What's the bleeding time?

When I first started attending meetings in Indonesia and found myself standing at the front with a microphone introducing myself, I thought the obsession with ‘status’ was an Indonesian wide phenomenon.  By ‘status’ I mean, Single or Married?, Children?,  How many?, No!, Why not?, Are you trying?.  But yesterday I discovered that this may simply be a local,  NTT point of interest.

There was a meeting yesterday about nutrition with representatives from NGOs and various government departments when a new cohort of doctors arrived and took their places in the front row.  Give them a few months and they will be in the back row sending text messages with the rest of the rabble, but for now they are following orders.  They were notable for their youth, I am always astounded at how young newly qualified doctors look these days - probably due my own increasing age more than anything else - and their slightly frightened demeanour.  They will be posted at various health centres throughout Sikka for around 6-12 months and this was their initial orientation period.  The entire group of 7 hailed from Java and seemed to all have been born in Jakarta or Medan.  This was their first time so far east in Indonesia and they were pretty shocked with the new change in their living standards. In fact I got the impression they were shocked to find that this backwater was still in Indonesia.    They were keen to hear whether I had contracted malaria and shrunk lower in their seats when I pointed out triumphantly that not only had I survived Malaria but also Dengue fever.   They seemed to take little comfort from my reassurances that it hadn’t done me any harm.  On hearing that I had been in Maumere for nearly two years, one doctor exclaimed, ‘but how come your skin isn’t completely black?’  The fear of these paler-skinned, Javanese doctors was palpable. Skin colour is a big issue in Indonesia with natural skin tone getting darker the further east you travel. People with lighter skin take great pride in that fact alone and whitening creams are very commonly advertised, lighter is better.   

I am sure that some of them will settle in and hopefully more than a few will grow to love the place and people as we do.  My hope is that either way they learn a little about the disparity of wealth and opportunity that exists in their vast country.  They, by virtue of luck, were born into relatively wealthy Javanese families who paid for them to get the schooling required to attend medical school and qualify as a doctor. I am sure they worked hard and their families’ sacrificed to pay the fees, but there is still an element of luck to have had the opportunity in the first place.  In Flores, on the other hand, the quality of schooling is incredibly poor and it is extremely hard for a bright child to be identified, tutored and encouraged in further learning.  Most families struggle to pay the basic school fees causing a  lot of children to not finish the most basic level of  school, let alone daring to dream of higher education.

The government does have a scheme that financially aids a small number of students from NTT to attend medical school,  but by the nature of medical school training this process will take a long time to have any sort of significant impact on the doctor numbers throughout the region.  So we are left with the current system of newly qualified doctors being posted to regions they don’t know and in some cases really do not wish to be in.  Because of this and the short-term nature of the placements, it can make it very hard to involve the doctor in creating positive health changes for the local community.  There is a tendency for the unhappy ones to count off the days, escape to Bali as often as possible, consequently leaving little time to invest their talent in a sustainable way.  This can leave the local community feeling abandoned and let down by their local health centre as the doctor is rarely there.

I am certainly not saying that this applies to all doctors working here. There is a core group of committed doctors working in the community and the local hospital who are from all over Indonesia.  But it is a small group and they lack the sufficient support and funds with which to tackle the diseases and the root causes of disease that are endemic here. 

Getting back to the meeting.   They were all asked to introduce themselves to the audience and one by one they took the microphone and each neglected to inform us of their status. After much heckling they caught on to what the crowd wanted and informed us of husbands, wives, children and how many.  As the female doctors revealed they were single,  the head of the health department called to the guys in the audience to make a note of their name, pointing out with a chuckle that this girl may be potential girlfriend material.  As I was one of the hecklers, it occurred to me that perhaps I have been here too long. Political correctness seems a distant memory, but I guess new doctors do not tend to get introduced to their colleagues in this raucous manner back in the UK?