Nursing School Accreditation

It is time for me to play catch-up on the blog. There has been lots going on that I haven't gotten around to posting about. Sorry about that! So here is the first post of several...

I have been talking about it for awhile and asking you to pray about it for a long while too. Both our hospital and nursing school were due this year for accreditation. The process here (and it is similar in the US) involves preparation of many documents that are then submitted to the accreditation team and reviewed by them before a site visit. The site visit for the nursing school happened on February 5th (which also happens to be my sister Kristin's birthday!) but there many many hours of work and late nights before that, starting with the deadline to submit the documents several months ago and then again in the final days before the site visit. Here are a couple of pictures of many meetings held in the days prior. You can see the stacks of documents being prepared and finally shaping up to look quite nice in color coded files in our conference room ready to be shown to the assessors during the site visit.

The day of the site visit dressing up in your official Nursing School uniform was required. It is all polyester with long sleeves so it doesn't come out of my closet very often :) The school also got dressed up with a nice banner welcoming the assessors, some new paint, and trees trimmed. 

The scheduled visit is suppose to last 3 days including travel time but our assessors were hoping for a quicker trip so we did it all in one day with travel the day before and after. That meant an early start and a late finish. It was after 9 pm before we were done and they were stressful hours so everyone was quite worn down by the day's end. Following introductions (and barely waiting for those to finish) the assessors went for our jugular which is our lack of master's prepared teachers. Those who actually have a master's in nursing is one - me. We have one in school and plans for at least two others to go back if they can pass the entrance exams. We also have several with master's degrees in health or related field but technically not enough and I don't even really count as a foreigner. It felt like that put us on the defense from the beginning and caused people to be more nervous resulting in several missed steps. One assessor in particular kept asking the tough questions and pushing for the documentation to prove it. 

The assessor is on the right. One left are three of our staff explaining some of our documentation. 

By the end of the day we all looking a little worn around the edges! 

Our final grade was issued last week and we got a C. We had been hoping for a B but based on what I saw of the standards I think a C is fair. I could however probably argue that the standards are based on a developed country (I think there is a strong chance they are pretty much borrowed from somewhere in Europe or America) or at least a nursing school in a big city. That said they focused on some significant weaknesses we have and improvements that need to be made. We have been putting in a lot of work based on their recommendations that day and now that the grade is final with more feedback there is more work to do. Please be praying for us as we implement these recommendations to the best of our abilities and specifically that we would be able to focus on those that will truly help our program improve and our students be better nurses when they graduate. 

Field Fellowship

I just recently returned from our annual team meetings and time of fellowship. This year we were hosted by our teammates who serve in Southeast Sulawesi here in Indonesia. It was my first time to that area of Indonesia. It is always fascinating to visit another island. 

We kicked things off with a night of worship and prayer but thanks to some late planes and my need for a quick stop in Jakarta for an ultrasound of my leg the Kalimantan team missed the first evening activities. We were incredibly blessed by a special speaker and a team from his church who came out to help care for the kids of our team. Much of the time our team members are the ones leading, preaching, and teaching so it was a blessing to be on the receiving end instead. We were also blessed by the presence of one of the founding team members of WorldVenture Indonesia. He was able to share wisdom from his years of serving here. Each family/unit also had a chance to share an update of what is happening personally in their life and ministry and be prayed for by the rest of the team. There was also of course time for business updates and discussion of legal issues. Finally we ended with some play time. We took a couple of boats out to an uninhabited island with some great views, swimming and snorkeling. It was so relaxing and beautiful to enjoy the warm water with friends. 

Here are a few pics from our time together...

Listening to our special speaker - Dave. 

Listening to updates from each family. 

Hearing video updates from those who have been appointed to join us here in Indonesia and are in the partnership development process. 

Spending time with those who have walked this journey before and listening to their wisdom.

And then there was the fun times! A night of parlor games and a fun night. Apparently I have a real skill for pulling kleenexes out of a box one at time as fast as I can as that is the only game I won :) 

Our final day together we went snorkeling and swimming at a beautiful island. 

Nope that is not pool - just a beautiful white sand beach!

Some of my teammates getting a lesson on snorkeling before they head out. Note to self bring contact lenses next time so I can see while snorkeling. 

The best part though was spending time with friends...  

Plus I got to catch up with the little ones of our team who I helped welcome to the world last year. Little Josiah is growing so fast! 

And Miss Charlotte has hit her stranger anxiety age but we still managed to have some fun together. At 11 months old she is an expert satay eater :) 

All in all I came home tired and a little sunburned around the edges (missed a couple of spots with the sun screen!) but with some sore laughter muscles and a lighter heart. 

Going Home!?

I always though my first reaction to hearing I needed to go back to the US for a visit would be one of excitement and joy. I was sure I would be excited to see family and friends, visit places and do some shopping etc. When I heard that my Grandma was sick though I realized going home to the United States this time is very much a mixed blessing. Yes I am excited for all the reasons listed above but I was also sad and tired just thinking about the long trip and the details to be arranged. Honestly, I thought if I needed to go home it would be for a good reason - a sister getting married or something.

So it took awhile to process it all and finally book those tickets. It became a daily question for awhile from the teammates I was staying with - so have you booked your plane tickets yet? And my answer was always "belum" which is Indonesian for not yet. Maybe it was because they were expensive, maybe it was because they were on airlines I didn't prefer (United), maybe because time and weather difference in December is a physically hard adjustment for only two weeks, and on top of that reverse culture shock is mentally hard work too. Mostly though I think it was because I didn't (and don't!) want this to be the last time I see my Grandma on this earth.

As things have settled though and those plane tickets have finally been bought I am finding joy and excitement in the idea of being home for Christmas. There is so many people I want to see and so much I want to do! In reality though most of that will have to wait for my next home assignment scheduled for the end of 2016 or maybe the beginning of 2017 now. For now I plan to focus on being with my family and friends. Enjoying these moments with them and making memories.

You will probably need to have a little extra grace for me as navigate life in a place where I haven't lived for two and half years but is still considered home. I am sure I will occasionally say a word (or an entire sentence will pop out!) in Indonesian. I will most likely also be confused as what side of the car the driver sits on and which side of the street the cars should be on :) And there are places guaranteed to send me into reverse culture shock like Wal-Mart and grocery stores!

Please do be praying for the trip. It is never fun and more stressful to travel alone. Pray that I can be fully there despite the jet lag and manage to recover from reverse culture shock long enough to do a little shopping :)

The Haze Part II

And purple use to be my favorite color! In this case though it means the air quality is in the dangerous zone. This is from the city 5-hours away. Farther south it is above 2000. 

A video from the southern part of our island:

. . . . . TABRAKAN BERUNTUN DI BASARANG KAPUAS . . . KARENA JARAK PANDANG BEGINI . . . KADANG HARUS BERHENTI . . . KARENA JARAK PANDANG KURANG DARI 1 METER . . . DI_AMBIL JAM 06.10 WIB . . .
Posted by Marcos Tuwan on Sunday, October 18, 2015

Not only is the haze dangerous to drive in, it is dangerous and even deadly to breathe in, especially for such a long time. The Indonesian government estimates that 325,000 people have become sick with respiratory illnesses like asthma and pneumonia from the haze. And that statistic is over a week old now and only counts those who have been seen at government health facilities. They also estimate that around 3% of those people have died. That may not sound like many until you do the the math. That is almost 10,000 people killed. And I see the effects through my Facebook feed almost every day. It is customary here to take pictures of the bodies of family and friends who have died, so I will be scrolling through my feed catching up on news from friends and then suddenly there is a picture of a dead body, very frequently a child or baby. Their smaller airways and lungs are not as able to handle the haze.

Check out this BBC video on the health effects of the haze, especially on children.

Help is on the way though as Indonesia has finally accepted help from places like Singapore and Australia who are lending manpower and airpower to help fight these fires. Unfortunately, all of that help seems to be going to the island of Sumatra instead of Kalimantan. There are more hot spots there and it is closer to Jakarta, Singapore, and Malaysia making it the more visible problem. The air quality however has been worse in Kalimantan, especially Central Kalimantan. As I write this it has passed 2000 psi again in the city of Palangkaraya (I am not sure how far past because the gauge stops working at 2000).

Please continue praying for rain, that wise decisions will be made by the government of Indonesia as to where their resources should be allocated and how to best punish those involved in starting the fires. At this point I am needing to use inhalers frequently to keep my asthma under control, so I am thinking about relocating to another island in Indonesia for awhile to give my lungs a break.

Time for a little R&R

The week between graduation and the start of the new school year, I took a little break away to Malaysia. This island (3rd largest in the world) of Borneo is shared by three countries - Indonesia, Malaysia, and Brunei. The Indonesian portion is called Kalimantan and is separated into 5 different provinces. With just a 5-hour car trip and 45-minute plane trip or 12-14 hour car trip you can get yourself across the border to Malaysia, specifically the city of Kuching. We go there for visa work but we also go here to shop and enjoy things like Indian and Thai food or yummy McDonald's french fries :)

So what does a little R&R look like...

Look tall buildings! With multiple well-stocked malls and fun places to eat within walking distance or short taxi ride from my 14th story hotel room

Look its a bathtub! Ok so I wasn't a big bathtub person in the U.S. but I love a good soak here. Unfortunately for 3 of the 5 nights my hotel didn't have hot water (which they apparently didn't think was a big deal). I will confess that one night I resorted to filling the tub with mostly tepid water and then adding several of the kettles of hot water from the kettle provided in the room :) It wasn't great but it did work. 

I am not a huge fun of McDonalds in the U.S. but sometimes a girl just needs some french fries and a chocolate milk shake. 

I am not usually one of those girls who takes pictures of their food usually, but I also had a delicious seafood meal at TopSpot and some pretty delicious Indian food plus Pizza Hut and McDonalds. There are also numerous much better stocked stores in Kuching including places to get a large amount of cheese. Yep I was that girl with 5 kg (11 pounds) of cheese in her carry-on plus bacon and ham! The poor customs guy just about had a heart attack when I told him that there was pork in the box. Pork is considered unclean for Muslim people, so he had to go find someone else to inspect my baggage. Anyway, all in all it was a good trip. I am ready for my next vacation to have a little more adventure though - maybe Bali. There are definitely benefits to living in SE Asia! Anyone want to join me?   

The Haze

With the dry season well upon us and lasting a long time, the haze has set in. This is annual occurrence here in Indonesia, as land and jungle is burned for planting. In the not so distant past it was mostly famers who used this method to clear small areas of land but in more recent years with the money to be made with palm oil tree plantations and other cash crops, large portions of land are being cleared and burned each year. For several years now this has caused numerous problems with the air quality both here in Indonesia but also in neighboring countries like Malaysia and Singapore. For the most part those who use this illegal method have not been punished and it is just something we all have to deal with. Partially, because while it is the local people starting the fires they are under intense pressure to clear the land by the owners, many of which live in big cities on other islands and even other countries.

This year though the dry season has lasted longer and the haze has reached extremely high levels, affecting the health of many. Here in Indonesia kids don't get snow days but instead smoke days off from school. There have been several reports of people, especially children, dying because the smoke causes an asthma attack or pneumonia. Our hospital here has seen a large increased in lung infections and asthma. Airports are also closed for much of the day, causing problems. Plus of course this only increases the rate of deforestation.

Here are a few pictures to illustrate what is happening:

Air Quality (or lack thereof!) in our nearby city of Pontianak. Anything above 350 is considered dangerous. Other cities in Indonesia are even higher. In comparison for those in the Northwest, on this same scale your air quality this summer at the peak of your forest fires was mostly between 150-350. 

The view from my house on a normal day

The view from my house on a smokey day. You can barely see across the soccer field. 

But at least we know how to poke fun at ourselves too. This comic has been making its way around social media lately. You are looking at the flags for Indonesia (right), Malaysia & Singapore (left). Indonesia recently celebrated its 70th birthday and apparently they all got together to celebrate...

Please join us in praying for rain, for those responsible to be held accountable, and for the health of all affected by the haze.

For those interested, you can read more here:
A good basic article on what is happening here.
And an article on the arrest of some of the executives here:

A New Class

So it all starts with a...

This is basically a nice brochure the school puts together that outlines the curriculum, the application process, and costs etc. There are also banners put up around the area with information about registration.

Then over the next two months young people (mostly high school seniors) come with one of their parents and register. They have to meet requirements such as height and weight, provide a picture, and pay a fee to register.

Then in mid-August they come to campus for the entrance exam. This year we had 78 register and 60 show up to take the test.

Lining up the morning of the entrance exam

 The test has four subjects - Indonesian, English, Math, and Science. It is a total of 100 questions and they have 3 hours to complete it. It is actually really hard, especially considering they are not allowed to use a calculator.

Hard at work taking the test

Once the students are done taking the test, the correction team gets to work. Each answer sheet is coded, removing the student's name from the answer sheet, to help prevent cheating. Each year members of the correction team receive offers of bribes from family members of those who are applying. There is also temptation because many who apply are local kids and some have extended family members who work at the Nursing School. We also have each answer sheet checked by two people and then a third if there is any discrepancy. After the grades are entered, we make a final decision as to how many students will be accepted. We usually try to make it a definitive answer like they passed in at least two of the subjects but this year we didn't have enough to reach that point. The average was quite low unfortunately.

We don't have a scantron machine, so each correct answer block is cut-out by hand and then corrected by hand

Waiting for the results to be posted

In the end we accepted 50 students. They still had to pass a physical exam though and go through an interview. Our final class new freshmen class has 46 students. It will be a lot of fun to get to know them in the coming three years. I will be providing academic counseling and support to 3 of them: Nimrod, Gusniati, and Dolina.