I have returned to Indonesia!  Here in the land of endless rice fields and motorbikes galore, I am filled with joy as this website continues becoming more global in scope: Glory’s diligent blogging from Tanzania has led to nearly $1,500 in donations towards her dream of a University education (donate here!), and Tigi’s plans for a primary school in her home, Ethiopia, are rolling out now (be one of her first supporters!).

Back  in Bandung and back in action already – as I type here from the kantor (office), Ginan is on the phone with a young client’s mother, a teen addicted to anti-depressants who has not lasted more than a month in our rehab program.  Another staff member has just rummaged through his bag and pulled out a plastic bag spilling over with tiny yellow pills.  Three counselors shake their heads in disappointment – this young man has had so many good days with us, only for his progress to come to an abrupt halt with this kind of drug abuse.

I can hear the staff now in the next room sittin with him in peer counseling (for new readers, all Rumah Cemara staff are recovering addicts and living with HIV, offering peer support towards recovery from addiction and healthy living with HIV) — and while I’m overjoyed that my Indonesian has improved enough to understand, I’m deeply saddened by the difficult reality of his addiction.

This isn’t the first reminder that I’m back in Bandung.

On my first day back, Ginan and I went to our dear friends’ wedding only to be interrupted (unsurprisingly) by two hospital calls – one to a friend whose ARVs were reacting poorly with her liver, one to a brand new client who arrived at the office just before I did, already in stage 4 HIV infection (2 CD4 cells left in his body, full blown AIDS).  Rumah Cemara had rushed him to the hospital, but in his depression that his family had rejected him because of his status, he committed suicide by removing his IV tubes and strangling himself.

Welcome back.

In all three cases – this young man’s addiction, the young woman’s hospitalization, the poor soul who took his own life – I’m reminded of why Rumah Cemara’s work is so important, and why – in addition to health policy work and consulting with large institutions, I will always be involved at this level where health lessons are so evident.  It’s because humans are complex people who make irrational decisions, usually based on fear and insecurity.

This young man, he has no father and before coming to Rumah Cemara, had no friend group.  His spiked, bleached hair is evidence of his attempts to lash out at a world in which he has never felt cared for.  Though we can’t change him, we can support him, and I’m heartened to hear right now that (after a serious discussion) an entire team of staff are calling out the Serenity Prayer with him …. and see him stumble by me now, their arms around him.

As for our girlfriend in the hospital, she had not known that alcohol would react poorly with her ARVs, and I was surprised when she began whispering to me in the humid hospital room as I braided her sweaty hair to keep it off her neck.  She said her mother, who was sitting just outside, still didn’t know she was living with HIV, and she had arranged with the hospital staff for her mother not to find out.  Can you imagine being so ill and keeping the reason for that illness from the person who stays with you through the entire process?  That’s how strong the stigma is, that’s how high the walls are to overcome.  Again, our staff cannot force her to share her status, but they can support her through the process of disclosure, and make sure she understands going forward more about her ARV therapy.

As for the final young man, there is little Rumah Cemara could do to save him, as he was already nearly gone by the time he arrived.  Throughout the evening on Sunday we drove around to arrange his funeral service, as his family refused to be a part of it – they were so ashamed of and hurt by his drug addiction.  He was Buddhist, and our staff had not yet prepared a funeral for a Buddhist, and so we made calls to find out the proper procedure.  We bought him new clothes (“Long or short sleeve?”, Faisyal asked me, holding up the options), ordered him a wood coffin, and made preparations with the cremation service, who still insisted on family’s permission before proceeding, which Faisyal tried diligently to secure.

In public health, offering the services that seem logical – free rehab programs, free ARVs – are useful only to the extent that they are utilized.  And with the high levels of stigma still surrounding HIV, and that will always surround drug use, it’s likely that such services are under- or poorly-utilized by people without any peer support for their addictions or infections.

I’m back at the place that gives that peer support, and happy to be back in a place where – for all the sorrow and pain that the staff faces everyday – there are equal amounts of joy and laughter.  For every problem that exists, I’m back with people who never, ever turn a blind eye, but who step up to face even the grisliest of realities, with the confidence that even if they cannot change the immediate outcome, they can be part of an eventual solution.

And many are in the works – since I left in August 2010 there are new developments across the board — new funding for a major harm reduction program, improved income-generation projects (motorbike washing and an internet cafe), vastly expanded support networks for the “For Life” PR campaign, including a book to be published soon with contributions from writers across the country on the topic of fighting stigma towards people with HIV, and many new staff members who I have been delighted to meet.  And of course, all the old, beautiful faces who I feel so blessed to meet again.

Up this week: the “Oprah of Indonesia” TV show, “Kick Andy” will be in Bandung interviewing Rumah Cemara on Friday, and the men of the Mr. Indonesia national competition will be visiting tomorrow, two exciting PR successes that will bring more national attention to their work and methods.  I’m still working on the Ethiopia study and on a few new projects as well, so I will update pics and posts as often as possible.

In the meantime, please share these posts, especially Glory’s and Tigi’s, and my deepest thanks for your continued readership — terima kasih banyak, thank you very much.