Report from Aceh - Team I Yayasan Bumi Sehat
from Robin Lim (March 4th, 2005)
Dear Concerned Ones,
The Indian Ocean off the West Coast of Sama Tiga Aceh is the exact temperature of tears. We put our feet in the water. Kelly Dunn, Canadian midwife, found a child’s rubber slipper there on the beach. She made it an altar, with shells, rusty wire, stones and broken plastic. Ari Tueku wrote poems on the shore, and let the gentle waves take them away, just as the Tsunami had taken away his grandmother, closest cousin, and nearly 70 dear family members.
The earthquake that struck just offshore of Northwest Sumatra on December 26 and subsequent tsunami has changed our planet both physically and emotionally forever. Geologists speak of a rise in the underground water table, as far away as Florida. Spiritual leaders tell us it is an opportunity to open our hearts, as so many people, all around the world have been effected. An accurate accounting of the loss of life can never be achieved. In Aceh, Indonesia alone experts began to conservatively estimate 500,000 homeless survivors, and around a quarter of a million souls lost. The remains of the dead continue to be unearthed by search and rescue workers, at an alarming rate, everyday, even two months after the disaster. The only thing that has become clear is that we will never fully understand the extent of the devastation.
I am to write a report of the Yayasan Bumi Sehat (Healthy Mother Earth Foundation) relief efforts there. I am having trouble doing this. There are just too many faces of anguish, the sleepless guilt lines a mother wears, because her baby was torn from her arms, the tsunami was just too violent. The fierce strength of mother’s love was not enough to keep the children alive. A man comes to cry for his daughter, also torn from his arms, his wife still missing, and he has no photos of them. No home, no spoon, nor tool nor bed mat. His skin is covered with scabies and there are festering wounds, now weeks old, from the debris he swam in on December 26th.
We arrived in Medan a busy Sumatran city, not hit by the giant waves. We were able to make contact and meet informally with World Food Bank staff, to discuss the problem of infant formula distribution, which could undermine breastfeeding, with devastating results. They agreed with our recommendation to only give infant formula if the mother had actually died. We also met with International Medical Corps, UNICEF, IRC/CHRDI, Catholic Relief Services, and Global Relief. Also during our whirlwind two days in Medan, with the help of Yayasan WALHI (Friends of the Earth- Indonesia) (huge thanks to Lenny, Monang, Herwin and the WALHI staff) we purchased a huge truckload of cacang hijau and cagang tannah, (mung beans and peanuts). We choose protein for a population who for over four weeks has survived on coconuts, white rice and dry packaged noodle soup sent from relief organizations. Those who had already seen relief, were fortunate. We were to learn that there are still pockets of survivors in places so remote that medical and food relief had not reached them.
We also loaded the truck with school supplies donated by Yayasan Ibu Puduli (Mothers Who Care non profit foundation) of Bali. We organized kitchen buckets for families who had lost everything, in the hope of making a step toward the restoration of ‘normal life’. We were to learn that ‘normal life’ must be redefined forever for Aceh. Loaded up onto the truck were baby sets, in little plastic baby bathtubs. Small, small clothing, blankets, a little hope for a new post-tsunami generation. We had big plastic boxes filled with precious medicines. A hundred jilbabs, so the Muslim women who lost their necessary head covering could come out. We were given bras to distribute, because that apparently is what women had asked for along with underpants, and prayer books, salt, kitchen knives, mosquito repellant, candles, matches and other essential survival items.. We loaded the truck until it seemed it would burst, and then we loaded up three generators, tools, drums of fuel. The truck and the rental car went over land, with Benny, Ari and Ida, traveling over 16 hours, through dangerous mountain checkpoints, military and rebel tension zones, to the far northern province of Aceh. The rest of the team, Thoreau, Wil, Deja, Oded, Kelly and Robin would catch a free Red Cross Red Cresent flight to Meulaboh. (Thanks to IRCRC director Phil, a true angel) In Meulaboh we found a city more than half destroyed. While the ‘Search and Rescue’ teams were still packaging bodies and parts of people, the remains of a market was open. Oranges and selak fruit for sale, even some fish, though there are nearly no fishermen or boats left. We were blessed to find, thanks to Ari and Benny, Ibu Rosni, Ibu Dosni, Elly and Ibu Makbid of Yayasan Anisa. Anisa means woman in Arabic, Yayasan means nonprofit organization. This grassroots organization had lost its office during the Tsunami, Anisa staff had lost family, but they kept working. These brave women were the first to give relief to the tsunami survivors in Meulaboh. It was the Anisa staff that organized and distributed the precious kitchen and baby buckets for us. They told of the dilemma of host families, who had not lost their homes, but were housing many, sometimes 20 or more victims, and feeding them on a family budget that was inadequate before the tsunami struck. We were able to report this to World Food Bank, who immediately acknowledged that displaced peoples outside the tent camps were not getting food relief, and they promised to address the problem immediately. IbuRosni and the Anisa staff hosted Kelly and I to teach a day long workshop for midwives. We were amazed to find that 41 Bidans (midwives) attended. Most of these women had lost family and home. One midwife, walked three days to attend. She had lost her husband, child and home, and was 30 weeks pregnant. For her this workshop was an opportunity to get back on her feet, so she could continue to help people. All of the midwives attending the workshop reported that they had lost their equipment and birthkits. We were able to convince the medical director of UNICEF Indonesia, Scott Whoolery, to attend our meeting. He was thrilled to be meeting so many of the women who are actually out there, doing the primary healthcare for the citizens of Aceh. He promised that each midwife would receive a UNICEF midwife kit. Scott will be using the network of Yayasan Anisa to be certain that the birthkits are delivered to each midwife in her home village.
Sadly we found a high rate of infant demise due to tetanus. Because most of Aceh has no refrigeration, (the TT vaccine requires refrigeration) it is not reasonable to believe that a tetanus toxiod vaccine campaign could solve this problem. One must also consider the fact the midwives and ‘dukun bayi,’ (traditional birth attendants) who are attending the lion’s share of births in Ache, do not have a dependable source of water and means to keep instruments sterile. (Plus remember that most of the midwives’ cord cutting instruments were swept away by the tsunami.) Kelly and I taught these 41 birth attendants how to safely burn the cord. This method eliminates the danger of tetanus or other bacterial transmission from non-sterile instruments. The midwives were thrilled. They came away from the workshop feeling like they had learned a skill which they desperately needed. We were also able to encourage them to get medicines free from Ober Berkat Foundation. As well as seeking help from Medecines Sans Frontiers and Global Relief. Meanwhile at the camp we shared with the WALHI / IDEP clean water and sanitation crew, staffed by 16 hard working Balinese men, an American dedicated to testing wells for salinity, a Mexican doctor and run by Nuragh and Christine, a clinic was being built for us. We barely arrived in camp and we started seeing between 30 and 70 patients per day, in a bamboo structure with blue tarps for rain protection. (Oh yes it rained and rained, and yes, we had earthquakes!) While pumping the salt water from wells, and making pit toilets for the people of the 15 or more villages surrounding the community of Cot Seulamat, the Balinese crew turned trees felled by the tsunami into lumber and built a beautiful clinic. At the clinic we found that nearly every mother had lost children, within 2 to 3 days after birth, long before the tsunami washed over their lives. Over thirty years of civil war has deeply compromised the people’s nutrition, adding to the maternal and infant mortality rate. One morning, early we were rushed to the home of a mother who had just given birth. We found Ibu Bulan,(Ibu means mother, Bulan means moon) a traditional midwife in attendance. She had already cut the baby’s umbilical cord with old, blunt school scissors. The baby appeared fine, though small, about two kilos. The new mother, Roswita, a thirty five year old woman, having just birthed her fourth baby of which two had already died, most likely of tetanus, was not in good condition. Roswita was hemorrhaging, her placenta was retained and Ibu Bulan had done cord traction, and pulled the cord off of the placenta. I gloved up quickly, and manually peeled the placenta, centimeter by centimeter off of the inside wall of the mother’s uterus. This was painful for Roswita, and doubly difficult as culturally she was not comfortable opening her legs, even to save her life. Kelly talked me through the intense procedure, while Ibu Bulan spoke soothing words to Roswita. When finally the placenta, the most unhealthy looking one any of us had ever seen, was born, Ibu Bulan fell sobbing into my arms. "Thank you, thank you, this has never happened to me before, I was terrified, I did not want my friend’s daughter to die." I learned that just 8 months earlier Roswita’s sister in law birthed in the same home, with the help of Ibu Bulan’s daughter, also a traditional midwife. That young woman was not as lucky. She also retained her placenta, and died in transport to Meulaboh hospital, which is 45 minutes to one hour away, by swamp road. This near fatal complication turned out to be one of the many blessings along our way in Aceh. Ibu Bulan’s trust was essential if we were to serve these communities of hard-hit tsunami victims. She later did a birth with the Bumi Sehat midwives of team II, Jenny and Indah. They burned the cord and Ibu bulan is now sold on this much safer protocol. No doubt this alone will save countless neonatal lives. Oded from our Bumi Sehat team, along with the WALHI Bali crew, was busy helping the surviving villagers of Pucuk Leung and Lhok Bubon to resettle. We gave them generators and strung electric street lamps, to help the people conquer their fear of the night. Though the homes were completely destroyed Oded and Christine networked with Mercy Corps to get the families tents and kerosene cooking stoves. He organized the people into work crews to fix the Mosque roof, and make a rain catch system for wash water. Oxfam brought in a 10,000 liter bladder for drinking water, which they deliver every day or two.
Catholic Relief services paid for a new roof for the Mosque of Lhok Bubon. The survivors of this village are mostly men, who were far out to sea fishing when the tsunami hit. When they returned home that evening, they found their wives, children, old people, friends and homes, were all totally gone. The only building standing was the Mosque, where 70 people were marooned on top.
One of the women clinging to that roof was Sarjani. Sarjani had lost her two daughters in the deluge that day. Deep in the water, nearly unconscious she resigned herself to death. A carabou (water buffalo) nudged her with a huge horn, and Sarjani grasped it. She was huge with child and could not swim, the gentle animal took her to the surface and deposited her beside the roof of the Mosque. As the sunset, that evening and the tsunami waters receded, and the men of Lhok Bubon came home to a nightmare of devastation, Sarjani went into hard labor. Also among the survivors on that roof was a midwife. "Alhamdulilah, (all glory to Allah) as the Muslim people of Aceh say when they’ve been blessed.
The resettlement of these villages is essential to the physical and emotional survival of the people. Those people who do not go home to their destroyed villages, to attempt to rebuild their lives on ancestral soil, face generations of displacement. Many will live in tent cities, surviving upon relief foods, or in military barracks’ where five to eight people will be housed in rooms with one small window, and hundreds will share toilet facilities. Those people going "home" face other hardships. Citizens of villages close to the sea may find themselves permanently displaced, as the Indonesian government has delineated a conservation zone, disallowing any resettlement within 500 meters of the sea. For this reason the small fishing communities are rushing to return home, before they are stopped. The resettlement of Lhok Bubon and Pucuk Leung, facilitated by our IDEP/ WALHI team and Oded from Bumi Sehat, was not in our budget. Going there late at night to do medical relief, in a tent, and sharing their meal of the mung beans and peanuts we donated… was a beautiful feeling. I heard rumor that Oded bough them a volley ball set, also not in the budget! Oh dear.
Other heroic deeds include, the WALHI Bali staff pumping wells, testing and mapping wells for salinity, building the clinic, and to finding the time to build a bridge, connecting Lhok Bubon to the rest of the world. What these guys can do with some dead trees, a chain saw and a lot of cooperation is an ongoing miracle. We are hoping IDEP can continue to fund Christine and Nuragh’s amazing crew, so that they may continue their clean water and sanitation efforts. Graham of Catholic Relief Services is planning to work with the WALHI Bali Crew and with Bumi Sehat in "livelyhood" efforts. One request from the resettled villagers was for baby fruit trees.
Thanks to Nils of Mentor (and to the tireless efforts of Midwife Kelly and Dr. Dario) we were able to get malaria Rapid test kits and medication for both children and adults with P. falciparum malaria. Team II from Bumi Sehat is in the field now, and recently found a small girl with falciparum malaria, they were blessed to be able to diagnose and treat her in time. A member of the WALHI Medan team died this morning of malaria he contacted while doing relief work in the field. The Bumi Sehat team is taking preventative medications for malaria, which is only 30% effective, so light a candle for us.
The Bumi Sehat free walk in clinic in Cot Seulamat, Sama Tiga, Aceh, serves an average of 70 patients per day. The rolling staff consists of volunteers from all over the world, based out of Bali. The Aceh staff is growing and will give solidity to our dream of sustainability. This clinic is a neutral place where tsunami victims, host families, military personel, and the most marginalized peoples feel comfortable coming for help. Some of them are very sick, or have infected injuries. There are an increasing number of malaria victims. Others are pregnant, most all the people we saw were malnourished. 100% were traumatized. For many just telling their story, saying the names of their dead children and wives, brothers, sisters, mothers, uncles, gave enough comfort to allow them a night’s sleep, finally. I am still not sure what we dreamed our goals could be in going out to Aceh. We were asked to go, helped by the donors to IDEP Aid for Aceh, and many others. I hope we did a good job for our donors and the people of Aceh. We got a Clinic going and must try to keep it staffed. We bridged many Indonesian Aid organizations and care providers with the big International NGOs. We made some beautiful friends in Aceh.
Huge thank you to our ground team in Bali, particularly Josh, Nita, Ibu Sundari, and Melanie, who take care of us so we can take care of others. The gang at IDEP, Petra, Frank, Rhoda, David, Mary, Endang, Made, Peter, Samantha, Chakra, Rebecca, Cat and all of you… My graphics team who developed the "Clean, Safe, Calm Birth book for Aceh, Josh, Lakota, Zhouie, and Ibu Brenda who did the writing. Zion, the Bumi Sehat team t-shirt rocks. The Bumi Sehat Staff, Sandi, Harvest, Ibu Budi, Ibu Susanti, Dr. Bobbi, Suastini, Kadek, Ketut, Pastika, Kadek Kick, Pak Tunjung, Iloh, Ibu Putu, you are so wonderful. Special hugs to my household staff, IbuWayan, Tini, Liwati, Made and Sandi, for putting up with this crazy lifestyle of SEVA (service). My family, Husband Wil, who joined the Team with son Thor and daughter Deja bringing media support and nursing skills (By helping Search and Rescue bring bodies home to the families for proper burial, you built trust and showed great courage.) Ari, Benny, Ibu Rosni, Isnyati and Ibu Aysha, thank you for being our Angels in Aceh. Oded, Ida, Christine, Nuragh, Pak Made, Tyak, all the Bali crew, huge thanks and so much love. Agustian, Noel and Zion for joining team II, even though that really is gunfire you hear at night in the woods behind the clinic. I know testing and mapping well salinity, driving around, and supporting the midwives, collecting medication, translating, digging the WC, moving the water tower, and constant clean up, are pretty thankless jobs… you are so great to be doing all this and more. Kelly, you and your family have given a thousand percent. Plus you took the hardest patients on, with smiles. Team II midwives, Indah, Jenny, Cheryl and Louise, I pray you are finding joy in the tremendous job you are currently doing out there in Aceh right now. Harvest, Carolyn and the Team III members yet to be named, thank you advance. I’ll be back in Aceh around the first of April, God-in-all-of-us willing.
From the perspective of our goodbye flight on the International Red Cross Red Crescent plane, flying low and slow all along the West Coast of Sumatra, it looks quite hopeless. There are big, once busy Asian cities leveled. Huge barges four or five kilometers inland. The road North of Meulaboh is hopelessly ruined. The beaches are littered with broken toys and broken dreams. My midwife friend Shirley Tidy once said, "Maybe we can’t change the world, but we can give it a go!" This has become my mantra. The wounds of December 26 are scaring over. I felt no ghosts in the night at Aceh, there is a peace, a sweetness between people, and a prayer for healing.
Ibu Robin Lim
March, 2005, Bali, Indonesia