Bumi Sehat addresses some questions

Our Google Hangout with Erin Ryan of Bumi Sehat elicited some follow up questions. Interim Program Director Veena Khandke posed them to Erin and Bumi Sehat. Here are their responses.

Why midwives have cell phones?
How are your facilities equipped?/a>
How many non-Indonesians give birth here?
What are your other fundraising efforts?
What is the poverty profile in Bali?
What impact will Universal Health Care have on poor women in Bali?
What other services do you provide?

Q. Can you explain why your midwives have cell phones?

A: Unlike in the U.S., cell phones are the only affordable way of communication (in Bali). A land line is very expensive to put in, maintain and isn’t terribly reliable. Most Indonesians could not afford a land line. In Aceh, the tradition is to give birth in the home of the mother. We have a clinic for higher risk women but lower risk women wanted to stay with their tradition. We gave cell phones to the traditional midwives so they could call for back up or an ambulance when needed.

Q. Your facilities look very nice and well equipped. How do you get funding for your labs?

A. The fact is our building is too small, old, crumbling and in need of constant repair. While we feel very proud of our clinic and keep it clean and try to keep it up to date, I have seen the faces on the Westerners who come for tours. They are surprised at the state of the clinic. They would not come here to give birth. Their standards are much higher. But by Indonesian standards we are offering women the opportunity to give birth in a private space — something not possible at the hospitals there.

We do now have a lab. Paid for and sustained by an ongoing grant from Every Woman Counts. Lab work is very expensive in Indonesia. It was rare that any of our mothers had any lab work done especially not important screenings for anemia, sexual transmitted disease or HIV. We are very lucky to be able to offer lab work as well as providing services for women with HIV. It has allowed us to offer better safer care for women.

Q. You mentioned that you have women come from other parts of the world to give birth. Are these women paying? How many are there? 

A. The non-Indonesian women who come to the clinic are one of three types of women.

1. Married to an Indonesian — these couples tend to be living on Indonesian pay and in traditional compounds.
2. Expats working in Indonesia
3. Traveling to Bali to give birth at Bumi Sehat.

Our international patients are definitely less than 5 percent.  We mention the traveling birth mamas in our talks to emphasize how a small clinic in a small Indonesian village is getting the attention of women from around the world.  And how difficult is it for women all over the world to find the type of respectful care they are looking for.  It is also a sense of pride for the Indonesian midwives and clinic staff that Western women would choose their care and their clinic. Ache serves no western women. All non-Indonesians are asked to “donate” enough to more than cover cost of their birth.  And in every case they do.  Unless they fall into the first group of living on an Indonesians husband’s salary.

Q. DFW is not your only source of income. Can you outline some of your other fundraising efforts? 

We are constantly fundraising. While we are now have more foundations that support us yearly with money. We also give tours to tourists from all over the world, we sell t-shirts and mugs to these people. We have a fundraising concert every New Year’s Eve.

Q. There is a perception that Bali is not that poor. We have looked at Indonesia’s Gross Domestic Product (GDP) and surely it is a mid-income country. Can you describe what poverty looks like in Bali? 

A. With a country as diverse as Indonesia, it would be difficult to assess the living standards by looking at the GDP. Much like the U.S. there are places that have much more money than others. For example, Maryland was the wealthiest state in the U.S. again last year, with a median income of $72,483. Mississippi, in turn, was yet again America’s poorest state, with a median income of just $37,963.

The following information comes from another NGO in Bali:

“In Bali, there are as many as 162,051 people living in poverty and this figure has been on the increase. In the villages, the rate at which the number of poor is rising is twice as much as that of Bali’s urban areas. In the Balinese countryside, it is estimated that more than 77,400 people are living in poverty. Currently, in 82 villages out of Bali’s 706 villages, the poverty rate hovers above 35 percent. To make matters worse, on this tourism-focused island where the number of tourists almost matches that of the locals, the incomes of farmers are dwindling and the prices of essential goods are becoming more and more unaffordable to many Balinese.”

Personally, I saw extreme poverty while in Bali. As a tourist you would never see it if you didn’t seek it out. We give the patients a list of what to bring when they are in labor- sarongs, clothes and blankets for the baby. Many times patients brought nothing. They had no money to buy baby clothes or blankets. We would provide what they needed from donations from Australian tourists. Every family is given a package of baby clothes and these were always gratefully received and treasured but for the families living in poverty that didn’t even bring basic supplies we also gave them toothbrushes, soap, vitamins for older children. Poverty has a fairly specific look- sunken cheeks, thin forearms (less than 23cm for women), dirt in the cracks of the skins. While we provide breakfast for patients they provide their own lunch and dinner. If we saw women just eating white rice, we would get her food for her stay. We also kept an extra eye on these mothers for infection.

While pondering this question I asked my 13-year-old son if he thought people in Bali were poor. He said “yes.” I asked how did he know. He replied “Mama, just go to their houses.” He is right. If the ladies of Dining for Women would go into any of the homes of the women who work at Bumi and who we serve they would be surprised to find 6-7 family sharing a kitchen and then each family having a room where they can all sleep on mattresses on the floor. You would not see computers or toys. A washing machine or telephone is luxury. Running water is common but it is never potable. Because most people go to Bali as a tourist destination and the tourist areas are kept up to wonderful beautiful ideal tropical standards they never see the way most Balinese people survive.

I can certainly provide more detail here if needed. There is really no question of the economic reality of the women we see and the clinic.

Q. Indonesia is about to get Universal Health Care. Will this reduce the need for privately supported programs like Bumi Sehat?

A. While I was in Indonesia there were two different programs that offered free health care to pregnant women. What they did not tell women was it was near impossible to get as you had to have a specific identity card requiring an Indonesian birth certificate and then you would need a letter from your local banjar (government). Then you could apply. The government only issued a limited number of policies. If you did get the state insurance it in fact did not pay for you’re the cost of a hospital birth. It did not cover a bed, nursing care, gloves, medicine, episiotomy (yes, they charge for this), or the suture needed to repair the episiotomy. It did not cover the stay in the hospital after or any care needed by the baby. In other words the promised “free” births were in fact very expensive.

I have little hope that Universal Health Care will reach Indonesians anytime soon. If it does it will certainly be burdened with more issues that what we are facing in the U.S.

Q. What kinds of other services do you offer? Family planning? Cancer screenings? 

A. When I left, the lab was in process of setting up cervical cancer screening for women. We are waiting to have a training from a group that does ‘see and treat’ where women can be screened and treated for cervical dysplasia at the same time. It is not realistic to ask women to return for cancer treatment. We can cover vaginal swabs for infection. Whenever possible we help the women address issues with acupuncture, herbs and homeopathy before using western medicine like antibiotics but we do have antibiotics at the clinic.