So while we are here working on paperwork, I have a little time to write about the model we are using here in Bali as our treatment delivery. Which is a formal way of saying: how in the world can we treat 200+ people in a day effectively, compassionately and efficiently with 2-4 practitioners!
Last year we found that when we went to more remote villages the need was much higher that what we saw in the Bumi Sehat clinic. In Ubud, there were still a few options for people to engage with the health care system, though even there the options were not great and often hugely expensive.
But imagine walking into a village of 300 or 500 families, NONE of which has seen a doctor before. There’s 2,000 patients right there. Most of rural Bali is quite poor with families living on $1/day. People do intense physical work in the rice paddies, carrying heavy bundles and working the land without electricity or running water. Even though the climate is mild compared to the northeast US, constant rain makes for constant damp and we see a lot of conditions related to “cold-damp” such as painful arthritis, asthma, colds and flu. Under these conditions, people often have a limited diet of rice, few vegetables and small amounts of meat and fish. Children of 10 years often look 7, and we warn practitioners at orientation not to judge a child’s age by their appearance. The adults also often look much older that we would expect coming from the US. I often had the experience treating people last year who I assumed to be in their 50’s or 60’s only to find they were much closer to my age of 42. So with the help of a member of parliament (who was up for re-election and wanted to make good on his campaign promise of helping villagers with better health care), we had targeted poor and remote areas where we felt we could do the most good.
We divided up our group of volunteer practitioners into two groups of 5, one group to stay in the northeast area of Karangasam–a poor region on the slopes of volcanic Mt Agung and famous for its rocket-fuel version of fermented palm sap: Arak. The other group would work around southern Bali for the first week and then travel up the central corridor to Singarajah in the north and finally finish in Negara in the west.
This way we would maximize our ability to reach poor villagers. Each team consists of 4 practitioners, 1 logistics manager, and 2 translators. In addition to our herbs and acupuncture supplies, we are also bringing 12 “beds” or portable mattresses with bamboo mats that we can set up in the community banjars to create a make-shift clinic. We also used plastic chairs to create community style acupuncture where we can treat small groups at the same time.
Here are some photos of Sunday and Monday’s village visits to see the set-up: In the first one you can see the villagers waiting to be interviewed. Then, once they have been interviewed and we have determined their chief complaint they are sent to wait at the table until a bed is available for their treatment. This was Dan’s first village in Selat, and had 250 people registered for GAHP’s first visit. Dan also roped off the banjar–a great idea to help eliminate the chaos of people wandering through our treatment area so they can check out what is happening…
Independently of each other, Dan and I both came up with similar systems for managing the crowds. Organize the larger crowd, determine the chief complaints, and treat in small groups. The village leaders also helped us in this task by organizing the crowd and having everyone register first and then come in groups of 20.
However, in my first village we didn’t have our matresses until later in the day–and space was very limited. 
So we chose to set up chairs and treat as many people as we could seated. I also didn’t think of roping of the banjar so you can see that the space is a bit more chaotic. If you look closely you can see multiple practitioners working at once, and also a youth leader helping us to moxa (the guy in the green shirt kneeling to do moxa in the lower right corner). Aslo present: me doing an intake with Matt following to do the acupuncture, and Julie (blue shirt center, back to the camera), needling a patient.
So necessary to this model are our amazing logistics managers. On this trip we were lucky to have two powerhouse moms from Wyoming–who have not only taken all of the GAHP continuing education seminars, but also took Tui Na Level One so they could help with body work. Katie is taking this picture and she is the one seeing the flow of the day, making sure we have all the necessary equipment sorted and available, and jumping in when needed to perform tuina or do moxa! We really would have been suffering without Katie and Mimi helping out in this way.
Also critical to our success were our 4 highly capable translators. These guys rocked! They were all young recently graduated students and incredibly skilled and enthusiastic to help out.
Chrisma and Agus Maye and Nisa
When Agus learned that we needed to go up to Amed to meet with Dan’s team, he volunteered to drive us up there. That is how we learned that in Bali whenever you drive past a temple, over a bridge, see a cat or a dog, you must honk quickly to greet the spirits there. And that when asking directions, it is very rude to roll down your window and stick your head out–instead, you must get out of the car to talk to the person respectfully. Poor Agus had to do that several times as we made our way up the island!
