Asia 2010

Christmas in Bali is looking really good, even Hong Kong is freezing cold (about 10 degrees C). Ming and I jumped in the hot tub at the hotel and even it was cold! Fortunately there was a sauna to warm up in. It has been rainy, wet and windy so far.

Can't wait to get to Bali and the warm beaches and sunny days. It has been great visiting family here. The elders are getting older and really appreciate the visits. Bak Bak, elder uncle, is looking great! Last visit I thought he would not still be here but it looks like he may have beat the throat cancer that he had with his radiation treatment. He is looking fit and very happy now though perhaps still a little too thin. His bride is almost blind with what sounds like macular degeneration but her main complaint about life is that Uncle will not let her go out alone anymore, she says she can still hear and see the outlines of people, so she can get around fine on her own. These are resilient people! And so happy.

Not all play some photos of the work we were doing

Isn't it funny how the fun is what gets talked about when you write home. We also got lots of work done in Timor! Casey and I were able to meet with many health care providers, educators, students and NGO staff. We have collected dataon the duration if stay and number of primary healthcare providers, a comprehensive list of all healthcare related NGO work, both for the past decade. We are working on getting the demographic and health data for the country from 2003 and the most recent not yet published data as well from 2009 and the 2010 census data. Once we get these together it will be possible to lookat what works and what is most cost effective in a developing country in terms of improving health status. In 2000 there were essentially no doctors and no functioning hospitals or even clinics in the entire country.

Here are some pictures of us at work:

We met with the Cuban Ambassador and the leader of the Cuban Medical Brigade in Timor to get their cooperation to obtain the data on primary care in rural areas.They were very helpful. In photo the First Secretary, Casey, Cuban Ambassador Vazquez, Frank, Head Physician of the Cuban Medical Brigade, Dr Remanya.

After Dili we went to Baucau, the second largest city.

This is the main entrance to the hospital, Dr. Ozman is the Chief of Staff an intensivist and Dra Celestrin is a dermatologist. Notice the "No Kaleshnikoff's" sign on the door behind Casey. Very clean, efficient outpatient and inpatient programs. Lots of TB and other infectious diseases. No diabetes, lots of hypertension.

After a tour of the hospital we drove to a small rural clinic nestled under the second larges

mountain in Timor ( Mt Matebian ). Casey had rented a motorcycle and driven to Mt Ramalau a few days before we left on this trip and climbed to the top of Timor's tallest

mountain. Atthe clinic we met a young, very earnest physician from Cuba, Dr Acarda. We also saw the ambulance that takes patients from this suco (village) down to the hospital in Baucau. It is hard to appreciate in this photo but the back window has a large hole in it. Not a good sign for the very dusty roads of Timor. More seriously it also had no gasoline. It was one of two times that there were situations where for want of gasoline for the ambulance seriously ill patient were not able to get to a facility with more comprehensive services, leaving care to the isolated doctors on their own.

We went from spirited discussion in the rural areas back to Baucau about how to manage the protein malnourished children there that day to a visit to the medical school where we saw students with little more than and mosquito net and a few note books taking turns on some very dated computers.

They were very earnest and the teachers with both skilled and knowledgeable in both medicine and pedagogy. We attended a lecture and then saw the students rooms

. When I had to use the bathroom there there was a moment of quiet embarra

ssment as only one of the 4 toilets was in working condition.

The medical school is one of the places that you simply want to

do all that you can to help with. The students are eager and very bright the faculty are valiant in their efforts to help these young minds mature into seasoned healers.

We went to Los Palos a place that was where the brunt of the Indonesian represion took place because it was one of the more remote regions and the cradle of the revolutionary army that over time helped to make the country free.

Once we left the hospital and medical school in Baucau we made our way (after a day of rest on the beach!) to Los Palos. the pictures above are photos of that visit where we met Dra Ovalis and the other medical staff as well as some Timorese medical student. They currently are training in the clinics and hospitals doing rotations where they double as translators and medical students all at once.

Saturday trip to the beach!

We worked hard all week and now for Saturday! Casey headed to the mountains on a motorcycle, texted that he just finished the best ride of his life and was safely to a small town where he had a hotel room near he highest peak on the island. Sean and Sierra have had a tremendously challenging week (though I think that is actually the norm) and Ethan had missed the ferry (on left) to Aturo which will be his new home starting next week. The ferry left early as the Prime Minister was already on board. We packed up and headed to the beach about an hour east of Dili.

The most notable thing is that there are no people to speak of and the second thing is that the water must be 80 degrees. Of course Timor is 8 degrees south of the Equator so it is warm here. Lots of shells on the beach too I brought home two bags full. The fish are amazing and there are two or three small reefs off the beach before it drops off stepply into a trench that is 5,000 feet deep! We swam and just hung for a few hours. Fortunately there was a few clouds so the sun was not unbearable for us fair skinned types. I know this is all anathema to my Bellingham friends but that is how it is here in Camelot.

Ethan and I made a sand castle. The tide barely changes here but the waves wil

l get it eventually.

Ethan and Sierra swam way out into the ocean and they had brought swimming goggles! They worked great to watch the fish. I did not get out far enough to see the big coral but hope to when we got to Aturo next weekend. It was so quiet and peaceful. There are no houses, no traffic, few people and the place is simply amazing from a beauty point of view.

Eventually we decided to go home but it was a relaxing day at the beach. It was great to see Sean and Sierra relax after a very busy week.

Timor

We have been in Timor for a week but it seems more like a month. Sean and Sierra make it seem as if we have access to the express lane in life. They have a wonderful home that is secure, clean, well stocked with food and drink and they both have the ability to get almost anything done in short order. Sierra had two large grants due today so she has been very focused on those. Money to run Ba Futuru (for the future) is increasingly hard to find with the larger economic down turn and she still have a large staff and their families to be the provider for. Sean is very busy organizing the upcoming Tour de Timor bike race, and underwater photography contest and other events. He has, as usual, proven invaluable in every way. He even got us up at 5:30 a few days ago for a fishing trip down the north coast to the east. Did not catch any fish but saw hug pods of dolphins right beside the boat and flying fish that seemed to go right under the boat as we trolled along, popping up and flying for 30 of 40 feet beyond the boat. We have an invite to join the US Ambassadors family at the pool side tomorrow afternoon, I will likely go but Casey is itching to get into the mtns so will be taking a motorcycle to a town near the highest peak in the country and spending the night there.

Our real work is going very well. We have met with most of those that we need to, have got some initial data and made many new contacts. I believe we will have all the data we need for our study but some may not be available until November. The young man that I suggested come here from Bellingham showed up about 6 weeks ago and now is moving to the island of Aturo just off the coast and has been working for Sierra since he arrived. Ethan has learned fluent Tetun in about a month, mostly because he prefers to hang out with the locals rather than the expats. He is now an employee of the program and will be living in the house that Matthias and Andrea built on the island. We will head over there next weekend to visit.

I also met with Matthias and Andrea's friend Anders, that I had met on my first trip here several years ago. They are working on setting up Wide Area Networks so that folk in rural areas can have access to the internet and so that clinics can communicate and store medical information. Anders has developed a full electronic medical record system for the communities he is working in in Ermera. I could not be more proud as a parent than when I come here. One woman I met said, "Oh you are Matthias' dad!" He had helped here when he was here and made a very good impression.

I have posted a number of photos on Facebook, but will try to put some on my old website if I have time so that everyone can have a look at them. It is amazing how fast time goes by, we will be heading home in just 10 days!

Bali on a good day, not sure if there are bad days here....

Arrived in Bali today, short 5 hour flight from Hong Kong. Sierra and Sean were just behind us coming in from Timor, we were just going through customs when they came in. We all got our luggage and Sierra and I headed to the hotel while Sean and Casey went to Ubid to leave off some graphics files for public relations work in Timor. Sierra and I checked into the hotel, a nice place with a view of the beach and ocean, long zig zag pool through the middle of it and the most amazing ‘bonzia’ trees in huge pots that were about 6 to 12 feet tall. Sierra is so efficient we then went to a grocery store, changed money, got a phone card and into a taxi within about 5 minutes and were off to Kudeta to get tickets for tomorrow nights dinner.

Kudeta has an annual ‘whites party’ where there is a dress code that everyone has to wear white clothes the theme this year is Be an Egyptian. The place has a large boat in the center next to the dance stage many 15 foot tall statues on the way in of pharaoh looking fellows and a large pyramid at the entrance and on the beach side of the dance floor. I will definitely take photos and post them when we go tonight. This is Sean’s birthday and his choice of a fun evening. Casey and I brought white clothing, as Sierra had asked , now we just have to figure out how to look Egyptian in them.

We had a great pizza dinner and I headed off to bed about 10:30, Casey, Sean and Sierra heading off to the local club to dance. From my room there was really great live R&B wafting in the window for about an hour, lovely way to go to sleep in paradise. The bed was in a window seat with tall glass windows on two sides overlooking a palm tree lined garden-courtyard. You could also hear the waves crashing in on the beach just across the street.

This morning it is so quiet at 6 AM, with no one in the courtyard out front or out back and just the waves crashing on the beach. The sunrise is just a light pink. It is a wonderfully quiet time of real peace, just a gentle breeze off the ocean. Sitting on the deck and looking out over the open ocean with a hot cup of jasmine tea. It is still cool and the birds singing are my only entertainment. Life is good in Bali, everyday.

Hong Kong!

Well it is very early in the AM here. Wonderful flight, slept over 8 hours on the flight. Had a great veggie meal then watched Alice in Wonderland, talked with the lady across the isle and then off to nap land. The woman across the isle is Canadian but has lived in Thailand the past 10 years starting first one and now running 7 homes for orphans. She is clearly hooked on what she does and has been gone so long that she has to enter as a 'guest' back to Canada. No glitches so far in travel plans. Cathay Pacific managed to get me an isle seat even after the entire flight was full. Thanks to Jiasong and TaiMing for taking me to dinner in Vancouver and getting me to the flight several hours earlier than everyone else, I was first on the list for seat changes. I hate being in the center seat, and fortunately did not have to be. Casey and I are good travel mates with lots to talk about. He has finished his third year of medical school and is very well traveled so the conversations are endless. I am looking forward to this time together just to catch up on the past few years when he has been so busy studying. It is inspiring to see a highly motivated, talented and caring person setting out to a career in medicine. Can't wait for Matthias and Andrea to get far enough along that we can start to do projects together!

Hong Kong is such an easy place to be. Great food, clean, well organized as always. Easy to like. Breakfast at the same place that Jiasong and Taiming and I always eat in the airport. Not enough time to go into town and it is too bad beautiful, clear day. You can see the gondola going up to the huge Buddha statue on top the mountain here on Lantau Island, the hydrofoil going by from Macao. Beautiful to day. Almost time to get back on the plane and head to Denpasar, Bali.

ready to go.....

Sitting in the Vancouver BC airport waiting to board the plane to Hong Kong and then Bali. We will spend Fri, Sat and Sun in Bali and then on to Timor. Everything is a finished as it can be at home with work and family. Always more that could have gotten done but all the critical things are done for now and a new vista of work is emerging through the cloud of issues that is in front of me. We have appointments to make and keep with key people as soon as we get there. The pivotal issues of how data driven vs how 'qualitative' the project will be is still a major issue ahead of us. The level of cooperation from the health ministry and other key partners will not really be know until we are there and have talked with those key player in the process. As always Sierra and Sean have already and will continue to be critical to our success. Small nations are always so interesting because you can see how the power structure works so much more clearly. The same things go down in the US government we just do not get to see at because we are so far from the leavers of power.

It is so exciting to get out on the trail. I feel sorry for those still at home. Jiasong most I think, she loves so much to travel and it is really hard on her to have me out there and her at home. I really do appreciate how supportive she is and how organized and helpful in making this (and all the projects I do) possible. TaiMing was great tonight at dinner speaking three languages and being so polite and thoughtful far beyond his 6 years. He really enjoys speaking Cantonese and is expanding his vocabulary and takes the tonality of nine tones in his stride. The waiter and waitress were smitten in a wonderful way with him. I will need at some point to improve my Tetun (easy to do as I am moving up from nothing).

Wonderful to have two great kids in Timor before me. The more I learn about Matthias' projects the more impressed I am. Sierra just keeps cranking out amazing work too. Sean has been having more fun and doing more travel and organizing than ever. One proud papa her all the way round.

Well just checking in before getting on the plane. Hope you will stay in touch!

Frank

Here is a map of the context of Timor, with the Philippine's just north and the Land of Oz just south of this tropical island just 8 degrees south of the equator.

Leaving for Timor in a few days. Just asked Casey to pick up a freestanding mosquito tent. Looking forward to NOT getting another tropical illness this trip. Here is the destination. We will start in Dili. Well actually, we start in Bali, Sean and Sierra are going to meet us there and spend a couple of nights there on the way to Timor! It will be fun, they will be celebrating Sean's birthday and we will be celebrating getting to see both of them. Casey is ready to go after a few weeks working in Haiti earlier this month, Timor will seem like an easy place I am sure. We are both excited to get on the road. I have an almost infinite amount of work to do be fore we leave on Thursday. Two more days at Nooksack and one long Wed in San Juan to get a months worth of work done. We are opening a new clinic that the Nooksack Tribe will own in Deming but will serve all the people in the region starting in January so a great deal of planning going on there. An on San Juan there is Pertussis outbreak and a Norovirus outbreak right now (in both a summer camp and a childcare center). So race to the finish line for now. Just got off the phone this morning with Ed Kelly about Jhamtse Gatsal School in India and the likelihood of getting a dentist to go there to use the dental equipment that I helped to install in the spring and it is looking more likely now.

Frank

Back to Timor

I am still recovering from Chikungunya 4 months after my last trip to Timor. CHIKV, that is how literature refers to Chikungunya viral fever is an infection transmitted by mosquito bites that is very similar to Dengue fever. Actually I got both Dengue and Chikungunya in Timor on the last visit, but Dengue goes away after a few weeks of fever, headache, severely painful joints (it translates to 'breakbone fever in many languages). The problem with CHIKV is that it last for months after the acute infection is gone. I had trouble walking, could not lift a teapot and generally was miserable. Drugs helped though and soon I was on very high doses of a kind of anti inflammatory called celebrex, the only problem with it was that rarely it caused heart attaches and bleeding to death without warning. Needless to say I was ready to be off it the day I started it. Eventually, after consulting several doctors both the infectious disease specialists at UW and CDC and a local joint specialist I started on a very old drug used to treat malaria, hydroxycholoroquine, and am doing better now. One of the interesting things was that the joint specialist recommended acupuncture, and some Chinese friends abducted me and took me to Vancouver BC for a treatment by a Beijing trained acupuncturists. It did not make much difference in the pain that day but the following day I woke up pain free, that lasted 5 days! I was impressed, but as she had said it would be temporary. By then the new medicine was kicking in and I can do most things now with only discomfort and it is not so painful that I cant do the routine every day things I need to.

Day before yesterday I started rowing again, first time in 4 months! It felt great to be back on the water. Last night took the canoe out and today other than a few sore muscles feel great. It makes the small joints in my hands a little more sensitive but not so much that I can't type. You get so de-conditioned when not exercising, it will take a while to get back in shape.

The upcoming trip to Timor is exciting. Thursday, Casey Hastings and I met with Ali Mokdad at the UW center for international health metrics and came close to a final design for his MPH thesis project. We will be comparing the impact of primary care vs disease specific programs. There have been huge amounts of aid and aid funding flowing into Timor over the past 10 years and life expectancy has increased by 10 years in the past decade, now well over 60. We will be looking at the reasons for the decreased early mortality in infants, children, childbearing women and the overall population. There is a political edge to the project as well in that the primary care changes were brought about by the Cuban government when they sent Cuban physicians to every district in Timor nearly 10 years ago, took hundreds of Timorese students into the medical school in Havana and started a medical school in Dili with 90 professors. The aid programs from the US and other donor nations has focused on disease specific efforts mostly in the largest towns and more urban districts.

Casey and I fly out of Vancouver on Aug 19th and will return to the US Sept 9th, a short trip but it will allow us to get the core work done, Casey will be headed back later to finish up the data collection. One of the best things about flying to Timor is that you have to over night in Bali both going and coming because there are no connecting flights the same day you arrive! It works well to have the day to catch up on get lag and Bali really is one of those special places where you simply have no choice but to relax and enjoy, it is just the way the place works.

I will try to post regularly off on another adventure there and back again.

Frank

Malaysia to Taipei

Sitting in the airport in Kuala Lumpur waiting for my flight to Taipei. It is hot out side but very comfortable inside. A bit of excitement this morning when I went to the wrong airport and had to taxi about 20 miles to the other on short order. Very lucky that it was Saturday and there was not much traffic. Then when I got to the right airport after using my credit card to pay for the taxi, my credit card would no longer work for checking my luggage! I had not changed much money, dont get to Malaysia very often. Fortunately I carry a back up debit card for larger transactions and getting cash from my account at home, which did work. Luckily I am headed to Taipei where there are friends and it is easy to do the business of setting things straight. Malaysia is very modern, clean, efficient and friendly. Would love to come back and spend more than one day. Over all the trip has been great. Timor is always great because Sierra and Sean are there, they are such a joy to visit. I am a proud father every minute of my time there. I know that Sierra does not see the impacts of all that she does but it is wonderful to see the lives that she has touched and changed. Mostly the staff that work with her. They are transformed and will be the people that carry forward the work of human rights and peace in that nation. They are strong and firm in there resolve and it has been through the constant support that she has provided. Not just the person that comes for a few months but for a substantial part of her life. She too will forever be changed by what she is doing and has done. She is clear and strong and sure of herself... as I said a proud father indeed. I wish that I could have stayed until Matthias arrived everyone there loves him, his energy, his willingness to try to fix anything.

Jhamtse Gatsal was a challenge and joy. It was hard being so sick there and loosing 3 or 4 days. It was a short visit so it had to do double time to get all that I had planned done but the dental clinic is set up and ready to go. All the staff and children got examined and some management plans put in place for the most urgent. Jason, stayed on for a few more days to continue the treatment plans. He was a great help. The kids were healthier than last year and though progress is slow it is wonderful to see the new buildings taking shape and the program growing with new students and staff. Watching the kids get a year older was amazing too. Such a positive place. The new vehicle was what got me the last leg of the trip from Tawang to the school when I was coming down with dengue and took me to the hospital in Tawang a few days later to get tested for malaria, so I appreciate that capacity and am thankful for it being there and being able to take sick folks where they need to go!

Well time to board the plane to Taipei...

one more leg, an easy one! Taipei is always a joy to visit. Everything from the States is there and all of Asia as well.

Frank

Last full day at Jhamtse Gatsal

Today is a sad day for me in two ways. One of the people I admire and love the most in life is about to die. Tutu Iverson is an amazing person that retired from being a children's librarian and then took on a full time job to keep Interfaith Clinic running for many, many years. Over those years she did everything from cleaning the bathrooms to running the front desk to medical records to doing patient care her self when needed. She was always a joy to have around and far too often she had to pick the lock of my office door when I did not have the keys. You learn a lot as a children's librarian. She spent 40 hours at our home when TaiMing was trying to get out and into the world and was a wonderful support in the fun times and also with the crash C-section. She has a magical way of disappearing and reappearing when ever she is really needed. I sent her a note and said to get out of bed get a plane ticket and get over here to the Himalaya because I needed her help but I expect her family will talk sense into her and keep her home. She is on oxygen and in renal failure but I can feel here presence here with me now, yes really. She was one of those people that was always there when you needed her, always got the job done no mater what it was and did it all with an impish smile and warm heart. I brought that part of her with me and will leave it here with these Mopa People from Tibet that I am caring for so that they have some of her to live on here too. I feel like she handed out love to anyone that needed it and that is the most powerful medicine of all.

The second sadness is that I leave tomorrow. This is a special place, the kids are so happy here and they have literally nothing, well nothing other than happiness that is. They play with one another, new kids come and the others just hug them and hold their hand and ask them to come and play. Often the most common game is like hopscotch with lines drawn in the hard ground and a rock tossed to the place that you skip to. Fairly low tech, eveyone has what it takes to play and they all seem very happy to share what ever else they do have. When they walk by they say 'good morning sir' or 'how are you?'. Since English is the 3ed or 4th lanugage for most of these kids I always try to take the time to talk with them out of respect for their efforts. I have finished what work I can get done and now have to do the work back home so I can return again.

love you all, life is so precsious and we have so little of it. Be happy and love one another as best you can.

Frank

Internet and I are both up and working

For the first time in many days both myself and the internet are up and working! I had the last rash from Dengue yesterday and am back to full speed. The new internet here is wireless and works amazingly fast and efficiently. Very knowledgeable young man from Assam has been working on it with Nawang to put in the antennae and getting the software in place. As always the Mac was a bit harder to network with the PCs but it is all very happy working together now. Held clinic outside in the sun today. Kids are much healthier than last year. One eye infection, one ear infection (yes just one!), one child with worms and some skin infections are the little stuff. A few more serious problems, untreated or even fully evaluated seizure disorder, heart murmurs that I am unsure of the significance of, and a couple of others. Some of the staff have much more complex medical issues advanced Graves disease in a fairly young person, lots of what must be H. pylorie infections and a surprising number of staff with increased BP (I keep checking both mine and Jason's to be sure that the cuff is working properly).

Off to get back to it now.

Frank

Fever on a hot day

I never thought of a fan as a weapon against deadly diseases. But lying in a bed at night in the tropics, 8 degrees south of the equator, in the monsoon it definitely has the power to save your life. With a fan that is set to sweep across the bed very 5-10 seconds this mechanical miracle is what keeps the mosquitoes away which transmit malaria, dengue, Japanese B encephalitis and chikungunya fever, to name a few of the most prominent here in Timor. You can hear the familiar buzzzz in the room at a distance staying out of the blast of air from the fan. There are many people coming down with the type of malaria that causes 90% of the deaths from the disease, Plasmodium falciparum malaria and the just inconvenient dengue fever that lays you up for about 2 weeks, the local translation of the word for it is ‘break bone fever’. It is now at the end of the rainy season but still very hot so the fact that the fan keeps you a bit cooler is an added plus. The thatch roofed home that I have been in for the past week is beautiful and very functional but is also open to the outdoors entirely. It was sort of an academic insight about the fan until I began to feel hot two days ago. Yip 103. Then the headache… I worried about dengue… then malaria. But a paradoxically reassuring grumbling deep in my stomach let me know I had less to dread. Every thing inside me quickly flowing out, in both directions. Then came day, a daze that passed for a day in my life when everything was a fog. I have not spent 36 continuous hours in bed, ever. Being dehydrated you don't even need to get up to pee, and as I said my innards were cleaner than the preparation one gets for a colonoscopy. The nothing in… nothing out equation works for a while until you start to feel light headed and drift into delirium.

Sierra and Sean once again came to my rescue. The day before I had hitch hiked the 5 kilometers into town with a flat bike tire on the back of a dump truck but today I needed curbside service. They picked me up and deposited me in their spare bedroom. I am generally not a fan of air conditioning but when you are hotter than the temperature outside in the tropics it feels really great to turn the AC down to 23 degrees centigrade and get cozy under a single sheet. The other advantage of AC is you can keep the windows and door closed and you can swat the few mosquitoes that make it through when the door opens to get into the room.

My blood was drawn at the local clinic, the guy was really good, there was almost no fluid left in my body and he still managed to get 3 cc’s out of me in one stick. The tests for Malaria, Dengue and a CBC were off and would be back in a few hours. Never take chances with fever in malarias regions. One of Sierra’s staff came by and picked me up at the laboratory and deposited me back at her house, retuning to the womb of the air conditioned room. I knew I was getting better when Sierra came in the next day and thought the room was too cold and I actually felt not hot for the first time. The day before no matter how cold the AC went I felt like I was in the Saudi desert.

When you are sick sometimes you do not think very clearly, I was sick, very sick. I went to the pharmacy and got doxycycline and started myself on it! Great idea for the prevention of malaria, not a great idea to treat it and a really bad idea for treating diarrhea. It was the next day when my brain came back to functioning a bit that I though……hum…… what about a drug that kills gut bugs maybe? A single dose and I was out the door to Hotel Timor for tea. I have not eaten for two days except for a bowl of soup at lunch today. Perhaps tomorrow I will feel like eating again. For now I am back at the picturesque bungalow… with the fan pacing back and forth keeping the fully loaded mosquitoes at bay.

Sierr's past 5 years in Timor, letter from a father

What follows is a letter that I just finished the recommends Sierra for an international Human Rights award. It says most of what I need to say about how proud I am of her and her work here in Timor. I do not know if she will be awarded the Gwangju Prize or not but she has already won what matters most the love and affection of many people in this place that has been on very hard times for a very long time.

Frank

23 February 2010

Gwangju Prize for Human Rights Selection Committee

Albeit unusual for a parent to write a letter regarding a daughter’s nomination for the Gwangju Prize, I believe my point of view can provide perspective on the broader issue of what it means to a society when our youth literally risk their lives to protect those of others, while at the same time assist in providing information which may be useful for assessing the qualifications of Sierra James for the Gwangju Prize.

I was awoken at 2 am by the phone ringing, I am a physician and this is not an uncommon event in my life, but the person on the other end of the phone line was not a patient but rather my daughter. She had been working for two years in Timor-Leste on a peace building and human rights initiative that she stared in 2004, before the conflict reemerged and the situation there grew even more dangerous. Timor-Leste is one of the newest countries in the world and one of the poorest nations in Asia.

That night on the phone she got directly to the point. It was the worst headache she had ever had, to go outside she had to wear dark glasses because the bright light was too painful; she had a fever. Then she said that her neck was very stiff, too stiff to bend. I knew that her life was on the line in an instant.

She had an infection in her brain and spinal cord, it was a medical emergency, but there were very few physicians in Timor and at that time it was still unstable. There was nothing I could do but urge her to go to the hospital. I had visited briefly in Timor and already knew that there was not much there - no real laboratory support, few medications, and the hospital was still surrounded by a camp that housed hundreds of Internally Displaced Persons from the recent civil unrest.

Eventually she was able to get into the military hospital where Australian doctors and nurses attended to her treatment. They decided that it must be meningococcal meningitis, although they couldn’t test for it in-country. They were able to get her the medication she needed swiftly before she died, even in the United States this can be challenging as we often only have minutes after diagnosing someone to get them treatment for this disease before they expire.

As a parent I had to decide, to insist that she give up her work in Timor and return home or to let her stay and be at ongoing risk, where danger literally was around every corner.

A few months later another incident occurred, which I learned about from her brother. She had been detained by drunken men with machetes when they stopped her car on a back road by standing in the roadway. As the men turned around to discuss what to do with her, she stepped on the accelerator and was able to get away narrowly escaping what could have only been a very bad outcome.

On another occasion she called me in tears after she returned to her house to find it covered in blood and missing all of her worldly possessions. The intruders had killed her puppy with a steel shafted arrow from a small crossbow - these were common at the time as they were silent so an ideal tool in robberies at night - and then taken just about everything, not even the hot water heater was still left in the wall.

It was an educational experience for her to realize that all the material things in life do not matter so much, but it was also practically hard to rebuild her life and overcome this traumatic experience so that she could continue the human rights work that had become her passion. She considered herself lucky in a way as at least her house had not been burned to the ground which was a common strategy to prevent evidence coming to light about the identity of the thieves.

There was a point at which I had to give up and try to let go of my fear that she would be killed or maimed in the seemingly endless civil war that was going on in Timor-Leste. The only comfort I had was that she was doing what she loved. Back in the United States the most likely reason for a young person to die would be in a motor vehicle crash, a senseless, meaningless way to die, but that was a small comfort. The only comfort came from knowing that she was following her heart to serve other people and to be fully alive to a life in solidarity with those that were suffering.

Others will tell you more of her work and her accomplishments in peace building, human rights education and being a resource for the people of Timor-Leste, but there are two stories about her work itself that I want to share with you.

During the height of civil strife in Timor-Leste the police and the army were at odds and the country become divided between those from the East and those from the West. Sierra had been working for several years by then to bring people together, developing programs that taught human rights and child protection while also providing people with alternative dispute resolution skills to resolve their differences peacefully. One of the young men that she had trained was on a bus when it was stopped by a group of vigilantes with machetes. They came on the bus and said that anyone from the East side of the island had to come with them. Several people slowly and fearfully stood to leave the bus with the vigilantes, but before harm could come to them Sierra’s student a loveable young man with keen intelligence and courage stood up and said to everyone on the bus, what if I were from the East? Then slowly, first one then two then everyone on the bus rose to their feet looking at the men with machetes. They backed off the bus and the bus went on with all the passengers. When I heard this story I knew that Sierra had done her work in Timor well and that someday she would be free to return home and leave this small nation in the hands of those whom she had trained and who would be the real future of that small nation.

The final story is about how the work of peace building goes on in the community in much more settled times. She has taught about the human rights of children and of women in particular but perhaps the most telling story is one when two of the heads of villages, Chefes, who were required to attend her trainings on conflict resolution and human rights. Women are not often in positions of authority locally and the elderly men charged with being both judge and jury in local conflicts seldom listen to a women’s perspective, however almost all of the trainers that Sierra has working with her are Timorese women. Women have a natural affinity for peace and human rights being the center of family and having to resolve many conflicts each day. These village headmen begrudgingly sat in the back of the class with their arms crossed. But over the course of several days what they learned was how to resolve conflicts effectively with the best chance of everyone in the conflict being heard and feeling a sense of ownership in the final outcome. By the end these elders were not only happy they were there but grateful for their new skills. As one said, he had to live with the people in the village for the rest of his life and the better he could negotiate and resolve conflict the more likely he would have a peaceful and happy life. The word spread and now there is a waiting list for the heads of villages to take the training on conflict resolution at their own initiation, even though it is taught by women, most of whom are much younger than the village leaders. These are the kinds of outcomes that are hard won and long lasting.

Peace comes to a country one person at a time. I could not be more proud of my daughter and her work and humbly ask that you consider her gifts to the people of Timor-Leste, her time and talent, and that they may warrant consideration for the Gwangju Prize.

My trip had been uneventful until I got to Bali. Flight connections….. Flawless. Slept for 8 hours across the Pacific. Free Internet in Hong Kong was great. Perfect seat assignments on the isle and interesting passengers to chat with all along the way… Then I got to Bali. Even there I was almost the first person off the plane, the hall were you clear customs was unbelievably full (especially for 1:40 AM), in fact it was entirely full and overflowing up the walk way from the planes, hundreds and hundreds of people. Mostly Chinese mainlanders and Korean tourists in groups filled the hall. Even then I walked through the disorganized cacophony of a crowd to a line to purchase visa permits (now up to $25 for a thirty-day single entry visa). I was now ahead of literally several hundred folks still trying to figure out what line they were in and what they were suppose to do next, and was off to the immigration agent, again looking ahead I crossed over to the opposite side of the large hall and there before me was a line with less than 10 people in it, a new worker had just started a new line and I was just in the right place at the right time. The other 10 lines had 50 to 70 people in them.

A few minutes later I was the first one form our flight looking for my baggage, the others hundreds of people behind me in a line moving like a slug on a cold wet day back home. The baggage was being stacked on the conveyor belt two high and when the belt careened around the corners the luggage would tumble off to the side, sometimes inside the belt, sometimes outside. The first few first-class passengers were just arriving when my old, black Samsonite suitcase straight from the Goodwill came around the corner on the belt. Soon followed by the box that Sierra had sent with me that contained a thick temperature conforming mattress for her bed in Timor to help her sleep with the herniated disc in her back. The box was small about 2.5 feet on a side. The queen sized mattress was compressed into the box, or more accurately the box had a very dense round ball inside of it with a highly compressed and then covered in plastic wrap mattress, sort of like the sponges that kids sometimes get in a very small container that when gotten wet expands to many times it size. The box had the cover for the mattress too, which took up a lot more space than the mattress itself because the mattress was so powerfully compressed.

I walked directly from the conveyor belt where the items had been collected to customs, again no line and no problems. I put the box, the suitcase and my briefcase in the x-ray unit and walked around to pick it up on the other side. All came out fine but as I walk toward the door a short mustached and uniformed man held up his hand and directed me to the bench where luggage is searched. He was not the least interested in looking through the briefcase, and suitcase. I had two computers in my briefcase that might requires some real explaining and had a supply of medications in my suitcase, enough to take care of an entire school of children, that I was headed toward in the Himalayan part of India when I was finished in Timor, which likewise might take some detailed explaining. But he had eyes only for the box, which had a hastily encircled rope, actually two ropes. One old piece of hard yellow plastic line and an even older cotton rope of a much smaller diameter, that has been tied hastily around it so that there was some way for the luggage handlers to easily pick up the parcel. He untied the ropes and started to cut open the box, I was afraid he would cut the mattress inside so I offered to open it for him. He immediately handed me a box cutter and happily watched me carefully cut the seams open and lift the lid of the box. Another man approached and stuck a wand inside and went off to a machine on the side of the hall.

Now I have always seen but never really thought about those signs I had just walked by that say in all Capital letters: DEATH TO DRUG TRAFFICERS in blood red letters. As the alarm went off a second time the machine that tests for illegal substances I began to think about those signs. The mattress in the box was brand new, was bought in the US, the box had not been opened, all the pertinent facts raced through my brain as the customs officials of higher rank gravitated to my station. The questions began, where had I come from, where was I going, what was in the box, where had I bought it, how much did it cost, did I have a receipt…… Lots of very straightforward questions. When first asked what was in the box I had said that it was a mattress I had bought for my daughter because I did not want to go into the long explanation of why I was taking something for someone else into another country. Instantly life became more difficult as they asked what store I had bought it at and how much, exactly, had it cost. I said “Kmart” reflexively and guessed $215. They retorted that it would be much more expensive than that here in Indonesia. Then they sympathetically said they wanted to test it further. My sense was that they believed I was who I said I was but now they needed to prove that the test was wrong. They took the highly compressed mattress out of the box and tested it again this time reaching down inside the outer wrapping of plastic that kept it compressed …… same result. Then they said they wanted to put it through the x ray again.

Not since I had been detained a few years ago in Laos by the military police for having a satellite phone, have I been in this much of a stressfull situation. I had taken photos of some political posters and then made a call to a friend that was near death from recurrence of her breast cancer from a bus station in Luang Probang. The station manager had asked to see my passport, he kept it and soon a man with a gun showed up followed by three and eventually by a truckload of men with rifles. They had taken me off to the basement of the military police headquarters to talk with me, requesting through three different translators just one thing, why did I have a phone that did not go through their phone system and who had I been talking to. Not unreasonable questions, I just did not have what to them were satisfying answers. Not since then had I felt the pressure of being abroad and feeling like something could go wrong that could not be fixed by the light of day on the issues at hand.

Back at the x ray machine, first a high definition one and then the regular one with a crowed of inspection officers huddled around, I peeked a look too. The mattress just looked like a very dense gray cloud, much denser at the center. I had kept an eye on my other belongings as there was now a stream of tourists flowing through the customs station which had been almost entirely abandoned by the staff and the bolus of passengers that I had gotten ahead of now swelled to overflowing and even those that have been backed up into the baggage area were now a torrent of people through the inspection benches. I returned to my suitcase and brief case and waited for the head officer, who directly came to me to say politely that they would need to open up the highly compressed mattress. Now all the customs people, about 10 were focused one my box and the flood of passengers flowed by in what seemed like a torrent of people, no one stopping but many watching what was going on. I said it would be impossible to get it back in the box, a fact they were well aware of.

We negotiated and the lead inspector very generously said he would keep the box over night and that I could pick it up in the morning and take it with me to Timor, presumably letting the Timorese customs people deal with it in a place where a queen size mattress would be easier to manage since it would be in a place where a huge mattress could be transported by car rather than by plane. Just as this was agreed to by both of us as a great resolution a short 40ish man in civilian clothes walked up to us and spoke to the customs official, both were then frowning, more talk in Indonesian, and then the customs official turned to me. “My boss” the man in slacks and a civilian shirt, “says we have to open it up, now”. There was no doubt in his voice and the certainty of the tone let me know it was time to figure out how I was going to get a huge item like a mattress on to a plane as luggage, thinking that someone in Bali was going to have a new bed tonight. There was little to negotiate at this point. I knew it would expand but was not sure how quickly. They carefully opened the box took out the gray plastic wrapped mattress that looked like an over grown football but less pointed ends and about 2 feet long. The plastic wrapper was pulled out and was a tough plastic wrap like you would put a sandwich in but about 4 feet wide and considerably thicker, about 3 yards of it unrolled easily and they we came to the mattress material, it was very dense and began to move as if it were alive but very slowly, like a genie getting out of a bottle after centuries of captivity. About 5 feet of the mattress was now laying in an 18 inch wide flattened mass perhaps 4 inches thick. Fortunately the young man with the testing wand quickly took a sample and directly walked back over to the testing device. Everyone looked at him as the line of tourist slowed to gawk at the proceedings but never came to a halt; they just became a molasses like group of upright sardines with rubbernecks looking back at the proceedings.

The thought crossed my mind that perhaps someone had put something inside the box to get it here and then would steal it back once I had left the airport and that I could be in real trouble, but before I was able to perseverate on that fear, and as quickly as it had all started with a casual request to look inside the box all my fears vanished as the man who had taken the test shouted to the boss that it was the plastic wrap and not drugs that were responsible for the results. The clear plastic wrapper had tested positive but the mattress itself was fine. Presumably some plastics cross react with more malevolent substances. Even though it was said in Indonesian I some how understood and everyone had a look of relief on their faces. The head of the uniformed customs officers explained what I had already guessed. He apologized for the bother but at the same time he and his team were rapidly trying to put the genie back in the bottle. Amazingly, and entirely unlike in the fairy tail, the mattress was as quickly as possible rewrapped in the plastic and though it had expanded some it was possible to stuff it and its cover back into the box from which they had emerged, bulging on all sides but still it fit! We taped the edges and then I tied a rope to be sure to hold it together, still fearing that the genie would try to escape again.

Out I went into the late night air to find a taxi to the hotel where Sierra and Sean were waiting for me to arrive.

One week to departure date!

One week to departure! Very busy at work and at home getting things set to leave. Jiasong and TaiMing will leave not long after me and go directly to Taipei for about 5 weeks, with a short stay in Hong Kong along the way. Just about have all the tickets to travel still 3 to go. This is the most complex itinerary I have ever traveled: Vancouver, Taipei, Bali, Dili, Bali, Kuala Lumpur, Kolkata, Guwahati, Tawang, Jhamtse Gatsal, Tawang, Guwahati, Kolkata, Kuala Lumpur, Taipei, Vancouver and then back home March 20th! Really only three main stops but a lot of short legs along the way. Dili in Timor Leste will be from Feb 18 to March 1st, Jhamtse Gatsal in Arunachal Pradesh, India from about March 2nd to March 12th and Taipei, Taiwan from then until back home. I need all the luck I can get because one late plane departure and it could make for a cascade of other flights not working out. The biggest risk is on the way back home from India where the helicopter over the Himalaya on the far eastern side of Bhutan is notoriously late. Last year we waited about an hour. Wish me luck!

Frank

Ready, set, go.......

Well not quite yet, but soon. Feb 15th the flight will leave from Vancouver BC to Taipei, overnight there and visit with friends. On the next day to Bali, again overnight there and catch up with Sean and Sierra. The next day we will fly together to Dili, Timor-Leste. The time in Timor will be spent getting ready to do a study of the relative contribution of money and people to improve health status of a new nation. We will attempt to look back over the past decade and see what has helped the most. Life expectancy has increased and that is good, why it has increased is a more interesting question. The next three steps in the trip will be to NE India where Bhutan, India and Tibet meet high in the Himalaya to visit again this year Jhamtse Gatsal the school and community I spent a month at last year about this time. And then the final part of the trip will be visiting Tzee Chung and Ping in Taipei, where I will catch up with Jiasong and TaiMing. TaiMing will be doing his annual month or so of studies in a Chinese medium of instruction school.