East Timor Medical Elective - Week 1 (Part 1 / 5)

Week 1 (1/9/14 – 5/9/14)

I arrived in Dili, East Timor on Monday 1^st September, 2014. In the week prior, I was getting very excited and nervous about my elective here, and wasn't entirely sure what to expect both in the city and at the Clinic. I already spent several months studying their main language Tetum (more specifically “Tetum Dili/Prasa, an Austronesian language with very heavy Portuguese influence) casually, but in retrospect should've just learnt Indonesian/Malay as pretty much all of the adults can speak it fluently due to previous Indonesian rule, plus the fact there are far more quality language resources for it in Australia. I suppose the nice thing about Tetum is that there are hordes of Portuguese loans that sound like English, making vocabulary acquisition relatively easy.

After arriving at the (lacklustre) airport in a sleep-deprived state, our family met up with a local BPC volunteer called “Rico” (not real name) who helped load our luggage onto the ambulance and dropped us off at the Motel.

  The back porch of the Motel in Dili.

                                               

The Papaya tree in the same back porch.

My Motel Room. Air Conditioner thankfully is working atm. The TV had Indonesian channels + 1 Portuguese channel. Strangely I was unable to find a TV Channel in Tetum. Can't drink tap water (too dirty) so you need to use either bottled water, or boil it / treat it with purification tablets in advance.

We slept in the morning and walked to the clinic in the afternoon for a tour. I must say when I first arrived, BPC looked rather...”run-down” (compared to an Australian hospital). I didn't even realize I was near the clinic until I saw the Red Cross symbol near the entrance.

 BPC's sign at the entrance.

Poster next to entrance showing signs of Leprosy.

 Main courtyard of BPC.

However, I'm not surprised given that this is a developing country, and BPC's funding is virtually dependent on donations, and they have very high patient-load (outpatients and inpatient-wise). Patients were already queuing up outside the main building 1 hr before Dr. Dan arrived for the morning ward rounds, even though they'd be seen in the afternoon.

 Waiting area outside Outpatients building. It looks quiet in the photo coz I accidentally came too early (misinterpretation due to time difference from Australia), but it gets crowded very quickly in the MORNING as patients and their families queue up to see Dr. Dan in the AFTERNOON (after he completes the morning Ward Rounds with the other doctors and medical students).

Rico showed us the different adult and paediatric wards. Adult Medicine, where I was going to spend most of my elective in, was split into “TBC” (TB), “RTB” (Suspected TB) and “Baixa” (Hospitalized, ie Gen Med).

TBC (TB) Room

RTB (Suspected TB) Room

Baixa (Hospitalized, ie Gen Med) Room

He went through some info about how BPC runs, and explained about East Timorese culture, eg dressing conservatively and being very careful re: sexual topics. I also had a chat with Dr. Dan and the Clinic Manager Ms. Fiona Oakes who both welcomed me to BPC and provided further information about its operation. There were at the time 2 medical and 2 pre-medical students who were doing their elective here, along with a British junior doctor and 2 Italian infectious diseases Specialists.

The next morning, I joined in on the morning ward rounds and watched Dr. Dan Murphy ask patients how they were going and providing medical advice. I could only understand some of his speech, but it was clear that he avoided using jargon to facilitate their comprehension. I was interested in the factoids that he gave us about how the medical conditions were managed and investigated for given the limited resources.

The wards looked quite primitive, with no curtains to separate the patients for privacy. Everyone could hear what the Doctors and medical students were saying. If a sensitive exam (Breast/Pelvic/Prostate) needed to be done, the patient would have to be escorted to an empty room, which was troublesome for those with mobility problems (especially the ones who already had a stroke).

The sink outside Baixa Room.

There were no sinks or toilets in the wards either, so if you didn't have alcohol gel, you'd had to get out of the building and wash your hands at the sink just outside the “Baixa” ward. There was a shortage of anticoagulants for DVT prophylaxis, so it was rationed out, and most bed-ridden patients were rotated hourly by nurses.