Headed East

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Our plane is descending, arcing its wings away from the west.  I can see the lights of Jakarta below— a flickering reflection of an elongated sky.  I feel both excited and guilty.  A month ago, Seongeun and I were headed to Bukavu, DRC--  Our plane is seriously off course.  The job was in a way everything that I had been working towards:  Francophone, in the Congo, with the IRC, directing a large multi-pronged program with health, education, community engagement, and emergency response components. But then again it wasn’t.  As the recruitment process lengthened over the Christmas break, it become clear that a job Indonesia introduced to me in passing would advance me further and faster, forcing this freckled old dog to learn new tricks.  The work in the Congo would have greater immediate impact but largely go unnoticed.  It would be intensely interesting but put a lot of stress on my and Seongeun's relationship.  My Dad had already taken me off of his will for choosing Liberia.  Did I want to kill him too?  As my sister Nancy said, “Seems like you can always go back to the DRC.  No one wants to go to the DRC.  Seems like the job with Save the Children is a chance to join the real world.” Sometimes I hate Nancy.

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From my vantage point at 25,000 feet, it’s hard to believe that Indonesia has problems. For the last three years I have landed in the dark where the few glints of light seen from above on the ground are family fires; where crowds of people engulf you at the airport when you emerge just like in the movies, where the only vehicles to be had are SUV’s which can endure diseased roads.  The rest of the population walks.   Now I see confluent cities pulsating below—you can almost hear the beat.  A picture taken at slow shutter speed would produce a fabulous laser show blinding and enlightening those in its path.  I read that in Indonesia, one of its many Four Seasons is a top-ten world hotel destination.  Jakarta has more Banks than NGO’s.  Smartphones are ubiquitous as is rapid internet.  The country possesses the 16th largest economy in the world.  

Yet somehow, amidst all this, Indonesia has among the highest neonatal death rates in Asia. The neonatal mortality rate is 15. That means 1.5 in 100 babies die before they reach one month’s of age. The neonatal mortality rate in Singapore is 2.  In Thailand it is 7.  In China it is 8.  In Vietnam it is 11.   (In the DRC, by the way, the rate is 47.  Does it make sense to play this type of number’s game?)  What is it about Indonesia?  Is it the 1 in 7,000 patient to doctor ratio? Is it the tropical climate and the killer diseases that come with?  Is it the over 18,000 islands which are ill-connected to the mainland?  Is it the consequences of 400 years of Dutch occupation or forty years of Suharto dictatorial rule? 

My job is to lead a large part of a 55 million dollar USAID funded project which proposes to reduce the number of infant deaths in Indonesia by 25% over 5 years.  I am frightened because every once in a while I think I don’t know what I am doing; that I have gotten in over my head; that my body and certainly complexion have aged without bringing along the customarily associated neuronal tissue.  I am also not convinced that USAID has its theory of change right.  The project wants to dramatically improve the quality of delivery and baby care in Indonesia’s health care facilities starting with 150 hospitals and 300 Community Health Centers called Puskesmas’, short for pusat kesahatan masyarakat.  The idea is not only do the majority of neonatal deaths happen in health care facilities (not true), but that drastically improved health care facilities will have a trickle down effect on the thousands of private practice doctors and community mid-wives who move through them (unproven).

But if I focus my attention away from the goal of an English speaking federal bureaucracy, the prospects could be great.  Indonesia is the fourth most populous country in the world with almost 250,000,000 citizens.   A substantive change in health care facility quality would lead to millions of lives saved and millions and millions more happier and healthier people.  Because of the project size and connection with Indonesia’s government, medical organizations and health care institutions, the project could influence the necessary but protracted shift from institutions set up to make doctor’s lives easier to institutions, which put the patient as customer first.  “Bole saya bantu anda?” -- May I help you?  “Apakah anda baik?” – Are you good?  This could provide a mechanism for real community outreach, which would address such things as the large number of unsupported home-births.

Before I left NYC to Jakarta, I gave a formal talk to Emergency residents at a Hospital in Harlem where I occasionally work.  The talk was on international health, what it is, its attraction and requirements.  As we talked, I slowly felt the excitement grow in the chilly classroom and watched faces light up like firebugs in the dimly projected room. Later, one resident asked two questions at once, “How can you contribute if you don’t have (as) much time (as you)?  You mean, you are going to learn Bahasa?”  If I could have communicated anything to this fun but tired group it would have been that by working hard and for something bigger in the present, they were already contributing.  The next step would only be a choice; that there were no wrong decisions so long as you believed in what you believed and when faced with opportunity or error, were willing to adjust course.