So this time a long story, with the travel to jepara, first week experiences in the hospital and more.

On the saturday the 26th we made our way to Jepara, leaving Semarang and the RSDK.
Jepara is a gathering of villages grown together to form a really spread out city. Nothing like semarang.

With a black minivan we travelled the DISTANCE to jepara. Ofcourse this van had no seat-belts, and sometimes overtook cars exceeding 80km an hour barely missing the opposite traffic. The view during the travel was extraordinary, ecpecially the traffic. Imagine trucks with stock loosely piled up to a meter above the truckers cabine, with some indonesians just sitting on top of that. Imagine how they, (and the cargo), would get catapulted if he ever hit the breaks, and i can't imagine getting catapulted from 3-4m high is healthy. Apart from the traffic we had a good view of the palmtree's and the more idylic sceneries as you would find in a folder from the tourist agency.

The rumah sakit Kartini is a lot smaller hospital and looks very inviting.
Our homestay is shared with some other co-assistants, and a few residents. (the new surgeon here). The mosquito infestation is also of much larger proportions, having killed 7 on my first night, and trying to plug all the holes and gaps in my windows which allowed them to keep pouring in.

The first week after our arrival we had a good share of the experiences in store for us.

At 7:00 a.m. there is an appel in front of the hospital which everyone needs to attend, very militairy style with salutes etc. Ofcourse noone told us however we were also expected to be asked in front and introduce ourselves to the entire hospital staff..... Which kinda took us by suprise. But nevertheless a fun experience. What they actually call when saluting is hard to make out really, but it should be something as in the title, but then in indonesian slang. :P
At Friday there also is a complementary workout at 6:30, aerobics. As most people know this wasn’t really my cup of tea, i do not really have the best rhytm sense. Still at least i tried! Which was more then a lot of the other co-ass did, only 2 out of 5 male Co-ass attended the training, even though it wasn’t voluntary. And no, mum, sanne or whoever takes an extreme pleasure in watching me humiliate myself, i already made sure no video’s pop up from sanne B’s her videocamera. It’s just a matter of leaverage.

This week i was appointed to the surgery department. Which only does surgery in the morning 9:00-14:00. It was a bit hard to also assist on the operations since a lot of them are operations in a style not seen a lot in the netherlands. For instance Gangrene debridement and small amputations where carried out by just the co-ass under supervision by a nurse of doktor. Not really the kind of “small surgery” i am familiar with. Still it makes it perfectly clear WHY we have diabetes nurses in the netherlands and regular follow up. It makes really no sense at all seeing a diabetic with an skyrocketing Glucose (medicines, what?), with 3 chronic ulcers (a.k.a. holes) in his feet, and gangrene up to his knee refusing amputation for both financial and emotional reasons. How did it come this far, and second for the non med schooled, the gangrene will be his death without amputation. A full debridement (opening the skin above every puspocket), can hardly be survivable with a diabetic leg as this, still that was the only thing we could do now without permission to amputate.

Apart from the operations i also did my shifts in the IGD or emergency department. The scala of patiënts here is quite diverse, although 3 groups clearly stand out. These are the following:
1. Traffic accidents, and then i mean a LOT. The motorcycles here may look nice, but the way people drive here is a very unhealthy habbit. Unfortunately it is often the weakest participans who pay. Often busses or cars take over at huge speeds, sometimes hitting an opposing car or more often motercycle. (they just sound the horn for the motor to get out of the way). Most people i saw still had minor injury’s except 2. One a middle aged male broke 4 ribs, hematothorax and skull-fracture lived, wonderfully with his brainfunction intact. One boy of 10 who got hit by a bus while crossing the street was less lucky, and had a GCS(glascow coma scale, 3= lowest(deep coma), 15= highest(no coma)) of 3 at the start, with the typical Foetus-posture, which signifies major brain damage. At the moment he is a pediatrics but still only has a GCS of 5-6. Chances of him recovering are slim. Apart from these there were about 10 minor victims (some simple fractures/cuts/ minor head trauma)

2. Malaria, officialy malaria falciparum is not endemic here, but with 2 patiënts with malaria falciparum and one with a chronic Vivax, i really doubt that statement.

3. Snake bites. Here in indonesia, and ecpecially in jepara some cobra’s reside, and they don’t like humans crossing there territory. Since the furniture production in jepara lot of people enter the forests for lumber just with sandals or on their bare feet. I saw 3 patiënts with the results from that on the emergency department. The big suprise however was that it happens to be that the factory producing the antivenom is out of stock, which means no anti-venom for the bites. And as everyone already knows, cobras are some of the mostly deadly snakes around, the damage they can do to a human body is truly staggering. I really hope there soon comes another batch of antivenom, till that time you won’t see me wandering around in a forest, that’s for sure.

And ofcourse the football! We ofcourse watched all the dutch matches, and the 1/8 finals and 1/4 finals here in jepara. Completely in indonesian style ofcourse. Which was outside on a concrete badmintonfield with a big screen being watched by 100-200 indonesians sitting on the ground. Here and there some small cooking places popped up for the (way to sweet) indonesian coffee, or some casave. Too bad most indonesians really wanted brazil to win, still they congratulated us and also cheered for the dutch goals.

Regards to everyone reading this, i hope you also will find some time to react. I always enjoy reading them, and they are a big support for me here.

Greetings to all, take care.