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.
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