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.