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

Being Home

Home is where the heart is. That's what they say. I finally get it.

My cousins, aunts and uncles in Indonesia all make me feel at home. When I'm with them, I think, "maybe this is tolerable".

As soon as I'm not with them, however, I feel like I'm at a party full of people I don't trust or can get along with and I can't leave.  I distrust everyone. When I'm in public I clutch my backpack close. I always look out for an exit strategy just in case something happens. I look at everyone as a potential threat and figure ways to neutralize them, groups of them even.  I look at everyone in the eyes, challenging, making sure they don't see me as a victim. 

My money is always separated into big bills and small bills and I never show the large bills unnecessarily. I never play with my electronics in public (maybe at the malls) in fear of being targeted.  I don't wear nice clothes in fear of being targeted. I never trust what anyone tells me anymore (OK, maybe I do need to be less trusting, but I should be able to trust SOME people).

Here's the thing that might be difficult to understand for some people.  It's not that these things are not things I don't have to worry about in Oregon.  There are robbers, impolite people, bad drivers, untrustworthy people, you name it, they all exist in Portland and all over Oregon.

But it felt like home there. Like opening the door to your home and finding things familiar and comforting. Even if you don't like how small your TV is or that one spring poking out of the sofa, you know it.  Even if your bed is hard as a rock, you're familiar with it.

That's the difference for me. Besides my family here, I don't feel at home. I don't feel that there is anything comforting. Everything is foreign and uncomfortable.  Not just because it's a different culture. But because it's not home.

I have arrived

I'm here! Not sure where here is, but... ;-)

OK I do know where I am, I'm in Makassar/Ujung Pandang on the island

of Sulawesi. If you remember, I currently reside in Bogor on the

island of Java.

So this is my first time getting on the airport in Indonesia by

myself. It's better than if I was in Japan, China, Vietnam, Thailand

or any other countries whose alphabet I wouldn't even recognize. I

wasn't so much worried about getting on the plane, but more about

getting on the RIGHT plane.

There are a few differences, it seems that people here don't know how

to be in a line. Well, they do, just the Indonesian way. I'm just not

used to that. People keep cutting in front of me when I would let a

half of a person's space between myself and the next person ahead of

me. When I tapped their shoulder and told them I was in line, the

response was "Sorry, I didn't think you were" and they would look away

from me to ignore me and my subsequent taps.

While waiting in one line, another counter opened up and she smiled at

me and beckoned me over to her counter. Well, my luck with the line is

changing...woohoo. As I gathered my backpack, rolling luggage and the

box of samples I am carrying, several people were tripping over their

own stuff trying to hurry to the new counter. oh well...I guess

when you live in one of the most densely populated cities in the

world, that's what you have to do to get your way.

My one piece of check in baggage is a 1000 liter/day gravity powered

water filter. It's 5 feet tall and 10"x10". When I was at the counter

the person there asked me what was in it and said that it was a very

odd size. And it's heavy too at 33 lbs. I said no, it's not that

heavy, and I have close to 50 lbs allowance. We kept exchanging

exclamations about the size of my box for at least 10 minutes. The

person behind me must have taken pity upon me that I didn't understand

"the system". She gave the person behind the counter the equivalent

of $1.11 and said "let's go". Oh...I see...

After checking in and finally getting my baggage through, I'm ready to

go into the inner sanctum of the airport. I had lots of time and

contemplated about getting some food. I can choose to eat in this area

or inside of the terminal area. I thought that there would be some

decent restaurants inside. Plus I have about $11 of work's money that

I can blow on food for the day. After paying the airport tax to get

into the terminal, I started to look around for restaurants. Remember

this is an international airport. I counted 4 reflexology massage

centers and 4 restaurants and 2 bookstores. So I spent $5 on some

dubious looking restaurant.

Now the waiting games began.

5:45pm boarding time came and went without so much as a peep. I meant

the gate is still closed, we're all still sitting/standing around and

we're all wondering what the heck is going on. At about 6:15 or so,

there was an announcement on the PA system that due to maintenance and

repairs, my flight is delayed 45 minutes. I'm not sure whether it's 45

minutes from the original time, from the time they announced it, or

from the time Santa arrives all sweaty because his coat is way too

warm for Indonesia. Not much I can do about this, they'll open the

gate when they do, so I just waited.

While waiting though, some thoughts about this airplane entered my

head. I really had no idea what to expect as to this airplane. Will

it be a jumbo jet? a single propeller bush plane? I don't know. I have

no idea how big the other airport is, can it even accommodate a jet?

It was such a relief when I saw that the plane I was getting on was a

jet (737) and not a rickety old single prop plane. To be honest I

wasn't sure what to expect. Though I swear the seats are just that

much closer together than what I'm used to, I keep bumping my chin

with my knees.

Two hours of flight and one hour of time zone difference later, I

arrived at the airport of Ujung Pandang (UPG). After I arrived, I

went directly to the baggage claim area. The airport was eerily

deserted, almost like in Stephen King's The Langolier's if you've ever

read that book. After I grabbed my stuff, I was stopped by some kind

of security person asking for the baggage ticket. I have no idea where

it is, and I wasn't really sure what he was asking for.

My Indonesian is not that good when it comes to some stranger

speaking. I have to get used to their spoken words first. I've gotten

by pretty well so far by anticipating the subject. It's not that I

know what people are saying word by word, but I got the gist of it. If

I don't know what they're talking about, I just have to answer by

looking at their body language and the tone of their voice.

Anyway, another disaster averted (my not getting out of the baggage

claims area) and now to find a taxi to the hotel. Out of the whole

event, this was the easiest part. I was told which company to go with

and sure enough, they have prepaid fees. No need to be afraid that I

would be cheated or anything.

And now, I'm in a smoking room, on a smoking floor with the AC on.

What's with the chopsticks?

So...chopsticks.

I've never been good at it. I've always been much better at spearing my food with them or using rubber bands and rolled up straw to make a spring loaded one.

These days, I'm used to fork in my right hand, a knife on the left side of my plate should I need to cut something.  A spoon is something I use to eat soups and stews out of a bowl.

Then in my current situation, I observe people use the spoon on the right hand primarily and the fork is a secondary device on the left hand.  Rarely is a knife used.

Being immersed and familiar with all three situations above, I have a theory.

In China, where chopsticks were invented (as early as 3000 years ago), the foods are traditionally cooked after being cut fairly small.  Was the food cut in bite size pieces first or was the chopstick invented first? I believe the food was cut in bite size pieces first. Food cooks faster when cut smaller and with the resources of China at the time, it makes sense to me that they would find ways to preserve cooking fuels.  Thus, the culture of China (and the other countries it permeates) is such that they use chopsticks to eat.

The US learned its use of knife and fork roughly in the 19th century from its European ancestors (who learned it in the 18th century).  With slight differences (the way the utensils are held and whether to switch hands after cutting the food or not), a knife and fork works well for the kinds of food eaten in the US.  Roasts of beasts, dollops of mashed potatoes, apple pies, are all best eaten primarily with a knife and fork.  Except maybe peas.  The spoon is relegated to bowl food duty such as soups and stews.

Indonesia, having been a colony of the Dutch for over 350 years, learned the use of knife and fork. Being in close proximity of China and a center of trade in Asia, it also learned how to use chopsticks. But we will focus on how their knife and fork use is different than another colony of a different European country.  Indonesia uses the spoon on the right hand with a fork on the left to "spoon" small pieces of food on to the spoon.  This is because rice is its staple food, 3 or more times a day.  Eating rice with a fork is rather difficult, as would the chopsticks.  In the past, Indonesia eats with its hands, and it is still acceptable today even in restaurants serving traditional foods.  But the use of a spoon in the right hand is definitely necessitated by the fact that eating rice is much easier with a spoon than a fork or chopsticks.

So this case supports my larger, encompassing theory about cultural behaviors. Often cultural behaviors has its roots in a particular need.  The types of food eaten, which is driven by resources available in the region, necessitates different eating utensil behaviors.  When cultural behavior is taken out of context of its place, time and people, the behavior can become inappropriate in its new environment.  This is when we, the cultural behavior practitioner, must change and adapt.  This is when we, the cultural behavior recipient, must understand the origin and be patient with the practitioners as they learn to adapt.  This is mutual respect for both cultures, the guest and the host cultures.

Taking an ojek

Huh? What the heck is an ojek? In Indonesia, it is simply a motorcycle with a rider giving rides to strangers for a fee. Sounds like a taxi? Yep, it's unregulated motorcycle taxi.  They are usually for short trips up to 3 miles or so, though it's possible to go farther, not that you want to risk your life (or knees) for any longer than necessary.  You come up to a street corner where most of them congregate and negotiate a price. There are no meters on this motorcycle taxi.

You then get on the motorcycle as a passenger.  Most of them will give you a helmet to wear since it's the law in Indonesia to wear helmets. Indonesians are known to strictly follow traffic laws. If you don't mind the cooties, sweat and other unsavories from countless other people who have worn the helmet, by all means wear it.  Though the way these guys drive, it's a good insurance.

The motorcycles here are mostly what's called an underbone motorcycles. It doesn't have a backbone and a tank that you straddle like most in the US. It looks a little bit like scooters, but without the flat floor for your feet.  Also, the maximum legal displacement for the engine is 250cc.  Most people get a 125-150cc, rarely do you see anything larger. With them not being allowed on the toll roads (the only kind of freeway they have here), there aren't many places that you can go fast on a motorcycle.

Because the bikes are so small, when I got on, my knees are spread out away from the bike. In a V formation. Quite a bit wider than the motorcycle and the rider.

As we zoomed in between cars and other motorcycles, getting up on the curb and onto the sidewalk, avoiding people, I feel quite safe. Despite not wearing the helmet provided. The reason I feel quite safe is because I'm worried, quite worried about my knees. Either I'm lucky or my rider is one heck of a rider.  My knee would scrape other cars and motorcycles ever so slightly. If he had missed by 1/4", my patella would have been crushed when it hit the back of the car or the motorcycle, or another knee.

More photos in this album:

http://picasaweb.google.com/andreosae/Pftt#

My daily trek home

This morning was the beginning of my second week working at Contained Energy. I live in Bogor, and the office is in Jakarta, about 40 miles or so.  My cousin Alfa is kind enough to take me with him in the morning even though it's a slightly longer route for him to take. I get up between 4-5 am and leave with him by 6-6:15am.

I would arrive at the spot where he would drop me off by 7:30-7:45.  If we leave any later, traffic would be so bad that I wouldn't be able to make it to work by 9am.  

From this point on I have an option of taking a mini bus, a medium size bus or hoof it on my own.  So far, I've only taken the medium size bus once and the rest of the time I walk in. 

Even this early in the morning, I am already feeling the heat and would be sweating even if I was just standing there. By the time I get to work, it takes me over an hour in front of the AC at full blast to stop sweating.

In fear of standing out from the rest of the crowd on my walk, I usually wear a tshirt and shorts.  The road I have to walk on passes by the courthouse where they're currently having a high profile trial. This trial already caused one riot resulting in several deaths and dismemberment. Funnily enough, that riot happened during my interview for this job.

The walk is not far, just about 3km (a touch under 2 miles).  But it is more like a trek. Sidewalks are practically non existent and I have to be on the road with the motorcycles and cars. When there are sidewalks, I have to watch where I'm stepping lest I fall into the hole that leads to the open sewer system underneath the sidewalks.  If the sidewalks are still intact, it's not really for pedestrians, but mainly for the motorcycles. But most of the intact sidewalks are neither for pedestrians or motorcyclists. Rather they are for entrepreneurs who set up shop willy nilly where there's space for them.

The road is narrow, barely wide enough for 3 cars abreast, but the lines indicate that it's for one lane each way.  No one follows this convention.  When the traffic is bad, there not even enough room for me, a single pedestrian to walk through it. Despite my willingness to risk getting burnt by the motorcycles' exhaust pipes.

Coming home is slightly different. I still need to walk the slightly under 2 mile walk to the same area where my cousin drops me off.  There, I pick up the bus that go straight to Bogor on the toll road.  If I'm lucky it will take between 40-50 minutes, up to 75 minutes if I'm not lucky.  One the bus is in Bogor, Dina might be able to pick me up or I have to take another bus home and about a 1km trek.  

Check out the road conditions and sidewalks on my picasa page, starting from this picture to the end:

http://picasaweb.google.com/andreosae/Pftt#5529322000144611410