A Medical Mystery

For the past few months, I have been troubled by an array of odd symptoms and even odder medical advice. It all started the day my plane landed back in NJ after my first ten months in Indonesia. I noticed that the right side of my body sometimes felt very strange - a little bit numb, some tingling sensations - and felt colder than the left side of my body. And then the left side of my mouth started drooping! Alarmed, I went to see a doctor at home who ended up sending me for an MRI to rule out the possibility of MS. The MRI came back normal and the doctor concluded my symptoms must be caused by stress. This seemed to be a cop out answer to me since there was nothing in my life that I was feeling particularly stressed about. But in any event, my symptoms lessened and I returned to Indonesia feeling relatively fine.

However, by the beginning of October I was forced to acknowledge that I really wasn't fine. The odd sensations and mouth drooping were back, I felt unusually tired and lightheaded at the end of the day, I was having trouble gripping things in my right hand and, most disturbingly, there was a period of two to three days when I experienced really bad headaches that made my head feel like it was going to explode. These shooting pains in my head scared me enough to confide in Ingrid and seek out a doctor in Yogya. Ingrid did some research and took me to a doctor that several people had recommended.

Unfortunately, this doctor in Yogya turned out to be a bit wacky. His initial assessment of me was done through iris imaging. We looked at pictures of my eyes on a TV screen and he told us how spots on the iris correlated to organs of my body. My heart and lungs were fine but he mentioned in passing that I have a dirty left ovary. I'm sorry, what? A dirty left ovary?? But I quickly forgot about this as he announced his provisional diagnosis. According to him, I had a 'viral infection on a nerve in the brain'. Yikes! A brain infection?? And he can tell this by looking at pictures of my eyes? I was doubtful, but he ordered some blood work done and I figured a blood test would probably be a more reliable measure.

So the next day Ingrid and I went back to see him about the results of the blood test. He glanced at the paper we handed him from the lab and he announced that I have rubella. Really? I knew I had been vaccinated against rubella as a child and I didn't have a rash so this struck me as odd, but perhaps there was an Indonesian strand of the virus that I did not have immunity against. What do I know; I'm certainly not a doctor. Anyway, he prescribed two different medications, 6 to 12 rounds of physiotherapy, a detoxifying ionic foot bath (more on that in a minute) and last but not least he wanted me to wear a cervical collar for a month to put my facial muscles back in place. A cervical collar!! I asked him many questions but I could tell he was getting impatient. Ingrid translated that he felt like he was giving a lecture. He ended our session by saying that if I had any more questions I should just Google them. I promised myself I would do just that as soon as I got home, but first there was the experience of the ionic foot bath.

The ionic foot bath consisted of a tub of cold water with some sort of metal device that was plugged into a machine. The guy in charge (the attendant, the technician?) explained that the impurities from my body would float out of my feet and collect on the surface of the water as a layer of scum. Well, those weren't his exact words but that was the idea. If the scum formed one circle that meant I was relatively healthy. If the scum formed separate circles, it meant there was a problem somewhere. I peered into the tub; three distinct circles had formed. The guy looked at me sadly and shook his head. He told me the best thing to do in my case was to pray. Then he held up a worn copy of an English language book entitled 'Alone with God' and asked me if I wanted to read it. I politely declined and high tailed it out of there with Ingrid. I'm not saying prayer won't help, but it's not exactly what I wanted to hear at the doctor's office!

Back in my room, I Googled 'rubella' and found out that the blood work I had gotten done tested positive for the presence of IgG rubella antibodies, which should be present since I was vaccinated. I had tested negative for IgM rubella antibodies, which would have indicated that I currently had the virus. I sat there dumbfounded by the idea that the doctor I had gone to see had misinterpreted a simple blood test like this. On the spot I discounted everything he said to me - which to be honest was kind of hard to swallow anyway - and wrote to my RELO supervisors to see what I should do next. They suggested I fly to Jakarta to see a more reputable doctor at the International SOS Clinic.

On the day of my flight to Jakarta I found out that the neurologist I was scheduled to see had to cancel because of an emergency surgery. At the last minute RELO was able to get me another appointment with another neurologist at a Jakarta hospital. This doctor listened to what I had to say, did a few physical tests and told me I had migraines. Now, migraines sounded much more plausible than rubella but it still didn't ring true for me. I had been experiencing all these weird symptoms for over three months and only had one bout of bad headaches. And there was no aura or sensitivity to light or noise or any of the classic other migraine symptoms. I also didn't care for his recommendation of avoiding cheese, chocolate, coffee, citrus and cola. No cheese?? That's a horrible, horrible thing to forbid a girl who spent her twenties in a country famous for its cheese and who was cheese deprived for the entire 10 months she spent in Gorontalo.

To get a second opinion, I booked another appointment with the SOS doctor that I was originally supposed to go see. Of the three doctors I saw, Dr. Amanda did the most thorough testing and questioning. In fact she was so thorough that she sent me to get more extensive blood work done, an EEG and two evoked potentials tests called VEP and SSEP. The SSEP test was horribly painful. My body was hooked up to all sorts of electrodes and tortured with a vibrating current. It was most painful in my feet.

When the lab doctor wordlessly handed me her report at the end of the session, all I saw where the following words in bold type on the top of the page: Diagnosis: Multiple Sclerosis. At first I was stunned. Oh no!! And then I was angry. Who does that??? Who hands somebody a diagnosis of MS without saying a word about it?? It was shocking and I spent the taxi ride back to Jackie's quietly contemplating my fate and calling my parents. By the time I got back to the apartment I was visibly upset when I told the other girls. But Megan, to whom I will be forever grateful, calmed me down and explained that this was probably just a bad translation. A better wording would have been something like this: Reason for Test: Possibility of Multiple Sclerosis. Megan also pointed to the conclusion section of the report which said nothing about MS and just stated that the test results were compatible with sensory neuropathy in both lower extremities. What did that mean? Well, I had to wait another week or so before I could go back for a follow up appointment with Dr. Amanda.

When I finally got to sit down again with Dr. Amanda, I learned that I have a calcium deficiency. I had grown up knowing that I should drink milk for strong bones but I never realized before or had forgotten that calcium ions transmit messages from one nerve to the next. My decreased level of calcium was slowing these transmissions and causing nerve pain! Dr. Amanda speculates that I depleted my calcium stores living in Gorontalo where I pretty much involuntarily eliminated milk, cheese and broccoli from my diet. Never underestimate the importance of cheese! No wonder I craved pizza practically every time I left Gorontalo. My body was literally crying out for it. To fix this, Dr. Amanda prescribed me some calcium/vitamin D supplements and B12 supplements for good measure. I also asked her if there were any specific foods I should be eating as well, thinking she might say something like milk or cheese. But instead she replied, "Bone." Bone?!?! Bone has never been a diet staple in the part of the world where I'm from. She clarified by explaining that those little tiny fish that Indonesians dry and salt are a very good source of calcium. Right. Dried whole fish. Sounds yummy!

I tried the dried fish one night with some nasi goreng. They tasted just like bacon!

After months of worrying about what could be wrong with me, I'm relieved to find out it's something as simple and treatable as a calcium deficiency. I'm so glad it's not MS or migraines or a 'brain infection'. I just need to eat more cheese...and bone!

World's Most Expensive Coffee

On the islands of Java and Sumatra there lives a small cat-like animal called a civet (or luwak by the locals). This cute little animal likes to eat cherry coffee berries. The coffee berries tumble around in the civet's digestive system, some chemical reactions happen, and then the still-intact coffee beans are pooped out. These beans are then washed, dried, roasted and brewed as usual. 

A luwak (www.elephantmountaincoffee.com)

Cherry coffee berries (www.kealaolafarm.com)

Luwak poop (www.wb7.itrademarket.com)

World's most expensive coffee (www.artsyspot.com)

Although I've lived in Indonesia for more than a year, I had never tried this specialty until today. I was walking around the Grand Indonesia Mall in Jakarta with Jackie and her friend Miranda when I spied a Kopi Luwak cafe. Spontaneously, I suggested we go in. The sign on the table reminded us that kopi luak is the world's most expensive coffee; a pound of the stuff apparently goes for $300 in the US. And at certain establishments one cup of this special joe can cost $50. Fortunately for us, this particular cafe was selling it for about $8 a cup, which, while still super expensive for a cup of coffee in Indonesia, is still much cheaper than $50 in the US. So, I ordered one cup for Jackie and me to try.

No sooner had we placed our order than we were approached by a camera crew from CNN wondering if they could interview me as I drank my first cup of kopi luwak! What a way to make this special moment even more extraordinary! The woman interviewing me turned out to be Sara Sidner, an international correspondent based in New Delhi who was putting together a multi-day feature on Indonesia that will air November 22nd to 26th. She asked me if I came here today especially to drink kopi luwak (no, it was a spontaneous decision), how I thought it tasted (good...I guess), if I thought it was worth the price (well, maybe just once to try it) and a few other questions. I wonder if my interview will make it on air. 

With Jackie, Miranda and Sara Sidner at Kopi Luwak Cafe

What I didn't say was how surprised I was that the coffee wasn't freshly brewed. Instead, the waitress came over with an empty mug, a bag of powder and a thermos of hot water. Essentially, she was making instant coffee for me at the table. Really? I'm paying $8 a cup for instant coffee? To her credit, she let us all sniff the contents of the powder bag before she stirred in the water. It smelled aromatic enough. We were then instructed to wait two minutes for the coffee to settle in the mug. The camera crew hovered nearby as Miranda kept an eye on her watch. And then the moment of truth. I raised my mug, inhaled deeply and took my first sip. I was expecting to be wow'ed by its exotic flavor and hints of whoknowswhat but instead it just sort of tasted like regular coffee, albeit a very dark and silky one. I usually don't drink black coffee and had to fight the urge to add milk and sugar. I will say, though, that it had a very nice, clean aftertaste. 

If anyone sees us on TV, please let me know!

Dining Out in Yogya

I'm writing this post while drinking my second cafe latte of the morning, having just finished a big Sunday brunch consisting of an omelet, toast, chicken sausage, melon and baked beans. Oh yeah, and I just ordered a chocolate croissant to go with my second cafe latte.  What's more, I'm connected to the internet because this cafe has fast and free wi-fi! And all I had to do to get here was walk down the street from my guest house. Ooohhh...my croissant just arrived and it's even warm! I think I might make Sunday brunches at this cafe a regular event. Few things make me as happy as the prospect of a delicious meal.

I am truly in culinary heaven here in Yogya. I spent the past week checking out the various restaurants around town with Ingrid and my housemates. Highlights included spinach fettuccine and a tomato and mozzarella salad at Via Via, a chicken and mushroom brick-oven pizza followed by tiramisu at Nanamia, guacamole with toast and a spinach pancake with homemade cheese and mushrooms at Milas, chicken korma and pumpkin soup at Sangam House, and even a delicious 3 mushroom creamy fettuccine with garlic cheese bread at the Pizza Hut down the street. Italian, Indian, American....I definitely won't starve here!

This is a big relief, since, as followers of this blog know, Indonesian cuisine seldom whets my appetite. That said, the other day Anastasia, John and I were wandering around the kampung by the university looking for a place that was actually serving lunch during Ramadan and stumbled upon a great little warung that had a whole menu of tasty Indonesian options. I ordered nasi goreng tuna (fried rice with tuna) and terong goreng tepung (eggplant fried in flour). Even though both dishes were fried, they were surprisingly delicious! I washed it all down with a fresh strawberry juice, happy that I just found what might become my new regular lunch place.

You Gotta Be Kidding Me!

My friend Mark, the English Language Fellow in Makassar, is also a diver and came up to Gorontalo this past weekend for his first visit, lured by my blog posts about whale shark sightings. Although we didn’t see any whale sharks this weekend, Mark enjoyed his time here tremendously and said the diving here was the best he’s ever done – and he’s dived the Red Sea, Bunaken, Bali and, of course, Makassar. He was thrilled with the colorful and abundant corals, the swirling schools of fish, the deep caverns, and the “swim through” at Sand Channels. The phrase he kept repeating with awe throughout the weekend was, “You gotta be kidding me!” Yep, that’s Gorontalo!

We also had two very memorable surface intervals between dives. On the first day after the second dive, we pulled into the fishing village of Olele to eat our lunch of tuna and rice, which had been prepared for us by the boat captain’s wife. Not long after we arrived, a small traditional fishing canoe pulled up next to us with its catch of the day – a very big yellowfin tuna! And the men had caught it with a hand line, imagine that. We followed them to the cleaning station where they gutted and weighed it. It was 62 kilos, which they said would fetch about 1.5 million rupiahs at the market (about $165). They asked us how much such a fish would get in the America but we had no idea. So we just posed for pictures with the tuna before we watched the men expertly cut it into pieces. Tuna is a very big part of the local diet in Gorontalo.

The next day we had just climbed back on the boat after our first dive when we heard one of the boat crew cry out, “Lumba-lumba!” This is one of the handful of Indonesian words I know – dolphins! There was a pod of Risso’s dolphins swimming off in the distance. The boat crew carefully maneuvered the boat a bit closer and we spent a good part of the surface interval watching these beautiful creatures swim and dive around the boat. I counted at least nine but there may have been more. It was hard to tell because they kept going underwater and resurfacing. For Mark, this moment was extra special because it was his first time seeing dolphins in the wild.

Even after the diving was over, Gorontalo continued to impress. On the way back to the dock after the last dive of the day, we passed pristine beaches and majestic limestone cliffs. As we pulled into the river, an extremely large bird flew overhead. Mark took one look, shook his head in disbelief and said, “Of course”. I smiled in response as I watched the Brahminy kite soar above the river. That night, after a bit of jalan-jalaning in a bentor, we went to a seaside restaurant to enjoy some ikan bakar with dabu-dabu iris by the ocean. We just missed the sunset, but we had plenty of time to linger over our food and chocolate ice cream while enjoying the cool ocean breezes. Mark confided that he thinks I quite possibly have the best site out of all the ELFs this year.

Unfortunately, he had to return to Makassar after only two full days in Gorontalo. On Sunday I went diving again and, wouldn’t you know, on my 50^th dive I saw a blacktip reef shark! I posted this sighting as my Facebook status and Mark was the first one to comment: “You gotta be KIDDING me!!!!!” He will be back again soon.

A Recipe for Gorontalo Poki-Poki

Here’s the recipe for this eggplant in a coconut chili sauce dish as told to me by Ibu Elsje. It should serve 2-4 people. You can also use the same recipe with chicken or tofu instead of eggplants.

5 eggplants (or 2-3 American sized ones)

3 red chili peppers

2 candle nuts (skip them if you don’t have them)

1 white onion

2 red onions

4 twigs of fresh basil leaves

½ pandan leaf (skip if you can’t find this)

1 spring onion

2 lemon leaves

1 lemon grass

1 small box of coconut milk

2 cups of white rice

coconut oil

salt

1. Using a mortar and pestle, pound the chili peppers and candle nuts. Add the white onion and the two red onions. Pound everything together until you have a nice thick paste. Put this aside.

2. Wash the eggplants, trim the stems and peel most of the hard green collars. Cut each eggplant in half and then in half again, leaving the eggplant attached to the stem. Cover the eggplants with a dusting of salt and wait about two minutes.

3. Sauté the eggplants in coconut oil until they turn dark and soft. Remove from pan.

4. Using the rest of the oil in the pan, heat up the chili paste until it turns a brown color.

5. Add in the collection of green things – basil, pandan, a chopped spring onion, lemon leaves and lemon grass. Mix these all together and then pour in the coconut milk. Let the mixture come to a boil and then turn off the gas.

6. Add the eggplant to the pan and mix together with the sauce. Serve over rice.

Selamat makan!

A Day in Gorontalo (Part III)

Saturday, February 6^th 2010

8:00 a.m. I meet Ibu Elsje in front of Amanda Jaya and we head off to the Liluwo market, which is held every Saturday morning from 6-11. Ibu Elsje tells me that this market is where everyone in town gets their food because they have the cheapest prices. Even the slightly more expensive food that is sold daily at Pasar Sentral (Central Market) originally comes from here.

8:15 a.m. This is my first trip to the traditional market and I am instantly enamored by the sights, sounds and smells. As far as the eye can see there are tables piled high with fresh vegetables, beautiful baskets full of eye-catching fruit, and large sacks of rice and grains. In the back there are long tables covered with fish of all shapes and sizes and in one corner there is a meat stand with large slabs of meat hanging from hooks. The stands are so tightly packed together that there is barely enough space to walk around. Vendors beckon me to examine their food while shouting out prices. Young boys constantly tug on my sleeve to ask if I want to buy a bag or if they can help carry my bags back to the bentor. Women touch my arms and excitedly call to their friends, “bule, bule!” I pause to smell some fresh herbs and am distracted by the sight of a woman carrying a large dead chicken by its feet.

9:30 a.m. With my backpack filled with eggplants, bananas, langsats, rambutans, sadri, limes and a couple of kilos of rice, Ibu Elsje and I head back to my place for a cooking lesson. She is going to show me how to make poki-poki, a local eggplant dish in a coconut/chili paste sauce. And I have to admit that I love the name of this dish just as much as I love the taste.

9:45 a.m. When we arrive at my place, Ibu Elsje surprises me by asking my cleaning lady to make the poki-poki instead. She thinks I am overpaying her for the work that she does and instructs Uni to cut the eggplants, grind the chili peppers and clean the rice cooker that I inherited from Jonna but have never used. And then it turns out that I don’t even own the required mortar and pestle to make the chili paste, so Uni quietly disappears to her own house down the street to make the paste and purchase some coconut milk at Pak Thalib’s store and then comes back.

10:15 a.m. While Uni is cooking, Ibu Elsje gives me a vocabulary lesson on food:

Rempah-rempah campur – mixed spices used in poki-poki; Kemiri – candle nut; Kemangi – basil; Kangkung – water spinach; Bayam – spinach; Sadri – leafy green for soups; Tinutuan – a porridge from Manado with pumpkin, sweet potato, corn, rice and various leafy greens

And some useful phrases: Ayo kita makan! – Let’s go eat; Nasi sudah masak – The rice is done; Karna enak sekali, saya makan banyak – Because it’s delicious, I eat a lot; Saya sudah kenyang – I’m full!

11:00 a.m. We eat a delicious early lunch. I have to admit that maybe I overgeneralized when I declared that all Indonesian food is horrible. Clearly, there are exceptions such as terong belanda, ikan bakar with fresh dabu-dabu iris sauce and now poki-poki. I genuinely LOVE these things and hopefully I will continue to discover foods here that I can truly enjoy.

1:00 p.m. Ibu Elsje and Uni have both left so I decide to nap. A lazy Saturday afternoon nap is a wonderful thing indeed.

6:10 p.m. I hop on a bentor and head to the De La Rosa salon where I’m meeting Sarah and Alexa for a girls’ night of pampering. Alexa gets a pedicure, Sarah gets her long hair cut and saves it to give to Ismail who requested it for fishing line (only in Indonesia!) and I get a cream bath. A cream bath is a delightful Indonesian spa specialty where you get your hair washed and deep conditioned with a creamy conditioner (hence the name) AND a head, neck, shoulder, back, arm and finger massage at the same time. It lasts for about an hour and is one of the most relaxing experiences you can find in Indonesia. And it only costs about $5.

8:00 p.m. The salon officially closes at 8, but we’re still not done with our treatments. I imagine that in other places in the world, the staff might try to hurry things along to get you out the door, but not here. They take their time blow drying our hair and also serve us dinner! Sarah and I burst out laughing at the ridiculousness but also wonderfulness of being surprised with free nasi kuning (yellow rice with meat) while sitting on salon chairs getting our hair styled. After we finish our dinners and our hair is done, the three of us pose for pictures with the entire ensemble of staff and their friends and family members who have somehow magically appeared during the two hours we are there. Then they follow us out the door and stand waving to us as we ride away in our bentors. We will definitely be back.

8:30 p.m. The night is young and we’re feeling pretty so we round off the evening with a drink at the rooftop café above the Mega Zanur mall. Nothing alcoholic mind you - Alexa has an apple juice, Sarah has some sort of mixed fruit cholesterol reducing juice and I have a very good papaya juice, which I have been making more of an effort to drink since Wayan, the Balinese healer, told me I needed to.

10:30 p.m. I crawl into bed and start to read my new book, Unlikely Destinations: The Lonely Planet Story by Tony and Maureen Wheeler, the couple who founded the Lonely Planet series of travel guides. I only get through about two pages before I feel the gentle exhaustion of a day well spent settle over me.

Epilogue: The next morning I found out that my cousin's second baby, Ella Ruth, was born on the other side of the world on February 5th, 2010 in Maryland, USA at 11:09 p.m. EST. So, with the time difference that would have been just after I had had my delicious eggplant lunch on February 6th in Indonesia. Welcome to the world, Ella! And welcome to the family. I hope you have a long and happy life full of marvelous adventures before you.