Field Testing Begins

After a four day weekend of relaxing and lots of parties (two kids' birthday parties, and a party for the women's national swim team) work started again on Monday. We finished our draft survey last week and Isti contacted midwives at a local puskesmas (government-run clinic or CSCOM, depending who is reading this) and her private clinic and coordinated our visits on Monday and Tuesday, respectively.

Now, first a note on the size of Jakarta and my daily patience testing with traffic. Not only is Jakarta is this ridiculously crowded city, it's also gigantic. I recently read that Jakarta - including suburbs - is 229 sq miles or 661 km²! That didn't really mean a lot to me, until I started comparing it to other places that I'm familiar with:

• Washington, D.C. - 68.3 sq miles or 177 km²
• Bamako - 97.3 sq miles or 252 km²
• Chapel Hill - 19.82 sq miles or 51.3 km²

I mention all of this to say that the distance, in conjunction with the throngs of traffic, makes it miserable to drive in Jakarta, unless it's 1 AM. I left our office at 7:20 and arrived at my destination in Cibubur (pronounced chi-boo-bur), only 12 kms (7.5 miles) away, at 8:20. It took us another 30 minutes or so to navigate through some construction and arrive maybe 5 km away. Ridiculous. We finally arrived at the puskesmas and I was really shocked - it was palatial, compared with the clinics in Mali I'm used to. Granted its in Jakarta and has the potential to serve a very large population, but it was so nice.

Puskesmas in Cibubur

We entered to find at least one hundred people waiting for various services and moved our way though the crowd to the maternity clinic. The floor of the entrance was covered with sandals, typically taken off before entering someone's home or in this case medical facility, and after taking off my own sandals I saw a large group of pregnant women, doctors, midwives and medical and midwifery students. Isti's mother, a very well known midwife, teaches at the school where all of the midwives at this puskesmas attended, so Isti was very well received. We visited the head Doctor to get approval for our visit and explain our questionnaire's intention, and he was very open and the meeting went very smoothly. He actually invited us to come back once we finish all of our research and present to him our findings (a real breath of fresh air after dealing with Docs in Mali who are seemingly just interested in slipping some money under the table to get to do these interviews).

Pregnant women waiting for their antenatal care (ANC) visit with the midwife and doctor.

Midwifery students completing the paperwork for patient's vital signs and weight. The midwives rotate, so sometimes they work on the registration information and other times they work in the exam room with the women.

After our approval, we went back down to the maternity suite and greeted everyone again and got settled in a small corner of the office to start our questionnaire. Since these were field tests, we simply needed to test the questionnaire out on a small sample of women to determine if they understood the questions, if the questions made sense and if they were in a sensible order. Isti and I started the survey on our first patient (photo below) and determined that it took about 20 minutes to administer. Unfortunately, the ANC visits went so quickly that we soon had a line of people waiting so we decided to administer the survey to two women at once. This turned out to be a mistake, we soon found out, since some of the women were maybe too lazy to listen to the questions we were asking and instead were saying, "Yeah, I agree with her." So, lesson one learned: interview women separately.

Our first interviewee: a young woman, pregnant with her first child.

Our young pregnant mother with her medical student, listening to the fetal heartbeat. This is actually the first time I've heard a fetal heartbeat.

We wound up interviewing 10 women before I decided we had done enough. We originally planned to interview 20, but there were some errors in our questions and I thought it to be a waste of time to interview. If the questions aren't perfect, we can't use the data we collect so it was time to stop. We worked the rest of the day on improving the survey since we had interviews to do on Tuesday as well.

Immunization Chart, in Bahasa.

After we made the changes we thought were necessary, we took to the streets on Tuesday to continue. This time, we used Isti's family's private clinic as a base, and one of the midwifes at her clinic walked us through the surrounding neighborhood. The interviews here were again just tests, this time with the slightly changed questions. Of course, one of our questions asks the respondent to rate the quality of service she received with the midwife who delivered her baby, and having that midwife sitting next to her, smiling, didn't necessarily give way to the most honest responses. So, lesson number 2: have midwives help us find pregnant and postpartum women, but don't allow them to sit in on the interview.

Postpartum woman who delivered at a private clinic

We did about 5 more interviews on Tuesday and then went on a wild goose chase for my cell phone that ultimately wound up lost. Amazing how these things disappear in a matter of seconds. By the end of our two days, we thought that our survey was pretty good and ready to be put to the test out in the districts. Little did we know what would happen next....