It's funny the things that grab people's attention, and gobble up the work day. Today it was a surreal exchange of views about designing t-shirts marking the relationship between my organization and the Japanese government. It started simply enough but took a turn for the weird when someone tossed in the idea of commemorative lighters (cheap to make, useful etc) only to be shot down by someone else who thought it condoned smoking. A day later and they're still at it, firing rounds across cyberspace.
And then there's the stuff that goes off like a wet fart. Two weeks back I circulated a report to all department heads about the situation at Banda Aceh's main hospital that recommend we steer clear of that viper's pit. I've not been asked a single question about it.
Here's the report in full:

Zainal Abidin hospital is in crisis.
- Local nurses and paramedics are threatening to strike.
- In some cases basic medical assistance is not being delivered at all because of poor morale, incompetence, and a lack of access to the necessary donated supplies exacerbated by endemic corruption.
- At least two children have died needlessly at ZA in recent weeks despite the presence there of a team of French doctors, and there are persistent rumors of a third preventable neo-natal death.
- Donated medicine and supplies are vanishing from ZA storerooms to reappear in the private, for-profit clinics who charge for the drugs, and on the black-market.

STRIKE
Local newspapers are carrying stories about demoralized nurses threatening to strike if their demands are not met. Paramedics are angry, exhausted and ready to walk out.
Specifically they feel they are not being adequately paid and are angry at the attitude of many of the doctors. They perceive the doctors benefiting and enriching themselves from the relations with the foreign organizations while they themselves are being shut out.
Many doctors are being seconded as consultants to international organizations (at one point not that long ago, one of the top physicians at ZA was working as a translator for the head of mission of one of the larger organizations in BA) while others spend most of their time in their own private clinics.

PATIENT DEATHS
A seven year old girl named Baitul was recently admitted to ZA in serious condition suffering from TB contracted pre-tsunami. She may well have aspirated tsunami water as well. She responded well to three days of treatment by French doctors working in the children’s ward, including an intervention that removed large quantities of water from her lungs. By the weekend she was laughing, eating and moving around on her own accord. The French returned from their Sunday day off to find she had taken a dramatic turn for the worse.
She relapsed because the ZA nurses failed to give her the necessary injections needed to prevent water from building up in her lungs. The French team was “scandalized” to learn that donated drugs were kept under lock and key and were not being made available to the nurses. When the child began having trouble breathing, the nurses put her back on oxygen. When the oxygen bottle ran out they simply turned it off and did not replace to empty canister. The result was the child spent an agonizing night during which the oxygen levels in her blood plummeted. Despite the efforts of the French team, Baitul died 24 hours later.

In another case the same French team literally had to break their way into a locked store room in order to retrieve an incubator for a newborn premature baby. They left explicit instructions that the intubator (the tube delivering air to the infant’s lungs) was to be checked regularly through the night. When they returned in the morning the intubator was lying in the bed and the infant died a short time later. It is unclear whether the tube was deliberately removed but the doctors learned that none of the nurses has checked the child during the night.

After this incident the French physicians threatened to leave. Following an angry meeting with hospital administrators some equipment and medicine did appear in their ward.

There is also a story making the rounds that I cannot verify. It relates to a second premature baby who was placed in a donated incubator. The nurse turned the temperature inside the incubator to 70C and the child died under the most appalling circumstances. I’m told this incubator was donated from Europe and none of the instructions on the unit were written in Bahasa Indonesia.
If two children (possibly three) have died while under the direct care of the French, I invite you to imagine what is going on in other wards. For their part, the French team has returned home in the past few days traumatized and extremely upset about what was going on in ZA hospital. It is unclear whether they will return.

CORRUPTION
It is common knowledge in ZA that medicine and equipment are being sold on the Black-market, in some cases as far away as Medan. In recent weeks observers at ZA have watched stores of drugs and equipment like wheelchairs, trolleys, medical lamps and items like gastro-intestinal scopes vanish.
There are also unconfirmed reports that an entire German operating theatre has disappeared.
Witnesses report local doctors writing up extensive “wish-lists” of medical equipment for foreign donors that in many cases they have no idea how to operate and/or are already sitting un-used in their original plastic wrap in locked store rooms.
Similarly there is strong evidence that outside physicians are buying large quantities of donated medicine and equipment directly from the hospital stores in order to restock their personal pharmacies. They then charge for this medicine.
ZA administrators keep large quantities of donated equipment and medicine under lock and key and it is extremely difficult to get access to what is needed. The problem is particularly acute when the person with the key to the main storeroom goes home for the day. Thus the need for the French to break down the door.
I’m also told that in some cases impoverished family members of patients are being told that no medicine is available and are being directed to the national pharmacy down the road from ZA where they are being charged full cost for domestic brands.
COMMENTS
With the exception of the recent news reports, I cannot independently verify any of this information but it dovetails with what I personally observed there in the two months after the tsunami. The information was collected by a close friend who spent six days at the hospital over two weeks observing conditions and conducting interviews with patients and their families, the French physicians and local nurses. My source is extremely reliable, speaks Bahasa Indonesia and has many years experience in Aceh specifically and Indonesia generally.
I’ve been to ZA many times over the past five+ years. The negligence and endemic graft that are a feature of most large hospitals in Indonesia has been amplified in the case of ZA and by extension the entire provincial medical system.
ZA was allowed to decay pre-tsunami because of promises that BA would get a new hospital when the existing facility was no longer usable. There was no investment in the hospital for years prior to the tsunami: the drains in the hospital for example backed up regularly for years before the tsunami because of a lack of proper maintenance.
Even the local press, when asked about backdoor deals, graft and prevantable patient deaths at ZA, say it is back to “business as usual”. All indications are that as direct international oversight at ZA is withdrawn, the situation for patients and staff is going to get even worse.
I bring it to you because we facilitate the delivery of medicine and supplies to ZA. I believe well-intentioned donors mistakenly think that once delivered, their donations are going to find there way into competent and caring hands when in fact the opposite is often the case.
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