Medical Mission Trip to Papua, Indonesia

I am finally writing up my trip to Papua and posting some pictures and videos! I will try to give the highlights and some of the things I have been thinking about, but obviously there is so much one could write about when traveling to a new and interesting land. Hopefully the subtitles will help you pick what you want to read about.

Dr. Julius and the Luke Society: Our connection to Papua
Our trip to Papua, Indonesia is the result of a working relationship between Dr. Julius Surjadi (Indonesia doctor) and Dr. Steve Baker (an American family doc) through the Luke Society (http://www.lukesociety.org/), which pairs up Christian North American doctors and business people with Christian healthcare workers in developing nations who have a vision for reaching their own people, but need some further support on making the vision happen. The North American workers pledge to pray, visit, and support the national doc as they do their work. Dr. Julius' mission is to reach the interior tribes of Papua with the Gospel and medicine by training national Papuan evangelists from the interior in basic healthcare skills to bring with them to the unreached tribe they are settling in. These villages are very remote, unreached by the outisde world and so have remained virtually the same for thousands of years. They have no modern technology (electricity, running water) or the Gospel, and sometimes no written language either. Dr. Baker began SMI (summer medical institute) as a way to engage healthcare students/professionals in serving the poor for Christ and serving cross-culturally, but also to help Dr. Julius, who spends most of his time training rather than doing clinics himself. By bringing in a short-term team to do clinic in the remote areas, Dr. Julius and the local evangelists gain more time for training and crediblity with the locals; which are important for maintaining the long-termwork there.

It takes a long time to get there...
We spent over 40 hours on planes plus transit time to get to Sentani, Indonesia, which is like the Sea-Tac of Jayapura (the capital of the province of Papua). Papua is located on the island of Papua New Guinea, but is a province of Indonesia rather than the independant state of Papua New Guinea which is on the eastern half of the island (confused yet?). It is right on the equator, and therefore extremely hot and humid, and the days last from 6am to 6pm pretty much all year round. By the time we finally landed in Sentani, I was so exhausted and jet-lagged--I didn't know what time I was in. We spent the first day recovering in "Hotel Rata" and waiting for our "surat jalan" which are "walking papers"--i.e. even though we had visas, because of politcal unrest in Papua, the government requires foreigners to carry extra permission papers. I ended up sleeping most of the day, and then in the evening we had dinner together on the roof. A Christian missionary joined us who is working with tribal peoples to create public health messages (in the form of stories since this is a story-telling culture) in their own languages with native music. For example, she showed us one they are working on for AIDS, as that is a new epidemic in Papua and yet there is being little done to educate people there. We also met up with Pastor Sumiren (Soo-me-ren), a local Indonesian pastor who helped our group with connecting to the village we would do clinic in. He recruited some of his parishoners to help us with translating and cooking, and a few of them also joined us. This group of young people turned out to be invaluable to our work there, and we so enjoyed the sweet fellowship between believers and working right alongside them to serve the poor.

Sentani Lake Clinic: The Needy Village of Barbronka
The next morning we packed our bags and trunks of medicine and supplies into vans and headed to the boat launch area where we crossed the lake to a village called Barbronka. The boats had a small outboard motor and could carry a fair amount of weight. The fishing boats however, were a single hollowed out tree that looked like your bottom would barely fit in and looked tippier than any canoe. The village ran along the shore, as most of the houses were built on stilts over the water. Without sanitation, the shore water was pretty disgusting--hogs swimming around, chickens scratching, thick algae, bits of trash, and whatever other kinds of waste. We all slept on the floor of a big open platform with a roof to keep the rain off. Our bathroom had been made for us--a little tin shack over the water with a hole in it so that our liquid waste went...right into the lake. It was also where we bathed by dumping water over us--a bit chilly, but refreshing because the it was so incredibly hot and humid we were sweating all the time.

Before opening clinic that afternoon, we had "opening ceremonies" in what appeared to be the village community house--a plain building with concrete walls that went about 4 feet high and had no doors which also would serve as our medical/dental clinic and pharmacy. The district chief and village chief each expressed their thanks for us and to Jesus and explained to the curious onlookers what would be happening in the next few days. They also talked about how they had no access to healthcare, except that a public health worker used to come once a month for the women and infants. We began a busy clinic that afternoon with our pharmacy, dental team, and medical team trying to get our footing. We had a few translators, but as best we could we tried to use Indonesian directly with the people. Talk about language immersion! The first day was a bit frustrating in parts because I felt so inadequate as a medical student-playing-doctor, but thankfully Dr. Baker and Dr. Julius were right by us to consult with and help us. The language barrier was also challenging to work with, in addition to cultural differences. For example, it is inappropriate to give things or touch people with only your left hand (due to sanitary practices)--kind of hard for someone who is left handed to remember! People were always watching us too--us curious-looking white-skinned people! We saw so many men, women, and children--3 medical stations in one open room plus a dental station. The patient would hand us a card with their name and chief complaint written in Indonesian and we would go through our algorithm and try to determine a diagnosis and treatment. It was a very different style of doing medicine than I was used to in the US: here we had no lab tests, X-rays, or CT scanners, physical therapy, a limited supply and range of medicines, and no charting or rules about HIPPA or official prescription pads. The range of disease was somewhat similar--a lot of people with chronic joint or back pain (which it is NO WONDER since they do tons of physical work just to survive), upper respiratory infections, ear infections, GERD. But we also saw many illnesses that we don't see much in the US except perhaps among the very poor--malnutrition, worm disease, fungal skin disease, scabies, yaws, machete wounds and open/infected wounds (again, related to lifestyle, poor sanitation, not wearing shoes!), malaria, and even a possible case of leprosy. It was sad when we saw things we couldn't treat--a few cancers, TB, club foot, and other illnesses needing surgical intervention. We couldn't address very many chronic care illnesses which we didn't even screen (for like HTN or diabetes) because they require long term medications which without a doctor/nurse in place could actually be dangerous to treat if medications were not controlled. Instead we focused on what we could help with. We even were able to help by testing eyes and providing reading glasses, which was really fun. By the end of our third day of clinic, we had seen 568 medical patients besides dental, and people had come from other villages to receive care as well!

Our daily lives were pretty simple: we arose early in the morning to a spectacular tropical sunrise over the lake, began sweating, ate breakfast, had group devotions/worship, and began clinic work until 5pm that evening with a break for lunch (while sweating). After cleaning up clinic, we would chat a bit, and then have dinner, bathe, and collapse underneath our mosquito nets to begin the same thing the next day. Our last evening, the dental team put on a short interactive presentation for all the children of the village about cavaties and brushing teeth, and then handed out toothbrushes. While we were there, we feasted 3 times a day on good Indonesian food--lots of fish, the best banannas ever, oranges, chicken, and LOTS OF RICE...every meal...there was no cause for hunger unless you decided not to be very adventurous and try the delicious yet sometimes suspicious-looking foods. We even had "sago" one time--a staple in Papuan culture. It is this wood from the sago tree that is ground into a pulp and then cooked down or made into flour. The traditional way to eat it was quite interesting--basically it forms a big sticky GOO, like orange glue with very little flavor but you add broth to your bowl to give it some. Of course, I tried it--but needless to say, I could do fine without ever eating it again.

Why go? Serve and learn...
You may be thinking: things sound pretty rough, why even go? These poor people were in great need of healthcare, and it was such a privilege to come and serve them in even simple ways. Matthew 10:42 in the Bible talks about how "if anyone gives even a cup of cold water to one of these little ones because he is my disciple, I tell you the truth, he will certainly not lose his reward." Matthew 25 also talks about how when we do simple acts of compassion and releiving suffering, "whatever you did for one of the least of these brothers of mine, you did for me." And so though it may seem like all we offered was "a cup of cold water," the people were so appreciative to have someone to care for them and we were able to serve Christ by doing this. There were many blessings in serving these people. We were able to do these clinics openly in the Name of Jesus, and we prayed with nearly every patient for both their physical needs, family, and spiritual needs. What an opportunity! for all of us as well to learn about the joys and challenges of serving Christ by serving the poor. Papua is an island that most people do not want to be sent--the Indonesian people (straight hair, tan skin) tend to look down upon the Papuans (dark skin, curly hair, aboriginal type) because they are viewed as backward, and kind of stupid, like they are a lower caste. It was the Indonesian peoples that took over the island of Papua. And so by going there to serve the "lower caste" of society, we were helping fill a gap that no govt. or even secular group is filling as far as I know. I learned about depending on God more: so much of our medical care is that we depend on God for only the hard stuff--the cancer, the hard-to-treat, the difficult patient. But there--every person, independent of their physical ailment or treatment, was given an opportunity to receive prayer/spiritual care for that physical need because we recognize that Jesus, the Great Physician, is really the one who heals. Sometimes prayer was all that we could offer them. And they were glad to receive it! But really...Jesus is all that we really need. Sure--God chooses to use our medical knowledge and drugs to benefit people too, but it's still a good idea to realize that truly He is the one who sustains us. That is something that is very hard for us who have so much to realize.

We also learned a great deal about the challenges of cross-cultural care--something we will all encounter in our careers, whether it is with our co-workers or patients. Sometimes there is a language barrier to deal with, and most times there are cultural beliefs or practices that change the way you approach medicine.

Another thing I enjoyed so much was the encouragement of fellowshiping with other believers who, though speaking another language and being from another culture, had the same Spirit of God in them. What a joy to hear them worshipping and praying to God in their own tongue and in their own style. A literal taste of Heaven!

Moving to higher ground: Wamena, Pyramid, and Bogapa (transitioning to the highlands)
On Friday morning, one week since leaving the US, we said our good-byes and made our journey back across the lake to transition the next day to the mountains. Friday evening we spent at the sponsoring church (in the dark and sweltering heat because the city shut off the electricity) giving a presentation about the trip to Christian medical Papuan medical students and visiting with them, with the goal of getting national students to come on this trip so that they will catch the vision of serving their own underserved people. It was exciting to for both nationals and us to meet Christian med students and fellowship with them as well.

The next day was spent trying to get out of Sentani. There are 2 flights per day to Wamena, one of the largest cities in the world that is only accessible by air travel. The first flight was delayed 5-6hrs due to cloud cover, and then we finally made it out on the second flight. In the process, I slept on the airport floor, as I had taken some medicine due to having bad nausea. We also listened to Pastor Sumiren's testimony which was very inspiring. Over and over again on this trip we listened to people tell their stories--and every time it involved 2 principles "trust and obey". That is, submission to God's plan was a huge part if not the determining factor for why they were in Papua in the respective posts.

After arriving in Wamena, we were escorted by a Christian Indo-Chinese businessman to his house where we spent 2 nights. Joseph and his family have a vision for ministering to missionaries on their way into the interior by providing housing for them, and so he graciously allowed all 14 of us to stay there! In fact, God has blessed their business so much that he is building a whole complex of rooms for people to stay in. They were wonderful hosts, and served us great food too--including "pre breakfast" of fried veggie pastry and fried banannas, coffee, and tea! wow! Also interesting was how they honored the Lord in their home by placing big flourescently lit "Jesus" pictures and signs on their walls. To us it would have seemed tacky, but they were so proud of the big Lord's Supper picture with big colorful Christmas lights around it.
Saturday evening was spent with Kim Dugger, a long-term missionary from America who has just set up a mission clinic in Wamena. The group got a tour of the place, and he showed them some very puzzling medical cases. In the evening, his wife and child joined us too for a wonderful dinner and time of sharing about cases he'd seen and their story of how God brought them to Papua. Amazing!

Sunday we went to church with the host family in a big building, probably Dutch reform. What was so funny was that we were all prepared for 2-3 hr services (often the case outside the US), but it was only an hour! And they sang some old hymns that had been translated to Indonesian. Thankfully I knew some of the words, so I could sing along too. That afternoon we traveled about 90 minutes outside the city to a village called Pyramid, where some missionaries from MAF (mission aviation fellowship) were having a retreat. It was neat to meet up with long-term missionaries, and also get to enjoy being outside in the countryside again. Rose, one of the MAF pilot wives, helped us buy local crafts from the crowd of village people surrounding the camp.

The next morning we left Wamena by small plane (piloted by MAF) to Bogapa and then by helicopter (Helimssion) over tall mountain peaks to Bubisiga, which was our final clinic destination in the remote highlands. It was amazing to look at the green hills and mountains we were flying through and see huts out in the middle of nowhere! No roads in sight! The mountains were very craggy, and tall--16,500 is the highest peak, and contains Papua's only glacier which is pretty amazing considering we were on the equator. We had a quick stop in Bogapa--another mountain village, but one that had an airstrip.

Bubisiga: Medical care and back to the basics

We arrived by helicopter to a small village tucked away in the mountains and jungle, only a short flight by air but hours to days of travel by foot. It was an amazing sight--a hundred men, women, and children gathered around and greeted us. It was like stepping into a National Geographic article--complete with decorated naked men wearing gourds toting their bows and arrows around, thatch huts with the smoke seeping out the top, and children with bellies distended from malnutrition. The village had a tribal pastor, who welcomed us and showed us their prized church building--complete with a tin roof, low wooden planks for benches, and Catholic-style posters of Jesus on the walls. The church and the volleyball court were the centerpieces of the village. We quickly tried to settle in so that we could run a short clinic that afternoon, so we started filtering water and cooking Mountain House (freeze dried food) for lunch and tried to figure out where we would hold clinic. That afternoon the dental team set up under a tarp, and the medical team created a semi circle of stools and wood planks for patients and doctors to sit on. This was defintely clinic-in-the-rough! It was defintely challenging at first during clinic because we had 2 translations going on: English to Indonesian (in our heads), then Indonesian to Moni (tribal language which the evangelists helped with), then back again. Thankfully our time in the lowland village was good preparation for a more simplified (because we followed the algorithm closely) but circuitous interaction. Sometimes we just had to ask the same question over and again until they answered "ya" or "tidak", to keep it simple. We also prayed with our patients here, and worked right alongside the evangelists, who also worked in the pharmacy and gave lots of shots. Oh that's another thing that's different: they not only like shots (suntik) when they come to the doctor, they expect to get one!

By the end of our short clinic we had already seen almost 50 patients. We then ate our evening meal and crawled into our tents to rise with the sun the next morning. The next day I decided to venture into the "bathing area" for a very cool but refreshing dip. The natives had been told by Julius that we needed some privacy for bathing, so they built a little fern wall to wall-off a small pool with a stream running into it. Unfortunately, the main trail went right over the top of it so that people could easily peer down into it! I don't think the natives took the opportunity to be voyers, for which I was thankful. They also built us a little 3 walled latrine (a hole in the ground) from ferns and sticks -- I was continually amazed at how resourceful the people were!!

Before beginning clinc, the tribal pastors and ministers held a church service dedicating the clinic. It was so awesome to see the whole village be called into church, men (some just wearing gourds!), women nursing their young, children, and elderly until the little one-room church was packed to the point of people sitting in the aisles! They spoke in Moni, so we couldn't understand them, but we tried to sing along to their tribal worship-music anyway. When that was ending, one man stood up and started yelling about something. It turned out that when the cheifs found out that we were only there to do clinic 1 more day, they were not happy because people were walking from over 10 surrounding villages to be seen! It was almost like a cry for desperation because they have so few resources--they were demanding us to stay longer, which we could not do unfortunately. Thankfully, God gave Dr. Julius wisdom as to how to negotiate so that we could get clinic started again. I looked out into the village and saw a multitude of people milling about--far more than were there the day before. I felt perhaps what the disciples thought when they saw the multitudes of people listening to Jesus, desiring healing and teaching and hungry and all they had to offer were 5 loaves and 2 fishes. But God was able to help us work efficiently and quickly so that we saw over 150 patients that day--more than they had ever seen in the highlands before!! Again, some of it was very sad for the complicated infections or deformities, knowing that they would probably not have access to the care they really needed. But it was very satisfying to help those that we could. Dr. Julius also used the afternoon to train the tribal evangelists in medicine and give them a whole pile of basic medicines to use! How awesome to see Dr. Julius working with those who are making real lasting impact in the villages. At the end of clinic, the village people taught us some things from their world: how to start a fire (without matches of course!) using bark, how to shoot arrows (they laughed so hard at our failed attempts to shoot their dud arrow), and took us on a tour of their village. In fact, Brian and I took the opportunity to sleep in a honai (traditional thatch hut) that night! Brian stayed in the guy hut and I stayed with the pastor's wife and kids in their hut (men and women sleep in seperate huts). The huts are really neat: they heat them with a fire in the middle and the smoke seeps up through the roof (hence, stay low to avoid being smoked out), and there are two walls to insulate the room, with a woven wood floor elevated above the ground. I was amazed that we stayed completely dry despite the rain. It was so awesome to stay in the honai because it was entering into a more intimate part of their world, and I was able to "talk" about basic things (where I was from, marital status, foods) with them using the bits of Indonesian I knew and a lot of sign language. They also played their mouth harps called "bigigi" and offered me bits of their food: sweet potato, sugar cane, greens, and some root I've forgotten the name of. It got a bit cold in the night when the fire got low, but I don't know how the people survive just in their bit of clothes with no bed or blankets! One of the other "nona"s (single girl) ended up cuddling with me...kind of interesting.

Timika: Rest and the long journey home

Wednesday was our transition day out of the mountains. We packed up our things and helicoptered back out to Bogapa where we transferred to small plane to fly to the southern city of Timika. In Timika we had some time to rest at a Indonesian "resort" (more like a nice hotel...ie. hot water and a pool!). We spent some time as a group debriefing and sharing about what we enjoyed, what was frustrating, and suggestions for next year. One of the best parts of our debriefing time was to hear the testimony of Dr. Julius and his wife Debbie who are an amazing couple that are completely submitted to God in their marriage, family, and work. Of course, it didn't start there, but the process of them coming to Papua was literally an act of God. And God is richly blessing their work--the only of it's kind in Papua. It was also neat to hear from Hiya, the first Papuan medical student to join us on this trip. It was quite an eye-opening experience for her, having never been in the remote areas of her own country and not having practiced medicine in a rural area like that before. She was so inspiried to tell her classmates about what God did and what the experience was like--I pray that not only her life would feel the lasting impact, but that other people through her would be inspired to serve the Papuan people. On Thursday we flew out of Timika--a miracle almost! Airline security and rules are bit different in Papua, and for some reason there was a hole in the landing strip which nearly prevented the airplane from landing (acutally, the airline wanted to land but the airport said no). Then they were supposed to have it patched by a certain time in the afternoon, but by 4 hrs before our flight time we still didn't know if we would actually get on that plane. The downside being that this flight happens once a day and missing it would throw off a delicate schedule of flights. We prayed, and thankfully made it on the plane with only a small delay. That night we spent in Jakarta and the next day we briefly traveled around Jakarta bwith a church friend of Dr. Julius'. Then we flew out to Kuala Lamur, where we also had another overnight layover, and then finally to LA and PDX. Whew! We were glad to get on the ground and stay there! I thank the Lord for a safe trip and that we all got where we needed to be--it was kind of dicey for bit in KL because of some airline mistakes which almost left half the team behind. After many hours in the plane...we finally landed in PDX and saw our loved ones. Praise the Lord for safe journeys and a blessed time!

It has been a tremendous learning experience--one I will carry with me through my career, and a wonderful adventure! I love serving the Lord, medicine, traveling and experiencing a new culture!