Bumi Sehat Clinic sees both grief and relief

Catherine Wheeler, Contributor, Ubud

This account by Robin Lim was prepared by Catherine Wheeler, Robin is the the midwife who founded the Bumi Sehat health clinic in Ubud, Bali. Lim and a team of volunteers went to Aceh as part of a relief project. The team has established a walk-in clinic in Cot Seulamot near Meulaboh on the west coast of Aceh.

The Indian Ocean off the West Coast of Sama Tiga Aceh is the exact temperature of tears.

The Bumi Sehat free walk in clinic in Cot Seulamat, Sama Tiga, Aceh, serves an average of 70 patients per day. It rains endlessly. There are earthquakes. And there are tears -- lots of them.

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 personnel and the most marginalized peoples feel comfortable coming for help.

Some of them are very sick or have infected injuries. There is an increasing number of malaria victims. Most of the people we saw were malnourished, and 100 percent were traumatized.

Informal counseling was part of our work. There are many faces of anguish. A mother wears sleepless guilt lines because she lacked the physical strength to prevent her baby being torn from her arms by the violent tsunami. A man comes to cry for his daughter. His wife is also missing, and he has no photos of them.

His skin is covered with festering wounds, now two months old, from the debris-choked waters he swam in on December 26th. Most of the schools we saw were either destroyed or filled with mud and debris. A school teacher in his early forties came to the clinic to ask for help sleeping.

"I had 116 students before the tsunami, only nine survive," Pak Abdul said before he broke down. He cried for a long time, then softly began to say the names of his beautiful students. We gave him homeopathy remedies to take before bedtime, and we listened. Two days later he returned, looking much better. "Thank you," he said, "for hearing their names. I am now sleeping a little."

Kelly and I taught a day-long workshop for midwives in Meulaboh. We were amazed when 41 midwives attended. Most of these women had lost families and homes. One midwife walked for three days to attend. She had lost her husband, child and home, and was 30 weeks pregnant. 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 had lost their equipment and birth kits. We invited Scott Whoolery, the medical director of UNICEF Indonesia, to attend our meeting. He was thrilled to meet so many of the women who are delivering primary healthcare to the citizens of Aceh, and arranged that each midwife would receive a UNICEF midwife kit.

Sadly, we found a high rate of infant demise due to tetanus in Aceh. Vaccination will not solve the problem; the tetanus toxoid vaccine requires refrigeration, which is rare in rural Aceh.

The traditional birth attendants of Aceh lack dependable water resources and the means to keep instruments sterile. Many midwives' cord-cutting instruments were swept away by the tsunami. We taught these birth attendants how to safely burn the umbilical cord.

This method eliminates the danger of tetanus or other bacterial transmission from non-sterile instruments. The midwives were delighted. They came away from the workshop feeling like they had learned a desperately-needed skill.

We were also able to encourage them to get free medicines from Ober Berkat Foundation, as well as seeking help from Medecines Sans Frontiers and Global Relief.

We shared a camp in Cot Seulamat with the WALHI/IDEP clean water and sanitation crew. [WALHI is a non-governmental organization that campaigns mainly on environmental matters, while IDEP is a Bali-based, social welfare charitable foundation.]

About 70 patients a day appeared at our free, walk-in clinic made of bamboo draped with tarpaulins for rain protection.

We found that nearly every mother had lost children within two to three days after birth, long before the tsunami washed over their lives. Chronic malnutrition adds to the maternal and infant mortality rate.

Early one morning, we were rushed to the home of a mother who had just given birth. The traditional midwife had already cut the baby's umbilical cord with old, blunt school scissors and pulled the cord off the placenta. The baby appeared fine but the mother was hemorrhaging and her placenta was retained.

I gloved up quickly, and manually peeled the placenta off the wall of the uterus centimeter by centimeter. Roswita and her baby survived but I learned that just 8 months earlier her sister-in- law had not been as lucky. She'd also retained her placenta, and died on the way to Meulaboh hospital, 45 minutes to an hour away by swamp road.

This near fatal complication turned out to be one of the many blessings along our way in Aceh. The midwife'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 the traditional midwife is now sold on this much safer protocol. No doubt this alone will save countless neonatal lives.

While we operated the clinic, our support team worked with the WALHI Bali crew to help the surviving villagers of Pucuk Leung and Lhok Bubon to resettle. We gave them generators and strung out electric street lamps.

Though the homes were completely destroyed, Oded and Christine networked with Mercy Corps to obtain tents and kerosene cooking stoves for the families. Oded 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. Mentor donated malaria rapid test kits and medication for both children and adults with P. falciparum malaria.

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, parents, friends and homes had disappeared. The only building left standing was the mosque, with 70 people marooned on top. Catholic Relief services paid for a new roof for the osque of Lhok Bubon.

We left Meulaboh on the International Red Cross Red Crescent plane, flying low and slow all along the West Coast of Sumatra. From high above, it looks hopeless. Busy cities have been leveled. Huge barges rest five kilometers inland. The beaches are strewn with broken toys and broken dreams.

But the wounds of December 26 are scarring over. I felt no ghosts in the night at Aceh. There is a peace, a sweetness between people, and a prayer for healing.