Monday, August 29, 2011

Welcome to my Jungle Clinic. You are here to stay................

Bintang rules at Rantung
It's  eight PM, Rantung Beach Bar, Sumbawa Indonesia and I'm at the bar finishing off a plate of Mie Goreng (Indonesian for noodles, chicken, veggies and extra-grease) that is big enough to feed a small local village.  Rantung Bar is at a small resort about 10 minutes from the Mining Campsite down an unlit winding, unmarked road with potholes big enough to house the small local village I already mentioned.  It  is an open-aired beach bar done up in local chocolate colored wood, a thatched roof, rectangular bar, bamboo tables, Christmas lights surrounding the bar and arguably the best view of the sunset I've ever seen in Indonesia.  As it is one of only 3 possible places to go for food and drink from the mining site where I live,   I usually know everyone there and everyone knows me.  The bartenders are 3 local girls who will, through astute intuition or psychic powers, have your drink waiting for you at the bar by the time you drive through the front gate.

Both of my phones are up on the bar, the second one (the Bat Phone) brought along because Rantung Beach  is in a dead-spot for mobile phone coverage and I'm still on-call.  I've gotten brown Mie Goreng grease on both phones. The bat phone rings.  My 5 year old son was  playing with the phone and  changed my ringtone to   "loud farts and burps."  He started giggling like a mental patient.

The call is from our clinic about 3 jungle miles up the road.  The nurse on the night shift says that there's a pregnant woman in the clinic who's having some problems.

When I hear the word "pregnant"   an internal groan goes off inside my head and I make sure to hang up the phone before I quietly say.................."shit."  While I recognize and honor the magic and the beauty of pregnancy, it is no accident that I've never tried to be an Obstetrician.  Even as a medical resident, when offered the opportunity to bring a new baby into this world;  to take part in the most intimate and magical part of life and creation;  to reach into a person and bring out the bundle of joy that will change the course of its parent's lives forever , my response was always, "uh, why don't you let the medical student do it this time.  He still thinks its exciting."  Delivering babies is loud, sloppy, full of moments of tension and stress and always has a lot of gooey and bloody bursts of liquid associated with it.  No thanks.  Just not my thing.  God bless my fraternity brother Dr. Freddy Rau  who, in college, had such fascination and obsession with the female anatomy that he channeled it into a vocation and is now one of the finest Obstetricians and Gynecologists in the great state of Connecticut.  He said that he knew from the first day in medical school that it is what he wanted to be.  I knew from the first day that I did not.
Da Doc & Da Dog on Da Beach

There will be no turfing tonight's emergency case to anyone more or less capable.  It's mine.    Earlier I had written that I was still on-call while at the Rantung Bar. This is not completely accurate. What I should have written was:  at the mining camp medical facility I'm always on call.  24-7, nights, holidays, weekends, parties, Superbowl, Rugby 8's, Ramadan and Christmas.  I will be on-call for three months before I get a break and get off this rock, the island of Sumbawa.  I'd like to make this sound more heroic and desperate, but in reality its not so bad.  Generally there's not a lot of medical and emergency activity at night except around full moons and huge blow-out parties celebrating the completion of big mining projects (mining people can  party!).  It's kind of a welcome challenge really and since I live 4 minutes door to door from the clinic I usually get some sleep unless a really severe case comes into the Emergency Room.

"There's a pregnant woman in the clinic who's having some problems."  It's still in my head.  I throw a few hundred thousand Rupiah on the bar, gather my wife and son and head up the dark twisted road to the hospital.  There's no time to drop them off at the house so they come  with me to the clinic.  When we get there I ask the clinic driver to take them back home, but my son wants to stay and watch.  He's generally fascinated with all the action, devices and equipment in the hospital, but mostly he wants to play Plants vs. Zombies on the nurses computer.  Not tonight

Enter:  worst case scenario (almost).  I walk in through the emergency room door and see a woman laying on the stretcher in bay #1 looking anxious and uncomfortable, but still with a stoic smile I've come to recognize in some  Indonesian women, not wanting to appear to be any trouble even when they are having an emergency. My hands still smell like greasy Mie Goreng so I divert quickly to the ER sink and wash up.  I know this woman.  She is one of the secretaries at my son's international school.  It's always worse when you know the person on the emergency room table.  It's not like you would treat them any differently, but it gets a little more personal no matter how detached you try to be.

She's lying on her side and tries to give me a smile when I reach the gurney.  I ask her some questions and the answers come in a mix of English and Bahasa Indonesia.  The nurses translate for me.  She tells me that she is pregnant for the first time.  She's been trying to become pregnant after nine years of many, many fertility treatments and finally it happened almost eight months ago.  She says that she thinks her water broke tonight.

Not good.

As I said before, I'm no Obstetrician, but I do know my way around a uterus and ovaries.  Babies need as close to 9 months as possible inside their mother  to be mature enough to survive in the cold cruel world we call our own. A couple of weeks early or late and its generally not much of a problem, but six weeks early is a big issue. The  babies that come out this early need a lot of care and a lot of expertise.  Here's what would normally happen in your local hospital:    The emergency room doctor would call the Obstetrician, who would call the high-risk Obstetrician and the high-risk neonatologist (pediatrician for the really, really sick little guys).  The frightened expectant mother would be rushed along to the high-risk Obstetrics ward quickly and efficiently where the high-risk Obstetrical nurses would go to work, preparing for the best and the worst possible needs and outcomes.  At the same time the high-risk insurance registrar would also getting into the game because high-risk care is not without high-risk pricing.  Emergency Room doctor finishes up his charting and heads back to bed for a precious little snooze while there's a lull in the action.  His job is done.

Back to our situation:  we are in a place called the "Jungle Clinic."  It is called the "Jungle Clinic" (you guessed it) because we are in the middle of a jungle on a fairly remote island.  Now, for a remote clinic in a distant land this clinic is pretty sweet.  We have an x-ray machine, a basic functional laboratory, an ultrasound machine  and enough medicines to last us through your basic biologic disaster or extended civil unrest, whichever comes first.  Our staff is mostly young, but quick, motivated and willing to learn.  Most of them speak enough English to counter my deficiencies in Bahasa Indonesia, which is a current work in progress.  

Here's what we don't have:   we have no dedicated obstetrical facilities, no Obstetrician, no high-risk experts, no pediatrician and the closest  specialty  hospital is in Bali, an hour's flight away on a sea-plane or the company helicopter (we have no airport).  And as much as I would like to get her to that hospital in Bali as soon as safely possible that's not going to happen tonight.  No flights happen between sun-down and sun-up and it's too dangerous to try.  She's here for the next eleven hours no matter what.  And its a full moon.

But we do have me and I'm a practical man.  In theory I know  what to do.  This is not Chinese algebra.  I've read the book and the book says that the baby wants to come out, but we don't want the baby to come out yet.  We must keep the baby in.  There's medicines that can do this, well-tested and tried medicines.  We have them here at the Jungle Clinic and we know how use them.  Then I ask myself, "What would Dr. Freddy Rau do?  What would Dr. Freddy Rau do?"  Its becoming my mantra.  Fortunately time-zone differences are on our side here.   It is the Indonesian night which means that a mere twelve time zones behind us, in the great state of Connecticut, Dr. Freddy Rau is probably awake, alert and just starting his gynecological day job.  I will try to call Dr. Freddy Rau.

I call his mobile phone and a woman answers the phone.  She has a detectable New York accent and I'm suddenly, but momentarily nostalgic.

"Is Dr. Freddy Rau available?  This is Dr. Erik Travels calling from Indonesia.  Can I  speak with Dr. Freddy Rau while we still have a reasonable phone connection?"  (One hint I can give my readers  is to mention that you are in an exotic, distant place if you want to get someone on the phone as soon as possible.  It suggests an air of mystery and gives the person answering the phone  the sense that the bamboo and wires that  you've McGiver'd together to even make the call are in danger of failing at any moment.  In reality, we have mobile phones here.  Lots of them.  Don't tell anyone.)   Fortunately, at that moment Dr. Freddy was scrubbing and sterilizing his hands for a surgery.  His nurse held the phone up to his face.  I pictured a pristine and freshly sanitized Connecticut operating room with finely contoured  white ceramic sinks and glistening American Standard chromed faucets from which sparkling blue water flowed with adequate high pressure.  We have none of those things.

In short, I described the situation and what my plans were and Dr. Freddy Rau provided confirmation of my plans and threw in a few Obstetrical pearls of his own. Dr. Freddy rules!

 I felt empowered. I did an ultrasound, checked the baby's heartbeat and my crew of young doctors and nurses went to work on this scared woman in what I now call Operation:  No Contractions. Intravenous lines went in, bags of medicines went up and monitors were in place. This baby was not going to come out until it was safely in Bali. Not on our watch. We just had to hold out for the night.  Just until sunrise.  The seaplane could be wheels / pontoons up at 0700.

It was nearly midnight when she was finally stabilized. We made calls   to  arrange the aircraft and to the doctors who would receive our patient in Denpasar, Bali the next day.  I went outside into the calm and balmy Sumbawa night.  The town was completely silent.  Mining towns shut down early and wake up even earlier.  I got into my car and headed  up the hill  to check on my family.    My steering wheel was greasy and smelled like Mie Goreng.  I took a deep breath that felt like the first one I'd taken all night.

We're in the jungle and we're ready for you!


  1. How'd it go, Doctor? Baby safely delivered? Great post!

  2. Great stuff, Erik. You really transport us to Sumbawa where we can (almost) live the experience with you...our prayers to the woman and her baby...and taste/feel that Mie Goreng.

  3. Wow Erik, amazing story, keep them coming.

  4. You're a dead set legend doc. However, to serious business - how's the diving?

  5. Hi Erik

    Any pictures of your accomodation you can post on your blog? Are you guys set up in houses there or 40 foot containers?