Indonesia Elective 2012 Rebecca Sauerwein , MS3 OHSU School of Medicine

1. Indonesia Elective 2012Rebecca Sauerwein, MS3 OHSU School of Medicine

2. Location: Serukam, Indonesiain the province of Kalimantan Barat (West Borneo)

3. Bethesda Mission Hospital • Established by mission organization World Venture in the 1960s to serve the Dyak tribal people (former headhunters) of Borneo – spearheaded by missionaries Dr. Wendell and Mrs. Geary (who happened to be visiting while I was there!).

4. Bethesda Hospital Mission Statement • “..Bethesda Mission Hospital at Serukam purposes to be an instrument for the spreading of the Gospel of Salvation in Jesus Christ to as many people as can possibly be reached through the avenue of health care which is competently and compassionately made available to any and all who come, especially reaching out to those who are isolated and forgotten, poverty stricken, lacking in formal education and who reside far from adequate sources of health care."

5. Mrs. Geary, Dr. Geary, and me

6. The hospital’s mission is carried on today by Dr. Geary’s son, World Venture missionary Paul (internal medicine and member of administration), and wife Becky Geary (outside right and left)

7. Bethesda Mission Hospital Specs • Approximately 100 inpatient beds • Outpatient clinic • Surgery, radiology, OBGYN, pediatrics, opthalmology, dentistry • Nursing school • Rural health outreach to around 70 villages, formerly reached via MAF (airstrip on site), but Indonesian regulations have made this difficult in recent years

8. Funding • 70% of Bethesda’s patients cannot afford the full price of healthcare. Their care is funded by profit from more wealthy customers and from the “Dorcas Fund” which is a pool of money supplied by donors from the US (largely through World Venture) as well as Indonesian donors. The sustainability of this system is never guaranteed from year to year, but has continued since the hospital’s opening roughly 40 years ago.

9. Airstrip (old photo) and nursing students performing weekly flag ceremony

10. Lay of the land – Serukam is barely a town, and is surrounded by dense jungle….

11. …And rice fields. It was not uncommon for patients to come by ambulance from 3 hours away or more since Bethesda is the best equipped hospital within that time radius.

12. Foreign Missionary Presence • Bethesda formerly hosted enough expat missionary doctors and families to warrant an MK school on campus (my FM preceptor from this year, Dr. Dan Crawford and family was one of these). Indonesian regulations beginning in the late 80s/early 90s severely restricted the abilities of expats to professionally practice medicine in the country. Bethesda now has only 1 permanent foreign doctor (Paul) and two foreign nurses from New Zealand and Australia (sponsored by New Tribes Missions). Bethesda, for this same reason, has an Indonesian administrator to whom Dr. Paul Geary is an advisor.

13. An opthalmologist and his family from the US, the Andersons, are also there for four years. Dr. Anderson specializes in cataract surgery and participates in rural outreach cataract surgery. He has his own organization called Global Eye Mission which sponsors similar outreach clinics around the world. I spent one day shadowing him. His wife Carol teaches at the local school.

14. Native Missionary Presence • The hospital is now run almost entirely by Indonesian staff. Indonesian doctors must make a statement of faith and be committed to their Christian walk and to missions to be accepted to work there. The specialists (OBGYN, surgery etc) have clearly sacrificed “the good life” in larger cities to follow God’s call to this underserved area.

15. The GP’s (general practitioners) are often straight out of medical school (no residency required) and were my favorite bunch. Energetic, encouraging, inspiring Christian young people! They were also very involved in the local community and invited me to all kinds of events. Here’s a picture of us eating durian on my last day.

16. I was at the hospital for a total of four weeks and shadowed the Indonesian OBGYN, Dr. Kristiyan Wong, the majority of the time. Days would start with morning report ….

17. Followed by scheduled OR time…usually CS, hysterectomy, or ex-lap with staging for ovarian cancer

18. More OR photos

19. Delivery room: midwives performed most of the deliveries, so I only joined Dr. Kristiyan when there was a complication.

20. OR was followed by scheduled clinic patients.

21. My level of involvement with patient care was limited by my current level of training and my inability to speak the local language. However, I had just finished my OBGYN rotation and so Dr. Wong quizzed me on everything that was going on. I also first-assisted in the majority of his surgeries. I took a few language courses while there and was able to ask patients basic questions like, “where does it hurt?” Pictured below – for listening to fetal heart tones.

22. There were also the emergency cases: One of the most memorable patients was a lady with retained placenta from an outlying village who arrived clinically anemic from uterine blood loss. The hospital has no blood bank and relatives are relied upon as donors. None available at the time, I was able to donate (grateful for my O positive), and she was taken to the OR for a D&C after fluid resuscitation. She was in such bad shape that she was in the ICU for about 3 days afterwards because of anemia and sepsis. The lady was a Muslim, and I think because of the dynamic of my blood donation, Dr. Wong and general surgeon Dr. Leo took a special interest in her. I didn’t know this happened until after the fact, but the two of them were up at 5am praying at her bedside for her salvation! They shared the gospel with her multiple times on rounds and I also prayed for her on rounds. Much of this took place in the local language, of course, so I had to fill in the pieces. I was so amazed and inspired by the doctors’ dedication to evangelism in their career! I thought, not for the first time on that trip, “This is the real deal! This is a mission hospital! This is real!” I don’t know if the lady accepted Christ or not, but for sure she heard the message and experienced the compassionate hearts of the Christian doctors. Really cool.

23. In the OR with Dr. Thressia. One of my first days in the hospital I mentioned to her about the new WHO recommendations for neonatal resuscitation. She really took it to heart, there was much discussion, and by the end of my four weeks one of the GPs gave a presentation and the protocol at Bethesda was changed. Maybe they will have lower rates of neonatal pneumonia! Very open, dedicated group of doctors.

24. I participated in one rural outreach trip with two evangelists and two nurses. 3 hours drive, 2 by boat, 1 by walking. The guys who did these trips regularly were really amazing.

25. Scenery along the way

26. This village is visited a few times per year by hospital staff for outreach clinic. Because it was Christmas time, the primary purpose of the visit was evangelism.

27. We stayed with a nurse who had graduated from Bethesda nursing school. I taught a brief English class and helped with the church services. Singing (left), and giving my testimony (right)

28. At one point on this weekend trip, I took a short hike by myself on a trail out into the jungle. As I was crossing this bridge, the realization of how far I was from home hit me. I thought – “If I fell and lacerated my leg right now, would I live to see home again?” Then I thought about how people lived their whole lives in such a remote place without emergency medical care. It was sobering.

29. Back at Bethesda, other weekend activities included birthday parties and dinner parties. People were always inviting me over for dinner, and I also attended ladies bible study once a week. The Christian community here was totally awesome. Like nothing I have had before. I guess it’s such a small place filled by passionate, driven people that it just lit up! I felt so welcomed and loved – the amazing Christian community was definitely the highlight of my trip – hands down.

30. Last day I spoke in chapel and Dr. Wong presented me with some gifts from Bethesda during morning report. It was an unexpected, happy moment of closure for my time there – check out that awesome map (we are here)!

31. In Conclusion Thank you so much for sponsoring my trip! I feel grateful to have had such an adventure during medical school, and I strongly believe God made it very smooth sailing for me to arrive there for a reason. It was very encouraging for me to be surrounded by Christian missionary doctors who are dedicated to their calling. When I am making very important decisions about my career these next couple of years, I will keep those individuals very strongly in mind. I also got to see another part of the world I previously knew nothing about which was unveiled before me during the trip. Am I convinced I must work in Indonesia as a missionary doctor after residency? No. But I am convinced that missions is still very real and medical missions in particular is a unique and salient avenue for sharing the love of Christ. The old medical mission model of a hospital run by foreigners may be on its way out, but it was encouraging to see the new model – of a hospital run by Christian nationals– fully functioning. This trip was a great blessing in my life. TerimaKasih! (thank you)