A doctor goes to work in a remote community in Flores

Dr I Ketut Agus Sunatha

Remote communities in Indonesia suffer from a lack of doctors, nurses and midwives. The Temporary Contract Employee (PTT) program requires doctors to spend two years working in a remote area before they can open a practice. Besides helping the local community, it also allows the doctor to experience some of Indonesia’s diversity.

Dr I Ketut Agus Sunatha graduated from medical school in his home province of Bali in 2002. He was then posted to Ritaebang, West Solor, off the island of Flores, for two years. He departed, leaving his wife and young son in Bali. This is his own account of his experience.

The journey to Ritaebang, West Solor, was exhausting. I waited for two weeks in Kupang to receive my placement but finally I was able to go. I took a ferry from Kupang to Larantuka, Flores, and then a smaller boat to Pamakayo, on the island of Solor. I wasn’t used to ocean travel. From there, I got onto a truck which had been modified to serve as a bus. When I arrived in the village of Nusa Doni, a free health clinic run by the Ritaebang puskesmas (community health centre) was underway. The people seemed happy to see me, perhaps because there hadn’t been a doctor there for a long time. There were so many patients that I forgot my weariness from the journey as I treated them.

Afterwards, I departed for the village of Ritaebang with the puskesmas staff, on the truck-bus. I was surprised at the unpaved, dusty roads weaving through the rough terrain. It was so different to the roads in Larantuka. But I had made a commitment to myself: ‘wherever I am sent, I will be strong and steady, as everything is arranged by God.’ Arriving in Ritaebang, I discovered that the town was not what I expected for a sub-district (kecamatan) capital — it was more of a village, and a very isolated one.

On my first day there, I was given food which I had never tried before in Bali: cassava leaves with papaya flowers. The cassava leaves were very bitter, but after a week I became addicted to them. It is said that the leaves help to prevent malaria, a dis ase I was afraid of catching.

Malaria and diarrhoea

The staff at the puskesmas all welcomed me and gradually I came to know them. I was worried I would disappoint them, as there were many patients. The most common illnesses were respiratory infections, malaria, rheumatism and diarrhoea, all of which could be treated with puskesmas medicines.

West Solor consists of 17 villages, the most remote being Lewotanalein, which is on top of a hill, and cannot be reached by car. I was very worried about this village, which did not have even a midwife. A trail bike donated to us by the Health for All Foundation was very useful in getting to the more remote villages. We had no ambulance, and no funding for one, and our office motorcycles were very old and not suitable. With the donated trail bike, we tried to offer free services to those 17 villages every month. It was very tough work, but I felt that if I did this God would give me strength and abundant rewards.

A mother’s death

We held regular public health meetings in order to provide the latest health information to the villagers. One day I was very distressed because I couldn’t help a woman who had experienced haemorrhaging after giving birth at home. I arrived at her village after travelling for two hours, to find her already cold after losing a lot of blood, and in the end she died. This experience made me wonder how to deal with these emergencies, since the medical staff are few and far between — there are only nine midwives to serve 17 villages in such a vast territory.

After one year in Ritaebang I became very close with the staff and the community there. I felt appreciated by the locals, who often gave me vegetables, fruit and other foods.

Eventually I was able to enjoy living in Ritaebang, since it was so peaceful and beautiful. The white sandy beach reminded me of Kuta Beach in Bali. Two years had gone by, and I had come to the end of my tenure in Ritaebang. The puskesmas staff and the villagers seemed sorry to see me go. I was also very sad to leave them. But I had to be strong and steady, just like when I arrived.

Dr I Ketut Agus Sunatha (agus_sunatha@yahoo.com) is a doctor in Bali.