Bali Trip

Made it Home

2008-01-13T13:18:00.000-08:00

I'm home now, and rehabilitating. Jonah met me at the airport with a roasted chicken and mashed potatoes. All my friends have been feeding me and taking good care of me. I have a lot to be thankful for and am really happy to be here.

I don't regret the trip (just wouldn't want to re-live the typoid part!), and the experiences I had before getting sick were incredible. How often do you get to have a continuous stream of pregnant patients like that? Being part of the birthing process, learning from the midwives, seeing direct results from a few simple acupuncture points. There were many cases in the acupuncture clinic and in the villages we would never see in our own country. Sometimes it felt like our work was really helpful, and other times the problems seemed beyond our scope. There were definitely some cases where all I could offer was compassion and a referral to a facility they may or may not be able to afford. It makes typhoid look like a walk in the park.

So that's my story. Thanks to everyone who had my back, even from far away.

Love,

Karen

Heading home

2008-01-06T21:46:00.000-08:00

Hi again,

I am feeling much better now, still on antibiotics but fully functional and ready to travel. My flight for Malaysia leaves tomorrow and I stay one night there, then home Wednesday. Tonight Sara, Mark and I are at a nice hotel near the airport. They leave a day after I do.

I am happy to be feeling well, and happy to be heading home. Ahhh, home.

Love,

Karen

Typhoid

2008-01-04T20:09:00.000-08:00

Turns out it was typhoid, actually, and after 6 days of not holding down food, 5 days of no sleep and unrelenting pain in my head and eyes, and 3 days of continuous vomiting I am back to the land of the living, for real this time. At Sara's insistence and instigation, and with help from Bobby (the local acupuncturist) someone came to my room to draw blood for the test. When the fax w/ results came Mark went online and found staff to interpret (no small feat). He told Frank, who called infectious dz specialist to find out dosage of antibiotics. I couldn't hold the first few down but Sara and Mark took turns reading to me to distract me long enough to absorb a little. I gradually increased the time between puking and broke on through to the other side after a few doses. They think I threw up ballpark 30+ times. (Sara says I looks anorexic but Mark corrected that technically it's more like bulemia.) I've never experienced such prolonged, intense, unrelenting pain, it made the hours crawl by and left me begging for my get-out-of-jail free card. I'm done building my third world cred, I'm never travelling where there is a "dirty" hand. Two clean hands for me please. I might not leave West Seattle, or my yard.

I have no idea what the rest of the team has been doing. My reality was limited to the path between my bed and toilet. Sara and Mark were my lifeline. Last night held down pureed potato, this morning two boiled eggs. Can move my eyes w/o too much pain now. It's going to be ok. Just wanted to let you know since lots of emails not answered.

Karen

Dengue woes

2007-12-31T04:35:00.000-08:00

Yep, Frank says Dengue. He and Victor called the local version of the cdc and it turns out there is an outbreak happening. I've turned a corner and am back to the land of the living, after two treatments and some herbs. Apparently the cycle happens this way, you feel better after a few days and a smaller episode hits again around 6 days later. Now the awful pain behind my eyes is mostly gone and the ache is receding. Before the fever broke it was pretty painful (spine, hips, femurs,eyes), but apparently I had a mild case on the spectrum of things. The moral of the story is that you should always travel with your own personal team of acupuncturists!

I probably won't work for a while, so now that I'm not doing anything productive and have nothing to report I have lots of time to report it :)

The rest of the team looks tired to me, all except Dan who still has time to blog and do tech stuff in addition to treating large numbers of patients.

I'll keep you in the loop but just wanted to let you know I'm on the mend.

Happy New Year!

K

Sick

2007-12-29T20:48:00.000-08:00

I got really sick last night. I thought maybe malaria since it was painful waves of chill followed by fever. Called Frank but he thought it wasn't, since there is no malaria to speak of in Ubud and I would be feeling fine after the episode was over. Feeling very...not fine, but finally able to get out of bed. We'll get ourselves back to Ubud today and get it sorted out. Sara has a touch of it, whatever it is, but much less severe. It hit us both at exactly the same time--headache, pain behind the eyes. Very achy. I hurled this morning but hoping it's a one-time deal. So hard to self-diagnose in this state. Researching on internet looks more like dengue.

I'll let you know. Thankfully Mark is our support wagon and is taking care of things for us.

K

Layers of chaos

2007-12-29T04:33:00.000-08:00

Today was a day off, sort of. We met with the midwives for a few hours this morning so Frank could teach them more about our potential role in the birthing clinic. After a good night's sleep and some down time I have decided that working here is just a matter of sorting through the layers of chaos. There is always a baseline, even when there are no patients there is activity everywhere, scooters idling just outside the clinic, dog running through the treatment room, somebody looking for someone or something. Then you add the patients, who have seemingly endless patience and wait hours for their turn. Add to that the fact that there are very few places to refer patients in need of different care--that they can afford. (The guy with the bone infection sold all his land and his scooter for initial treatment, and has nothing left.) There is a doctor on the staff but he's been out with kidney stones since we've been here. The first I saw of him was yesterday when he came to the acupuncture clinic for treatment. The next layer is my own, being a greenhorn and trying to adapt in all directions.

The communication is also a wildcard. I'm so used to checking in with my patients at home a lot, always making sure everything is ok. It's hard to do here--they wonder why you are asking. Of course they are ok and if they weren't they would tough it out. I can often only go by what I see: muscles relaxing, change in breathing, change in pulse. Maybe that's part of my lesson here. And if I find myself wondering how much good I am doing I have to tell myself that this may be the only care some of the patients ever receive, and if there is even just a small benefit to a few it is something. My teammates are doing an incredible job and teaching me a lot. I still dread pediatrics shift.

Sara, Mark and I are stealing away to the beach for a quick overnighter, 45 min outside of Ubud. Surrendering to being a tourist temporarily. I need to recharge, which doesn't happen if you are anywhere near the clinic.

Love,

K

Day in the clinic snapshot

2007-12-28T05:48:00.000-08:00

Since my camera broke on the second day of my trip and I've been blogging so inconsistently, here is Dan Wunderlich's blog, complete with pics and a lot more details, if anyone cares to see more:

http://mytripjournal.com/IntegrativeReliefBali2007

Another long day in clinic today. Saw some really gnarly stuff, still trying to shake it off. I don't know how to read x-rays. I don't know how to read Indonesian. There is no diagnosis from the doctor. Baby screaming. Where is the blood pressure cuff. Two babies are being born right now. There are no blood pressure cuffs to be found. What does this x-ray mean? I could just treat what I see, but what if I miss something critical. Where is a translator? This person's liver is enlarged. We got her blood pressure to drop 20 points. We can't get the bp to drop. This woman's kidneys are failing--the husband with pleading eyes asks if she can please take the herbs instead because the meds aren't helping. He is stressed, worried, exhausted and broke, and just wants to take care of his wife. This woman's feet are black and feel like wood but she says she doesn't have diabetes. This man's leg is infected to the bone and has been for a few years. . .

When Sara and I arrived Dan and Jen warned us that in the clinic you forget to drink water, you forget to go to the bathroom, you work through lunch, there is always something happening. They were right.

That's my latest. Thanks for the notes from home.

Love,

K

A little of everything

2007-12-27T06:27:00.000-08:00

I just have a few minutes before the internet cafe closes but here is a little something I wrote last night.

26 dec 2007:

I am in the most amazing place this evening, being hosted by a generous and kind couple-- Victor and Kamor. Jen and I just worked a long day in a small village outside of Ubud and now we are being pampered. The two of us together treated about 85 patients. Saw patients who had broken their backs previously and whose spines are grossly contorted. One woman's abdomen looked as if a nest of snakes were roiling just beneath her skin--she had dysentery. Several people had goiters bigger than grapefruits and it wasn't even the main complaint. Our helpers lit moxa, pulled needles and translated. THe lights went out now and then and a cloud of flying termites swarmed in at one point. Whenever I looked up from working a sea of faces were all watching. I was told they had never seen anything like it before.

The previous day was christmas and we were graciously invited to 2 differrent parties. Lunch was at Ibu Robin's house. It poured all day. I waded through water up to my calves to get to breakfast that morning. Now I understand why everyone we are treating has cold-damp. I was expecting to treat much more damp heat.

The 2nd birth I witnessed I was up close and personal--it brought tears to my eyes. All went well, no complications. Another time in the acup clinic I was asked to assist a labor that had stalled out. After 20 min w/ needles the woman started having strong contractions and her baby was born swiftly that night. We've also been turning lots of breeches.

My biggest struggle here so far has been pediatric clinic. The babies often cry just seeing a western face. they cry when you put the thermometer in the armpit, they cry no matter what (of course--they are uncomfortable!) That would be difficult enough but then the translation is also a problem, not to mention my own inadequacies and lack of experience in pediatrics. I am learning from Frank, though, and hope that will change.

There is a dog in the clinic named "Highway" who bites. He seems nice most of the time but he has a psycho-feral side and has bitten Frank, Dan and a kid, among others. I asked what they do about it--one midwife said she tries to appease him w/ food offerings. I had been prepared to intervene if anythig happened but when I saw him bite Dan I realized he is psycho--he was wagging his tail seconds after the bite. None of my usual repertoire seemed appropriate and frankly I'm a little scared of him.

That was last nights entry. Today we spent the afternoon back at bumi sehat. I was called in for the second time by the midwifes to treat a post-partum mother whose baby was going to die. I don't think there is a point strong enough for that but I did my best.

That's all I've got for now.

Love,

Karen

First Days

2007-12-22T19:12:00.000-08:00

Hi There,

I'm just getting my first breather to write a little something. I think I was up for over 48 hours with no sleep to speak of on the flight, but everything went fine. However, when I arrived in Denpasar none of my luggage was there. Sara and Mark were there to greet me at the airport and the clinic had graciously sent a driver to pick us up. Now I see why you should never rent a car in Bali--you definitely want a local at the wheel.

The next morning we started a full day in the clinic. That day was prenatal clinic, so women in all stages of pregnancy came in. We have 8 treatment tables set up in the open air clinic and a few translators to relay to us the main coplaints. We work quickly and flow is continuous. Meanwhile the midwives are working on the other side of the clinic, delivering babies and also doing prenatal care. They often bring women to our clinic to ask us to induce labor or turn a breech. Before Sara and I arrived, the rest of our team (Frank, Dan, and Jen) turned a 39 week breech, which is incredibly difficult to do since by then the baby is usually too big to turn. Inductions with acupuncture are also very helpful to them because otherwise they would be sent to the hospital, a much worse environment for a birth. This facility (Yayasan Bumi Sehat) gives the most incredible care for women in labor. They are experienced, calm, caring, and gentle. They sing or chant as the baby is being born. There are big tubs in the rooms for the women and a comfortable recovery room also. It is truly amazing. I saw my first birth yesterday (I observed while Jen did some needling while the woman was having contractions). It is a top-notch facility that runs on a shoestring.

Our clinic schedule is 10-1 and then 2-8pm. Sometimes it is just open clinic for anyone, other times it is for kids, kids with special needs, or prenatal.

Friday morning Bobby (the local acupuncturist who runs the acupuncture clinic at Bumi Sehat), Mark (Sara's husband) and I went back to Denpasar to run errands and get my luggage from the airport. Two of the local clinic staff drove us. I was expecting the worse at lost & found/customs, etc but all went smoothly and my bags were intact.

Saturday (yesterday) was supposed to be our day off but babies were coming and we were assisting the labors, meanwhile as we were trying to organize supplies and assess gear for the mountains in East Bali the midwives kept bringing in women to be induced. It's incredible exposure to this process. The flow of pregnant women never stops. We didn't wind down until 8pm.

The food has been great. The nature of my jetlag has been that I crash and burn after dinner, so that's why I've not been able to get myself to an internet cafe until now. Today is actually a real day off so I might try to get a little reflexology for my poor feet and read up on my notes. There is also some kind of concert we are all going to this afternoon that is a benefit for a new school. Ibu Robin is hosting us all at her house on Christmas. Dan, Sara, and Mark are going to a remote village on Monday to treat a huge number of people there. Mark has been a champ, helping to organize and alphabetize the chaotic clinic supplies.

That might be it for now. I'm really excited to be here. I will try to check email more often, but when I head to East Bali there might not be access.

Hope you are all well,

Karen

Eve of Departure

2007-12-16T18:33:00.000-08:00

So I thought I would learn to blog in the last few hours before I leave for Bali.

Thanks to the help of so many, I am packed to capacity and ready to leave tomorrow. I will be the last of the group to arrive. I have some 37 hours of travel time to review notes, learn Indonesian and study more about the finer details of labor and delivery.

Still more to do before I go so I'll keep it short, but wanted to get this blog rolling.

The websites for two of the organizations we will be assisting are:

www.bumisehatbali.org (midwife, mother and child focus, labor and delivery, etc)

www.eastbalipovertyproject.org (focus on education, nutrition, hygiene, agriculture, clean water, medical/dental, etc).

Thank you, everyone, for the many ways you have supported me, taught me and equipped me for this trip! I will give it my best.

Karen