A Project in Bali

It feels like life in the slow lane here most days. That can be delightful, especially in good company, and I’m not wishing any of it away. Riding in the rice fields, dressing for temple ceremonies, muddling through good-natured conversations in Indonesian, laughing over cocktails at Mingles bar, random conversations with complete strangers; these and many more experiences colour and enliven my time.

But there are long gaps. I can only read so many books, have so many massages, and I’m not often into afternoon naps, so when the morning walk or ride is done, the game of Mah Jong is finished, and the coffee (excellent) at Anomoli has been savoured, I’m often at a loose end. Which feels a bit silly really—here I am in Bali, where half the world dreams of coming, and I dare to be bored! After all it’s only ten days this time, so what’s this about?

Partly it’s because I came alone. Without my boon companion I take quite a while to get used to my own company. She and I savour experiences a little differently together, and there’s a deep comfort in that. A friend of mine said home is where his partner is, which pretty much fits for me. We don’t have to be together all the time, but after a few days alone I do get a bit out of kilter. Life is a project, an endless process of change, and she’s a key member of my project team.

It’s also because progress with my personal project is frustratingly slow. Many expats in Bali get involved in some effort to improve things for people, animals and the environment. Mine is trying to help establish mental health services in the community, which are almost non-existent. This is close to the norm in most countries outside the fully developed world; certainly it is much the same story throughout South East Asia.

While there is a mental hospital in Bali, in Bangli, it has no outreach or in-reach connections to community health centres or private GPs, so apart from some short-term benefit from modern psychiatric drugs, and a bit of respite for families, it plays a minimal role in the ongoing support of people with severe mental illness. That is the family’s burden, with little or no help from local health services. Not surprisingly, some drastic restraints are common, including stocks, (wood and concrete) cages and chaining to trees. This is called ‘pasung’ in Indonesia, and is illegal, but that has little bearing on the reality.

Last year, I and an Australian colleague travelled to Java and Lombok to see projects that have established a community-based response to severe mental illness. They were inspiring, both led by one highly committed and competent person who has taken several years to carry their health systems through a dramatic change to the point where almost no-one in the districts is suffering pasung, and families are receiving long-term support. We have brought this story to Bali, and some connections have begun (after an initial response of ‘I don’t think people from there should be telling us what to do in Bali’).

We are babes in the woods when it comes to Indonesian/Balinese policy and funding processes, but we have been lucky enough to meet two doctors, one a GP in charge of a large private clinic, and the other a psychiatrist, who are making a small start in a district which is part of Ubud. We’ve thrown in a little bit of funding to pay for medication where the person/family is not registered with the national insurance scheme, and so can’t access free drugs. But the real effort is coming from the GP clinic, which has already identified a dozen people who have not received any services before, and is treating them for free. The next step is to recruit volunteers in each village, who will be trained to identify people that may have a severe mental illness.

Actually, now I write that down, I shouldn’t be frustrated. The fact that there’s not a lot for me to do at this stage is remarkably unimportant in the scheme of things. We have unearthed a leader who is well-placed to carry this project to the point where we can show the local health department the real nature of the problem and the solutions. Solutions that are not complicated or costly, and which can deliver human and social benefits very quickly. So I and my colleague need to stay on tap to the two doctors, and come to Bali as often as possible (somebody has to do it) to support them however we can. After the initial stages, expat money might become important, for day care centres for example, and then it will be our turn to get busy. On reflection, it is a very good start.

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