Jakarta Breaks and (scary) Indonesian Food

For the first two weeks I spent in Jakarta, all I could think about was getting out to the field and seeing what “real” Indonesia was all about. After being in the field for a week, I shocked myself by being pretty excited to go back to Jakarta. I know, I’m crazy, right? I’ve really learned to enjoy and relish the couple of days I have in Jakarta by sleeping in and spending at least one day by the pool working on my summer tan, killing my annoying psoriasis with UV rays and falling into the plot of a book. Since I’ve done this twice already and am coming upon the third time, I must say it’s the thing that makes me most excited to go back. Well, the pool and the food. Before I came my preceptor send me a short document about things to know/do before coming and one of them talked about the food saying that “Indonesian food is nothing special.” I read this a few times and thought, well, that can’t be right, there have got to be good things. As I thought more about it I realized I didn’t know one Indonesian dish, nor had I ever seen an Indonesia restaurant that I could test out. Nevertheless, I kept an open mind and trying the food remained at the top of my list of things to be excited about.

Before I talk a little bit about the food I’ve tried (which admittedly hasn’t been too much) and that I’ve seen, I want to send a huge shout out to Ibu Yumi, the cook at Anne’s house. She’s been a cook for many years for expat families and she can equally make a delicious tofu and stirfry as she can tacos or lasagna. The first few nights I thought, “Hmm, American food…not too exciting.” And now, I long for her cooking. My first day we went to a shopping mall, to the food court for lunch. Looking around, it was mostly Indonesian restaurants, but also Malaysian, Vietnamese, Korean and Japanese. The descriptions of food included cow’s feet, chicken feet, duck eggs and other mysterious delicacies that I didn’t want to venture into on Day 1. I also learned that a lot of the dishes are based in coconut milk, which isn’t abnormal for Southeast Asia. Normally, I love coconut milk and I even jumped for joy at Trader Joe’s when they brought back their Thai tuna packets that were based in red and green coconut curries. But I also took a cooking class in Thailand where all 9 of the dishes I learned to make were based in coconut milk and part of the class was to taste everything afterward. As of May 2009, coconut milk is one of my least favorite things. So, when I found out that the majority of the dishes are in coconut milk, my excitement level dropped considerably. The upside to Indonesian food is that all meals have rice! Even though I love a little variety in my diet, I could eat rice every meal for the rest of my life; that’s the Mali in me. All that said, when we’re not in Jakarta, food options are sparse. I’ve become very fond of this one “sauce” (based in coconut milk, can you believe it!) called renda (from West Sumatra), and of course there’s always a variety of friend noodles to be found. But in general, I eat a midafternoon lunch and try to avoid the food the rest of the day, instead searching for some fruit vendors on the streets.

The window of a padang restaurant

I thought I was doing alright, if not loving the food, at least tolerating it and eating what I found edible, but the other day we went to a restaurant that serves Padang food (the same food where the renda sauce that I like originates) and the style in these restaurants is to bring small plates of everything to the table. You then choose what you want and you only pay for what you eat. Afterward, I’m assuming, they take the plates back and return the dishes to their larger serving bowls and waits for the next customers. My issue with this style of serving food is that unless you arrive as soon as it’s cooked (presumably at 6 or 7 AM), the food is always cold. The rice is warm and the idea is that eating the padang food with hot rice will heat it up, but one of the many lessons I learned in Africa was not to eat cold or luke warm food; hot food meant that any germs, parasites or other contaminants would be less harmful to my digestive track and system. Nevertheless, I eat this food with caution and hope for the best. My other issue, and possibly the reasons I will limit my visits to padang restuarants, was the choice of dishes that were brought to our table. My renda was there, this time with a choice of beef or beef liver, two things I generally like, but then there was also chicken brain, tripe, intestines, lungs and spleen.

A variety of padang food brought to our table

I considered taking photos of each of these dishes and then decided against it. While I’m happy that all parts of the animal are consumed here – for many reasons, among which are the ever growing worldwide desire for meat, ensuring that the population has protein and not wasting it – it was a bit of a shock to see my fellow colleagues eating and enjoying these dishes. It also renews my vow to continue searching for greens and fruit, while outside of Jakarta, whenever possible. I promise more food photos, plus a trip to the market coming soon.

Extra Photos

A couple photos I forgot to include, and they don't really fit in anywhere else from Karawang:

After finishing some interviews at a private midwife's house/practice, I stumbled upon this school with all the children dressed to a tee in their uniforms. I gathered them together for the photo, this isn't the natural way they spend their day. Per usual, the girls act very demure and well behaved while the boys behind them try to show me their best devil horns or I love you signs, I can't really tell. Click on the photo to enlarge.

Problems in Karawang

I often feel like my life here is a comedy of errors and that all of a sudden, the guy from Candid Camera is going to pop out and say, “Surprise, you’re on Candid Camera.” Sadly – or maybe not – that hasn’t happened yet. Karawang certainly started off that way. Midway through the week, we visited a village that was only about a km or 2 from the city, but down a terribly broken road that was jarring for the 10 minutes it too to ride down. In addition to that, the only way to cross the “river” that divided this village from the jarring road, was a small foot or moto bridge that I wasn’t too trusting of to walk across. When the midwife coordinator suggested that our hired car drive across the bridge, I immediately imagined the driver being unable to balance on the edges of the bridge and us in the water. Luckily, he had the foresight to say no. The one thing I love about the villages that we’ve visited is that they are little labyrinths. The roads are narrow, and there are so many streets jutting off from the main one. We arrived at a posyandu in progress with tons of women and children. The village health worker, who was weighing the babies, was actually a man. I had, until now, only seen female village health workers, so I was happy to see that men were engaged in the fight toward maternal and child health as well. We set up in the village health worker’s house and got to work right away. The interviews started off as usual, but as we got to the end of the group, this weird thing started happening. We ask all postpartum women this question:

Would you recommend to your friends and family to deliver at the same location where you delivered? Which of the following is the most important reason influencing your decision?

And then we provide this list for them to choose from:

1 Cost

2 Distance

3 Cleanliness

4 Transport available

5 Good supply of drugs and equipment

6 Type of health provider

7 Experience of health provider

8 Attitude of health provider

9 Relationship with health provider

10 Being treated with respect

11 Facility where usually go

12 Safety for mother and child

13 Health worker recommended

14 Referred by another facility

15 Other (specify)

98 Don’t Know

Not only were many women unclear about the list of choices – it is a bit cumbersome – but women’s response to the question about recommending was often, “I don’t want to recommend anything. What happens if that woman has a complication or problem, then it’s my fault because I recommended it.” Interesting theory. I can understand the guilt that women might have in this case, but the question doesn’t ask women to be so complex in their thinking and think of repercussions down the road. It made me think that maybe women don’t sit around and talk about this stuff like I thought. I thought that on any day, when pregnant and postpartum women were hanging out, a conversation might come up about where the women delivered or were planning to deliver, and each woman giving her (unsolicited) opinion about which location is the best. Does this happen? Does it not happen? Obviously, I don’t really know. I was also surprised that women would go to such lengths to think through the repercussions of this question, yet they were confused and often unable to answer the question associated with the list. After this roundabout with at least 5 women, it felt like one of those days that I just wanted to go back to the hotel, crank the AC and read my Steig Larson book. Unfortunately, our hotel was ridiculously far and inconvenient, taking us about an hour and half from the village to arrive at the hotel. With that distance, we should have just stayed in Jakarta.

Destination: Karawang

Our second field visit, destination Karawang. Karawang is in Java, just east of Jakarta about one and half hours. Since its so close, we left very early on Tuesday morning to beat the traffic. Karawang is one of Jhpiego’s cervical cancer sites and that’s about all I know. I’m not sure what they’re doing in terms of cervical cancer, but I’m happy to know that the health systems are at least equipped to tackle cervical cancer, which is more than I can say about a lot of countries where basic health needs are barely being met. We started our visit with the obligatory visit to the District Health Office and then traveled to the puskesmas where we would be basing our village visits. I’m still constantly surprised about how big places are. I don’t know the square mileage of Karawang, but it seemed as if we could drive at least an hour in any direction and still be in Karawang. After we found the puskesmas, we picked up the midwife coordinator and headed to a small village, Dukuh Kariya, to begin our interviews. I was already pretty tired at this point, I only slept like 4 hours the night before, so the thought of interviewing 15+ women was not getting my pumped about the day. We met at one of the village health worker’s houses where the posyandu takes place. By the time we arrived, the posyandu was already finished, but she was able to go and call and bring some of the women back to talk with us.

Midwife Coordinator, Ibu Yuli, who was very awesome and very maternal.

Posyandu sign in Dukuh Kariya

Our interviews went pretty well, and we were learning a lot about services in this village. I previously talked about jampersal, a governmental program that will pay women to deliver in facilities. There are some challenges around it because the government will only reimburse the midwives 350,000 RP, when they might normally charge 700,000 RP or more. So, I think it’s a good program to get women into facilities, but I think its limiting midwives and creating a situation where they can start to corrupt the system (which we’ve already seen) by telling women that it costs only 100,000 or 150,000 Rp instead of 700,000 Rp and then they’re pocketing the 150,000 and getting the 350,000 Rp reimbursement from the government. Confused? Just read it again. The bottom line is that there are still kinks to work out and since the government hasn’t (and can’t) implement jampersal nationally, it’ll take awhile for the individual districts to work out the problems. That said, Dukuh Kariya took jampersal in a whole new direction. The private midwife who lives and works in the village is a government employee who also works at the puskesmas and earns a monthly government salary. Based on this, it appears that it wasn’t so much her decision to implement jampersal in the village as it was decided for her. We then learned that jampersal is accepted at her private facility as well as for HOME BIRTHS. That’s right, home births. The whole idea of this program is to get women to a safer facility, and now we’re offering them to stay at home and deliver for free. Problematic, for sure, but I had to remind myself – as I have to almost daily – that we’re not here to change things, we’re just here for data. This news was the biggest of the day because it was so odd. Since Indonesia decentralized, which I don’t know much about, the districts have more power than the national government and therefore decide what to use their money on. That’s why we see that Karawang has implemented jampersal and Minas, for example, hasn’t. Apparently the districts use the money for infrastructure instead of health, which isn’t exactly surprising. So, it was good to know that Karawang took the leap and started providing free deliveries for women, but it doesn’t sound like it was executed the best way.

Posyandu, filled to the brim with women and their children

Concerned mother with her newborn, talking to the midwife and village health worker about the progress of her baby's health

As I mentioned, our interviews went well with the exception of one woman who made me lose confidence in this research. She was in her mid-thirties, dressed to a T, wearing a satin dress with gorgeous embroidery and a beautiful hijab. Her features were striking, her skin not too light and not too dark, her eyes dark and seemingly full of life. I had high hopes as she walked into the room and sat down. She was pregnant and told us that her plan was to deliver at a private midwife’s clinic because she thought it was safer for her and her baby. These are the women that make me jump up and down with joy. But, as the interview continued she slipped up and told us that she actually wanted to deliver at home because it was more comfortable, and that she lied to us because she was scared. My frustration comes in that, is this happening often? Are we getting responses because women are scared or are the telling us what they think we want to hear? How many respondents are doing this? And what do I do with this woman’s interview? My initial feeling is to throw it away, which is probably what I’ll do, but it’s frustrating to think that more of our responses might have this problem and we don’t know about it.

The gorgeous landscape and rice fields of Karawang

Minas: in Photos

I'm sharing some photos from my last few days in Minas. Not all have or need captions or comments.

Women attentively listening to a village health workers health lesson

Though not one of our respondents, I think this woman is beautiful.

Triplet Girls! Mom was only able to deliver one with the midwife and the Doctor came from about 10 km to help deliver the other 2.

This little one's face is so full of expression

Rantau Bertah

While the elephants may have been the highlight of Minas, we still have three more days of interviews. We traveled to Rantau Bertah, which was about an hour outside of Minas on a pretty bad road, but a beautiful drive. The second half of the drive was through a heavily wooded area which I later learned belonged to a paper company - I'm hoping it'll remain beautiful for a long time. We had planned to visit a Mother's Group of pregnant women but when we arrived they hadn't yet started their meeting, so we instead headed over to a posyandu which was overflowing with women coming for their ANC checks and baby weighings. This is definitely a day I would have loved to have been a fly on the wall - with my Nikon, of course - but per usual, we were shuffled into a back room and set up for interviews.

Village health worker noting the growth progress of a baby on her growth chart

Village health worker and posyandu-goers

The antiquated baby scale that I'm certain does not produce accurate weights. And for once, I think this system of baby/children weighing is worse than the system in Mali.

We started our interviews and got many more than we had initially planned. I'll share two stories that highlighted the day in Rantau Bertah. The first is a woman, in her mid thirties who only received an elementary school education, told us about the great relationship she has with the midwife at the puskesmas. She stayed at the puskesmas for both of her births and said that she'll return there for any subsequent births as well. Despite being relatively poor, she didn't care about the costs of childbirth or anything else - she loved her midwife and wanted to be safe.

Surprising me beyond everything, this woman - with an elementary school education only - has given birth at the puskesmas twice. It proves that education level isn't the only determinant to facility-based birth, but that a woman's relationship with their health provider is greatly important.

After meeting here and hearing about her experience with the village midwife, it was great to hear that midwives are more than just baby catchers and that women feel a real connection with them. These midwifes likely offer advice and other pregnancy and birth related services. They also likely provide friendship. After having this wonderful picture painted for me of a midwife who really cares about her patients, we met our next mother. Unfortunately, this woman had possibly the worst experience with the same midwife. As she stood and bounced her newborn to avoid crying, she answered our questions and interjected her story along the way. She planned to deliver at the puskesmas and when she began to have labor pains, she walked to the facility (maybe a km or so). When she arrived, she was 6 cm dilated, but the midwife told her she wasn't ready to deliver and that she should go home and come back when it progressed. As soon as she arrived back at home, her labor pains were worse and she sent a neighbor to bring the midwife to her house. She said that when the midwife arrived, she was annoyed that she had been bothered to come after just sending the woman home. She delivered the baby, but at the same time left the mother with a terrible birthing experience.

This little girl has such a full head of black hair - she was the first infant I saw with so much hair.

Two conflicting accounts of the same midwife. Interesting how two experiences can be so different. It's also a shame that one woman had such a terrible experience that perhaps next time she is pregnant, she'll choose a traditional birth attendant to help her deliver instead of feeling disrespected by the village midwife. For her, I hope she'll take into account her safety and that of her baby, or the fact that the midwife at the puskesmas can handle simple complications that a TBA cannot. It was at this point that I ran into an ethical dilemma. Part of our research asks questions about how women are treated during their stays at facilities. With such a negligence of duty by this midwife, and not knowing if other women have had similarly poor treatment, I'm compelled to report it someone. However, I was told by more than one person that it's not my responsibility and that it's a tricky road to go down. So instead, we leave a midwife of questionable work ethic in place and do nothing. Not an easy situation.

A happy mom and health baby girl with pierced ears

Sign in the posyandu saying:
"Come to the posyandu. Keep Children Healthy. To determine the growth and development of children." And was created by the Health Promotion Improvement Project of West Sumatra in 2001

I know I said I only had two stories, but as I was writing I remembered a third. After we finished at the posyandu, we headed over to the Mother's Group - remember, the original reason we came to Rantau Bertah? - and talked to a few pregnant mothers. In this small village we found a university educated woman who I believe was a teacher. She was very petite, but I remember her being very stunning as well. Throughout the course of our conversation with her, we found that she planned to stay home to deliver her baby. I was shocked and probed a little bit more to find out. Turns out - which has actually been the case in a lot of our interviews - that she was planning on staying home to be close to her family and because it was more comfortable. She said that the only way she would go to a facility would be if her entire family could come and stay with her throughout her stay, until she was discharged.

I enjoyed Rantau Bertah, but it proved that there are always surprises around the corner.

Elephant “Conservation”

Dooni!

During our first morning’s drive to Minas, we passed a sign that said “Elephant Conservation.” I was immediately interested and thought that if we had a free afternoon, or finished work early, that we could have a small adventure and take a look. We headed there Tuesday afternoon. The road was a little bumpy, nothing unusual, but the forested area around me kept me looking out the window, wondering if I was just going to see elephants grazing. We finally came upon the entrance and started driving toward the offices of the organization. On our left, a baby elephant was feeding next to a man who was doing some type of cultivating. This baby was so cute, I just wanted to get out and touch her! But, not knowing what type of conservation organization this is, I decided against it, thinking that she might be aggressive.

The baby elephant who greeted us upon our arrival

We continued a little further down the road and saw three adult elephants and another baby, and the office area which oddly had a circus-like grandstand and some props for elephants to do tricks on (it did not help that I had seen Water for Elephants two days prior). I was pretty confused by the grandstand and the props, but we parked the car and got out and started talking to the men that worked there. They explained that the conservation (which, for the record, I would change that name) was established and funded by the government. Elephants were shipped from all over Indonesia to this area and were then tamed and trained to be sent to zoos. My heart sank, more than a little, since I thought these animals were being rehabilitated from zoos and being returned to the wild. Again, I think the word “conservation” is a bit misleading. All in all, there were 31 elephants there that were being trained. Of the elephants that were close to us, one was being ridden by his trainer who said that he was very nice and gentle.

Dooni, with an unfortunate rider and chain that held his feet together

The trainers, getting Dooni ready for our short ride

What I loved the most was that his name was Dooni (in Bambara, this means small or slow or gentle). I was encouraged to touch Dooni and as soon as I approached him, his wet trunk started sniffing me, presumably looking for something to snack on. Since we had arrived in Minas, I hadn’t found much good food to eat, certainly not any fruit, but on our way back from the site, I saw a small market and we stopped so I could buy some mangoes and apples. They were pretty expensive and I was really looking forward to eating them, but when Doonie was expressly looking for something, I couldn’t resist but share with him! I’m not really sure what I thought, but when I offered an apple, he opened his gigantic mouth, and I was not expecting to see that. I hesitated, but eventually kind of gently placed/tossed the apple in and it was gone in a second. So much for savoring that granny smith! As soon as he swallowed it, his trunk was back, wanting more. How could I resist? So, I shared another apple, but was more comfortable putting it in his mouth this time. Since all I could really see was a lot of skin, I wondered where his teeth were – though I’m sure there was no chewing going on! – and one of the trainers opened his mouth wide to reveal these gigantic white teeth which I did not want my hands anywhere near.

Inside this gentle giant's mouth

Dooni’s skin was perfectly pachadermal – so dry and rough, and on his head right above his trunk and mouth, he had this longer, course hair. Together, they were great new textures to touch, in getting to know Dooni.

The trainers could see how enamored I was with him and asked if I wanted to ride him – uh, yeah, I was afraid you’d never ask! Of course, I was torn by this since these animals would probably never again live in their natural habitat and would constantly have humans bothering them, but nevertheless, I couldn’t say no. The trainer got off, they put on some crazy red cloth/sign for me to sit on and another trainer got on. Dooni sat down and they instructed me to step on his foot in order to get on him. It was challenging to scoot myself up to his shoulder area because he was quite wide, but I made it. Now again, I could have ridden Dooni all day, gone into the forest for lunch and dinner with him, and spent all night hanging out with him (perhaps as a result of Water for Elephants!). But, since I was with others, who really didn’t seem to care about my instant connection with Dooni, we just took a short stroll up the road and back. We took some photos and he gently sat down for me to dismount, and then the trainer pulled him back and he did a “trick” for me. At this point, all I wanted was to take Dooni home, forget about the issue of the plane and lodging –he was adorable. Of course I had more fruit and had to reward him for allowing me my small pleasure of a short ride. This time, I have him a small mango, but instead of placing it in his mouth, he actually took it from me with his trunk and fed himself – I guess the shape and texture of the mango was easier for him to handle.

This picture was taken at the point that I wouldn't let go and wouldn't stop petting Dooni

Dooni, showing off his skills

It was sad to leave, especially since we were only there for only 20 or 30 minutes. On the drive home, I thought about how great it would be to be an elephant keeper, but decided I’d have to hold off on that for my next career, though I could see doing some sort of Maternal and Child Health of elephants project.

Another baby elephant

Remarkable Women Deliver their own Babies

The nameless and brave woman who delivered her own children.

We travelled about an hour outside of Minas to Minas Satu, where women met us at the polindes for the interviews. So far, I’ve talked about puskesmas and pustu but polindes is basically just a village health post, where the ANC clinics and Mother’s Groups take place. Of the polindes that we visited, this one was by far the least equipped. It was a small two room building, with chicken wire for a window and just a wooden table for an exam table. I’m not sure what type of ANC is done here since there was nothing else in the building. When we arrived, there were already tons of women waiting outside. The midwives put together an impromptu health session so the mother’s felt occupied before we could get to them.

Interviewing in the polindes, which you would never expect to be any type of health center from the picture

Things went more or less the same way as the previous day, but we met an incredibly brave and remarkable woman. The primary language spoken is Bahasa Indonesia, and while most ethnic groups speak Indonesian, this women was not educated and from an ethnic minority. Because of this, another mother that we interviewed translated for her. If we hadn’t been so pressed for time, I would have loved to have talked to her more. She is 41 and has had 11 births, 10 of those children have survived. She had recently delivered her 11^th. What’s remarkable about her is that she delivered all of her children at home, by herself. When asked why, she said that she was too embarrassed to deliver in front of anyone else. She was a smart woman, despite never attending school: she had a plan, were there to be any complications with her delivery. She must have taken good care of her children in order for so many of them to survive, in otherwise dismal circumstances – she was poor with so many mouths to feed. I wanted to ask her more about her life and I would have loved to have spent some time with her, but our schedule didn’t allow for it. Even though, in terms of our research, this woman will be considered an outlier, her story is really amazing. I can’t imagine giving birth alone, let alone delivering my own placenta and cutting my own umbilical cord….11 times. Perhaps what I’m even more amazed about is the fact that she and 10 of her children are still alive. The odds of maternal mortality are greatly against her.

Globally, it's rare to see father's with their children. Children are often attached to their mothers, in some form or another. I've seen a lot of father's holding their children here, and not just for the obligatory 20 minutes during the day. I try to capture this as much as possible.

Baby wrapped up in his mother's batik

As a side note, I’m not used to “parachuting” into these sites, visiting and interviewing for a few hours and leaving. It’s a real challenge for me. I’m learning about each woman for 15 to 20 minutes and then saying goodbye. What I really want to do is sit around and chat and learn about their day to day and see where they live and meet their families. There are a ton of barriers to me doing this, least of which is that I don’t speak Bahasa Indonesian. It’s hard to realize I’m not a PCV anymore, and I’m worried that I might never again have the chance to interact with people like when I lived in Mali. Then I remember that I’ll live in Mali again, and that, at the very least, my family will sit around and chat with me until we’re both bored. I get this feeling at least once a day, when I meet a really awesome woman – or more than one! – and can’t do anything to get to know her better.

This young mother waited most of the morning to interview with us, and benefited from health classes from the midwives and village health workers

This little guy was adorable, sitting on the floor while we interviewed his mother. He has a severe handicap of his legs, and as a child it's noticeable but doesn't keep him from running around. Unfortunately, there was another little boy to his left that kept kicking him.

Young girl waiting patiently for her mother's interview to end

Site Visits Begin – Minas

Our first week of field visits begins! Originally, I wrote that I thought we’d be going to Serang, Kutai Timur and Bireun, but the plans changed. Though it hasn’t been said, since my translator is pregnant, the Jhpiego team wants to keep the field visits relatively close to the capital and without poor travel conditions. That’s not to say we haven’t found bumpy roads, but…compared to what we could find, it’s not too bad. So, the plan, or so we thought, was to go to Serang, then Karawang, Bojoengoro and finally Minas. We thought we’d leave on June 13^th for Serang, by car, but on Friday the 10^th, we were issued air tickets and told we were heading to Minas, via Pekanbaru. Talk about putting the brakes on things. I guess it didn’t really matter where we were going and in what order, but I had already written it in my planner…in pen!

We started in Minas, early, on Monday morning. We went to the main puskesmas to meet the chief midwife, Bu Yuni, and the District Health Officer (DHO), Dr. Rani. We needed Dr. Rani’s blessings to conduct our research and Bu Yuni’s knowledge and networking to help us plan our week. Bu Yuni would accompany us to most of our field visits, since she’s in charge of all of the midwives at the pustu, or assistant puskesmas, or at the village level, and also supervises the community health workers. She was very accommodating in trying to get us the exact number of women that we needed, even if it meant waiting until 4 PM to eat lunch – which it often did.

Puskesmas of Minas - smaller puskesmas' are typically one building, so I was impressed that this facility was 4 or 5 buildings.

Labor and Delivery Room - only space for one woman to deliver at a time, and if another woman needs to deliver, she delivers in the ER (see below)

Maternal waiting room - I can't think of what this is called in English, but after the women deliver, this is the room they stay in. Indonesian women typically only stay at a facility for 2-6 hours, unless there are complications.

The Emergency Room - seemingly well-equipped with the bare essentials, but it leaves a bit to be desired, from a Western stance.

Ambulance - this one is out of commission, but was previously used for emergencies

A bit about Minas: Minas is one of Jhpiego’s Chevron sites, meaning they get funding from Chevron to conduct their work. From what I understand, the majority of the work they do here are trainings for the health staff. For example, two weeks after our visit, Bu Ita, from the Jakarta office, will be visiting to do trainings on infectious disease control. Though I don’t know the extent of what Chevron is doing, in terms of their social responsibility, I do know that everywhere we drove, the beautiful landscape was broken up by nonstop oil pipelines and oil refinery stations. There was even a military-like base for the expat Chevron employees and their families. Additionally, when we drove to each of the 6 sites, we were driving on primarily paved road – and some of these sites were 30 to 40 km in the bush. Since it’s my first site visit, I don’t know how the others will compare, but I do know that Minas’ infrastructure must be a lot better off than many other districts, because of Chevron’s investment. I also learned that the research we’re doing may be helpful in writing the next proposal for Chevron’s funding in terms of supplying the health clinics, so that’s potentially good news.

One of Chevron's oil refineries, maybe 20 km from the city

After meeting with Dr. Rani and Bu Yuni, we headed out to Mandi Angin. One of the activities that Jhpiego and Chevron supports are Mother’s Groups, similar to centering groups in the US for pregnant mothers. Centering groups, I learned this past year, are similar to antenatal care checks, but instead of visiting the doctor’s office a couple of times and having 15 minutes to discuss any questions or issues, you meet with a group of women and learn from and support one another. In America I thought it sounded like a great idea, and something that would be really interesting to implement in Mali – since most women sit around and talk anyway! – but it was exciting to see it in action here. Despite not understanding Bahasa Indonesia, there were photos and workbooks that the women were all working with, and it seemed like it was working well. It’s a newly implemented activity here, so it’ll be interesting to see if/how they’re monitoring the activity and what progress the groups make. All that said, the first group of women we met were a Mother’s Group, some pregnant and some postpartum.

Mother's Group

Our research questions begin by asking some simple demographic questions to determine religion, ethnicity, education level and income level. We already assume we know certain things: women of a lower education level and lower income level are less likely to go to a facility and more likely to give birth at home. For every interview, I hoped that the women would prove this assumption wrong. In Mandi Angin, we interviewed 13 women, most of whom either planned to give birth at home or had already given birth at home. The interviews were becoming a little tedious, until we met this one woman:

My day one hero who associated facilities with increased safety

We don’t ask names during our interviews, but this women was the first of the surprises during the week. She’s in her mid-thirties and educated only though elementary school. She was one of the few postpartum women who had delivered at a facility – at the pustu – and when we asked her why she chose to deliver at the facility, as opposed to home, she responded that it was safer for her and her child. I was so pleased, I almost came to tears! After 10 interviews, I was beginning to doubt I would ever hear those words, and I was beginning to wonder if women thought or even knew it was safer to deliver at the facility.

An older postpartum mother

It was a really long first day of interviews, but it ended with sitting on a straw mat, eating rice and fish with my hands, surrounded by a group of midwives and community health workers. It felt good to be in the field.

The midwives and village health workers who were very accommodating