Archive for January, 2008

Following Bourdain Eating Shark

January 29, 2008

For full article, click here

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I just got a chance to watch the recording of Anthony Bourdain’s No Reservations Singapore Episode last week. As usual, Bourdain visits nondescript, hidden, non-touristy places which are frequented by the locals with the sole goal to enjoy good food. For the Singapore episode, I’m glad to know that I too had known and love some of the places he visited, such as Maxwell Food Centre and Golden Mile Baharudeen Soup Tulang. I think the local fixer (was it Seetoh from Makansutra?) did a great job because he was able to paint realistic image of the daily lives and peculiarities of Singaporeans (except for the segment in Aurum restaurant).

One segment of the show was seafood, which I love! For this one, Bourdain visited a place that we didn’t know had existed: Tian Jin Hai Seafood. In the show, Bourdain and Seetoh ordered Chili Crab and Steamed Shark Head. Both seemed so much mouth-watering that I wanted to eat the TV. It was decided: I needed to try Tian Jin Hai seafood before going back to Indonesia.

Thanks to Google, I managed to found Tian Jin Hai new location ever since they moved out from Jackson Centre Kopitiam. I called Kevin Yeo, the proprietor listed in Makansutra forum, and he was very friendly in answering my questions regarding the food in the restaurant. He told me that since mid-January 2008, they have moved to Punggol Marina Country Club, a place soooo secluded that no public transfer available. One can take taxi, or hop onto the hourly shuttle bus from Punggol MRT station.

After confirming the address and made reservation to Kevin, Indi booked a car from the carsharing to go there. Joining us in the mission was the avocadolite family, having mandated to try the steamed shark by Cia, a faithful Bourdain follower.

The road to Punggol Club after leaving Punggol Central area was unique, as the road was lined with thick blanket of tropical trees. It took us about 15 minutes to drive from Punggol Central area. Tian Jin Hai restaurant is located by the marina overlooking Punggol Island. Unlike many other seaside restaurant, this one doesn’t face heavy traffic of freight ships and motorboat. It is quite pristine and the sea breeze is fresh.

Kevin had prepared a table for six persons at the terrace of the restaurant, with easy access into the Marina. It was not too sunny, so it wasn’t hot outside. When he asked for our order, we simply replied, “Just give us whatever Anthony Bourdain had!”. He continued to share stories on the many times Bourdain had visited them, to the details of what he had ordered. Bourdain even followed the chef to Jurong Fish Market to see firsthand where the restaurant got the fresh supply. We decided to order medium sized shark head, steamed. This dish is what Bourdain had ordered and Chef Jeremy Leung had spoken highly of during the World Gourmet Summit. We also ordered pregnant crab bee hoon – crab cooked with rice vermicelli, a dish that has inspired Chef Justin Quek. Too bad the bar, which is not managed by Tian Jin Hai, has not opened yet, so we couldn’t order Tiger Beer.

While waiting for our orders to come, we walked along the marina to see boats (our obsession!). Indi came across an old Catamaran and spoke to the owner, Paul. Meanwhile, Thalia posed for photos with daughter Aina.

A short while later, the pregnant crab bee hoon arrived. The first taste of the bee hoon has been quite orgasmic for Thalia, and soon I confirmed it. It seemed to be quite a simple dish. The seasonings and garnish were simple, complementing the natural flavor of the crab itself and the broth. I got the taste of the roe, and it was heavenly.

Noe couldn’t seem to get enough of the beehoon and crab meat. I had to keep taking out the crab meat for Noe.

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Then came the steamed shark head. Actually it was not the full head but the upper jaw area, not including the eyes. Again, it looked simple. With minimal garnishing, the real taste of the chewy shark cartilage and fat were brought out out with a hint of soy-sesame oil-garlic-ginger taste.

Thalia couldn’t get enough of it and even gobbled up the hidden parts under the bone. I was curious to know if the shark eyes were included in this dish. I love to eat fish eyes, and I bet shark eyes would taste good in this dish.

We girls tried to make sure that the restaurant staff needed not to wash the dishes

Overall we are really satisfied. The food is good, the service is excellent, the atmosphere of the place is great. We would definitely come back to this place. Next time, we’ll try the male chili crab, just like Bourdain had.

Tian Jin Hai Seafood (Note: the website still uses the old Jackson Centre Kopitiam address)
New Address:
Marina Country Club
No. 600 Punggol 17th Avenue
Singapore 829734
Tel/Fax: 6385-7831

Here’s the coordinate of the place to put into your GPS: 1.4158262136390132, 103.89919638633728

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Traveling with Toddler

January 14, 2008

For full article, click here

Many people considered that our last one-month trip to Mexico and Cuba has been a hard-core one. Meaning that people think that it is such an impossible journey, that many people would think many many times before actually committing into it. But I suppose traveling is so much our passion that we’re willing to take risks and plan such trip. If money is not an issue, we’d like to travel all over the world!

And why are we bringing our little one? Many (Indonesian) parents would think that toddler wouldn’t be strong enough to endure such travel. But we want to experience the world as a family, and we’re confident that we would be sensible enough to travel with considerations of our toddler’s needs and wants. We hope that Noe would be bitten by the same travel bugs that bite us.

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Indi+Noe against Carribean sunset in Havana, Cuba

So, some people have asked us, how do you manage to do such a major travel with a toddler. Our answer would be one word: planning.

Well, planning our trip is a separate article altogether. We’ve also been sharing our travel plan spreadsheet with several people, and they agree that it is so detailed that it looks like a “persiapan perang” battle plan, as you can see in our previous entry.


The Basics for Traveling with Toddler

The first and foremost requirement to travel with toddler is simple, you have to know your toddler very very well, knowing his ability and limitations, so that you could incorporate your toddler’s habits and life-cycle into the travel plan. How? Spend time with your child as much as possible, build trust between you and your child, and finally, test your child’s limit by allowing him to be independent and learn from his own mistake.

Secondly, plan your trip in great detail including incorporating the toddler lifestyle into it. This includes timetable, detailed itinerary, and logistics. Having planned our trip in great details, we know that there are some limitations imposed by bringing our toddler. For example, we won’t be able to go out to the night scenes. If we truly want to go to night scene, one of us would need to stay with the toddler to babysit as a compromise, for example, Indi would go to a dance club in Cuba while I watch over Noe. Also, we know that we have to constantly allocate time to buy snacks and tidbits for Noe. We would also simulate travel time by calculating distances in Google earth, so that we could allocate traveling time by car and allow rest stops so that Noe doesn’t get bored in the car. In terms of logistics, we need to know what would be available or not in the destination. For example, we knew that antibiotics is difficult to get in Cuba, so we had to take our supply of children antibiotics, just in case.

Thirdly, take precautions to reduce risks. Travel insurance is a must, and we spend time comparing different schemes in order to get the cheapest but best option. Also, we talk about our plan to our pediatrician. She would then suggest us to take necessary vaccinations and prepare prescription medicine as our first aid kits. She would also brief us on first-aid basics and how to use the medicine. Lastly, we had planned to take first-aid course but didn’t do it. We were lucky that we didn’t have to do any first-aid measures during our trip.

Fourthly, during the trip itself, be flexible with the plan, constantly watching your toddler. During our trip to Cuba, we had to cancel our plan to go to the provinces because Noe had Roseola Infantum viral fever.

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Traveling with toddler means traveling light, because you need to be prepared to carry the toddler anytime


Some Tips for Traveling with Toddler

The following are travel tips that had greatly helped to ease our trip:

  • Travel light and don’t overpack. You need to be able to carry stuff AND chase/carry your toddler when needed.
  • Ziplock bags, the sturdy type (freezer type), are useful for many things! Mainly they’re used to organize items in the backpack. Quart size to bring leftover food and on-the-road snacks, to pack medicine and toiletries. Gallon size is used to compress clothings for easy packing (Tip: Sit on the filled ziplock and zip them! This makes it into a pseudo-vacuum bag. Use this cheap option rather than getting the expensive special vacuum plastic bags). But don’t throw them away hastily. Reuse them as much as possible, and recycle when disposing them.
  • Breastfeeding! For me this makes traveling with toddler really easy. No bottle feeding kit to lug around. It also helped Noe to recover from his viral infection faster.
  • Wash your clothes during trip. This is how we get by with only bringing a few clothes.
  • Make it into a habit to sleep with lights off at night. This has been our habit before our kids were born. And this has helped the kid’s transition with the timezone better. There has been very little jetlag despite traveling halfway around the globe.
  • Make the most of the surroundings to entertain the toddler without toys. We’re also glad that Noe doesn’t need much toys. We can amuse him (and he can amuse himself) with things that are available on the spot. For example, Noe would have real fun looking at airplane pictures in the seat pocket. Anyways, the airline would most likely be giving toddler toy kit also. So, we didn’t bring too much toys. I think we only brought one Elmo doll, that’s it.

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Breastfeeding really make things become more convenient

The following are things we should’ve done or should’ve bring

  • Toilet training (we truly are a failure in this aspect, even up to now. HELP!). This causes us to have to bring disposable diapers, and to buy disposable diapers in the destination. And we make the earth a dirtier place because of it 😦 Unhappy.
  • Dog tag pendant necklace or anklet for Noe. Just in case if he goes missing (knock on wood), this would help. Even better, if we could put signal-emitting implants on Noe’s body that can be tracked using GPS. Just in case, you know. Thank God we’ve managed our trip without having to put these things.

The following are godsend items that had really helped:

  • Lightweight sturdy umbrella stroller. Lightweight is very important.
  • Baby Bjorn baby-toddler carrier (for toddler under 12 kg) or a sling. Carrying my toddler using this had freed our hands to do other things.
  • Ziplock bags, the sturdy type (freezer type). As mentioned above.
  • Waterless hand cleaner solution like Purell
  • Baby wet wipes. I know, this is not eco-friendly. But convenient nevertheless. Probably during the next trip we would change this with small lightweight microfiber towels.
  • Pacsafe Waist Bag. Safe secure and provide additional space in the packing system.
  • Pacsafe bag protector and steel wire security lock. Although people think that this is not useful, the pacsafe protector has provided us with the peace of mind. For example, we protected our bags by putting pacsafe on it and tying it onto solid column, while we spend time chasing Noe around the waiting room in Manila airport..

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This is typical carry-on-bag situation on the airplane. The big backpacks are checked in. BTW Noe never had his own seat because he’s under 2 year and we want the air tickets to be cheap. Another reason to travel light.


What To Bring for the Toddler: Our List

What did we bring for our toddler for one month? We try to travel as light as possible. Sometimes we were tempted to bring more stuff than we need, but we kept reminding ourselves that we need to travel light. And if we actually need more stuff, we could try to buy the thing once we arrive in our destination. However, this is rarely the case. So far, what we have brought for the trip has been enough (note that we need to allocate time to wash clothes every other night).

The list is actually quite simple

Noe’s Clothes

  • 6 trousers
  • 2 pajama pants
  • 3 socks
  • 2 shoes / sandal
  • 6 shirts / tshirts
  • 1 jacket
  • 1 long sleeve shirt
  • 1 hat

Noe’s Toiletries

  • 1 Kiddy toothbrush
  • 1 Kiddy toothpaste
  • 1 Kiddy bath liquid, also for his hair, the no-tear type
  • 1 Waterless hand cleaner
  • 1 Baby powder
  • Baby wipes, buy one pack containing 80 pieces every 10 days (should think of a more eco friendly strategy)
  • Disposable diapers, medium size, buy every 10 days (should’ve toilet trained him and use cloth diaper instead)

First aid kit for Noe

  • Paracetamol
  • Oralit
  • Ibuprofen
  • Malaria pills
  • Children’s amoxillin (antibiotics)
  • Cough medicine
  • Insect repellent
  • Zambuk for itch and insect bites
  • Vicks vaporub
  • 3 Syringe to give medicine when needed

Others

  • Sippy bottle for Noe’s water
  • Spoon, fork, knife, just in case
  • 10 piece gallon ziplock
  • 30 piece quart ziplock
  • Ikea clip to secure food bags or plastic bags
  • Flash light
  • Book with static stickers, sticker book
  • Small toys for Noe (as little as necessary): Elmo doll, a few metal toycar
  • Our PDA phones with Sesame Street videos for Noe and also our laptop with some videos in the harddisk (rarely need to use these though, but just in case)
  • Pacsafe waist bag and pacsafe bag protector

You can imagine that the above consists mostly of small items and all can fit into tiny backpack. We could do better by eliminating the disposables (diapers and baby wipes). Maybe next time.

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YOU can do it too!

Travel Planning

January 14, 2008

For full article, click here

Indi and I shared one common thing: We love to travel, to see and experience the world (*if money is not an issue). And with travel, we also share one common trait: we plan for it in detail.

Why do we plan? Easy answer: because that’s our style. Some people likes to travel unplanned, arriving at the airport not knowing where to stay or where to go. But not us.

A more difficult answer would be: Because we want to minimize uncertainties and maximise our enjoyment. As much as possible we do not want to be bothered too much with logistical issue. Moreover, we lug our toddlers along with us, hence the need for proper planning. Here, we’d like to share with you our style of travel planning.

We did this for most of our trips, particularly the ones outside South-East Asia.


A. Planning For The Trip

The first step that we do is of course, to decide on the destination. For the Cuba trip, for example, we were in a bookshop in Kuala Lumpur with our friend Fay, and there we came across with a guidebook for Cuba. Indi flicked the book and saw the beautiful photos of the Carribean blue seas, and we instantly knew what we were thinking. I instantly respond to Indi, “Let’s do it before Fidel dies!”. This was, six months before the actual trip began.

The second step is to roughly determine the dates and the duration of the trip of the destination. This happened immediately when we arrive home from that Kuala Lumpur decision. The dates were determined roughly based on the annual leave that we have. We built a basic spreadsheet with the number of days, and determined the dates which we need to travel by air (because this means the day is dedicated for major packing and unpacking). It looks like this, roughly.

Then we began our research… to the library! And to Google! We are very grateful of Singapore’s great National Library system and Singapore’s speedy internet access. We got ourselves the newest version of the guidebook and dissect it.

  1. First thing to research: Airfares and its schedule. This involves calling and emailing travel agents all over the world for quotation, and sometimes, when no penalty is involved, by doing reservation. Tim Ferriss actually recommends using last minute deals to save cost, but since we travel in a big group, we’re not so sure about this. Anyway, for our Mex-Cuba trip, we managed to get a pretty good deal by involving three different agents: The singapore agent to issue Singapore-LA tickets, Alaskan Airlines website for LA-Mexico ticket, and Mexican Airlines office for Mexico City-Cancun-Havana-Mexico City route. We’re glad that the schedules of the different flights fitted nicely, with about 8 hours gap between flights, allowing time for delays and rest.
  2. Second thing to research: Visa: Its validity, cost, and application time. This involves calling the embassies. For US and Mexican Visas, there wasn’t a real problem. It’s a bit tricky because Cuban embassy is not available in Singapore. The closest one is actually in KL, but they don’t serve Singapore residents. We had to do it in Jakarta, and with some persuasion, we managed to get them issued in one day.
  3. Third thing to research: Travel insurance. We chose AXA as it is the most economical.

To compile the research data, we use spreadsheet again, that roughly looks like this. We marked the best deals in distinct red color. Our rough schedule became more solid now that we have clearer data on arrival and departure by air.


B. Planning For The Details Of The Trip

For the details of the trip, we began to use the guidebook to research the accommodation options. We wanted a cheap, clean, and safe accommodation. If there is an option to stay with the locals and experience local culture, that would be even better. We also explored the option of hospitality club.

The second thing of this stage is to identify what we want to visit in our destinations. We also used the guidebooks, and we try our best to check the vehicle and distance required to travel between the objects that we want to visit. If necessary, we even use google earth and roughly measure the distance.

The approximate travel time is plotted down into a detailed itinerary spreadsheet, which uses hourly grid. This doesn’t mean that we plan our activities to the hour detail level. This hourly spreadsheet only helps us to put down the land-travel time, so we roughly know how much free time we have, and when we should be prepare to leave for our next destination by land. Later, we print this hourly spreadsheet, and on the road, we fill out the gap with the activities that we plan to do on the day.

Once we have this spreadsheet, we were also able to jot down daily budget and then approximate the final budget for the trip.

After this second level of planning, we began our bookings for the air tickets, hotel, and land transport.


C. Planning For The Execution of The Trip

Finally, we again reviewed and adjusted the spreadsheets that we have done based on the finalised bookings that we had. We had clearer pictures of the day-to-day travel time vs free time.

Then, we began to build logistics spreadsheet. This involves the list of things we bring and where (which bag) we keep them. Why is this list necessary? Firstly, so that we could travel as lightly as possible and as comfortable and safe as possible. Secondly, so that we know where to put things again, when we need to pack to move to the next destination, and also, so that we know where to locate our stuff without having to unpack the whole bag. During the trip, we need the discipline to store things at the correct bag.

This is how we build the logistics spreadsheet:

  1. The available storage:
    • Two large backpacks
    • Two daypacks
    • Two waist bags
    • Two hidden money belts
    • and Things to be worn
  2. The classification of things we bring:
    • Lower outer garments
    • Upper outer garments
    • Undergarments
    • Accessories
    • Sanitary/bathing items
    • First aid kit (VERY IMPORTANT)
    • Electronic items
    • Documents
    • Other items
    • We also have list of possible souvenirs to bring home.

Then we build a contact list that includes personal contacts in our destination, as well as emergency contacts (police, ambulance, and embassy).

Lastly, we build a spreadsheet for the money that we bring: how much in travellers checks, how much in credit card pre-payment, how much in cash (EUR or USD), and how much we expect to withdraw from ATM. Well, we don’t always do this list. But because we travel to Cuba, where money situation is a bit tricky, we need it.


D. Necessary Actions For The Execution of The Trip

Aside to the planning above, this is the list of necessary actions for the trip in chronological order:

  • Apply for ISIC card or discount cards
  • Buy air tickets
  • Buy travel insurance
  • Learn the local language using Pimsleur methods
  • Book accommodation
  • Book car rental
  • Book bus tickets
  • Consult our doctor and pediatrician for necessary vaccinations and preparation of first aid kits (she gave us prescription medication for standby and briefed us on how to use it. She also gave us letter outlining our medical conditions)
  • Buy items in the logistics list, including the backpacks
  • Pre-pay our credit card
  • Pre-pay our bills (utilities, cellphone, home phone)
  • Put the coordinates of the destinations into our GPS
  • Back up and sync our computers (leave the desktop at home, of course)
  • Put necessary documents as protected pdf into a thumbdrive, including money-related documents such as credit card info
  • Print the abovementioned planning spreadsheets
  • Print copies of travel documents, one each to be put into the bags
  • Print one copy of personal documents necessary for travel, such as medical conditions, insurance documents, etc.
  • Pack up according to the logistics spreadsheet
  • Ready to go!

There you go. Many people said our trip planning and preparation looks like battle plan. Is it true?

During the trip itself, we largely follow the plan. However we were quite flexible with itinerary. For example, we needed to cancel our plan to the smaller towns in Cuba because Noe was sick with viral infection. But that’s OK, we’re glad that our planning and preparation has resulted in a pleasant and memorable trip overall!

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Obsessed with Tracking Stuff

January 14, 2008

For full entry, click here

I think the sayings “What gets measured, gets managed” is quite true….

Tracking our expenses and transactions

We have been quite rigorous in tracking our expenses and transactions since the first years of our marriage. We log our expenses up to the cents.

When we got marriage, we were quite carefree about spending our money, particularly for dining out and entertaining people. Then we realised that we couldn’t account of the spending: it seems that our money just vapored out into thin air, and the savings didn’t grow as much as we wanted it to be. “It couldn’t be!” I thought, “Where does the money go?” Realising that something needed to be done about it, at the beginning, it was just me who took note of the expenses. But then I persuaded Indi about the benefit of doing so and he was willing to give it a try. After doing it for a few months, Indi too realised the great benefit of tracking. Now it has become a habit for both of us.

We didn’t just stop at tracking our expenses. Once a week, I took the duty of consolidating all the expenses into spreadsheet, classifying the expenses into different categories. Once a month, both of us review our income and expenses. It rings true enough, “what gets measured, gets managed“. The following are the benefits of tracking expenses:

  • We know where our money goes. Never again it disappears into thin air. This information is very useful. For example, it is often a surprise to know how much we have spent for small things over one year or more. Let’s say, small purchase of disposable diapers since 2005 until now has depleted our cash by more than 1,000 SGD, and even that, we were using one of the cheapest brand available. Plus the baby wipes, diaper rash cream, etc it may have been close to 1,500 SGD! This is called “The Latte Factor” which is small purchases that count to be a huge expense over time. Thanks to the detailed expenses log that we have, we knew about this and are able to take action (No more Starbucks!). Oh, and about the diaper, we’re currently planning to move to cloth diapering and elimination communication to save cost, but that would be a totally different blog post.
  • The tracking helps us to approximate the expenses for the next month, projecting savings, or to set out budget.
  • The tracking tells us how we could take actions to cut cost, hence save more money. For example, taking a taxi could stretch our expenses to a couple of hundred dollars. Since it is reflected in the spreadsheet, we knew that we need to take bus and walk more.
  • It becomes an interesting record of our spending pattern too!

And it didn’t stop at having a massive record of expenses. Those spreadsheets are useless unless we take action on it. At first, we only took note of the expenses. The next step we knew which corner to cut. Furthermore, we began to set out monthly budget for the expenses. Finally now, we set savings target that we need to fulfil every month and cut the money for saving, first thing in the morning when the paycheck come (Think about the boat, the boat, the boat!).

It worked for us so we’d like to recommend that everyone do it. And it’s not difficult at all, you’d only need a tiny notepad and pen in your pocket / handbag all the time and jot down the expenses as soon as it happens to you. Or, like indi, use the pda that could sync the data with the computer easily. Or, like me, I use twitter and sometimes notepad (my pda sucks). It takes us only 5 seconds at the most, after each purchase.

Tracking my time

Having been used to tracking the expenses, these past couple of months I have been doing the experiment of tracking the time I spent doing things, to the details of five minutes. I realized that I needed to do this, in order to accurately allocate time for doing personal projects or do freelance work. Indi thinks I’m crazy of doing this, but I have my reason. Indi is an employee, so he is able to segregate time for his work and time for other things. As I am a full-time mother and part-time anything else, my time allocation is jumbled and mixed.Before I have kids, I used to be able to focus on doing things for more than three hours straight, even without eating and drinking. Since I’m primarily an at-home-mother (and note, I hate that dicothomy of SAHM vs WM), I am often interrupted by the little ones. Now, I could rarely focus on doing things for more than two hours, which used to be the optimum way for me to be productive. Surely, I needed to change the way I work. But how? Again, “What gets measured, gets managed”. The first step is to know how much time I spend doing things, of course.

Everyday, I track the time I take for doing things, primarily using pda-twitter and also using small notepad. Each tracking took me 5-10 seconds, and each day, on average, there are 16-18 different activities. So it doesn’t take much of my time to track it. Once a week, I would consolidate the time spent into a spreadsheet and classifying it according to several categories (30 minutes per week). Once a month, I review them and this should allow me to decide what actions to be taken (30 minutes).

I found these interesting facts from two month of logs, one prior to Kei’s birth, and one after:

  • Before Kei’s birth, I spent about 9 hours perday of family time and household. After Kei’s birth, I spent about 15 hours perday for this (including more time dedicated for breastfeeding, and taking care two kids). This is given, can’t be reduced, as my kids and family are my priority. However, I should consider ways to make household work more efficient and timesaving.
  • Before Kei’s birth, I spent 3 hours perday to do useless things on the web like facebooking, friendster, flickr, and blogwalking. After Kei’s birth, it became 2 hours. This should be reduced even more: 1 hour per day at the maximum. Make it 30 minutes.
  • On the other hand, on average, I spent only 1 hour perday replying important emails, 1 hour perday doing volunteer work, 1 hour spending time with friends, and 15 minutes perday writing blog or get involved in wikipedia. These should be increased.
  • On average, I sleep 7.5 hours perday. This should be reduced. I use to be able to sleep 6 hours perday only.
  • On average, I spent 1 hour perday traveling or in transport mode. This should be reduced by planning travel more efficiently.
  • Before Kei’s birth, I have 6.5 hours to do work (personal projects or freelance thingy). After Kei’s birth, it became only 3 hours. This should be increased. I am targetting 4-5 hours perday should be available to do work.

Having logged my time in details enables me to decide what activities should I do less (aimlessly web-browsing), what activities should be made more efficient (household work), and what activities should be increased (spending time with kids, work, volunteer). How? Maybe I would try to elaborate more on this in the next blog post (depending on my time).

TV Confusion

January 14, 2008

For full entry, click here

You readers may have known that we, Indi+Rani, don’t have TV at home (many of you asked, “WOW, how do you manage to live without TV?” Then read this, thisthis, and this.)

Well, that doesn’t mean we don’t have TV set, actually, there is one TV set in the living room (and that’s not ours! That’s Yodhi’s TV Set which he bought for the world cup). But the TV set is only plugged into DVD player and not connected to an external antennae or cable network. So, beside video, there’s no possibility for channel flicking in the TV set in our home.

The thing is, although we are disconnected from the TV network, we do not totally prevent Noe from watching videos in the TV set. Why do we prefer video to TV network? Because we want to have the power to choose programs and we don’t want to be exposed to TV advertisements. So far, it worked well. We got ourselves various DVDs of kids shows ranging from Sesame Street series (love it), the Wiggles (initially hated it, but now loving it), Thomas the Tank Engine, Bob the Builder, Winnie the Pooh, and Barney (blech, yuck, hiss, but Noe loves it). We also got into the habit of accompanying Noe while he’s watching his favorite DVD, to explain to him what’s going on on the screen.

Besides DVD, Noe also loves watching video on youtube. He particularly loves Nascar race videos, music videos such as Daft Hands, anything with cars and balls.

We didn’t realize that watching on-demand video led us to a small but interesting problem.

Yesterday, Noe went to Xmas party at our cousin’s place. My dear cousin is a TV junkie, and he subscribes to cable network. Noe was instantly glued to the TV that was screening a car racing program. After 20 minutes, the program finished and continued to a different program, which was not car racing. Noe was confused and asked us agan, “Car again, car again!” We tried to make him understand that the car racing program has finished. But it didn’t work, Noe began to cry and throw tantrum. We panicked, and started to flick channels to find other programs. Luckily there was one program that screened motor racing event. At first, Noe paid attention to this program, but after 15 minutes he began to ask us again, “Car again, car again”. Again we tried to explain to him, that this TV was not playing video, and was unable to repeat or replay programs. Noe became really sad, he cried and threw tantrum again for quite a long time in front of the party guests. It all ended up with Noe vomited his breakfast, and we had to shower him in my cousin’s bathroom. What a headache for me! Luckily, after shower he stopped asking for the car racing program and began to play with other kids.

In conclusion, Noe was very much used to having video at home that he could always ask us to replay programs. That is what he does with DVD and youtube. Hence, when he first encountered TV program, he couldn’t understand why he can’t choose the program he wants, and that TV program can’t be repeated.

I hope now he understands the difference.

Quick Thought on a Pro-Family World

January 14, 2008

For the full article, click here

This is just my quick thought on a Pro-Family World, after a discussion with Ari-Thalia and responding to a discussion in ASIforBaby Yahoogroups. As I was quickly jotting down my thoughts on the issue, it was rambling, disorganized, and not well-researched. And perhaps it’s also politically incorrect or may be offending to some people, hence I apologize before hand if it is indeed the case. I decide to publish it here so that I won’t forget, and hopefully I would be able to write more about this issue.

Begin quoting from ASIforBaby Yahoogroups.

Kalo saya ngeliat masalah FTM (Full Time Mother) vs WM (Working Mother) itu masalah yg lebih gede lagi yaitu masalah norma sosial..

Masalah pertama, pemisahan antara urusan domestik dan urusan publik. Entah kenapa, norma sosial kita cenderung mendomestikasi urusan membesarkan anak (hamil, menyusui, merawat anak). Jadi, urusan2 yang berkaitan dengan itu dibatasi untuk berlangsung di lingkungan dalam rumah aja. Sedangkan urusan pekerjaan, bisnis, mendominasi dunia luar tanpa boleh terjamah oleh urusan membesarkan anak. Thus, wanita yang memilih jalur membesarkan anak sering terjebak norma sosial tersebut.

Padahal, coba dipikir lagi, apa iya anak kecil harus di dalam rumah terus? Waktu dulu, jaman revolusi industri baru mulai, mungkin iya, karena lingkungan kerja memang berbahaya utk anak (polusi, mesin2 berbahaya etc). tapi jaman sekarang, teknologi yang udah maju, dan kebanyakan dari kita di milis ini sebagai white-collar worker environment, yang tidak berbahaya untuk anak. Tetapi mengapa masih ada “stigma” bahwa membesarkan anak adalah urusan tertutup dalam rumah?

Masalah kedua adalah, bahwa kegiatan membesarkan anak tidak membawa keuntungan ekonomi. Wanita yang memilih dari FTM dianggap sebagai “cost” terhadap ekonomi karena dilihat sebagai angkatan kerja yang tidak bekerja (unemployed). Padahal, kalo dipikir, membesarkan anak dengan ASI dan dengan purna waktu bisa jadi membawa keuntungan ekonomi jangka panjang. Sayangnya belum ada riset ilmiah / riset ekonomi mengenai ini.

Jadi, dengan dua masalah ini, wanita dihadapkan dengan pilihan yang lose-lose dalam situasi ini. Jika memilih jadi FTM, ada stigma bahwa FTM tidak bergaul di luar. Jika memilih jadi WM, waktu untuk anak seringkali kurang banyak, apalagi bepergian ke tempat kerja di Jakarta sangat menyita waktu. Tidak ada best-case scenario, bagi si ibu. Semua pilihan membawa efek negatifnya sendiri. Karena itu bisa jadi banyak wanita memilih untuk tidak punya anak.

Lebih jauh lagi untuk kedua orang tua. Jika ibu memilih jadi FTM, bapak harus bekerja duakali lebih keras. Walhasil si bapak memiliki waktu lebih sedikit untuk anak. Interaksi anak dengan ibu dan bapak jadi tidak seimbang. Bahkan ada beberapa bapak yang menganggap pengasuhan anak sebagai penghalang kesibukan. Tapi mau gimana lagi, inilah yang umum terjadi di jaman ini, dan banyak orang harus mengambil pilihan seperti ini.

Karena itu kami (Indrani) di sini berusaha mendobrak stereotipe pengasuhan anak. Caranya sebisa mungkin mengajak anak dengan kegiatan2 yang kita lakukan di luar. Contohnya, saya sebagai FTM mengajak bayi saya (3bln) ke seminar ilmiah, dan orang2 melihat dengan heran karena ternyata anak bisa dibawa ke kegiatan seperti ini. Contoh lain teman saya yang berprofesi sebagai web developer/designer dan ada juga yang sebagai arsitek, sehingga bekerja dari rumah. Mereka mengasuh anak dan mengurus rumah tanpa pembantu atau BS. Mereka membawa anak untuk pertemuan dengan klien, membawa anak ke pameran seni dan pertemuan dengan rekan2 designer. Bahkan mereka membawa anak ke Bar utk dugem di malam hari (karena bar di singapur bebas rokok), sehingga mereka tetap bisa bersosialisasi. Teman saya ini membagi tugas pengasuhan anak antara ibu dan bapak dengan sangat seimbang dan merata. Nah, kata siapa, anak kecil cuma boleh di rumah?

Mari kita coba bayangkan dunia yang berbeda samaa sekali. Boleh dong, berkhayal?

Di dunia yang ini, teknologi komunikasi dan transportasi udah canggih banget sehingga ga ada bedanya berada di rumah atau di kantor. Pilihan untuk jadi FTM atau WM sama2 positif.

Ibu yang memilih untuk menjadi FTM tidak terisolasi, dan dengan network yang canggih ibu2 ini bisa membuat homeschooling dengan ibu2 FTM yang lain, sehingga menekan biaya pendidikan anak. Atau bisa juga membantu mengasuh anak2 dari WM untuk dapet penghasilan tambahan. FTM juga dengan sangat mudah bertukar informasi mengenai pengasuhan anak melalui media blog dan forum website (hehe kalo ini udah terjadi dengan milis ini). Para FTM juga bisa mendapatkan akreditasi dan ijazah mengenai menyusui, pengasuhan dan pendidikan anak dengan assessment kualifikasi mereka oleh organisasi FTM. Selepas anak2 besar, para FTM bisa menyumbangkan ilmu mereka pada organisasi ini untuk ibu2 yang baru melahirkan.

Dunia yang ini, sangat ramah dengan anak kecil dan menyusui. Menyusui dan mengurus anak di tempat umum menjadi hal yang biasa. Baik di taman, di busway, di carrefour, kapan saja dan dimana saja bisa menyusui atau mengganti popok anak. Anak dapat bermain dan berlarian di tempat publik dengan bahaya yang sangat minimum.

Dunia yang ini juga sangat ramah dengan WM. Di dunia ini, tidak ada cuti melahirkan! lho kok malah gak ada? Karena ibu2 ini sejak bayinya berumur sebulan membawa anaknya turut bekerja. Ketika anaknya masih bayi dan banyak tidur, bayi ditaruh di tempat tidur bayi di cubicle dan meja ibu, sehingga kapanpun WM bisa menyusui. Sampai mbak2 teller di bank pun membawa anaknya, sehingga mereka menerima nasabah sambil menggendong bayinya. Guru-guru dan dosen menggendong bayinya sambil mengajar. Konsultan membawa bayinya ke rapat klien, dan klien pun membawa bayinya ke rapat.

Ketika anak sudah bisa jalan, WM bisa menitipkan anaknya di penitipan anak di gedung kantor yang sama, yang dikelola oleh para FTM pro-ASI. Karena jumlah WM dan FTM seimbang, di semua kantor ada TPA. WM mendapatkan bantuan pengasuhan anak oleh pengasuh profesional (FTM), dan FTM mendapat penghasilan tambahan. Setiap empat anak diasuh oleh 1 FTM. Di waktu makan siang, WM menyusui anak di TPA. Saat WM mengantor, FTM memberikan ASI perah. Setiap pulang kantor WM mendapat laporan kegiatan dari FTM.

Ketika anak sudah berusia lebih dari 2 tahun, belum sekolah, dan menyusui hanya sedikit, giliran bapak yang mengurus anak sambil ngantor. Ada banyak pilihan pengasuhan anak balita. Bisa dititipkan di TPA di gedung kantor, dan bapak akan selalu mengajak anaknya makan siang atau minum teh di waktu2 istirahat. Atau bisa juga anak ikut mengantor dengan bapaknya, dan ini bukan hal yang aneh. Karena bapak mengenal anaknya dengan baik, bapak lebih bisa menghandle anaknya dan si anak juga akan berusaha mengerti kebutuhan bapaknya. Walhasil, si anak bisa diajak ke meeting-meeting dan ketemu anak2 kliennya. Hasilnya si anak akan mengerti apa yg dikerjakan orangtuanya selama di kantor, dan si anak merasa tidak terisolasi dengan dunia luar. Kalau anak bosan di kantor bisa turun ke TPA di gedung kantor.

Lebih ekstrim lagi, tempat2 dugem pun menjadi ramah anak2. Bebas rokok, dan tersedia playground / tempat tidur untuk anak. Orangtua yang suka dugem tetap bisa bersosialisasi tanpa harus meninggalkan anak.

Hayo, ibu2 apakah ada khayalan mengenai dunia yang ramah anak? silakan ditambahkan. mudah2an khayalan ini bisa terlaksana.

A Retrospective of Two Weeks Breastfeeding

January 13, 2008

For full article, click here

This writing is to compare two breastfeeding experiences: Noe’s first two weeks and Kei’s.


Preparation

Noe: I decided to fully breastfeed my baby because of what international health organization and experts recommends for baby’s first six months. But I thought that breastfeeding should be natural and should not be learned. So I made no effort in looking for any information about breastfeeding at all. Despite that, I was really confident that I wouldn’t face any difficulty breastfeeding. Later, it turned out that I was too cocky.

Kei: Having volunteered with Breastfeeding Mother Support group and received counseling training from them, plus, having purchased the Breastfeeding Answer Book, and having engaged a lactation consultant to counsel me during the first few days after birth, I am (hopefully) better equipped to breastfeed my baby. I roughly know the basics of breastfeeding and I know where to look for help if anything goes wrong. I am more confident but hopefully not as cocky as during Noe’s time.


Birth and The First Few Hours

Noe: (Details are here, here, and here)  Noe was delivered vaginally with only two pushes and I had very few stitches. It was relatively easy labor but with severe complications post-partum. After clamping the umbilical cord, Noe was given to me for cuddling, but I didn’t know that I could breastfeed him at the very moment. I thought I had to finish all the childbirth procedures; stitching and all; before beginning to breastfeed for the first time. Hence I handed him back to the nurse to be taken to the nursery, because Noe was crying (stupid decision by me). A few minutes later I had severe post-partum hemorrhage which was caused by lack of contraction in my uterus. The bleeding could’ve been reduced if I had been breastfeeding when Noe was given to me for cuddling, but I didn’t know that. The bleeding was so bad and I ended up feeling cold, shivering, and very tired. After the critical condition ended, the nurse asked me whether I wanted to breastfeed, and I declined saying that I was too tired. The nurse asked again, “But you asked for total breastfeeding..” and I insisted, “Yes.. but I am really tired now, please just give him formula if he’s hungry. I will try to breastfeed him when I feel stronger“. I regret this decision even until now, and this decision caused Noe to have nipple confusion which later caused a series of breastfeeding problems. I was then brought into Intensive Care Unit, and stayed there for 18 hours, before seeing Noe again for the first breastfeeding.

Kei: I decided to prepare for ideal condition to begin breastfeeding. First, I intend to have drug-free birth, because anasthesia is known to cause drowsiness in newborn and inability to breastfeed right after birth. Secondly, I engaged a lactation consultant during labor to assist breastfeeding during the first hour. I was glad that my birth plan was mostly followed. Kei was put on my breast for skin-to-skin contact within 10 minutes after birth, but he was not really interested in breastfeeding at the moment. So we quickly weigh him and measure him, and put him back into breast at the second 10 minutes after birth, and this time Kei is more interested in breastfeeding. The first time he nipple-feed me, which is wrong, so we had to break the suction and attempt for a more correct latch-on. Kei managed to latch-on beautifully during his second attempt, and despite his “weak” suck (compared to Noe’s suck, which is a toddler) I could feel the effect instantly. I felt a bit of pain in my uterus which means that it is contracting, hence reducing the bleeding. I think Kei breastfed nicely for about half an hour before dosing off to sleep. When Kei was bathed for the first time, he expelled meconium instantly since he had drunk the colostrum. The expulsion of meconium is very important as it will help to reduce the risk of jaundice.

P20050407-005
Noe
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Kei


The Second Day

Noe: Noe breastfed for the first time 18 hours after childbirth. Since he had been given formula while I was in ICU, he latched-on incorrectly to my breast just like he was sucking bottle. Noe was basically nipple-feed, and I did nothing to correct it because I didn’t know it was wrong. Ami Prasetyo, a friend who was visiting, pointed out my mistake, but I ignored it because I haven’t yet felt any pain. Meanwhile, no lactation consultant or nurse helped me with my latch-on, hence the mistake was not corrected. By early evening, I began to have sore nipple, but the massive dose of painkiller given to me masked out the pain. At night, Noe did cluster feeding. This means Noe feeds non-stop from 2am to 4am. I didn’t know that such condition is normal during the first few days. But I was too tired due to my bleeding and low hemoglobin rate, and I didn’t understand why Noe wasn’t satiated at all. At the end, I was overly tired and I asked the nurse to take Noe away to nursery and feed him with a bottle of formula.

Kei: Three hours after birth, Kei was brought in to breastfeed, but he wasn’t interested. I attempted to feed him for one hour but he stayed asleep. I thought that this might be a normal situation, whereas in the beginning the baby was a bit sleepy, and this might be nature’s way to help the mother rest after childbirth. I sent Kei back to nursery so I could sleep: making the most out of baby’s sleepy time. Kei breastfed for the second time approximately six hours after birth, and during the first day he fed every five to six hours. I tried to sleep as much as possible, because I expected that Kei would do cluster feeding sooner or later. During Kei’s third feeding, at around 10am, Doris (lactation consultant) came for a visit and helped me with a “refresher course” on breastfeeding. I learned that I had to catch Kei’s big mouth opening (say AAH!) in order to produce a good latch-on. This is a bit challenging because Kei’s behaviour was random (like most babies) and I was the one who has to be observant of his behaviour. Basically both mother and child are learning about each other’s ability and limitation. Kei’s was a quick learner, he learned that he would be rewarded with milk if he opened his mouth really big. As a result, Kei has always done good latch-on and I didn’t have any soreness. Later on, at night, true to my prediction, Kei began to cluster feed. This time, I was physically fit and prepared, so I said to Kei, “Let’s have a battle, who is stronger and who will survive the night with cluster feeding”. I fed Kei non stop from 1am to 4am, going from left to right breast and repeat the cycle, nonstop. At the end, at 4am, Kei fell asleep by himself, being too tired of cluster feeding. I was glad I won the battle. I then sent him back to nursery and I slept comfortably for four hours straight. After that cluster feeding session, Kei feeding hours began to become more regular and predictable.

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Noe
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Kei


The Third Day

Noe: During the second day I received blood transfusion in order to boost my hemoglobin rate. Noe roomed in with me during the day, and sent to me from the nursery every 3-4 hours during the night. My sore nipple was getting worse with the nipple skin peeling off. The painkiller started to lose out to the pain of sore nipple. I asked the nurse for a help to cure the sore nipple, and she was aghast to see such a bad nipple condition. She gave me medela ointment to apply to the nipple before and after nursing. The problem is, the nurse was not fixing the latch-on problem, which was the source of the problem, and I didn’t know it. In the mean time, no lactation consultant paid me a visit (and I didn’t know that there is such thing as a lactation consultant). Meanwhile, most people told me that sore nipple is normal for the first week and it will subside by itself. So I took it for granted that sore nipple is the normal pathway towards breastfeeding. Little did I know that sore nipple is not a normal condition and that it could all be resolved by a quick visit to IBCLC (certified lactation consultant).

Kei: Since I had a vaginal delivery without complication I was able to come home the second day. So far Kei has been breastfeeding well, as indicated by his pee and poo cycle. I saw that Kei has been having more than four poos, which was very good for a two-day old baby. Kei also didn’t show any sign of jaundice, so doctor let him out of hospital without prick test. We were discharged in the afternoon. Kei’s weight upon discharge was 2630 grams. Losing weight during the first days was normal because the baby shed meconium and excess water in the body. Back home, Kei feed every 1-1.5 hours. At night, he was again having cluster feeding, this time it was for six hours straight. I fed him in cradle hold position and fell asleep sitting down cradling Kei. Lucky that I managed to maintain the cradle position while I was asleep, and Kei was latched on all the way. That was the last cluster feeding session for the first two weeks.


The Fourth Day

Noe: Since my blood transfusion result was good, I was discharged at the third day. It turned out that going home was a struggle for me. I was considerably weak due to the blood loss, this means I was easily tired. Compounded with difficulty breastfeeding with sore nipple and baby blues, I became sad easily. Noe was feeding quite frequently and it tired me, and he was given formula. When my husband gave Noe the first formula bottle at home, it dawned to me that I did not want to bottle-feed him, because it seemed to be really cumbersome: preparing the formula, ensuring the right temperature, feeding the milk, and washing/sterilizing the bottle afterwards. Knowing me, I would be too sloppy and too careless to bottle feed Noe. Besides, my weak condition didn’t spare me enough energy to do the extra chore of making formula milk and cleaning it afterwards. From that moment I decided to go back to total breastfeeding, despite the pain of sore nipple.

Kei: So far the breastfeeding experience has been really painless (but still a bit tiring with its high frequency). And my mature milk has begun to come in: I experienced breast fullness and I could see white milk when they’re squeezed. Meanwhile, Kei’s poo has turned yellow and grainy like curry. His breastfeeding frequency has also begun to space out to 2-2.5 hours.


The Fifth Day

Noe: Away from the hospital and away from the painkiller, I just realized that sore nipple pain was worse than labor pain. I literally broke down to tears every time I breastfed because it was really really painful. My mother was really puzzled to see me crying and screaming out of pain of the sore nipple. People reassured me that the pain will subside after one week, so I decided to stay put despite the pain. Of course, with crying and screaming. The nipple skin peeled off leaving a really painful gaping wound. I decided to do away without bra, because the friction of the nipple with the bra aggravated the pain. Meanwhile, my mature milk began to come in and I began to leak all over the house. I also began to have slight engorgement. All the changes in my body had never happened before, and I was really stressed out because of it. Meanwhile, my husband went off to buy breastpump and nipple shield because he couldn’t stand to see me in great pain.

Kei: I began to have breast engorgement but no leak yet. There’s also lump in armpit. I gave cabbage compress for 2 hours and it was soothing. Noe helped empty the breast but didn’t help alleviating the engorgement. I also had a low grade fever, and I took panadol to cure it. This time I know that all those changes in my body were normal and it was my body’s attempt to calibrate the right milk supply. I was more prepared, especially with the breastfeeding book, and had known the first-aid measure to overcome engorgement. And by the way, I don’t have sore nipple at all, and this makes breastfeeding really enjoyable.


The Sixth Day

Noe: This time I tried to pump the milk so that I didn’t have to go through the pain of breastfeeding directly. To my horror, while pumping, the sore nipple wound opened up and blood was expressed alongside milk. I was totally freaked out seeing the bloody breastmilk. Not knowing what to do with it, I threw away the bloody milk and quit pumping at the very moment. I decided, again, to bear with the sore nipple pain, instead of having to bear seeing my nipple exploding with blood.

Kei: The low-grade fever subsided, but the slight engorgement stayed on. Due to the engorgement, latching on became more challenging. Luckily the “sandwich” technique as taught by Doris helped to ease the latch-on process. Kei adapted really well to the changes in my body. Despite all those changes, I managed to catch all Kei’s big mouth openings, and latching-on was easy. Kei had learned that his reward of milk comes with the big AAH that he made.


The Beginning of the Second Week

Noe: Breastfeeding and baby caring becomes a dreaded task for me. I felt really miserable. Compounded with baby blues, I really didn’t enjoy having a baby. At this stage, a baby is not yet responsive to eye contact, and this made me feel unappreciated. I felt really incompetent because my mom always criticized the way I care the baby. Moreover, breastfeeding was really painful with sore nipple. Breastfeeding was also a hassle. I had to change clothes very frequently because of bad leaking. I had to ensure that I install the breast shield to protect the sore nipple, and milk drips inside the shield,  onto the tshirt, onto the floor, creating a big milky mess all over the house. The whole house smells like stale milk. In short, I was feeling really miserable. But somehow I didn’t stop to change to formula feeding. Most probably because I didn’t have the energy to make formula milk, clean the bottle, sterilize it, etc. My hemorrhage made me fall tired really easily, and I just wanted to avoid extra work related with house chores, including cleaning the bottle. This is mainly why I stuck with breastfeeding. It wasn’t at all any noble goal to give my baby the best nutrition. It was mainly out of my weak physical condition and my own laziness.

Kei: At the beginning of the second week the engorgement had subsided and the milk supply seemed to have stabilized. The leak was not as bad as in 2005, surprisingly. Nevertheless, both Kei and Noe seemed well satiated. BTW, I am doing tandem nursing, which means I breastfeed both Kei and Noe. But I only do tandem at night. It is a bit tiring, but it seemed to lessen the sibling rivalry between the two. Despite having to feed to kids, so far I don’t have nipple soreness. Baby care and breastfeeding are now enjoyable for me, mainly because it is not a painful experience. Oh this time I also experienced baby blues during the first week, but by the end of second week it has subsided.


The End of the Second Week

Noe: At the end of the second week I truly regret my negative feeling towards breastfeeding Noe. This is because suddenly Noe was unable to breastfeed anymore (Details are here and here). At that point, I realized that I would take whatever pain caused by breastfeeding as long as Noe wants to breastfeed. Noe’s inability to feed came very suddenly, and I felt really rejected. Although I’m not a religious person, at that time, I prayed to God that I was really sorry to Her, to be so negative about my breastfeeding pain, and I prayed that Noe would return to breastfeeding. The story went like this. Suddenly, one morning, on Tuesday 29 March, Noe lost his ability to latch on. We tried for many hours to put him into the breast but he was just unable to do it. Indi was so worried that he took sick leave from the office to help me. We gave up trying to breastfeed after six hours trying when we heard grueling sound from Noe’s stomach, indicating bad hunger. We finally gave him formula, and Noe fell asleep, satiated. It was really weird because he couldn’t latch on my breast, but he would take the bottle. We went to a lactation consultant in our hospital for two days straight, but she was unable to give us a satisfactory answer. At the end, on Thursday 31 March, I went to Doris and she did a thorough analysis of my condition. Doris gave a clear diagnosis: an overactive milk ejection reflex, which means I have too much milk and Noe was like trying to drink out of a fire hydrant. She also gave me three steps to overcome the problem: 1. Pump before breastfeeding so that Noe didn’t have to cope with the let-down; 2. Breastfeed in lying-down position to defy gravity; or; 3. Pump and feed through bottle. At home, we tried the second way. Our good friend Karyn, who was active in La Leche League, also lent us her support by trying to get Noe back to the breast again. The situation was really bad that even my mom flew back from Jakarta (she thought Noe went on strike because Noe missed her). But amazingly, at night of 31st March, Noe went back to breastfeeding! It was the best birthday present for me ever, and I thank God that She answers my prayers. After two weeks, my breastfeeding problem didn’t stop. I had three times mastitis attack within the first three months. My hemorrhage had left me with a physical condition that is vulnerable to infection. But I could cope better because I knew how to look for breastfeeding information and where to find help.

Kei: Except for dripping and leaking all over the house, so far I didn’t have significant problem. I hope that breastfeeding would stay to be a breeze like this until Kei is at least six months, and hopefully, two years.


Conclusions and Lesson Learned

My first month breastfeeding experience with Noe was really bad and painful, plus, it was further aggravated with baby blues. The only thing that kept me from shifting to bottle-feed was my laziness and my weak condition after hemorrhaging. Moreover we don’t have permanent live-in helper (maid), and my husband couldn’t afford to be sleep deprived. Hence I simply didn’t have enough energy to do the extra effort of making formula milk and cleaning the bottle. Apparently my weak condition was the silver lining of my childbirth complication, that had forced me to breastfeed. Despite the rough beginning, eventually it became really easy. I am glad to be able to continue breastfeeding until now.

My experience with Noe taught me that breastfeeding is not easy and it is something to be learned by the mother and baby. If I have read breastfeeding references and prepare myself, I might have better and more pleasant beginning. But I was too cocky.

My second child birth taught me that good breastfeeding start is important to avoid the compounded problems that will arrive later. The first two days is good time to learn to achieve effective latch-on and learning about the baby’s cues (like, how to catch the big AH for a perfect latch-on), because the early days is not yet troubled with engorgement or leaking. I would highly recommend close contact with lactation consultant or counselor during the early days.

It is very important to know where to find breastfeeding help. Breastfeeding difficulty often needs to be addressed fast, that’s why, most breastfeeding support groups and hospitals provide breastfeeding support hotlines. First and foremost I would like to thank Google for helping me to find information really fast. And I’m very grateful of my lactation consultant and breastfeeding guru, Doris Fok (Thank Google from which I found her contact info). Too bad, many people didn’t know that there is a profession called lactation consultant that gives help for breastfeeding difficulties. Moreover, it is too bad that the modern urban culture has put breastfeeding as something to be embarrassed about, hence women nowadays couldn’t easily find reference about breastfeeding in public sphere.

Kei’s Birth 2 – The Day

January 13, 2008

For original article, click here


Keilani getting himself comfortable under infant warmer system at the delivery room of National University Hospital, Singapore.The last weeks

During my last hospital visit on 16 October, the CTG shows that I have been having steady contractions of 17 minutes apart. Funny that I couldn’t feel anything. Dr Li Lin said that those are inactive contraction, “practicing” for the big day.

The week after that on 23 October, I went to visit dr Chong who were surprised to see me still hasn’t given birth yet. I was also confused because I didn’t feel any contraction at all. I even asked him whether I should try inserting evening primrose oil pills into the birth canal (as it is a natural method of induction). Dr. Chong said such measure is not necessary as he would only suggest induction if I go beyond 41 weeks or if the USG scan shows any problems. So far USG scan result was good for natural birth. I was grateful and relieved.

At the same time I consulted the birth plan with him: that I intended to be accompanied by a birth coach, and that I want to have a drug free birth. He largely agreed with my plan that drug-free birth is possible, but he needed to inject oxytocin after birth to avoid possible bleeding. I agreed to compromise to accept the oxytocin flush, considering my hemorrhage risk. Dr. Chong also advised that I have to put my state of mind as relaxed as possible to minimise the pain (sort of a “trance” state), but he also suggested me not to be to bound by the birth plan : if I can’t cope with the pain I should inform the medical staff as soon as possible because such condition (tiredness or inability to cope with pain) won’t be productive for the labour. I agreed with his suggestion but kept emphasizing to him my intention to try to cope with the pain as much as possible.


The day before

On 24 October morning and afternoon I was still busy to finish work and to go to campus to return the books. Ever since my last visit to the doctor my mom insisted to accompany me wherever I went so that if anything happen there’s somebody to help. In the late afternoon it was rather difficult to get taxi in NUS and some inconsiderate academic staff decided to ignore my pregnant presence and she got a taxi from across the road, even though I waited for taxi before her. I wasn’t speedy enough to run to cross the road to chase for that particular taxi. But that bitch did! Oh well…

Evening, 24 October, I breastfed Noe to put him to sleep. Unlike the other days when I breastfeed during pregnancy, this time the feeding session seems to increase the intensity of uterine contraction. Not long after that I began to notice faint contraction pain. I began to time it, and it seemed to be regular, coming at 10-11 minutes apart. I began to freak out because I haven’t packed the suitcase for hospital. I jumped out of bed and pack the suitcase and prepare the documents to check into the hospital. Then I went to rush to finish my will, send it off to Indi to print tomorrow at the office, and back up the computer. Everything that needed to be done prior to delivery has been done, so I tried to sleep.

I couldn’t totally sleep because the contraction pain recurred. I laid down and rest my body as much as possible in between the rush.


The Development of the Contraction at Home

Morning 25 October. I woke up at 5 am and spend time browsing the web and do some work. Contraction as 7 to 8 minutes apart. My mom woke up and I mentioned to her about the regular contraction. She asked whether my mucous plug has come out, and I said no. She advised me to cancel going to Little India in the afternoon and just concentrate on the contraction. At 6am I sms-ed Doris and she advised me to call the labour ward to see whether I needed to check in. I called NUH labour ward and the nurse asked whether this is the first baby and whether I stayed far from NUH. I said this was the second baby and I lived very close to NUH. The nurse advised me to come when the contraction is 5 minutes apart or when the water broke, and that she would reserve a labor ward for me. So I decided to just wait at home as per her suggestion. Besides, there is no free wi-fi in NUH and I would be bored to death there.

The contraction stays regular at 7-8 minutes in the morning. I prepared Noe to go to school / daycare, and apologized to him that I might not be home in the evening because I needed to go to hospital to help the baby out of the belly. He nodded. We decided to call taxi to send Noe to the daycare, saving us from walking 1.5 km.

Strangely, after Noe went to school, the contraction stopped! I decided to take the opportunity to have a good sleep, because if labor did happen, I should have enough energy to go through it. Contraction stops for 2 hours and I had a good sleep.

At noon, the contraction returns, further apart at 9-10 minutes, but more intense. I continued with my activity at home, and stopped every once in a while to “enjoy the contraction pain“. I did the breathing out exercise to alleviate the pain. The contraction grew more and more intensely over the 5 hours period. At noon, the pain was focused in the lower front part of my abdomen, and slowly, the pain expands to envelope the sides. Eventually, at around 3.30 pm the pain enveloped into the whole lower back and got even more intense. Ibu Tuti, my mom in law, gave a massage at the low back area which nicely helped reduce the pain. It was painful, but lying down in my bed didn’t help. I had to sit or walk around, keeping on with my activity, and the pain would be less severe.

At 3.30 pm, contraction was 6 minutes apart. But my mom was still doubtful whether this is a true labor because my mucus plug hasn’t come off yet. Anyway, I decided to stay put and only go to labour ward when the frequency is truly five minutes apart. I kept drinking water to keep myself hydrated.

At 5pm my mom and mom in-law offered me fresh cut fruit. I made red raspberry leaf tea with honey from Katrina, which is said to help induce birth. Then I went to the toilet, as usual. I saw a surprise, the mucus plug had come off! It was exactly 5.30pm in the toilet. I called into labour ward and ask whether I need to go, and they said yes. I then call Indi to inform him, and it was just a perfect timing! He just walked out of the office! Indi decided to catch a cab to make a huge loop: first to get Noe from school, then drop him home with my inlaws, while me and my mom get onto the taxi, and off to the labour ward.

At 5.45pm Indi arrived home with Noe and amazingly Noe didn’t cry when me and Indi went off in the taxi. I was so grateful that he understood what was said to him in the morning. Our neighbour also waved goodbye to us.


In the Hospital

At 6pm I arrived in the A&E. Nurse put me into wheelchair and roll me out to the labor ward at 2nd story. I timed the contraction, it was about 4-5 minutes apart. The labor ward was ready, and I put on the hospital gown. The next hour was spent doing boring paperworks while I was coping with the more and more intense pain. I also complied to CTG since the nurse said it would only take 15 minutes.

Doris, my birth coach, arrived at around 6.45pm and she asked me to move into the most comfortable position. I said to her sitting down is the most comfortable. She also prepared warm compress. It was the first time Indi met Doris and the two of them instantly joked to one another. Having both of them in the labor ward really alleviates the pain.

Doris coached me to breathe out slowly and visualize the sea, and amazingly it really helped to alleviate the pain. When the contraction came Doris taught Indi how to massage the lower back while I squeezed their hands, breathing out slowly. In between the contractions, they all kept throwing jokes to one another and to the nurse too.

At around 7.15 a young doctor came to perform VE (vaginal examination) and discovered that I am 8 cm dilated already. I didn’t expect that, I thought I was only at the early stage. So we had to cancel our plan to have a warm bath in the jacuzzi as pain relief, since the dilation is almost complete.

After that came the most unpleasant moment, having IV patch installed in my left hand and blood taken for matching, while I also have to cope with the contraction pain, and my left hand unable to squeeze Indi. I really hate this moment but it was necessary to later perform the oxytocin flush. It took them about 10 minutes to complete the job. ARRGH!


The Peak

At this stage the pain reached its peak and what I’ll write down here is based on my vague memory on what’s going on. I could only write down what I felt and didn’t really notice what happened around me.

At around 7.30 the contraction became very intense enveloping the whole lower back, and I said that “I felt the urge to push!“. Doris coached me to go through the pain, telling me not to push and to just breathe through the urge slowly. For me, the effect of doing that was truly sublime and I came into the realization that I could sense what is going on during my labor! For me it was like an enlightenment, that I could understand what’s going on inside my body! I realized that the “urge to push” was actually the baby’s head pushing down when I was fully dilated. As I was restraining myself to push, I let my body do whatever it wanted to do with that pushing down sensation. At that time I felt that the “bulge” retracted back inside my body. Since the nurse heard me saying “the urge to push“, she called the junior doctor back to perform the second VE and he discovered that I’m fully dilated and the baby’s head is really really low. Someone then said to call the doctor, while the nurse midwife is getting ready for labour.

Doris asked me to go into sideways position and to brace into the bed railings, which I agreed to do. I was in the peak of pain and wanted to just fully concentrate to understand it and cope with it. When the pain began to come, I scream “The contraction is coming!“, I closed my eyes, concentrate, and breathe through it. Sometimes I felt the sensation of the head pushing downward by itself, and sometimes the pain came without such sensation. What I did was just breathing through it while translating / conveying what I felt happening to my body to everybody in the room. When I felt the head pushing down, I scream “I felt the baby is coming down!“. Doris then peeked into my underside and confirmed, “Yes I saw the baby’s head“. Then I felt the head retracted back up and I scream “It’s going back up!“, then the midwife peeked to see that there’s no head bulging out.

Then another contraction followed but the baby’s head isn’t coming down.

Then another contraction followed and I really felt that baby’s head IS COMING DOWN and I COULDN’T STOP IT. I scream, “The baby is coming out NOW!“, The nurse scream to me to, “Hold it, hold it” because Dr. Chong hasn’t arrived yet. But I couldn’t hold anything because I was not pushing! I said, “I cannot hold it! The baby is coming out NOW!” Again, I wasn’t pushing, I was just breathing through the force that enveloped me, my lower body just open up by itself, and my uterus just pushed the baby out by itself. It was really amazing, like, my body was possessed by an amazing external force outside my control. Really, I wasn’t controlling the process by pushing because, I wasn’t pushing at all. The baby just came out like a train departing from a station.

There was a bulge coming out and it was the water bag, still intact. Suddenly I felt that it popped / exploded, water gushed out, and everybody in the room scream that, “The water bag had just burst!” then followed “The baby’s head is coming out!“. The flow of amniotic fluid helped to ease the expulsion process. I felt the steady force expelling the baby’s head slowly, and I still wasn’t pushing! Then I sensed a short relief when it got into the neck part, and followed by another strong force that expelled the whole body. I kept breathing through it, and still not pushing, bracing myself to the bed railings in a sideways position. The exact moment when the baby is completely out I felt totally blissful, relieved, and euphoric which was an amazing feeling. I was also trembling and shivering like I had just finished a long run. It was 7.50 pm.

After that I just want to rest and shut my senses for a while, so I didn’t really pay attention on what going on around me. I only remember asking, “Did the baby cry?” and Doris answered, “Yes really loudly“. I also asked, “So he’s definitely a boy?” and everybody said, “Definitely!“. I also remember someone screamed, “Wow! The baby passes urine now!” Yeah, the first thing the baby did after crying was to spray pee to the people in the delivery suite. What a great way to thank them, Kei!

A few minutes later Dr. Chong arrived and said, “Congratulations, you just had a self-service delivery!” After that, my IV plug was opened and hooked onto IV drips containing oxytocin.

Meanwhile Doris commented that this is a second time seeing water bag intact during the last stage of delivery. Mine broke when it was just out of the birth canal. On another occasion, Doris saw her friend’s water bag delivered fully intact and the doctor was really eager to puncture it.


First Feed

I was then turned from sideways position to semi sitting position and getting ready to breastfeed for the first time, after the baby’s cord is clamped and cut. Doris wiped my perspiration using warm wet towel except for the chest area because she wanted the baby to know my smell. Kei (the baby) was put on my chest, I think, within 10 minutes after delivery, giving direct skin-to-skin contact. He hasn’t been bathed yet but he was very clean, with no trace of blood at all. Perhaps it’s due to the fact that the water bag only burst at the last minute when the baby is coming out, protecting the baby from any bleeding in my body. We (Me and Doris) didn’t do the “breastcrawl” method, instead, we try to offer the baby my breast. The first 10 minutes upon contact Kei was only moving his head around. When offered the breast he would just lick it and play with it. Eventually, during the second 10 minutes, Kei began to open his mouth to put the breast into it. At the first attempt he was just nipple feed, which is not correct, so Doris asked me to break the suction and try again. The second time around, Kei happened to open his mouth really wide and we shoved the breast onto his mouth, resulting in a perfect latch-on. The suck felt weak compared to Noe’s suckle, but he seems to actively nurse and swallowing the colostrum. Also, I know that it has been a good latch because I could felt my uterus contracting along with the suckle. Doris reminded me to work on the latch-on during the first few days, this is when both mother and baby learn the correct way to breastfeed.

 


Rani and her birthing coach Doris Fok are having a good time to get Kei breastfed for the first time. Kei did really well!

After a few minutes, I don’t know how long, Kei released the suckle and fell asleep, and the nurse took him away to be cleaned. The magic of colostrum worked immediately – Kei passed motion while being cleaned. This is very good, because the first meconium passage will help expel excess bilirubin from his body, hence minimizing the risk of jaundice.

In the mean time, dr. Chong delivered the placenta and ensure that the SOP to prevent bleeding has been done correctly. He continued to examine the natural tear that happened after delivery. He said, “I need to apply LA (local anasthesia) to do the stitching, OK?” I said, “OK doctor, is the damage really bad?” He said,” Yours is first degree laceration, this is considered to be normal. Even second degree laceration is still considered normal“. I asked again, “Do you need to stitch a lot?” and he said, bluffing, “Yes you need a wayyyy lottt of stitches!“, which means I don’t need too many stitches. Dr. Chong is always joking in a bluffing manner but it really helped to lighten the atmosphere.

After experiencing it by myself, I realized the importance of breastfeeding soon after delivery. For the mother, it helped the uterus to contract, hence reduce the risk of hemorrhaging and help speed up recovery. For the baby, the laxative nature of colostrum helped expel the meconium, the first stool, hence help reducing the risk of jaundice. And not to mention the non-medical benefit, such as bonding, an opportunity for the mother and baby to get to know one another through the skin-to-skin contact, getting the warmth and scent of each other. I am so grateful to be able to experience this, and I hope other mothers would too.


Aftermath

Kei fell asleep right after his bath and he was wheeled into the nursery for check up with the neonatologist. I will write down his story of the first few days in another entry. I was wheeled into the ward and given hot Milo with toast. Indi went down to buy me big dinner, because I didn’t have a chance to eat anything before coming to the hospital. I was hungry like mad.

Overall it was a really pleasant birthing experience. I thoroughly thank God for that. Everything fell into place nicely. First, Noe was not fussy at all when left alone without me and Indi, and he seemed to understand what was expected from him. Secondly, the last stage of birth began nicely, right when Indi stepped out of the office after finishing his work, giving him the opportunity to catch the cab and wrap up the tasks of the day, without needing to take his paternity leave for Thursday. Thirdly, I didn’t have to go through a long and painful labor. I am so grateful to be blessed with quick and smooth delivery. Fourth, it was also a perfect timing for Doris to come, after finishing her work during the day and she was also able to go home quickly since the delivery was fast. Fifth, I was able to get up and walk around within hours, thank God.

There are a bit of downsides too. I hate having the IV plug attached to me and having the drips on the whole first night in the hospital. It really restrained my movement making feeding difficult when IV was attached. Secondly, we’ve booked for the deluxe delivery suite with jacuzzi and stereo, because we intended to use warm water bath as a method of pain relief and relaxation, and in the end, we only spent less than two hours there without even used the jacuzzi and stereo! And we were charged full for the deluxe suite! Thirdly, the paperwork in NUH is a pain, and checking out of the hospital was not so straightforward. Moreover there are some error in my hospital bill and the NUH staff could only explain to us about it after repeated nagging, and NUH food was not so good (Lucky there’s Kopitiam).

So that’s the end of the birth chronology.

Kei’s Birth 1 – Preparation

January 13, 2008

For original entry, click here

I’m back into the real world after two days being confined and pampered in the hospital ! Now Kei is one week old. Anyway my handsome and caring husband has written the summary of the birth process in the previous entry, and I’ll try to write down more details of the birthing experience before I forgot, so here goes. This story will come in several parts: the preparation, the birth story itself, and some afterthoughts. These stories are personal story of mine, and I share it here for my family and friends. And it’s gonna be long because I want to dump as much details as possible that I can remember.

Technical (Medical) Preparation

I couldn’t help to think that the hemorrhage that I experienced during Noe’s childbirth is related to the drugs given during childbirth, mainly to induce contraction. The induction through drugs increases the risk of bleeding, and I am one of the unfortunate few who have the risk turned into reality. So this time around, I really really hoped to have the delivery process as natural as possible – drug free (ranging from induction to painkiller), in order to minimize the risk of such drugs. Luckily this time around the pregnancy went on quite well, with ample amniotic fluid in the womb, and the doctor said that there is no need to speed up the delivery through induction. This is unlike my first pregnancy when I was on the verge of pre-eclampsia and the doctor strongly suggested induction.

Aiming for drug-free birth, I needed to equip myself with references on natural process of childbirth. I would recommend “Ina May’s Guide to Childbirth” by Ina May Gaskin. It outlines the technical aspects of natural birthing process and the hidden risks of medical intervention. You can read this book, but with a pinch of salt because it is heavily biased against the medical approach of childbirth, so sometimes the language seems to exaggerate the risks of medical intervention. For me, the book has helped me in outlining a sensible birth plan while keeping in mind the medical risk that I have to bear.

At the end, doctor said my birthing process couldn’t be totally drug-free, considering my history of post-partum hemorrhage. I’m considered high risk, hence the doctor needed to safeguard against repeat bleeding episode by prescribing SOP. Upon the delivery of the baby, doctor will flush me with synthetic oxytocin through IV to speed up uterine contraction and prevent excessive bleeding. Well, at least the beginning part of the delivery process itself can be attempted drug-free.

I also prayed really hard not to have cesarean delivery as I am very scared to have my womb sliced. Luckily there hasn’t been any indication that warrants cesarean (such as placenta previa), so I kept my fingers crossed, hoping to not have emergency cesarean after trying for natural birth (such as in the unexpected situation of brow / facial presentation).

On the side note, me, Indi, and Dian are trying to make a small video on breastfeeding. Breastfeeding during the first hour would be part of this video. Since I have never do early-latch-on within the first hour of birth, I sought Doris Fok’s help (my trusted lactation consultant). It turned out that she was also enthusiastic about this video that she agreed to help me breastfeed the baby as soon as birth as well as giving input on the video concepts. At the end, she did much more than just helping the initial breastfeeding, she also became my birth coach and confidante that has helped me physically and psychologically even during pregnancy.

Mental Preparation and Coping With Death 

Ina May Gaskin’s book also strongly emphasizes the power of mind and positive thinking for childbirth. It even proposes that child birth can be totally painless when approached with positive attitude. Quoting “Childbirth without Fear”, Ina May argues that the exaggeration of labor pain comes from the fear of pain itself, and to sum up, it is important to maintain positive attitude towards childbirth so that your state of mind would help to minimize the “pain”. In short, the book tries to bring child birth to the women who bear the child herself, rather than surrendering to the mechanistic medical approach that sees child birth as pathological (sickness-related) problem.

Having read such an empowering book boosted my confidence to try for drug-free birth. But then something unexpected happen. My cousin passed away during childbirth, just three weeks before my own due date! Her death has made my mental preparation for my own childbirth even more challenging. My cousin’s death which was caused by amniotic fluid embolism during childbirth freaked me out because of two things. First, I’m due for my own childbirth within 3 weeks after her death. Secondly, it was inevitable that I became really distraught because my own past childbirth process was complicated by pre-eclampsia and severe hemorrhage. That practically put me into the high risk category, even though I don’t experience pre-eclampsia now. So basically the first few days after her death I was very much distraught, and I couldn’t sleep at night thinking about her death and my own impending. I became very scared of childbirth that faces me in a few weeks time. But I couldn’t explain to myself on what exactly made me distraught and scared.

My religious/spiritual upbringing taught me to always surrender to God’s will (pasrah) and not to fear death because it is inevitable. But why now suddenly I feel so scared? I try to understand the reason behind those emotions. After thinking and reflecting, it became clear to me that my fear of death was because I do not want to leave my young family alone. My fear of death is because I don’t want to see my young family miserable without me, because this is what I’ve seen in families where the mothers unexpectedly departed in early age. Eventually they cope with it, but not before going through very difficult times. Having witnessed this, I spent a few nights after my cousin’s death thinking, imagining, and crying about it.

When I finally spoke to my husband about my feelings, he listened with full empathy, and finally said jokingly, “Why should you worry and cry about your own death? It’s me who’s going to be troubled by it, if it happens!” Hmmmm, that’s true, I am not the right person to worry about my own death, aren’t I? Glad that my husband takes my worry light-heartedly, and uplift me. Basically he wants me to not to be troubled by my cousin’s death, and to think positively about my childbirth.

Indeed, talking to people has helped alleviate my fear. I talked to people in parenting and AFE Victims forums, and they gave me positive support and scientific explanation about the AFE condition. So is my doctor, who pinpointed the risk and scientific facts on AFE, and why I shouldn’t worry about it because the chance is very small. My doctor even said jokingly / tragically, that should AFE happens to me, there’s nothing can be done by the doctor because it is so fast and undetectable.

Doris, who has been my confidante for the current pregnancy and who will accompany me in the delivery suite, also listened to my concerns attentively and even suggested something radical. She suggested that I write, specifically, a final will, to safeguard all my concerns if the worst thing happens. So I follow her suggestion, writing a will while imagining the worst case scenario. It was amazing, once my concerns were locked into the writing of will, my worry began to subside and I began to assume a “surrendering” (pasrah) state of mind: to pray for the best with God’s help, but to also prepare for the worst when God intended it to happen, while approaching childbirth itself in the most positive mindset possible.

Preparing Noe

We don’t know how Noe would react with the arrival of the baby, so we prepare him by telling stories about pregnancy and baby. I show books with baby photos and pregnant women, and even make simplified story about babies coming out of belly through the underside of mommy and then the baby goes to breastfeed. In the story, Noe and baby would share breastfeeding together. Indi would make drawings of our family, with two kids, on paper and board, and Noe would name the family member. Indi would draw baby on my belly and Noe would say, “Baby!”, then kiss my belly. So far he has been always very gentle and loving to other babies such as Aina. We hope and pray to make an easy transition for him.

Preparation of the Household

During the last weeks of my pregnancy, Indi and I was pretty much occupied preparing our house for the new resident. It was rather tricky to juggle our work, spending family time with Noe, and organizing our house without domestic helper, but yes, we survived. The first thing we needed to do is to get rid of the junks and clutters in the house as much as possible. Basically, items that we haven’t touched or needed for the past one year go to the bin (either recyling bin or trash bin). Books, no matter how dearly we love them, were donated to the neighbours or the National Library, except for few books that are special for us. Dirty, broken, used toys are put into recycling bin. We were also surprised to find so much junk clutters, hidden in cupboards and shelves.

For me, it’s difficult to prepare the baby room for the second baby rather than the first one. For Noe, we practically didn’t spend much time buying and organizing stuff, because most (if not all) of our stuff were gifts! The good thing about gifts is that they are already wrapped, rather clean, and organized based on age. So, what we needed to do is just open them up and store it into the baby clothes shelves.But for the second baby, we needed to reorganize the unused baby items that we have plonked together into the big boxes in the storage. We made a mistake of not organizing the items when putting them into storage. That means we didn’t really know what’s in those boxes and had to reorganize them all over again. Then come, gallon ziplock bags! What a godsend! We sort the baby clothes according to age (0-3mo, 3-9mo, 9-18mo, 18-36mo, etc) and mark the ziplock bag accordingly. The good thing about those bags is that we can make it into cheap vacuum bags that saves space, yet visible to see what’s inside. Great idea for organizing things! We then grab the bags marked 0-3 months old, and throw them into the laundry. When they’re crisp and dry, off they go into the clothes shelves, waiting for the baby to arrive.

Then what?

The next step is just to wait for the big day.

Jakarta: Can we trust the doctors?

January 13, 2008

For the original entry, click here

We’ve returned to Singapore and now struggling with deadlines and work. We’ll put down the stories of our Indonesia trip one by one, once we have time to write it down. And let this writing be the last rants about our last trip. I’d like to emphasize that our trip has been really pleasant and fun, but we just want to put down some of the negative experiences that we had before going on talking about the good stuff. This last rant will be about several things, first, can we trust Indonesian doctors? And second, about the living cost in Indonesia. I promise, this will be our last rant from our last trip! Next time, we’ll write about the great, fabulous, orgasmic food we tasted in Surabaya!

1. Can we trust the doctors?

Noe Down with Fever

Every time we visit Indonesia, Noe has always been healthy despite the tiring schedule and erratic feeding time (that must be due to mommy’s breastmilk). But ever since he was weaned off breastmilk, he’s more prone to germs (although, thanks to his past history of breastfeeding, he recovers himself relatively fast as well). At the beginning of this trip, Noe was relatively healthy, but towards the end of the trip he was feverish. Perhaps his stamina was down due to flying off to three different cities in one week, going out at night for dinners, and because we’ve been sleeping under aircons for two weeks straight.

On 17 July morning, in Bali, he began to have fever. We gave him paracetamol and it helped to lower the fever. Noe felt really good in the early evening that he began to run around the hotel, and we decided to go out for dinner thinking that he had overcome his fever. Bad decision, we should’ve taken a rest that night, because Noe’s fever recurred that night due to his exhaustion. We then decided to stick around using Paracetamol to hold off the fever during our morning flight out of Bali, until we see the doctor in Jakarta.

Going to a Doctor in Jakarta Hospital

We decided to see a doctor in Jakarta because we were worried that it could be typhoid fever or dengue, since Noe had been vomiting, had bad appetite, and the fever had run into the second day already. We chose to go to a pediatrician in a hospital in the fringe of south Jakarta which has the reputation to be a baby-friendly hospital (according to the discussion in ASIforbaby yahoogroups).

When we arrived in the hospital, we were quite impressed to see that there is no blatant promotion of pharmaceutical products and infant formula. Then we saw the pediatrician, Dr. ND, a middle aged male doctor. He came across as a friendly guy. We began with describing Noe’s fever symptoms to him. He proceeded to ask the nurse to take Noe’s weight and quickly (I mean, really quickly) check Noe’s physical condition. Note, the doctor and the nurse did not take Noe’s temperature, which was odd, because in Singapore it is a standard procedure. Basically it was a really rapid assessment.

Upon assessing Noe’s condition, the conversation continued as follows:

It’s OK, ma’am, your son is only having sore throat. I will prescribe antibiotics for him so that he would recover quickly.

Antibiotics? But viral illness won’t be helped by antibiotics!

Hmmm… who said it’s viral? Antibiotics will surely help him recover faster.

Well, doctor, how do you know that it is bacterial and not viral?

Hmm.. he has sore throat and antibiotic will help to prevent the illness to spread. If it spreads away, it could get really bad, he can even get pneumonia.

But his fever is only for one day, doctor, are you sure antibiotics is necessary?

I was questioning the doctor because I’m so used to the Singaporean procedures, where they prescribe antibiotics to Noe or me after having a fever 4-5 days straight, or when clear signs of infection is visible, such as green mucus or coughing with phlegm. Besides, I’ve read about the danger of hastily prescribing antibiotics. That’s why I was rather shocked to be given antibiotics only at the beginning of the second day of fever. At this stage, the doctor was clearly annoyed because I was not obliging to him.

Look, Ma’am. If this kid is my own, I would give him antibiotics without hesitation!

So, now he’s saying that I’m a bad parent for hesitating to give antibiotics!

Besides, what have you been giving your son? He’s a bit underweight. Does he have feeding difficulty?

No, he likes to eat, including meat, rice, vegetable.

Hm.. so what brand of milk has he been drinking?

Well, he had just recently been weaned off breastmilk, and now he loves drinking fresh milk with chocolate flavor.

Chocolate milk? That does not have any nutritional value. You have to give your son Pediasure formula milk!

But he doesn’t like Pediasure, I’ve tried.

Well, just give other brand, but it has to be formula milk! If your son is as skinny as this, his growth could be hindered! Do you give him vitamin?

Yeah, I give him toddler vitamin..

What brand?

I don’t remember, but it’s for toddler..

I don’t think it’s a good enough vitamin. I will prescribe a better vitamin supplement for your son. Gosh, chocolate milk! Your son must be calcium and iron deficient, I will prescribe supplement for that also.

He then continued to get a phone call at his blackberry, when he was still consulting us. I was really pissed off at this stage. I wonder if this person is a real doctor or a pharmaceutical product salesman. He’s also very judgmental, and not open to discussion. At that point, I just zip my mouth shut so that I could get out the clinic really fast.

Paying for the Medicine

When I was out of the clinic, I went to the pharmacy and only paid for the paracetamol drops to lower the fever, and decided not to pay for the antibiotics and vitamins. Out of curiosity, I asked the pharmacist about the price of the prescribed medicine.

The paracetamol: Rp. 13K

The antibiotics and vitamin: Rp. 200K That is, like, a fourth of a monthly salary of a state school teacher in Jakarta.

When I saw the invoice of the paracetamol, I saw the doctor’s name. Hmm. So the medicine paid is linked to the doctor’s name. I wonder if he had been receiving commission or perks from the pharma company.

When I was paying for the paracetamol, I saw a group of medreps swarming at the pharmacy counter, talking to the chief pharmacist. I overheard them, roughly:

Medrep: Ma’am, the prescription for this medicine has been really low.

Pharmacist: Yes, I know… I have been asking the doctors to prescribe this medicine to the patient, but so far the usage has been quite low.

Medrep: I’d really appreciate if you could always remind the doctors to use our products.

At that time I was really sick to be in the hospital. Somebody should make a documentary movie about the healthcare system in Indonesia, which is overwhelmed with pressure from pharma companies.

To certain extent it is similar to the situation described in Sicko (Michael Moore). The difference is: in the US, the doctors are sponsored by the insurance company, while in Indonesia, the doctors are sponsored by pharmaceutical company. The similarity: there is no control over such nepotistic practices.

Noe’s Recovery sans Antibiotics

Back to Noe. we decided to just give him paracetamol to lower the fever, and take a rest in the house to let Noe fight the virus by himself. No antibiotics were given. The next day, the fever had fully subsided, but we stayed home for the day to minimize the risk of recurrence (besides, we have a wedding to attend, the next day). And true enough, Noe’s fever has totally subsided by the wedding time on 20 July.

I am glad that I didn’t have to pay for those expensive antibiotics! But then, seeing Noe’s speedy recovery, I become skeptical too, can I trust Indonesian doctors?

2. Living Cost in Jakarta

Indi has been living away from Jakarta since 1992, and it’s funny to see that he is still gauging the living cost using the 1992 prices. But even for me, who only had been away from 2001, is still shocked by how high the living cost nowadays.

Indi still remembers when 1 USD to Rupiah was just 1,500. Even until now, Indi still thinks that Rp 20,000 is a lot of money.  As for me, I still remember when I began college in 1996, I can still go to warung tegal and get a complete fulfilling meal for Rp 1,000, with meat or egg.

When we visit Jakarta this year, we realized that virtually everything comes in 5 digit price! Rarely can we find food in the restaurant that is priced with four digits. It is interesting to see, that Rp 100,000 felt as “cheap” as Rp 10,000 in 1997. And indeed Rp 5,000 felt like Rp 500  in 1997. Really, there is no use to have Rp 1,000 and Rp 5,000 in paper bill anymore, they are should be in coins. I am not an economist, so those figures are not based on any calculation, but I was just using my feeling. I don’t know how far have the inflation or the shift in purchasing power been quantitatively, but for me, it really felt that everything is 10 times more expensive than ten years ago.  Why is it the case? Can any economist answer this?