A Day in the Life of...

A PUSKESMAS doctor

On the wall just above her was a broken clock, being correct twice a day. On her sparse desk lies her own stethoscope and an old, mercury filled sphygmomanometer. Those are her only tools here. And her ears, listening patiently to every little detail. And her eyes, watching and observing. And her touch, compassionate to every symptom.

Perhaps the broken clock signifies more than just lack of maintenance. The speed with which she must attend to hundreds of patients each day contrasts with the stillness of the clock's unmoving hands. But each second she spends with the patient is more than just a diagnosis. She connects with them, jokes with them, and make them feel heard and at ease. All this she does within an amazingly short time.

8 hours of work, 3-400 patients from Monday to Friday and 200+ on the weekends (and shorter hours). Yes, less than 1 minute per person is her average time. Most of the ailments she sees stems from lack of basic hygiene, especially clean water to wash. 

Skin rash and postules, as well as infections on minor cuts are common. Diarrhea and other digestive problems are also common. And the third common issue is respiratory. Those three accounts for most of the ailments she sees. So much so that within the 1 minute or less, she already knows what to prescribe. The onsite pharmacy stocks these items like candy, prepackaged with the maximum number of pills each person may receive (less than what is required in most places). 

Occasionally, there are more serious symptoms such as fever from infections, or bronchitis. Some of these she is prepared to handle and the medicine is available at the pharmacy. But anything beyond that, especially if it requires a night's stay, will be handled by the larger hospital, about 15km away. About an hour's trip each way.

The sign outside is old, the paint peeling and rust spots peeks through from behind. It is still legible, and everyone knows it is the local free clinic. Well free if you have your national ID card signifying you live in the area and to ensure you're not double dipping on your medicine allowance. If you don't have your card, the charge will be Rp 3000, or about US$0.33. 

Funny, there's another sign that lists the different medical services available at the clinic. And it is shiny, it looks like new. It also has a large advertisement from a particular over the counter headache medicine. 

Despite the steep dirt driveway that turns into a mud pit when it rains, and the less than sterile image, everyone still knows that it is the clinic. A place to go for ANY medical issue, large or small. It does have a dentist on site, a small lab and a midwife. But being in front of the major thoroughfare in the area, often they have to deal with victims of car accidents. While they're ill-equipped to care for the wounded, they're well equipped to stitch up the wounded and prepare them for a longer transport to the nearest hospital.

Often, on her 90 minute daily commute to work, she has to stop at the accident site. Either stop and treat them now so the victims can be sent to the hospital (or home). Or she can wait until they're brought to her clinic much later.

All this for a monthly salary of Rp 1.8 juta, about US$200.

PS: sorry for any spelling or grammatical errors. First draft, uncorrected. These days I just don't have time to write properly. But I don't want to not write either. 

PPS: while I was in Kalimantan, it was a lot more remote (check out where Muarateweh is, and if you can find it the village of Luwe Hulu). And the doctors there make the rounds to each home.

If I had a bad day

Today would have been it.  I am thiiiiis close to actually being angry.

I was told by a client who was contracted to install the solar power system for a remote village to use inferior batteries and electronics. So that he can keep "maintaining" the system and he would buy them from us.  His exact words "if you use components that last 5-10 years, how am I suppose to eat if I don't get paid maintaining the system.  I'm sorry, but I had to not work with him anymore.  If I owned the company, I'd rather go bankrupt than do business with this guy.

Then I heard back from the chief facilities engineer (this guy really is a glorified janitor) of a fairly large hotel.  I had recently sent him the engineering calculations and Return on Investment/Break Even Point analysis for a hot water heater system I proposed.  1.5 year return on investment, and after that, free money. The components are even still under warranty for another 3.5 years.  He said that he didn't understand the calculations and that "in good faith" he can't recommend our system.  He kept mentioning how good the gas fired heaters are and how good of a relationship he has with the fuel supplier.  He stressed that when the system was designed, the designer worked closely on the budget with him.  Long story short, he practically told me that if I gave a 10% discount but keep the proposal the original price, he would make sure my proposal would be accepted.  As I said above, if I owned the company, I'd rather go bankrupt than do business with this guy.

In addition, I work with some of the laziest people in the world! All I asked for was an up to date list of the components we buy and from which vendor.  For one grouping of the vendors, I was willing to do the work. It is the most jumbled because we just go to this "market" for electrical stuff and buy circuit breakers, wires, etc from the market.  But we never know what we usually get from there.  All I asked for was the receipts from the last 3 or 4 visits and I'll make the spreadsheet containing the list of items we've purchased on those receipts.  No one can produce them, and I keep getting "just tell me what you want to buy and I'll tell you the price"  What The Heck!!!!

Someone cut me off in line for the ATM! And at the store! All within 15 minutes of each other.

Last but not least, when I was coming home, I had to wait for 45 minutes for the bus.  When I got on, the bus was so full, even a mosquito couldn't fly around in there.  I arrived at my destination bus station, where I usually take a short walk and get on another bus at a nearby station.  Since it's been a long day, I wanted to take a taxi. After 30 minutes of no taxi (I even went to the mall where there should be scores of them), I walked to the usual bus station for me to go home.  Those buses are delayed 30 minutes (at least).  So I had to go walk to another place to pick up these microbuses (angkots). Finally got home.  I'm lucky that no one pissed me off by bumping into me or running into me with their motorcycle or car.  I think I would have exploded.

Worst day ever

I am here

In Bali, Nusa Dua area.  

Greeted by a downpour as soon as I arrived at the hotel.

But what really made it really feel like I am here, was the arrival of the motorcycle that I am renting. The first day, there won't be a motorcycle available but for the next few days, I'd have a 125cc Honda Supra X with a 4 speed transmission.

What I wanted was a Kawasaki KLX dirt bike, so I can go up in the hills and explore the dirt roads. It's been too LONG. Way too long.  But alas, none are available for any amount of time.

Kawasaki KLX

So what would I do for the first day? Rent a different one of course! I'm already a little peeved for not being able to do the things I want to do and have the things I want to have.  And I've never really been into Harleys or crotch rockets, with very few exceptions. Dual sports or dirt bikes are my thing.

Comes the Honda Tiger with all its glory, sporting a 200cc engine. In case you didn't know, it's illegal to import motorcycles with a displacement larger than 250cc or cars with larger than 3 liters.

Honda Tiger 200

Well, being the conservative, frugal person I am, I only rented the Tiger for 2 hours, costing me a whopping 100,000 bucks!  At first, I was slow, deliberate, getting familiar with the controls. Then getting familiar with how it handles. Which is a little sluggish. Or I'm just too light and don't have the body weight to throw this beast around to do my bidding.

In the mean time, I also started to get familiar with how to ride a motorcycle in Indonesia. I still refuse to be on the opposing lane for any longer than passing a car or two. And I definitely still refuse to get up on the sidewalk to avoid traffic.

But other than that, I split lanes with the best of them, barely leaving an inch on either side. Although I still don't cut the cars off or make sudden position changes or try to slip in through narrow slits while the rest of traffic is moving. If anyone wants to learn situational awareness, drive in Asia.

Well, enough is enough. Time to take this baby for a spin. So I look at the map, and found the best semblance of a highway. Sure enough, the road is wider, 2 lanes and everyone else is going fast. Woohoo...So I rode up and down a 5 mile stretch of road to make sure I'm familiar with the turns and the pot holes that would swallow the tires if I hit it.

Long story short, there's nothing more satisfying that power shifting a responsive, torquey engine like this Honda Tiger. The feeling that the engine never stops pulling, accelerating as you switch gears smoothly and never letting go of that power band. In town, I can shift to 4th and still have torque to hit the throttle and go. On the open road, I've just shifted into 4th gear as we hit 110 with more to go

Anyway, here are some tips on riding/driving in Indonesia:

- the attitude of everyone else is "I'm doing what I want, you figure out how to not hit me"

- account for every vehicle around you, and if you're good enough, people, at all times

- lines that divide the lanes are mere suggestions, everyone else won't see it

- flashing headlights does not mean "you may pass me", it means "don't you dare even think of passing me"

The World According to Sherlock Holmes

"I make a point of never having any prejudices" ("The Reigate Puzzle")

That is something we all should try to do, though it is nigh impossible. From our 20th and 21st century, third party observer viewpoint, Sherlock had many prejudices.  But is it really? Or was it an appropriate culture for 19th century England? But really, that's irrelevant for now. I want to address the "never having any prejudices" first.

Trying to not have any prejudice is a good way to try solving problems and a good way to make decisions.  A very difficult thing indeed, as our personal beliefs and even when we try to remove prejudices from our OPINIONS, have been formed from our past experiences.  If all the clowns we've ever seen in our lives have been mean drunks, it's only natural for us to have a prejudice against future clowns.  It is ok to have this prejudice, IF you do the next step of verifying the facts of your prejudices to the problem in question AND acknowledge your prejudice.

Now, let's add "trust but verify" to our efforts in "never having any prejudices".  Trust but verify means to look at the facts, the only verifiable thing we can deal with.  In the example of the clowns, we trust our opinion/hypothesis that clowns are mean drunks. This makes us wary, and careful of clowns. But because we must verify the fact, and we have no prejudice, we will be able to look at the next clown and verify whether they're mean drunks or not.

There's the genius in problem solving and decision making, and in learning even.  What are we being told? What seems to be the information in front of us? Ignore the prejudices against or for the information such as who said them, or in what context they were said. Then separate the facts from the opinions. Last but not least, verify the facts and confirm the hypothesis we formed when the information was presented to us.  

With this method, we're almost sure to never miss out on possible solutions, and we're always learning new things.

I promised above to discuss a little bit about Sherlock's prejudices, as we read his accounts.  No one living today was alive in the 19th century. We can only surmise what life was like back then. Even given the facts of the period, we can not verify any hypothesis we make about life back then.  

But, remember that times have changed. Was Sherlock wrong in having a view of the world as he did? Perhaps. A Study in Scarlet portrayed a totally incorrect view of the Mormon religion as known today. But what was known about the Mormons in England in the 19th century? Then perhaps Sir Doyle shouldn't have written about it.

All good questions. But irrelevant.  The only thing relevant here is, regardless of who said them are two steps we must do to form an opinion, solve problems and to learn new knowledge:

- never have any prejudices (try to or at least be aware of your prejudices)

- trust but verify (deal only with facts, things that can be verified)

Now, go forth and seek your adventures, riches and knowledge.

"The game is afoot"

Immigration reform

So there are a lot of people talking about the DREAM act lately (hmm...someone I know could have benefited from that at one point).  

But I don't see anyone complaining about one of the laws preventing many from being able to get their legal documents. It is Section 212(a)(9)(B) of the Immigration and Nationality Act.  This section states that anyone who's been illegal for up to a year in the US will have a 3 year bar from reentering the US, and an illegal presence in the US for more than a year will have a 10 year bar from reentering the US.  This is despite the person's ability to have a visa to reenter the US.  

So let's say someone was brought to the US as a child (less than 18y/o) and accrued more than a year of unlawful presence.  Then s/he got married. Or s/he's a genius and can prove it and a company is willing and can get a work visa for him/her. Or other ways to get legal. Many of these visas, if granted to the applicant, will need to be picked up at the embassy OUTSIDE of the US.

As soon as this person, who are present in the US unlawfully, leaves the US, the timing for their 3/10 year bar starts. Even if they were leaving the US to pick up their LEGALLY granted visas.  So what can one do in this matter? Brought to the US as a child, the unlawful presence is more or less mandatory by situation, and they cannot become legal resident of the country they're now calling home.

As a result, they don't become legal. They can't. Not without staying out of their new home for 3 or 10 years.  How many of them are there? A lot more than you think. 

Here is a link to the law (click on LAW, then find section 212, and scroll down to the document):

http://www.uscis.gov/portal/site/uscis

Here is one fairly thorough study with sources (old study but still relevant today):

http://www.cis.org/articles/2003/back1003.html