I have two official assignments with our local partner organization. First, I am a medical consultant for a clinic sponsored by the local church, primarily focused on providing treatment for patients with HIV and Tuberculosis, while also offering general health services. The clinic is currently building a new, larger facility and hopes to hire a local doctor, in addition to the current nurses, pharmacist, and laboratory workers. My role is to support the local nurses and doctors as an advisor and consultant, while they are responsible for direct patient care in most cases. Most patients at the clinic are from a county of nearly 100,000 people, surrounding our town. However, some patients come from villages up to a 1-week walk away, where there are still no roads suitable for motor vehicles. The vast majority of patients are low-income people, many of whom do not speak the national language. The clinic is supported by patient fees, in addition to local government and international grants and donations of medications (mainly for the HIV and TB programs). The local church has a goal of the clinic becoming self-sustaining financially, but this has been difficult to achieve due to the shortage of medical workers here in the remote interior.

I also am a medical advisor for a local Christian foundation (aka NGO) supported by the local church. It supports community development, education and health care in a “county” of 150,000 people located in the rugged Snow Mountains to the east of the valley. There are no roads to any of the villages outside of the valley; even the capital town in the lowlands is only accessed by riverboat or plane, though the government has promised a new road for many years, and many villages require 1 week of difficult trekking to reach on foot from the nearest town. The organization works with 16 of the districts in the region. This area has about 1/3 of the population of the county and several hundred church congregations. Due to the lack of electricity, transportation, communications, and educational services, it has been very difficult for the local government to find doctors and nurses who will serve in the villages of this region. Previously western missionaries directly provided medical services, during the pioneering years of the 1970s to 1990s when these villages first had contact with the outside world. Now the local churches are largely independent and see a need to improve healthcare, education and the economic development of the community as part of the holistic mission of the Gospel. I help all of the teams with writing and translating grants and reports for their international partners, which have included USAID, the government of New Zealand, and Australian NGOs. I also help the Health team with training village health workers, developing written materials in the national language and local languages, and training Church leaders here. The health team also has the aspiration of opening a clinic in the capital city at their branch office in this new town (founded in 2008, now with 5000 inhabitants), which is a very different challenge from their current work and have asked for my help with this project.

Unofficially, I also provide medical care for the missionaries and local church members from my home, and also with the clinic associated with the international school in the main city in the province. As I am a plane flight away from most of the expat workers, most of my consults are over the phone, to assist the RNs in other towns. I also see patients at the clinic when I am in town for business, or if there is a medical emergency. Several times a year we are called upon to help arrange a medical evacuation for a colleague who needs treatment not available here.  I am often asked to visit local patients in their home or at the hospital for a consultation, however, I have to limit the number of these visits both to leave time for my official responsibilities, and because I do not have an Indonesian medical license (as these are not granted to foreigners, in practice). I see my role as mainly developing capacity in the local health workers and the local church, because our ability to stay here is always uncertain, depending on the whims of the government.

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