Richard Mowll is a civil engineer from Croydon, who travelled to Western Uzbekistan in January 2002 with MSF to rehabilitate a 600 patient TB dispensary. He then went on to prepare a 100 bed facility for multi-drug resistant (MDR-TB) patients, where he was Project Co-ordinator of the 16 Médecins Sans Frontières (MSF) staff programme.

“The dispensary building in Nukus was a mess – the result of the near collapse of the health service in this country over many years. Through my work there, one incident stands out. A minor incident but one which left a lasting impact…”

To know what new pipework to order, I inspected the Dispensary room by room to measure sizes and to identify the fittings. As I was in one open room with just a bath in it, a thin girl with a headscarf walked slowly past me and up to the bath. She held on to the side with both hands and with apparently all the strength she had, she coughed. Weak, pitiful, tiny coughs. She was clearly beyond just ‘ill’. A friend of hers came into the room and stood beside her holding her shoulders from the side, supporting her as she coughed.

What could I do? I’m an engineer who formerly specialised in road maintenance and concrete construction – she didn’t seem to need either of those specialities just then. I couldn’t do anything, but feel out of place. I left the room. This was a private moment for them, and I wasn’t helping by being there.

There were and continue to be so many like her – six hundred in the Dispensary itself (although in varying states of illness) and literally thousands of others throughout Uzbekistan. All of these TB patients were the victims of not only the infection, but also of the health system that was not just in a state of decline, but near total collapse, where doctors earn as little as ten pounds per month (how could that feed, clothe and warm a family of four?). How could a health system so under funded help the population overcome the spread of this disease?

What could I do for the girl? Nothing, by myself. But the medical staff and the MSF project that I was working on was trying to improve the system of healthcare for TB patients by using the World Health Organisation’s Directly Observed Treatment – Short-Course (DOTS) TB treatment methodology. This was where it struck me how MSF’s work was truly a team effort. I know nothing (or at least very, very little) about treating TB patients. The medical staff knew very little about rehabilitating a TB Dispensary building. But this rehabilitation was one link in the chain, which was improving conditions for the patients and helping lower the incidence of TB. The medical staff were more links in that chain.

I never saw the girl again – perhaps she got better and left, although I kind of doubt that that could happen. This incident made me realise two things. Firstly the total need for someone to help this girl and others like her – MSF are one of the few organisations doing anything here – and secondly the way that MSF missions are based so strongly on teamwork. I guess I also realised a third thing – that I was proud that I was working for an organisation that was trying to make a difference.

Today, Richard is back in Uzbekistan working with another organisation. The TB dispensary is part of a network of State TB facilities supported by MSF. It will be handed over to Uzbek Ministry of Health control by the end of 2003. The MDR-TB programme will start treating patients in the coming months.

If you would like to contact Médecins Sans Frontières, you can e-mail them on: office-ldn@london.msf.org or visit their website:

www.uk.msf.org

Post Script:

Kidnapped: our MSF colleague Arjan Erkel was abducted more than six months ago in Daghestan, Russian Federation. We still do not know what has happened to him. Please sign MSF’s petition to President Putin asking for urgent help to get Arjan released. Click here and pass it on to your friends:

Rank Country Area (square kilometers)

1. Russia (17,075,400)
2. Canada (9,976,140)
3. United States (9,629,091)
4. China (9,596,960)
5. Brazil (8,511,965)
6. Australia (7,686,850)
7. India (3,287,590)
8. Argentina (2,776,890)
9. Kazakhstan (2,717,306)
10. Sudan (2,505,810)

Dear Reader

Please let me introduce my country, Indonesia to you. I am a native born Indonesian and have lived here all my life. My life is very simple: I live in the suburbs, in a small village, Makassar, in South Sulawesi. I am working in tourism. My parents work as subsistence farmers. I would like to relate a little information about the area in which I live. This gives me the opportunity not only to practice my English, but also to become more self reliant and learn from others.

First, I would like to change the views of anyone who thinks that Indonesia is dangerous to visit. Be assured that the real problems that exist here are internal and are related to the way our government works. The people of Indonesia are peaceful and are as shocked by the recent Bali bombing as the rest of the world, and want no part of this global terrorism.

Secondly, I want to make one thing very clear, that Indonesia is a very beautiful country and is an interesting place to visit and far different to the media’s view of terrorism and danger. On behalf of all of my people, I would like to stress: INDONESIA IS PEACE LOVING AND FROWNS ON ALL VIOLENCE.

Most people coming to Indonesia know only Bali, which is a great shame as Indonesia is an archipelago consisting of 17,000 islands in 27 Provinces, and one of them is SULAWESI. Sulawesi, formerly known as CELEBES has a total land area of about 227,000 square Kilometers and is divided in to four areas or provinces : south, central, northeast and the north, with a total population of over 10 million people.

Sulawesi is home to an amazing variety of people. The majority are fisherman, catching flying fish, shark, tuna, mackerel, squid, as well as other fish. We have farmers who grow wet and dry rice, maize, tapioca, sago, vegetable, coffee, cacoa and cloves. There are numerous small groups of upland people who practice slash and burn agriculture in the interior of Sulawesi. Unemployment is a big problem in my country.

Sulawesi is full of rich and varied cultures and traditions, languages and religious beliefs practiced by several ethnic groups such as: Makassar, Bugis, Mandar, Pamona, Tolaki, Manadoi and the Hulontalo. There are many religions, including Islam, Christianity, Budhism, Hinduism, Confucianism and Animism. The Animism beliefs until now can mainly be found in Torajaland or Tana toraja, an upland area of southern Sulawesi. Here the religion’s belief has a special name in the local language called “Aluk Todolo.” Aluk mean :rules or belief and Todolo means: Ancestor. According to this teaching, human beings in the world have only two problems that are opposites, for example: ” lose or benefit”, and “happiness or sadness”. This philosophy has been manifested into their ceremonies and they have two kinds of ceremony: Thanks Giving Ceremony and Funeral ceremony. The Funeral Ceremony is very sacred because according to the Animists, Death is the end of life.

If you come and visit tana toraja in Sulawesi, you can see many houses in the village, and the owners put the body of their loved ones in a coffin in a room and consider them as sick person before they died, until a funeral is held although this maybe as many as 10 or 20 years have passed from the date of actual death.

After the funeral is held, the family take the coffin to a cave in a mountain for burial. The cave can also function as a house. Their philosophy is that ” Death is an event that changes from the real world to the unreal world”.

I hope from this small article you can get a feel for how remarkable Sulawesi is. Although it is my home, I believe it is quite special. If you are planning a trip to Indonesia, do please come and visit Sulawesi, and do not hesitate to contact me for information about tours and personal itineraries. I would be very happy to share my knowledge with you and help to show you around.

For more information, please visit my simple website: http//www.alamnusantaratour.ch

Please be assured that our traditions of warmth, trustworthiness and memorable hospitality make an enduring memory for our guests.

Syamsu Alam (Alam)

Tel/Fax. (062)411-553927

E-mail alamnusantara@hotmail.com

Website: www.alamnusantaratour.ch