Thanks to the funding from Direct Relief International, Rotary, Sakthi Foundation, YKI, Trend Solutions, BBC, IDEP, Vitamin Angels, and many many generous individuals, we have been able to continue giving much needed direct relief the people of Samatiga, Meulaboh, Aceh with our medical services. Sadly the operational funds Direct Relief was able to provide last year are no longer available. Bumi Sehat is actively seeking help so that our clinic services in Aceh and in Bali will continue uninterrupted. We hope some of the stories below will show just how precious this help is and how it does directly save lives.

Good progress has been made in 2007 with the new Rotary sponsored clinic building almost complete. Now it just awaits furnishings and solar power. The Vitamin Angel shipment finally cleared customs and they are being distributed to the local community as well as reaching other health clinics in Aceh, Bali & Nias.

Midwife Louise has been working very hard to educate the younger midwives and is concerned that her one-year commitment is not long enough to accomplish all she has set out to do. She has urged us to continue for at least one more year, so we are looking for another experienced midwife to take her place, please spread the word that Bumi Sehat Aceh is actively seeking an experienced midwife to make a long term (minimum 6 mos.) Commitment. Also keep in mind as you read that we need funding for operational costs for 2007- 2008.
Dr. Eman, Louise and Robin decided to give Ibu Saidia and her mother, Ibu Bulan, two traditional birth attendants in our area, hand phones. Bumi Sehat will also provide them with phone time, so they can call us to births or for transport, before there is an avoidable grave emergency.

Here are some excerpts from Robins Diary… April 2007
I am so in love with this project. It is so worthy of the donor’s efforts and the hard work of the support team at Bumi Sehat Bali. The Bumi team here in Aceh is sterling, every one of them. Even the construction crew is hard working, polite and well just wonderful.

Wil and I arrive in Aceh, and it has been a year for me. Last year I was here in Samatiga more than at home in Bali, so this was a wonderful homecoming. The staff where radiant. Midwife Louise had been here six long hard months, and I could immediately see the fruits of her heartfelt labor.

Dr. Eman had more recently come aboard, and his light was shining here in our little Tsunami relief clinic by the sea in Aceh. Since the staff ashram was now finished, it would be much more comfortable than all those long months of sleeping on the clinic floor, 6 or 7 to a room. The new maternal health clinic that the Rotary is building for us is astonishing, a beautiful celadon green gem in the swamp.

I mourned that the crew that graded the land and prepared it for construction had cut so many trees. This left the clinic grounds even hotter than before. In the following days our maintenance team, Pak Sudung, Adi, Jal and Hendra, would plant two dozen fruit trees to restore the shade and perhaps someday give food to the people. Earth Day 2007 inspired people to purchase more fruit trees to plant on the Bumi Sehat clinic grounds in Aceh, where the Tsunami swept almost all of the fruit trees away. 63 more fruit trees have now been planted at Bumi Sehat Aceh. How I wish the kind, anonymous woman who donated the funds for the purchase of the land could see the clinic now, and the fruit trees growing!

Normally within 24 hours of arriving at the Bumi Sehat Clinic in Samatiga, Aceh, I am called to a birth. This time proved the same I awoke before first light to bid Louise, our "Mother Midwife", goodbye, for she would be traveling to Singapore to renew her visa. "You have a birth at the barracks in Pucuk Leung this morning." Louise said. Our young midwife Devi and translator Lea were in the car with the birth bag in moments, and we sped off to the barracks.

Just before leaving Bali I had read in the paper, that there were no more Tsunami survivors living in tents or barracks buildings, that all had moved to nice new houses. I was to find out just how untrue the newspaper reports were.

Sliding in the mud and trash we climbed to the wobbly rotting porch of the barracks. Inside the dark room, no electric lights here, a vapor of urine and odors emanating from too many humans living too long in the post tsunami shelter, I found Murniati. She had been sweating and laboring for two days, the family worried, the traditional midwife, Ramlah was exhausted & the young government midwife, loosing confidence. As my eyes adjusted I found the young first time mother was pushing. She had been pushing for many hours, I was told. The young government midwife told me gruffly to put an IV line in, "She can't do it, she's too lazy and tired." I nodded, "Let's just see." I asked the elder midwife, schooled only by a lifetime of experience, "Have we any honey." Her eyes blazed, "Yes, honey, my mother used it in cases like this." A family member jumped to find some. The young government midwife scoffed. "It won't work, you'll see." I straightened Murniati's tired legs, massaged her and advised her to rest as much as she could. Within minutes of ingesting about two tablespoons of honey mixed with a glass of water, Murniati began good strong productive pushing. "We must make an episiotomy , or the baby will never fit out." The young midwife said insistently. 'Hummm," I said, "Why don't we leave it and trust the mother” The younger midwife, scoffed. The elder traditional midwife tenderly squeezed my hand in the dark. In less that half an hour we had a full crown and I was protecting the perineum with my gloved hands to ward off the episiotomy scissors. The baby wailed once as I placed him up on his mother's belly, Devi, the Bumi Sehat midwife, tenderly covered him with a soft cotton blanket. I stopped the young government midwife from cutting the cord too soon and received the placenta. There was a minimal bleeding. Devi, the elder midwife Ramalah and I helped Murniati put her baby to the breast. It was a happy scene. I returned later that evening to find Marniati resting on her side and breastfeeding her 3.25 kilo son.

Later that day I made home visits. In Cot Amoen I saw Lismawati. She had been mixing breast milk and infant formula, and was worried that her milk was not enough. We spoke of supply and demand, and encouraged her to breastfeed baby when he was most hungry, instead of giving the bottle. She said she was now exclusively breastfeeding, but I saw a newly emptied bottle rolling on the floor under the baby sling. We gave her vitamins, one of our new breastfeeding books and encouraging words.

In Alue Raya I saw Ibu Rosnizal, recovering from an emergency cesarean birth due to placenta previa. This was a case in which, had Bumi Sehat's midwife, Louise not been called, the mother and child would most likely have been lost. The baby girl, born 3 weeks early and weighing only 2.5 kilos, was very yellow and dehydrated. I felt she had lost weight. I did observe that this baby had a strong suck. I advised breastfeeding on demand, more frequently and for longer periods and gave the mother some vitamins and dressed her cesarean wound.

Lastly that evening after a very long day I visited with Misda Marie, who had lost her baby at birth about one month earlier. She was also post cesarean surgery. Misda was laying in the dark, on a mattress soaked with her own urine. Her parents said she would even defecate on the mattress. She had not been speaking and had hardly been up since the ordeal at the hospital. Louise had transported her for arrested labor, the baby's heart tones were strong and normal. The hospital did not take her to surgery until 22 hours later, by then the baby had died between worlds. The young mother's broken heart had left her paralyzed. I was able to get her to answer questions. She told me that her legs hurt unbearably, and she was weak. A look at her eyes told me she was anemic. I left her with vitamins and some massage oil, which her mother would use to rub her legs. I discussed the fact that the baby's spirit could not be free if her mother would not even resume living. I suggested that getting up, going to toilet and bathing were very important to the spirit of her child. When I went back to see her three days later, she was up. Her father said she had taken to heart my words and was bathing 4 times a day and 3 times per night. I am concerned that she sits and rocks and moans all the time. Gave her 'Hope' oil and a Bach flower remedy for trauma and to give courage. The next week Louise took her to the hospital and Misda Marie was diagnosed with a fistula and nerve damage. Bumi Sehat must raise the funds for her surgery two months from now.

It began as a slow day, patients coming into the morning clinic. Nurse Jo and Dr.Eman were covering, so I was quite relaxed. Then just before 5 pm, I was summoned, by a young girl on a motorbike, to help with a birth emergency in Gampong Cot. We flew and as it is our same village, we arrived in moments. I found many family members outside, crying. Inside, Elisa laying on her back, a tiny baby between her legs in a pool of blood and kerosene. The traditional midwife, Juariah was applying ice and kerosene to the new mom's belly, in an attempt to bring out the as the retained placenta. I took a deep breath and suggested everyone in the room do the same. First I wrapped the baby in a blanket, she was shivering, but otherwise healthy. I was able to discover that the baby was approximately two hours old. I felt the mother's belly, behind the retained placenta blood was building up. She looked shocked. I gave rescue remedy and asked Lea to mix four capsules of Yinan Baiyao with water. This seemed to calm Eliza, this was her fourth birth. Her first pregnancy produced twins who died upon birth. The second baby was swept away with Tsunami. There was a living toddler and now this baby girl 2 .25 kilos. "I am afraid I am dying." She told me, "help me, please help." There seemed to be no significant contractions, and this mom was hemorrhaging. I asked midwife Juariah to do nipple stimulation, put on a sterile glove, washed the area with betadine and went after the placenta. It was quite adhered to the top left of the uterine wall. I slowly peeled it off, and prayed. 15 minutes after our arrival the placenta was born, well with help, I gave 2cc pitocin and after the initial gush there was no significant bleeding. Two and a half hours later her blood pressure was normal, 100/80, she had bathed, peed, and eaten a big dinner. Eliza has been well at all subsequent postnatal checks. She named her baby Brenda, after my dear and courageous Islamic friend.

I am called to Darmiati's house, she is 22 to 23 weeks pregnant, this her 4th pregnancy, she has three sons. There has been bleeding since 19 Jan.(10 weeks ges.). I was happy to hug my dear friend, Ibu Bulan, the elder Traditional Midwife in this region, who called me to Darmiati's premature labor. Ibu Bulan quickly let me know that already a tiny 2.5 cm. long foot was being born. I listened for heart tones. The baby was still alive. I explained that this baby would most likely not make it through the labor, and certainly would not survive outside the womb. Darmiati cried, "I just know it's a girl, and I so wish for a daughter." She then decided to get up, walk, and eat. An hour later she came back into her bedroom, and birthed a tiny 1/2 kilo lifeless baby girl. We all cried.

Wil, Lia and I went into Meulaboh to visit Ibu Elly and the twins I delivered, a year and a half ago. Ibu Elly lost her baby and Toddler daughters in the Tsunami water... Less than a year latter she birthed these twin daughters at home into my happy happy hands. They were born on my 49th birthday.
We stopped at the hospital and gave all the midwives there small gifts from Bali, a 'thank you' for receiving the patients we often transport for intensive care. Sadly we were informed that two women who recently birthed twins in the Meulaboh hospital had died.

The Bumi Sehat twins, Mawar (Rose) and Bunga (Flower) have grown to be active, naughty wonderful toddlers. They both were suffering from many infected skin sores, which I treated. We heard that their grandmother had recently died. Elly was a glowing, as if her life were not lived in a shack, behind a black greasy motorcycle repair shop. I was happy to see that Elly was still breastfeeding, and gave her vitamins.

Elly's teenaged daughter, Yenni, had made the ranking necessary for her to enroll in midwifery school, and we had found a friend, Michell Smith, who would sponsor her education. Yenni guided us to "lapangan III", where over a year ago we had looked after a young woman, Rose, who had just had her 8th child, living in a tent. We found the Tsumani survivors living in this camp had received 3 X 2.5 meter wooden temporary houses from Catholic Relief Services. Sadly these people (approx. 1000 of them) had not received a food delivery for over a year!

Rose informed us that her baby girl, Rosediana had died at just four months of age. She had diarrhea and they did not even have enough money, about 70 cents to get transportation to the hospital. Rose is huge pregnant with her 9th child now. Bumi Sehat is looking after her, as she is very high risk. The camp she lives in is 2.5 hours away from our clinic. The Bumi medical team is very worried about her delivery, hunger, depression, unsanitary living conditions and a ninth time mom, she definitely will need skilled attendants. Louise has been following up closely with Rose. We also spoke with Ross from Catholic Relief Services to find out how water and sanitation conditions may be improved in this camp. Team Bumi will visit World Food Plan and find out why they are no longer getting food.

Last year Nursima, birthed a beautiful baby boy into my hands just 29 hours after he had died in the womb. She comes now to see me, 8 months pregnant, glowing, hopeful. We cry and laugh. We pray for a hopeful future together. In one week's time I have looked after four women who have lost new babies and at the same time have seen so many who bear the promise of new life. This is Aceh 28 months after the Tsunami. Robin Lim April 2007

We end this report with the sincere wish that we can carry on with our work in Aceh.

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