Guest blog by Alex Domingo
The second reflection in our Volunteer Appreciation Month series! Stay tuned for a new post from volunteers each week in April.
On my last day in Borneo, I awake at 6:30 as usual, I spend the first hour of my day meditating and reading while roosters crow in the dawn. Then, an invigorating morning mandi (bath). Though I can barely communicate with her and haven't said anything, Ma Unggal knows I'm leaving and made sure that my clothes were swiftly washed and pressed. Last week, I stopped by the house during work to find her humming in my room, folding clothes I had thrown hastily in my armoir after returning from a weekend at Tanjung Puting. I’m going to miss her care.
At the Clinic, we rounded on our in-patient, a woman in her late 30s with chronic weight loss and vomiting. She is gravely thin, her son and husband at her bedside. We fear cancer or TB at worst, a severe ulcer at best. She really needs to get an endoscopy at the hospital in Ketapang, two hours away. Even though she is covered by the new government health insurance, she can't afford to travel and stay in Ketapang for the procedure. In the meantime, we see if anything shows up on an abdominal ultrasound. First, Dr. Nomi scanned through the liver: normal. Dan, the new Emergency Medicine resident from the University of Rochester scans the stomach. Strangely, it was full of some semi-solid material, stretched all the way across to her right side, and with little peristalsis or gas. The pylorus appeared to be narrow with little flow through. We talk through ways that we could possibly remove some of it to ease her symptoms, ultimately deciding (by Dan’s creativity) that in lieu of an orogastric tube that Coca Cola would be our best bet for dissolving the material and getting her some calories. He ran to buy some next door as a gift before the family left. I wished I was here longer with Dan and Jessie (Internal Medicine resident from Stanford) to learn more from them. We all wished the patient could save enough money to go to Ketapang for more definitive treatment before it was too late.
Our next patient, a young mechanic, came from a village outside of Ketapang after getting a shard of steel in his eye; he’s the second patient with this issue in a week. Dr. Nomi donned jeweler’s glasses and removed the piece with a small needle, followed by applause from her audience. We then saw a woman seeking advice on contraception, a typical primary care visit for once. Then, the ASRI ambulance pulled up with a man who had gone to the government clinic for a lump under his chin and ended up with seven teeth pulled, now with continued pain, swelling, and drainage. He recently had several lumps on his neck that were incised by a surgeon in Ketapang. Dental x-rays he brought in confirmed our suspicion that the problem had nothing to do with his teeth and was more likely an infection of his lymph nodes (Similarly, someone came in last week with Bell's Palsy and had his wisdom teeth removed as the treatment). Removal of the bandages on his neck revealed oozing at 4 or 5 small incisions in his neck and over his sternum. Jessie thought it might be scrofula, TB of the neck. We anxiously waited for the lab techs to mount and stain some of the fluid on a slide to see what organisms were present. We all looked at the slides, nothing but pus. Perhaps the antibiotics he had started 3 days ago were starting to work. Later in the afternoon Dan and Jessie gave a great impromptu lecture on myocardial infarction (heart attack) management to the group of visiting health profession students, some of which ASRI is hoping to recruit as future staff members. I was grateful for an action-packed last day at the Clinic.
I head to our after-work meet-up spot at Pak Amat's cafe next door where friends were already waiting and wondering what I wanted to do for my last evening: sunset and kelapas (coconuts) at the beach of course, followed by karaoke--a traditional volunteer send-off. On the bike ride to the beach, I took a last look out to the sunrays shining on the mountains of Gunung Palung National Park, my companions from ASRI riding close by. I never have words on this stretch except to exclaim the perfection of the scenery, simplicity, and community of Sukadana, my riding companion kindly agreeing and humoring me. Voices of children yelling "hello mister!" emerge from the roadside houses. As we near the beach, teenagers eye us, some also yelling hellos, as they ride around. Motorcycle rides are their chance to embrace in public.
Sunset papaya juice, sweet and smooth with susu (condensed milk) and ice. I again marvel at the rawness of the forest-crested brown beach while the sun turns the trees into silhouettes and the first stars poke out. Jokes cut through heavy feelings left by those recently-departed volunteers with whom we shared songs (Forever Young, Toxic, Leaving on a Jet Plane) and laughter. The reality of my dwindling hours in Sukadana now setting in.
On my way home from the beach, I can’t help but feel the island is giving me a gift for my last evening as a blanket of bright stars emerged despite the rainy season. Last Ma Unggal dinner: boiled vegetables, chile-marinated boiled eggs, tempeh, and white rice. As a small gift for her care, David and I bought Ma Unggal a turquoise hijab for her en route to karaoke. Our main event opened with a heartfelt rendering of I Will Always Love You, the words resonant with my feelings toward those I would leave after tomorrow’s morning meeting. The heart-sob-sweat-bath carried on until late.
Back at the beach, David (fellow volunteer), Tiar (engineer), and I earned a Boy Scout badge for building a blazing fire with wet wood. Clouds now hiding the moon and stars, and the tide fully in, made for the brightest night of bioluminescence yet. Blue-green light flashing around our bodies in the waist-high waters, sparkles shimmering as water moved across. Bright lightening in the distance and thunder. An elderly man emerges from a nearby house bringing uneasy laughter. He puts some wet logs over the fire, leaves. It's 2 am, our swimsuits almost dry. We three fall asleep on sheets around the fire. We’re awakened by the sounds of the call to prayer, gibbons in the distance, and crowing roosters.
Last morning, surmounting insecurities, I wrote a postcard to my girlfriend’s father so he could collect a stamp from Borneo, then finished my farewell speech. I had it translated by the new Indonesian doctor over breakfast as he wooed David and I with small hints of brilliance. At the morning meeting, I fumbled through my going away speech to an expectant crowd. My 6 weeks ended with tearful goodbyes, me too choked up to talk, too tired to hold it together.
Smooth waters on the boat to Pontianak made for a relaxing nap. Of the many topics, John (ASRI visitor) and I reflect on how much easier it can be to relax when traveling and away from city life and how we want to live in the woods. We are shocked by the luxury of Santika hotel and excess of having a jacuzzi and an ice bath. For dinner, we find a vegetarian Chinese restaurant with Indonesian staples so Jonty (fellow volunteer) and I could try bakso (meatball soup), but the herbal seaweed ginger soup with mock chicken is the winner. Bubble teas (mine gritty with fresh carrot) and banana fritters for dessert. A feast for under $3 each. Back at Santika, we capped the last month together with four 32 oz Bintang. Welcome back to American prices and the goodbye to the innocence and simplicity of laughter without the influence.
Even in Pontianak there's some air of celebrity and extra friendliness, but now in the airport eyes flicker away, people cut lines, all but step on your toes. Blazers, jewelry, polished leather shoes, eyes glued to newspapers or screens--none of the things associated with the bliss of rural life where the simple pleasures (bucket mandis, rooms decorated only by the drape of mosquito nets over the bed) remind you that happiness needs nothing but the breath, simple food and shelter, good friends, nature, and purposeful work.
About Alex Domingo
Alex is a Yale medical student, pursuing a residency in Internal Medicine. He volunteered at ASRI from Jan-March 2016.
To read previous Volunteer Voice reflections, click here.