of the president's guards also died.
...international soldiers and police patrolled the streets of the capital, Dili, where many shops and businesses were closed. There were no immediate reports of unrest.
Reinado was among 600 mutinous soldiers dismissed by the government in 2006 -- a move that triggered gunbattles between security forces that later spilled over into gang fighting and ethnic unrest.
At least 37 people were killed and more than 150,000 people forced from their homes in the unrest, which also led to the resignation of the country's first post-independence prime minister.
Reinado was arrested but escaped from prison after several months.
He was charged with murder in connection with the 2006 violence, but had remained in hiding and had threatened armed insurrection against the government.
The streets of Dili were calm after the attacks, and Gusmao said an overnight curfew was in place. The United Nations, which controls security in the country, said checkpoints had been set up on main roads.]]

I had to squeak through two checkpoints, getting to Dili today.
Just outside laid-back Liquica, it's all smiles, backslapping and "how-ya'-doin". But Dili's fortified checkpoint greets me with the less-than-neighbourly barrel of an M-60.
The Portuguese UN troops immediately single me out for interrogation - the only foreigner, and a bestubbled one with a fancy laptop computer at that. The furrowed eyebrows, unslung rifles and clipped tones quickly dissipate, however, upon a shameless flourish of my stethoscope. Ah, a medic! I'm merrily planted back on my truck with fresh smiles. And another backslap.

Timor's not out of the deep waters yet, but the crisis appears to be over. We're drifting back toward normality.

- raj

Crisis

2008-02-21T18:44:00.000-08:00

11/2/2008

Timor is in crisis. Attempted assassination of the president and the prime minister in the capital Dili this morning.
At least three dead, several wounded. Prime minister has been evacuated to Darwin with bullet wounds. Curfew declared in the late afternoon, we're expecting state of emergency soon.

I found out en route to Dili.
Vehicles being turned away by a new military checkpoint just outside the city. Tension rising among the dozen passengers stuffed into the back of the minivan with me. Ominous snippets filtering to us from shouted warnings of drivers heading the other way: gunfights in the streets, dozens killed, mobs and looting. The women start crying.
Word of violence rapidly puts Timorese on edge - they've been through this too many times. The last outbreak in 2006 saw running gunbattles between the police and mutinous soldiers in Dili's streets, turning into inter-ethnic violence leaving 40 dead and 150,000 in refugee camps.
Our minivan turned back.

Home now.
No electricity, so no TV. The surviving cellphones only do incoming. The radio plays patriotic anthems, punctuated by a grating appeal to 'remain calm'.
Passports, cash and laptops sit in our backpacks, should we need to evacuate (to where?). Yudha gets the golf club, I sleep with the machete. I tell myself that we are fairly safe in Vatunau - agitation rarely reaches this far out into the sticks.

But we legitimately worry for the dozen or so missionaries and friends in Dili.
We worry for Timor. We know maddeningly little about the state of the nation right now, beyond the end of our street. We're sitting on a tinderbox, we don't know if the fuse is alight.
The uncertainty is bewildering.

Back In Timor

2008-02-21T18:36:00.000-08:00

5/2/2008

Back after 10 days in Singapore/Batam. Feels like I've returned home.

Top 5 things I've missed in Singapore:
1. Hot showers
2. Cold coffee
3.
4.
5.

Well... can't think of much else, really.

- raj

Traffic

2008-01-20T20:00:00.000-08:00

20/1/2008

We've had quite a turnover of assorted animals through our household lately.
The chicken population has exploded, thanks to new-year presents from several villagers. At its peak, we had fifteen chickens of various sizes running amok in the yard. It's down to a (slightly) more manageable 12 now. Two were curried, one fried.
Pak Leo, the village headman, has temporarily parked his scowling cow in our front yard, as the river that runs by his house is in danger of overflowing its banks.

[Picture: Scowling Cow]

Our two piglets have died. To be more precise, one died (malaria?); and the other looked moribund, so we killed and ate him. 'Tis life.

[Picture: Moribund Pig.]

Bagong, Pedro and Darling we picked up from the new litter at Pak Leo's. It's a challenge to get my slippers on every morning, with a trio of month-old puppies suckling my toes.

[Picture: Disgustingly Adorable.]

Sadly, two of our other dogs have met untimely deaths under the wheels of some 4WD hurtling along the road in front of the house. Chocolate, we buried. Taus, eaten by our neighbours. Ouch.

Of course with this many animals loose in the compound, the primary question to ponder is, 'but does it bite?' The answer, I've discovered, depends on the particular specimen's personality as much as on the species it belongs to.
So far, I have survived three chicken-bites.

-raj

It's a boy

2008-01-20T19:59:00.000-08:00

18/1/2007

Deliphina De Nunes delivered her first child today in somewhat better surroundings than Maria did (see "It's a girl", 30/12/2007).
Labour began at about 5pm. Baby delivered at 8, on a couple of sheets thrown upon on the earthen floor in the corner of the bedroom. Mama Leonarda, the village chief's wife, was again by my side to help; but no sign of El Mustachio this time round. I walked her through the delivery and aftercare, I wonder if she'll be able to do this on her own when I'm gone.
The neighbours' wives gathered outside the door were an opportune target for my routine sermon on breastfeeding - a subject I've become a rabid advocate of.

Having learnt my lesson from the shock of being asked to name the last baby, this time I had come prepared with a list. Sadly, proud mum and dad had already thought of a name. Oh well.

'Reuben', Hebrew, meaning "see, a son."

-raj

Earth

2008-01-20T19:55:00.000-08:00

18/1/2008

I had never really understood, back in med school, why so much time was spent learning about 'soil micro-organisms'. I think I do, now.
Earth, like air, is an ubiquitous part of life here in rural Timor. Most are born on the bare earth, spend their early years playing in it, expend the major part of their life working it... and finally laid to rest in it.

Not surprisingly, a significant proportion of the sicknesses we treat in our clinic are soil-transmitted.
Every other kid has a belly full of worms. The symptoms aren't too impressive: intermittent stomach pain, constant tiredness, the occasional disturbingly mobile bowel movement. The greater, more permanent damage lies in the stunted growth. The worms compete with the already malnourished kids for their limited food.
I dish out albendazole like candy. But the deworming meds don't stop the kids from running around barefoot and picking the worms right back up, the very next day.

Earth also features prominently - and frustratingly - in many traditional remedies.
I spent an excruciating hour last Saturday cleaning out the left ear of a resolutely noncooperative two-year-old. Her mum had packed it to the brim with soil and leaves, to treat a budding ear infection the week before. By clinic day, of course, the infection was positively fruiting. An unappetizing experience for all involved.
Traditional Timorese first aid for cuts while farming: handful of soil, dry leaves, hearty mouthful of spit. Mixed evenly, then slapped onto the bleeding wound before proudly presenting it to the doctor. Bad-tempered doctor then painstakingly cleans away the muck while delivering a long and animated dissertation on 'germs'. When the bleeding is controlled, I just dress the wounds - any attempt to stitch the skin after such overwhelming contamination would only worsen the infection.

Convincing a community that invisible germs exist, that earth is best left on the ground and not on or in their kids, is not an easy task. We teach, we teach, we teach. But until those ideas take root, someone'll have to continue cleaning the ears and the wounds, and dispensing the albendazole and antibiotics.

-raj

Skin And Water. And Skin.

2008-01-20T19:50:00.000-08:00

9/1/2008

Nothing frustrates me more than the endless line of filthy kids with skin diseases that attend our clinics. Rashes, sores, pustules and abscesses in assorted combinations. Nearly all of them preventable with just one intervention: soap and water.

Timorese kids don't like soap any more than kids anywhere in the world. But the biggest factor contributing to the universally poor skin hygiene is the lack of water.

Vatunau has a population of 2000, five wells, and a patchwork water piping system from the two rivers that flow through our village. A few households have small tanks rigged to the pipes, but most families still walk several hundred metres a day to fetch water. A precious commodity, not often expended on extravagances like daily bathing.
Various NGOs and government bodies have assisted with the water piping system since the late 80s, PPH has contributed to significant improvements in the last two years. Work in progress.

I can't, however, attribute my own rashes to a want of showers.
Right now, my legs are sporting five dressings over sores of various shapes and stages of evolution. Annoying, but not comparable to the awful 'cellulitis' skin infection crawling up my left ankle over Christmas - resolving now, thanks to the self-prescribed antibiotics.
No thanks to the bug bites from the garden, which likely got the infection going in the first place.

In the balance of things, I should be grateful for my cellulitis - it's made me more sympathetic now to the unwashed kids.

-raj

Floods

2008-01-20T19:48:00.000-08:00

7/1/2008

Unusually heavy rains for the last week. Several areas in the North-West of Timor have experienced landslides and floods.
Liquica market, five kilometres from our home, is a sobering scene of ruin. The overflowing river has wiped away several houses and damaged the market's permanent structures. A couple of electrical poles are down, those of us to the West of Liquica will likely be without power for a week or so.

The damage may not be dramatic in scale, but to those who don't have much, it is significant.
I'm worried.

-raj

Bernardo

2008-01-20T19:46:00.000-08:00

6/1/2008

We buried Bernardo, age 19, today. Died of internal injuries sustained from a traditional martial arts class a week before. Not a common event.

But evidence of a troubling underlying phenomenon: the recent proliferation of violent youth gangs often associated with 'martial arts' groups. The weekend fights are drug-and-alcohol-fuelled mass brawls, featuring knives and machetes. 'Martial,' yes; but not much 'art'.
The gangs are concentrated in the capital Dili, 50 kilometres from where we live, but we do see episodic disturbances in neighbouring Liquica, and occasionally even in Vatunau. Gang insignia has recently shown up spray-painted on the village bridge.
The police have been asserting themselves, particularly the 'Task Force', outfitted with riot gear and building a fearsome reputation for breaking bones first and asking questions later.

Timor is awash with NGOs and churches seeking to cope with the concrete problems of a nation emerging from a long and brutal occupation. But we may not have enough labourers addressing the social needs of a traumatized generation, now coming of age.
We're losing the youth.

-raj

Singapore 26/1/2008-3/2/2008. Help.

2008-01-07T19:16:00.000-08:00

Hello again, guys.
I'll be back in Singapore to attend a couple of church meetings, arrive 26/1/2008, depart 3/2/2008.
There are several items for the clinic I'll need to acquire then, to carry back with me to Timor. I'm planning to purchase these, but would be glad to take donated items. If you can help, do email me at rajrman@yahoo.com.

***

List of items to acquire for clinic from Singapore 1-2/2008
- MIMS drug directory x 1
- Pregnancy calendar/wheel x 5
- Latex gloves, medium size x 1 box
- Vaginal speculum
-- Medium x 5
-- Small x 5
- Urine Pregnancy Test Kits x 2
- Glucometer x 2
- Glucometer strips x 50
- Gauze squares x 200 pieces
- Alcohol swabs x 100 pieces
- Syringes
-- 50cc x 10
-- 20cc x 10
-- 10cc x 10
- Needles
-- Green (18G?) x 50
- IV cannulae
-- Blue x 10
-- Green x 10
- IV giving sets x 5
- Tegaderm Dressing
-- Various sizes x ?20
- Sterile sheets x 10
- Nonabsorbable suture, eg. Prolene
-- 3-0 x 10
-- 5-0 x 10
- Surgical ties x 100
- Micropore tape
-- Various sizes x 10

Acquire for clinic (meds)
- Paracetamol suppository x 5
- Emmolient cream x 20
- Pilocarpine 2-4% eye drops x 2 vials
- Becotide (Beclomethasone 50mcg/puff) MDI x 4
- Cloxacillin capsules 250mg x 400capsule
- Lignocaine/Lidocaine 2% x 20ml/vial x 10vials
- Ketamine for IM sedation

It's a girl

2007-12-30T17:20:00.000-08:00

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

2007-12-30T17:10:00.001-08:00

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

2007-12-21T17:22:00.000-08:00

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

2007-12-21T17:20:00.000-08:00

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

2007-12-16T20:11:00.000-08:00

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

2007-12-16T20:03:00.000-08:00

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

2007-12-05T00:16:00.000-08:00

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

2007-12-05T00:11:00.000-08:00

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

2007-12-05T00:03:00.000-08:00

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

Raj In Timor 2

2007-11-19T23:33:00.000-08:00

20/11/2007

Hey guys.

End of an eventful first week in East Timor. Phase 1 in progress: settling in, language acquisition, community penetration, data collection and community analysis.

Settling in.

[Picture: Yudha + Chocolate]

I've moved in with Yudha, PPHBC's missionary and community development consultant in Vatunau, a seaside village about 40 kilometres West of the capital, Dili. Amandi, Yudha's live-in helper, is the best-looking single male among the three of us. Our house is small and squeaky, but wholly adequate.

[Picture: House]

Electricity is erratic - but more 'erra' than 'tic'. We get maybe 8 precious hours a day now. One of the three main generators that supply all of East Timor is down, so I expect the rationing to continue at least for the next couple of weeks.

The allegedly November to April rainy season is around the corner, so fresh water from the mountain spring/reservoir isn't a problem right now.

Wastewater from our house goes either to the septic tank or the 500 square metres or so of vegetables, fruit trees and maize in our very respectable garden.

We have a varied schedule for most days of the week, but most start and end the same way. Up at 430. (Yes, 430!) Bible study. Clean the house. Gas the ants. Feed the chickens, the dogs, the pigs, the parrot, the fish - in no particular order. Water the garden. Breakfast. Amandi sets off on his 2-hour walk to school. Yudha and I on our assorted work. Amandi returns. Lunch. Nap (after all, it was 430...) Clean the house. Work on the garden. Dinner. Study, study, study. Bed 10-12.

Kitchen duties: Yudha cooks, Raj/Amandi eat. Good deal. Yudha is a sheer wonder in the kitchen, he managed to conjure up a pizza earlier in the week. With Bee Heng Chiang's bak kwa and canned sardines on our gas stove, no less! I am unutterably blessed.

Language acquisition.

Studying Tetum is consuming a tremendous amount of time, energy and brain cells. Having spent the preceeding 4 months learning from texbooks, I'm in the curious position of having a reading/writing fluency far ahead of my halting oral fluency.

Mealtimes present a useful, if exhausting, opportunity to practice Tetum. Between the three of us, Yudha, Amandi and I end up flinging some combination of English, Indonesian, Tetum and Portuguese at each other. Yudha insists on expanding our already embattled frontiers with occasional monologues in French.

The trial by ire came on Sunday when I subjected our local church congregation to my 15-minute sermon, almost entirely in Tetum. And elicited nary a raised eyebrow! Suffice to say, they are an exceptionally gracious bunch.
[Picture: IPTL church, Vatunau]

Community penetration.

Identifying, meeting and getting to know some of the key players in our village of 260 households has been made easier by the groundwork already laid by Yudha and PPHBC's short trips in the last two years. The strolls around the neighbourhood, house visits, the twice-a-week primary health clinic and weekly English classes are making the bearded Indian man progressively more recognizable in Vatunau.

The children are a joy - the entire brown-haired (protein malnutrition), wet-nosed, barefooted, giggling lot. So far, I've got a lot of social mileage out of wiggling my ears. I'm saving The Amazing Glove Of Death for later.

Data collection and community analysis.

Understanding the playing field is the single most complex task I have right now. I'm studying country information, mapping with my GPS (thanks HT!) and started spreadsheeting some of the data from our clinic for later epidemiological analysis. But it's the long, calculatedly casual conversations with various people met along the way that have been the most enlightening.

And humbling. The number and intricacy of the community's moving parts, is astounding. As is the depth of some of its wounds. There is much to do. I have no illusions of my adequacy to address all of the needs. I am glad I have Yudha beside me, and PPHBC behind me.

-raj

Blog In Timor 1

2007-11-19T23:32:00.001-08:00

20/11/2007

Hey guys.

End of week 1 in East Timor, alive and well.

Blog is up: http://rajineasttimor.blogspot.com/

No more mass emails from me.

- raj

The Two-Wheeled Terror Of Timor

2007-11-19T23:27:00.000-08:00

(Credits to L for the titillating title...)

15/11/2007

Borrowed Pak Leo’s motorcycle this afternoon. Perilous 4-kilometer ride to Liquica Hospital with Yudha to meet Pak Filomeno, the district health director.

This Honda [Something] is a 100cc pygmy that has been worked mercilessly by Pak Leo and pretty much anybody who can ride a bike in Vatunau for the last 7 years. And it shows.
Getting her started requires a brutal kicking, the engine is anaemic, frame rattles like a jar of teeth, lights don’t work.
The buttocks-shaped hole on the foam seat inadequately accommodates my standard-issue-Indian-buttocks.
Shifting gears is a vehicular Russian Roulette. I hold my breath, kick the pedal and hope for the appropriate the gear. Odds 1-in-4.
Brakes don’t work, so I keep her trotting along at a pace that would allow Yudha and I to skip off and run out of the way should we be faced with the prospect of a collision. I don’t think I’ve hit 30kmph – but then I can’t be sure, the speedometer doesn’t work either.
Approaching a junction is a particularly faith-stretching manoeuvre. Implement boots-to-road technique to slow down. Avoid stopping, as that might precipitate another engine flatline requiring painstaking resuscitation. Honk gratuitously. Look out for any approaching traffic that might necessitate an emergency offroading. All clear? Prayerfully throttle up through the junction. Phew!

Risk to life, limb and neurological integrity aside, it was an awesome ride. Views of the coastline and hills are spectacular, and the nakedness of being on a motorcycle brings a sense of vulnerability and proximity to the land that I don’t think I could ever have ensconced in the metal hull of a car. I can think of no better way to see Timor.

Wait, I can: A bike with brakes.

- raj

Raj In Timor 1

2007-11-19T23:21:00.000-08:00

11/11/2007

Dear friends,
Most of you are already aware that I will be heading to rural East Timor for Christian medical humanitarian/rural developmental mission work for 6 months. I leave today, I should return to Singapore 4/2008.

My church, Pasir Panjang Hill Brethren, has been working on an area development programme in the village of Vatunau, rural Timor from 2005. We have one missionary on the ground.
I will be joining him, I will be working with him in 4 major domains:
- Health (community health worker training, public health infrastructure, running a small clinic twice a week)
- Water/Sanitation
- Agriculture
- Education/Livelihood/Microenterprise

The reasons for my going are varied and complex, but one idea undergirds all of them: the pursuit of congruence - I want my life to be consistent with my theology.
I told Jesus in December 1998 that I would follow him.
Right now, I see his footprints lead to service among the poor in Timor.
I follow. Gladly.

I will probably be online once every month or two; I may not be contactable by phone.
I will try to email you guys periodic updates on me. If time and bandwith allow, I will put up a blog with photographs.

I am grateful, to the many of you who have talked, prayed, and walked with me through the months of preparation.

Here we go.
- raj