Taking You Back to Tangerang

After the magic of Bali, it is hard to come back to Tangerang, although it makes sense in the context. Everything about my experience in Indonesia, including Bali and Tangerang, spoke to the continuity of life. In our daily lives, we are often so sheltered from life and death that we fear death, forget about what makes life so beautiful. The memory of Tangerang Hospital was that fine line between life and death -- as mothers struggled to survive pregnancies and new babies came one after another into the world.

Between helping with the film, and catching up on other administrative tasks at night, I didn't get to write a narrative directly after visiting Tangerang. Instead, I took an excerpt from a piece that I wrote for Global Health Magazine, and pasted it below:

A day in the obstetric ward of Indonesia’s Tangerang Hospital is filled with the same sense of urgency as its home city, the congested, ever-mobile streets of Jakarta. Every other hour, a woman comes in needing a life-saving procedure. In one day, a midwife can assist 10 or 15 emergency deliveries—severe bleeding, ruptured membranes, retained placenta, pre-eclampsia, shock. They come by car and bus, with family members, friends or community midwives.

Most of the women referred to Tangerang Hospital, which is located on the outskirts of Jakarta, are poor and arrive to the ward straddling a tenuous line between life and death. Their conditions need to be managed within a six-hour window. After journeying from one, two or three hours away, Tangerang’s staff has only an abbreviated moment to save their lives.

These women are not alone. Every day, women risk their lives to give birth in developing countries around the world, because the services aren’t there to help them through their pregnancies safely.

In just six hours at Tangerang Hospital one Wednesday, an ESD team observed a woman whose placenta was retained inside of her uterus and needed to be removed before it caused her to bleed to death. Another woman suffered from pre-eclampsia, a lethal surge in blood pressure that often ends in life-threatening convulsions to the mother and loss of the newborn. The only way she could safely deliver was by cesarean section. To the team’s delight, both women received the critical care they needed.

An amalgamation of other young women with swollen bellies laid gaunt and fragile about the ward, awaiting care. Opening the door to the postpartum room, women, most who looked less than 20 years old, lay recovering side by side, without their babies. Some had lost them. Others were waiting for them to receive care in the emergency neonatal ward.

Inside Damayanthy’s womb, a slight woman with long narrow eyes and delicate features, her baby was trying to come into the world feet first. Entry by butt or foot often results in the baby’s head getting trapped in the mother’s pelvis, or its oxygen supply getting cut off. Despite the risks, Damayanthy’s husband and mother-in-law wanted her to deliver “the natural way,” as she had during her other births. While the doctor tried to convince the family members about the necessity of the procedure, Damayanthy, by a miracle of her own making, brought a healthy baby into the world.

Like most of Tangerang’s patients, Damayanthy came to the hospital because she is poor, could not afford private care, and her delivery was not going well. When she was shuttled off to Tangerang for treatment, Damayanthy did not know what to expect of hospital care. She delivered her first three children – ages 9, 7 and 5 – at home with either a skilled – or unskilled – birth attendant or a community midwife, as 67 percent of Indonesian women still do.

Seventy million people in Indonesia are still defined as living below the poverty line. For this contingent, access to life-saving health services is extremely low. Improving emergency care at government facilities like Tangerang, which primarily serve the poor, is, therefore, integral to bridging the gap in services between the rich and the middle class, and the poor.

Magic

There was something magical about Bali. Although the magic only came in glimpses, at times when I least expected it, it was still there, ever-present, lurking in the shadows.

During my last night, I would say I reached a pinnacle relationship with the sea, with all of my senses. At the peak of a fading sun, I watched the rainy season arrive to the shores of Canggu. With each passing moment, luminous clouds brought a more and more tumultuous wind. This changed the shape of the waves, making them larger than life. I could imagine where a Tsunami could be born. Only this Tsunami did not take away life, it did just the opposite. As I sat, almost alone, overlooking the water, I could feel the moods of the earth rise and fall. The humid air made my hair curl across my face and the salt from a taste of the ocean earlier in the day left a special glow to my skin. Something happened to me then, and it felt like magic.

The sky turned from a deep blue, to a lighter blue, to pink and orange and red. It then transformed into a deep scarlet that ate up the sand before my eyes and had the waves crashing onto the wall in front of me. As the sea sprayed me, I looked up to see the clouds running, the earth hastening its ever-moving path, to go from dry to wet. I sat on the porch, and the wind turned into a torrential rain. I couldn't then -- decipher -- between the surf and the rain -- what water I was encountering when. It all seemed to be one. In Bahasa, water is "air." This couldn't have been more true.

As I retired to my single room behind the porch, and a lone and seldom-visited eating establishment, I laid down and listened to the rain. It pounded the roof, and once again the waves became the rain, and the rain was the sea. My breath, and the taste in my mouth became the feeling inside me, which was the rain and the sea, moving within each other, around each other, together.

As I said before, the magic only came in flashes. It wasn't too long after I laid down that the constant cycle of water was broken by the base of party music -- a reminder that even magic is imperfect.

I would say Bali is warring between the old and the new, and, at the same time, is at complete peace with both the new and the old. Grand resorts have popped up beside modest villages, although most of Bali isn't modest at all. Even the most pre-historic of places are architectural wonders. Even the most disadvantaged families, live in aesthetic grace.

I am not a skeptic, but I am definitely a realist. I don't think I have ever characterized something as magical before. But to me, this feeling of spirituality, even if it was only temporary, of being so closely attuned to nature, comes seldom in life, if ever at all. It was not the distance from development, or a modernized world that gave me that sense either. It was something in the air, in the water. It was just something about Bali.

The old, stone Hindu carvings, the artistic rituals, the sensory experience, traveling alone through it all, brought me closer to myself. Getting to know my friend Brown made me more aware of the cycle of life. To him and his family, life doesn't mean trying to cram in as much as you can in this one life you have to live. For Brown, life and death are an ever-churning cycle. You will live one life, and you will live another. The dead should be honored as the living are, because there is no fine line between the two. Everything, like the sea and the rain, is running into one another. So just be.

As I was driven through rice fields that turned gold with the angle of the sun, and through old villages where people bathed in ravines and carried bamboo atop their heads, I couldn't help but let my guard down, internalizing what I saw. I just was -- Bali. Although Bali isn't undiscovered -- in fact, it is completely dependent on tourism, and as a tourist, you'll know it for most of the time you are there -- I found seldom hours and moments like this that took me somewhere else. I would have needed more time to find many more.

One moment came on my hike out of Ubud, up Champan Hill. Although the path was made of stones, not dirt, completely touched by human hands, I revolved around an untouched field of growing rice. I could feel something inside me start to melt. I thought to myself, this is a place I will always remember, and come to remember. If I was ever alone, at a loss for something in my life, this is a place I would want to be in to remember the loss, to take it all in, to be fulfilled by the sound of the grass swishing in the wind. This is the type of place that could rectify my losses. I'd been in places like this before -- on hikes that took me away from the chaos of every day existence, but this was different. I looked to the West and saw a small house, with many porches that overlooked this hill. I pictured myself as an older woman on that porch, remembering what had brought me there, remembering the memories I already have stored up for that moment.

To escape in Bali, to find its magic, you have to let your guard down, to breathe a little deeper and to try to get away from the resorts, the taxis and the commercialization that can eclipse its spirituality. Everywhere you go, you will see fine, archaic, Hindu carvings. You will see so many that one will become another, one offering of rice and dried flowers with become the next. I encourage you to take advantage of all of your senses at each passing moment, because even within the touristic culture, you can find beauty where ever you go.

In Ubud, beauty lined each store front. The art, sculpture was a phenomenal backdrop for my walk through town each day. The Picasso-like woman dancing with her arms raised high, the people toiling in the rice fields, the Hindu gods, the young meeting the old meeting their spirits -- I allowed all these images to come to life. I tried my best to realize the beauty, the sense in it all -- the smell, the touch, the sounds that were surrounding me as my admiration flourished. And for many solitary moments, it worked -- it was like magic.

Bali just is.

Money, Money, Money

You can’t avoid it. You feel like money, as if the bills are dropping from beneath your skirt, as if the change is rattling as you walk. It’s true. I felt that way in Niger. I feel like that sometimes as I walk through my own Washington, D.C. I was that way in Jakarta. I still feel as if I am flashing rupiah signs everywhere I go among the Balinese. Although the Balinese are spiritual, kind, maybe the kindest people I’ve known, they still have to think about money.

Up and down Ubud’s streets (you’ve heard of it if you’ve read the over-hyped “Eat, Pray, Love”), you would be confused and overwhelmed by the hundreds of boutiques, restaurants, and art galleries, set aside local shops trying to sell “typical” Balinese crafts, like beaded purses, beaded belts, beaded sandals, Batik dresses and lots of art. It is a high-class sensory explosion. And they all want your business.

“Taxi, miss. Transport.” “I have a special price for you miss.” “Massage?” Yes, I fell for that one. I picked the most unassuming little boutique I could find in this strip of spas, restaurants, temples -- and indulged in a massage. A young woman – maybe of 16 or 17 years old – spent an hour massaging every part of my body. It was brilliant, wonderful. At three o’ clock, I was Tadik’s first customer of the day. She got in at 9 a.m., and will leave at 9 p.m., as she does every day. Her manager, short, stout, maybe about 20 years of age, with long, colorful toe nails, tried to sell me a pedicure. Of course, I acceded and had the first foot treatment of my life. I paid them $8 for the services, and left a 60 percent tip. I am still admiring my feet, after the removal of my decade-old calluses.

I didn’t bargain for it. In fact, I did the opposite. And I didn’t follow the Balinese rules, according to one Canadian woman I met yesterday soaking in the pool outside my door. In Bali, you bargain, she said. “You start 50 percent below the asking price and then you argue.” I saw this in action, when Ms. Canada and I went to a traditional Legong dance last night. A young boy was trying to charge us 75,000 rupiah, or $7.50 for the tickets. She thought they should be $5. She fought with him, until it got uncomfortable. Then she paid the asking price. Didn’t go so well, huh, Ms. Canada?

Bargaining with the locals sounds like hell -- arguing over pennies, dollars. If you are in Bali and you are a tourist, you have more than the local people selling you their goods. Most of them have never left their beloved Bali, not even to go to Java, or their capital city, Jakarta. Shame on you, I thought. The Canadian had been globe trotting all over the world, and then she haggled over $2. Is this tourism to the Balinese? People haggling over pennies? I hope not.

But maybe I am wrong and this is the Balinese way. Among the hundreds of temples, as women lighted incense and wafted it over religious offerings filled with flower petals, banana leaves, rice, were they worrying about how much money they could make that day? It seems ironic, doesn’t it? So much spirituality, and fine, old Hindu architecture splattered with mass consumerism. I guess this is the way of the world. Spirituality only gets you so far. You have to live, make money where you can. In Bali, making money means serving people like me.

But maybe I am just feeding into the stereotype, the reality – the Western cash cow. I hate that. But I can’t avoid it. This is the grand conundrum: how to do good by the places we visit – how to give back to the locals, gracefully -- and how to make friends.

Brown (pronounced “Bron”) who drove me here, has now named himself as my “driver,” and my friend. Brown is currently in his home village – not where he lives now, but where he lived as a child. Why? Because Brown got me to Ubud from the South shore and now he wants to drive me back. He wants to serve me in this way. He says it is because we are friends, and he wants to see me safely through Bali. But I know he needs cash. His rent is $70/month in Denpasar. Sometimes, he brings home little more than $100 to $150 during the low season. So my $30 for a full day touring around Bali is like gold for him, and his family. He didn’t charge me $30. I made him an offer. He said because we are friends, he would not charge me. I had to give him my own price. I can only hope I was fair. Mulling the payment through my head, I became the typical tourist, distrustful, and tried to discern whether he was using another technique to rip me off. I can afford the $30, I reconciled. His mobility filled my trip with soul and spirit. Brown now wants to take me to meet his family in his village tomorrow. I feel like I can trust him. I have to go with my feeling, or else I’ll crack.

I have made the authoritative decision to believe that Brown and all of the Balinese are not cheating me. I have to believe this to enjoy where I am, climbing through rice fields, sitting in absolutely austere beauty, with only the sharp scent of the Durian fruit checking me back into reality. But even as I climbed through the rice fields, and crested the hill to my first village, there were shops. Artists’ enclaves were poised among the irrigation ditches, the long, green grass and the luscious surrounding forests. If you think the people in downtown Ubud are crying out for tourists, imagine the people at the tippy top of the hill. This is why I caved, and even within the serenity of my hike, bought two intricately detailed Hindu paintings from an old man sitting there, decorating wooden eggs on the hilltop. He was forever grateful. He charged me $10 each, for something that probably took him days to create with a fine tipped brush. I saw him painting the eggs. It’s not easy work.

In Bali, they say this desperation has flourished because of the world financial crisis. You don’t hear many people talk about Obama here – although he grew up in Indonesia – but you do hear about the crash that has taken away their tourists and left them crawling, crying out for more. This has been the slowest year in a very long time, according to the lovely ladies at the boutique. They struggled to ask me about my family, where I came from, but they easily explained that their struggles were because of the financial crisis.

So, again, I encourage you, if you want a sensory spiritual experience dashed with the comforts of home, if you have money to spend, come to Bali!

Bali's Gem, All Alone

I'm like a treasure around here, a long lost pot of gold at the end of the proverbial rainbow. I pass by the Hindu offerings of flowers, rice, coins that sit in store fronts, attach themselves to taxis, get smashed by the drunk revelers as the nightlife wears on, and think these might be for me -- not really. I am, in reality, just an American in Bali, post-2002. The bombs fell, and I still visit, alone, as a white, American woman on the shores of Bali.

So people wonder, then they ask questions, then they ask me to buy their services, then they beg and plead with me to pass on the word: Bali is lovely, warm, a place where Americans should feel at home. I'm telling you now -- Bali is nice. Bali is Hindu. How could you not love a people who want to give back to their deities everything life has offered them from water to an ability to study to their beloved rice?

But besides hints of this selflessness here and there, the spiritual Bali isn't what I've realized so far on the streets of Seminyak. In fact, I can imagine that day in 2002, and then again in 2004, when the bombs fell on Bali's premiere clubbing scene, its Miami, Las Vegas, Cancun. This is what I see. I can see the grand culture war that must be going on in Indonesia between the free-thinking, Western, "anything goes" contingent and those who are extreme and conservative. I see it melded into all shapes and forms, from women in full coverings riding their motor bikes through downtown Kuta to the barely dressed, tatooed women frequenting the bars. I see it in the group of French and Australian people I hung out with last night who are here to buy up real estate and sell it at a price that will give them a hardy commission. Their next conquest: untouched parts of Timor. They insist they will do it sensitively, with the community and not without them, as I looked to them skeptically. It seems they've almost done it here in Bali, only they haven't. No one makes enough money -- an average of $100/month -- and everyone will tell you about it. The government is corrupt and feeding their own pockets, while many Balinese sit on the beach penniless.

Can't there be something in between? I think there is. I found it today when I got a driver to high tail me out of Seminyak (pronounced without the last k) to a place a little north. A surfer's haven, the place provided a respite from the chaos. As soon as we left the traffic behind, we turned off the main road to a field filled with rice paddies, and upward to more green pastures dotted with men in cone shaped hats working the land. Despite the sense of serenity, I also noticed satellite dishes, and the frames of what seemed to be mega-mansions standing there and interrupting the sky. Turning on the last unpaved road to the beach, I finally found myself alone. I laid down, got a little sun, and waded into the crashing waves as they moved violently in between the jagged rocks. I felt like I had seen this beach before, maybe in South Africa. It was perfect.

I headed up to a small cafe, just above where I was laying down, ordered some papaya juice and continued reading my book about the story of one Ethiopian man's personal journey as an immigrant on the streets of Washington, D.C., and I finally felt very, very far away. The sound of Balinese men building a new, Hindu temple became my background music. My driver who calls himself Brown, pronounced "Bron," and the owner of the cafe, let me have 15 minutes of my soul-searching alone time and then they joined me. The questions started again: why was I here alone; wasn't I lonely; was I married. Ecetera. So I started questioning them. What did they believe as Hindus? And what were the rifts between the conservative Muslims and the Hindus. Bron insisted that the extremists are a small, fringe element in Indonesia. They are no good. He has no tolerance for intolerant Muslims, or intolerance in general. He said because he is Hindu, Muslims who he has driven around, won't even touch his hands. They throw their money at me, he said as he gracefully jetted an imaginary dollar bill into the air, so they don't have to touch me.

This must be the antithesis to how I feel on Bali. People want to know me, be near me, although it seems like they see tourists from other palces all the time. In fact, within five minutes of stepping onto the beach for the first time after my arrival, many women, maybe five, approached my chair and began offering me services of every kind -- manicures, pedicures, massages. I said to please leave me for now, maybe I could buy something tomorrow. Dear Kiki, can't you see I am so pale? I've been stuck on airplanes and then in between Jakarta's high rises for a week. I need the sun right now -- just me and the sun. Kiki said no, you don't, your skin is beautiful, white. I want white skin too. She began rubbing my skin against hers. This motion saddened me to the depths of my soul. Brown said the same thing today. He wanted to turn his shiny almond skin into snow, like mine.

So here I am all alone in Bali, traveling the world. But I dont think I'll ever really be alone. I'll always have my friends, or the people who want something from me, need something of me. Someone always will. It was clear when I was the only one eating dinner tonight on a huge veranda overlooking the sea that we Americans have abandoned little Ms. Bali. It is the Australians, the French, the Germans and the Japanese who keep this little island afloat. Yet the Balinese still want Americans back, or they want to go to America themselves, like my wanderlust waiter during my solo dining experience. He asked me all about the great, wonderful opportunity that is America, while a security guard with nothing to do overlooked the luminous hotel where I was dining -- alone.

Tomorrow, I leave the party scene and travel to Ubud to visit some temples, see some dance performances and talk to people about why I am an American in Bali. Join me.

The Cycle of Life at Fatmawati

Hospitals. I don't spend much time in them. Who would want to? Over the last few years, I remember isolated times -- when Heather had work done on her back, when my mom fell in the middle of the night, when my dad had to undergo a routine surgery -- where I spent a little time in hospitals among the company of my loved ones. I could come and go as I pleased. I had a destination at the beds of my family members. At most times, I could avoid what might be happening on the other side of the wall.

Today, I couldn't. I arrived at Fatmawati Hospital with the film crew, not knowing what to expect. I was told this hospital was much worse off than Tangerang, the hosptial ESD has already assisted. Driving up to Fatmawati through the lush gardens, and manicured lawns, I couldn't tell. From the outside, this place could have been what I remember as Stanford. The spanish roof and the nicely painted blue and cream walls seemed almost pristine. The nurses in their bleach white head dresses marched in and out, smiling with intention. Verandah-style walk ways intersected the different parts of the hospital. Doctors and nurses ate their lunches on the stoops of these polished buildings.

This facade, however, masked an entirely different reality.

Inside the emergency obstetric ward, I heard moaning -- a mother in labor. Although I am a 30-year old woman, these sounds were foreign. The strain in her voice alarmed me. The smell made my eyes water. The musty, heavy air had sweat dripping from my neck down my chest and landing safely on my stomach. Maybe it was the stagnant air, or it could have been my nerves. A man, slight and short with the high cheekbones of many Indonesians, brushed by me. Tears flowed down his dark brown, glossy cheeks. I sensed that it must be his wife in there, experiencing complications -- pre-eclampsia or postpartum hemorrhage. She was at risk. I later learned I was half wrong. His wife was the one with the still birth. Their dead newborn rested between her legs. His tears were for his lost son or a daughter. Behind the curtain next to his wife, another woman was the one experiencing complications, most likely a result of delayed care and/or poor antenatal attention. Eighty percent of women delivering at Fatmawati -- a government hospital in South Jakarta -- are poor and from outside of Jakarta.

I can't imagine how this woman even arrived at Fatmawati. She probably got driven in, in severe pain, maybe shock. It probably wasn't an ambulance that brought her to the hospital. If it was, she might have been in better shape. If she was from a poor family, they would have had to find transportation for her -- maybe from a family member or friend. They then would have had to fight Jakarta traffic that no matter what time of day is a congested muddle of bumper-to-bumper chaos. It might have been a community midwife who referred this woman for at-risk care. Luckily, in her case, it wasn't too late. She made it through her complications and delivered her child, unlike the many who never do.

In my 45 minutes in one room of this hospital, one life was lost, and another was saved. This is real life, I thought: the antithesis to the office work most of us D.C. locals succumb ourselves to everyday.

Upstairs, we visited the at-risk -- low-birthweight, infected -- newborns. As a woman of 30, this sound was also foreign to me. As the doctor checked a heartbeat, a newborn wailed. It was like music. Babies vocal cords must transform quickly, I thought. The cry stays lovely for such a short stint of time. I could have sat with those babies and listened to them all day. It was beautiful.

Rewinding, we then moved on to the antenatal ward -- mothers receiving their pre-delivery check-ups. I stepped in as the Dr. Didi, the lead obstetrician, checked inside a waif of a woman. This woman is too small to be pregnant, I thought. What is she doing here? Her Indonesian skin was lighter than mine. Ten minutes later as we departed the antenatal wing, we saw her being wheeled by us over the tiled walkways back to the emergency obstetric ward. I couldn't believe my eyes. Her case had turned imminent in minutes. She would be another life to lose or save. It happens so fast, I thought.

As a fairly healthy American, from a middle class upbringing, I am shielded from this sort of life. I don't visit hospitals. Birth to me, even as a woman, seems foreign. Complications are horrifying. I must admit, I didn't want to venture behind that curtain to see that woman's reality in the emergency ward. I was too scared. What if she was lost. I have never witnessed death like that. I didn't know if I was ready to. Some people don't have that choice. I had seen enough just by hanging inconspicuously by the wall. I saw women, maybe 10 years younger than myself, washed out, terrified, sickly, with little swollen bellies, waiting for care, lined up like sardines, in their hospital beds. I could feel, in a way, what they were feeling. Although I couldn't know them, it was hard not to feel.

When I asked the public relations representative from Indonesia's Ministry of Health, who had been accompanying us during the shoot, where she had delivered her three children, she said: "not here," in horror. This hospital, although it seemed cleaner, more pristine than many hospitals that probably exist even in the dilipidated parts of the United States, and even my own Washington, D.C., this place was public, government-run, essentially for the poor -- for people who can't go anywhere better. The public relations person said she had delivered at a private hospital in Central Jakarta -- the location of my grand hotel -- because she had relied on her husband to make the right choice for her. Private hospitals for people with private insurance are the right choice. A government-run hospital, of the government she works for, is the wrong choice. I wanted to say do you think these womens' husbands made the wrong choice -- do you think they had any choice at all?

Tomorrow, our team will visit Tangerang Hospital, the success, the place that managed to cut maternal mortality by two-thirds in one year by working with providers across the health care continuum so that they are ready -- at each stage of care -- to deal with complications that may occur. When I mentioned Tangerang at Fatmawati, however, it wasn't matched with the word "success." It was poor. Tangerang is for the very poor, for the people who have less socio-economic status than those being serviced at Fatmawati. Despite this, ESD will help Fatmawati to adapt some of the best practices in obstetric care that Tangerang has already adapted. It will help JNPK -- the Ministry of Health's National Training Institute --to teach community midwives up through the hospital's head doctors how to save more mothers' lives.

Because Fatmawati still needs help. Although it seems to possess a certain conviction for maintaining its grounds, renovating its infrastructure and keeping its exterior pristine, there are inevitably still challenges. No woman should die just because she gives birth. No woman should die just because she can't afford to go to a private hospital. These lessons are universal, I think. Although I do know from reading statistics that there are nearly no maternal deaths recorded in the United States, I do not know what the inside of the local emergency obstetric ward looks like. Maybe I'll have to visit different hospitals in different neighborhoods to compare -- when I'm ready.

Sanitization, Segregation, Pomp and Circumstance

"Development is about site seeing," my colleague said yesterday, half sarcastically. I see her point, I guess. It has us shacked up here in Jakarta's Grand Hyatt, a palace of pomp and circumstance. It is where Indonesia's rich and famous come to get married, to sip cocktails, to eat $20 sandwiches. The hotel is connected to a mall that could be Bethesda, Fifth Avenue, Rodeo Drive, Gucci, Hermes, Tiffanys...I am not kidding. The place is crawling with Christmas. Rockefeller Center's Christmas tree has transported itself into the Hyatt's lobby. There are presents galore. The call to prayer at sunset today was laced with the back-beats of million dollar weddings, happening around the Hyatt's pool. And no wonder there is a cultural warfare going on here, in this country with more Muslims than any other nation in the world.

All the pomp, the circumstance had my skin crawling with guilt. I decided I had to get out, to take a walk, to try to venture beyond these grandiose walls without sitting in Jakarta's congestion. The only way around that was to use my feet. I left the lobby, turned left, turned right, with no visible exit in site. A man with a kalishnikov, obviously a Hyatt security guard, pointed out the way. I walked on the sidewalk adjacent to the highway and breathed in the carbon monoxide, the smoke from the taxis, the buses, the mopeds on an adventure to somewhere away. I walked for about 10 minutes, looking for a local place to grab a bite to eat. I saw none. Skyscrapers lined the streets beside me. I could barely believe I was still on the long island in the middle of the sea. The sea seemed miles away. At the end of my 10-minute journey, behind a decrepit metal wall, I glimpsed a little of something different: shacks in a circle, sitting on top of a swamp. It reminded me of an upgraded version of the squatter settlements in Niamey. The families had hung their clothes to dry outside their ramshackle housing. I peeked between the metal to see if I could see who the families were. No one seemed to be around, just 10 minutes from the pomp and circumstance of Grand Hyatt Jakarta.

I headed back to my so-called home. I bought a sandwich and a beverage, which ended up costing me $35. Thirty-five dollars that could have been more wisely spent, I'm sure. It is just strange that in an industry that aims to empower poor people using what seems like only tenuous resources, that we spend so much on ourselves. It is funny that in an industry that tries to explore, to understand foreign problems, we visit and live so segregated from them. How can we understand something we only catch glimpses of for a handful of hours every year, or never at all?

Time Warp to Jakarta

Ten minutes to landing and all I could see below was a vast expanse of sea. I imagined landing there amongst the ships casting themselves at all angles, completely tangled up in blue. I could float from one ship to the next until it took me to my landing site, in the great, big city of Jakarta. This is Indonesia, I thought -- 17,000 islands scattered between the Indian Ocean and the Java Sea. I saw one, maybe two of the islands, which looked like pin pricks, barely bigger than the boats surrounding them. Twenty-six hours of flying time later, I landed within this archipelago of natural wonders, and tried to begin defining what I would see.

I departed the jet with maybe 500 pilgrims returning from their holy journey to Mecca. Dressed in white and light bluish green, with comfy shoes and green pins reading "Safari Sebu," I imagined these pilgrims reflecting on their great journey to honor Allah, Mohammed, the chosen one. They had probably waited all their lives for that journey, many saving up for what would be the ultimate pledge of devotion in this lifetime, which would only be a testament for the next. As I read through the final chapters of "Infidel," I kept the cover hidden and bound to my lap. I wouldn't want the man in white to have any idea I might be reading this controversial book about one Somalian woman's journey from her devotion to Islam to her position as an atheist and parlaimentarian in Holland, who dedicated her later years to renouncing Islam and its damaging repression and abuse of the world's women. Ayaan's story definitely made me rethink feminist ambitions and Western cultural sensitivities and how far those sensitivities should carry us.

Getting through the airport was remarkably easy. Unlike my landing in Niamey a few months before, the airport was well organized, air conditioned, and had people from all over the world, dressed in in an array of fashions from short mini skirts to a full black covering, with only face exposure. Anyone could feel at home here. I immediately began getting smiles, the ones I had read about. The small amount of Indonesia I had seen reflected a friendly, lively place, accustomed to Western tourists.

The drive from the airport to our hotel in Jakarta could have been the drive from LAX to its suburbs. The highways were well-groomed, and billboards loomed among red, spanish roofs and what I think of when I imagine a hacienda. There were little peaks of poverty, shacks with tin roofs, among the haciendas. But the poverty was certainly less overt than anything I had seen driving passed South Africa's townships or through the Swazi mountains, and certainly back from Niamey's airport at 2 am this past January. Everything was lush, the antithesis to the Saharan desert. A tropical breeze blew the green grasses from side to side, while we waited in my first Jakartan traffic jam -- something that will probably come to define my stay in Jarkarta this week.

A black smog lays low in the air among the downtrodden buses, overblown mercedes and thousands of mopeds weaving in and out of their larger four-wheeled comrades. Westerners stay locked up in air conditioned cars, as their drivers meander patiently among the aggression of the other drivers around them. It could take 90 minutes to go to 10 miles, at an off-peak hour on an average day. Because I am sheltered here, in this grand hotel with hi-speed internet, I haven't felt how this sort of pollution can consume your lungs and make your stomach twist. In Niamey, the pollution and the oppressive heat, on many days, had me lying down by 1 p.m. awaiting the sun to drop. I imagine that I would feel the same way here. I imagine the young adopt asthma at when they are just babies, riding on modeps sitting atop the laps of their fathers. The old probably cough violently, and succumb to emphysema. Or maybe they adapt. I'll have to see, to notice, in this financial bastion of hi-rises and smoke.

On my first drive away from the sterility of the hotel to the outskirts of Tangerang, to our destination hospital, I began to get a peak of destitution outside Jakarta's financial powerhouse. Children ran barefoot on the side of the road. Little, unhappy girls strum their fiddles trying to earn maybe 10,000 Rupiah ($1) from us outsiders. Although it wasn't the same desperation I witnessed in parts of Niger, people scrambling for single cheerios in the sand, it said something about the vast inequities between rich and poor within just a few miles. While the wealthiest families held weddings at our luxurious hotels, with sponsorships from mercedes benz, and dresses that could have been the cover of Vogue, others just a few miles away run barefoot into the street. In a country of 255 million, I am sure during my two weeks here, I will only get the most artifical glimpse of this inequity. I would have to hop from island to island for year after year to get a real feel for this sprawling country in the sea.

Pulling into Tangerang Hospital, I was amazed at its beauty. It stood out amongst lush bushes filled with colorful flowers, patients waited for services on outdoor brown tile porches. This scenery masks the 3o out of 3,000 women who had died due to complications experienced during labor last year. By improving emergency obstetric care, an initiative in a large part led by the organization I am working with -- Pathfinder International's Extending Service Delivery Project (www.esdproj.org) -- that number was cut by two-thirds in a period of just one year. By giving community midwives the skills they need to stabilize and refer patients and by giving providers the skills they need to save lives, many less women have been bleeding to death, simply for becoming pregnant.

Over the next week, I will work with a video team to document the success at Tangerang Hospital, and the Indonesian Ministry of Health's plan to scale up the improvements in emergency care to other hospitals throughout the country. It is our hope that this video will help to convince USAID, and, as a result, Congress, to give more money to similar initiatives that will help to better the health care situation for poor women living in the most vulnerable conditions around the world.

During my first short visit, I already met characters who will inevitably bring this film to life. Dr. Herman, the head of obstetric services, will talk about how they saved so many women at Tangerang. He will laugh infectiously as he explains the intervention in Bahasa. Decision makers will remember him, as I will. Women, like the one Salwa (the ESD manager of this project) approached in the delivery room will become a symbol of why vulnerable women are important, essential, vital to the state of the world. They will smile from ear to ear, and like Salwa's new friend, tell us that the care at Tangerang saved their lives. After a botched abortion, Tangerang was this woman's saving grace. It is our hope that Tangerang, and, eventually all of Indonesia's other hospitals, will be the same saving grace for many more.