It’s Not as Simple as Bandaging Wounds

Medan, Indonesia — I listened to an exchange between a doctor and a patient injured in the tsunami and it was readily apparent that it’s not as simple as bandaging wounds. Trust, understanding and the simple need to communicate accurately are put to the test in a disaster such as this.

The
physician was Indonesian. The patient was also Indonesian but from a Chinese
language group. An interpreter was needed to translate two dialects between the
physician and patient.

Fortunately, the interpreter was
Chinese-born but had lived in Indonesia most of his adult life and he could
establish a relationship of trust between the two. That’s a subtle dance that
is often overlooked in massive relief operations such as
this.

Trust between the care-giver
and the injured must be built. It’s easier to build trust if both speak the
same language and understand the same cultural practices. When this is not the
case important information might be withheld, or go unexpressed because language
differences make it impossible to communicate
adequately.

One advantage of the
relief operation I observed conducted by the Indonesian Methodist Church is its
cultural integrity. The Indonesians running the program are familiar with the
people they are serving and are operating within the same cultural
expectations.

Add to the language
mix the cultures of Muslim, Christian and Buddhist victims in this pluralistic
society. Then add unique differences between Indonesians who speak different
dialects and have somewhat different cultural behaviors.

Put that together with people who
may have never visited with a health care professional in their lives. And put
a health care professional trained in Western medicine in this Eastern land.
Quite a challenge to get the information necessary to provide the conditions for
healing.

Of course, this challenge
can be overcome, and many here are serving heroically in the face of this and
other more rudimentary challenges such as unsanitary conditions, heat, lack of
basic services such as running water and electricity. So, I don’t minimize the
work of these courageous volunteers who are delivering care. I commend them.

I’m just aware that they face
challenges greater than meeting immediate, obvious
needs.

I asked Issac, the
interpreter, about this cultural reality and he explained to me that sensitivity
to appropriate roles within the Chinese community here is critical to the
success of the services because roles are clearly defined and much depends on
appropriate behavior within cultural expectations. Likewise, gender roles
within the Muslim community affect the delivery of medical
care.

So, it’s not as simple as
wrapping a bandage on a wound and telling the patient to take two aspirin and
call me in the morning.

After
observing this, I spoke with a coordinator of volunteers from an agency in the
United States. He explained he had spent the past week in Banda Aceh searching
for an Indonesian “who knew how to get things done.” It was not intended as a
put-down.

It was an expression of
frustration that he could not find someone locally with the skills he needed in
program administration and local culture. Coming from the outside, he had no
contacts and no context. That’s a difficult
position.

As a result, his agency’s
efforts are backlogged and its program is not moving forward. When I related
the success of the Indonesian Methodists in establishing services to 11 camps
around Bireuen, he expressed surprise. “I didn’t know anyone was serving that
region,” he said. “We’ve thought it was
under-served.”

I assured him that
there are significant challenges, but finding people who speak the language and
know the culture is not one of them. The Methodists from the local church there
live in the culture and know the people they are serving. I told him they have
stepped up to the plate and are serving all who need assistance regardless of
religion or class.

He asked about
how they are integrating medical personnel into the program. I explained that
at this time medical volunteers are coming from South Asia, mostly Taiwan, which
has an abundance of skilled medical professionals close
by.

It’s efficient. It’s quick.
It’s economical. It’s effective to rotate them in and
out.

He dropped his eyes and seemed
frustrated. Eventually, he said, “That’s the way it should be.” And I agreed.

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