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.
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