An Asperger Medical Student in Oz: East Timor Medical Elective

Thursday and Friday afternoons was when I got to clerk new Patients for the first time. Due to the language barrier, I was unable to ask everything I wanted to ask, so was quite dependent on supplementing my information from physical exam findings. Most of my questions in Tetum were “Yes-No” questions, similar to how I communicated to patients with Expressive Dysphasia. Except the rationale was to make it easier for ME to understand their answer, and not for them to express it.

I felt embarrassed when clerking in Tetum, coz the other Patients in the room and their families would frequently giggle after I said a sentence, and when I asked why, they said “Komik” (funny). Nevertheless I received a lot of compliments that my Tetum was “Diak” (good), although I digress. I ended up presenting my information to the Junior Doctor, and assisted with writing patient progress notes, but aren't allowed to prescribe medications (yet?). I initially got frustrated not being able to narrow down the differential diagnoses as much due to lack of resources, but was told you get used to it quickly.

The patients all seem remarkably easy to placate though, from what I've seen so far. They don't seem to complain when the Doctors state what treatments and investigations will be done. They are in more tightly-packed warm rooms (no air-conditioners, fans only), and sit/lie in non-luxurious beds quietly or talk to their relatives/friends. It's a far cry from Australia, where I've met quite a portion with a sense of entitlement (even when already receiving Centrelink welfare), or being dissatisfied with whatever services they receive (even though it's way ahead of Third-World standards). In my mind, I was wondering if it was coz the East Timorese are more resilient people (thanks to their extremely traumatic history from World War 2 onwards), and/or if it's because they have low expectations from not having access to, or knowing any better about modern Western healthcare. If East Timorese people as a whole became richer with improving qualities of life, will they also become more demanding and “spoilt”, taking more things (including healthcare) for granted?

I don't want to stereotype them as “Noble Savages”, but in some ways they superficially seem more “innocent” and “simple-minded”. This may be supported by the fact that Tetum's vocabulary is extremely small compared to English, and a lot of the Portuguese loans (of which their English equivalents would be known to laymen Anglophones such as “association”, “coordinator”, “investigation”) are actually considered advanced/high-level to them. Tetum also seemingly has an incredibly high proportion of “undifferentiated” words (given its vocabulary size) that would otherwise exist as different words in English.

Their word “Uat” can mean “blood vessel”, “tendon” or “nerve”!!!
“Ain” can mean “leg” or “foot”.
“Fuan” can mean “heart” or “fruit”.
“Moras” can mean “sick”, “pain”, “condition/illness”.

- The “Moras” word is frustrating when clerking, coz when a Patient says it, it's not immediately clear if they're referring to pain or a medical problem associated with that area.

I'm getting the impression that East Timorese are quite conservative with regards to sexual matters (towards males at least). I was clerking a patient with lower abdominal pain but refused to take her sexual / menstrual history. I asked Natalya to do so with an interpreter, and I said in Tetum that I didn't want to ask about “sex”.

The interpreter said “Sex? What is this?”

And I said “Hola Malu” (Tetum for sex).

And she was like “OHHHHHHH”

I found this really weird coz IIRC “Sex” in Indonesian/Malay is “Seks”, and given that virtually all East Timorese people can speak that language, to not recognize that word means that they've never discussed it with others in public (when Indonesian was forced onto them as the official language).

I'm becoming more aware of the disturbing shortages of medications as well. Morphine is quite rare to get, so for the palliative patients, Codeine or Tramadol is used. Ceftriaxone is quite expensive, so Chloramphenicol apparently is used as a cheap substitute for things like Bacterial Meningitis. It was unusual that although Antibiotics are available OTC here, they still don't seem to have a known problem with MRSA or VRE yet, unlike most Western countries. But as mentioned, Drug-Resistant TB is a problem due to incompleted monotherapy regimens (they shouldn't even be on monotherapy in the first place?!)...

On the bright side (academically), this week I saw a case of Leprosy, a TB-Ulcer (!!!) and met a Woman with Patent Ductus Arteriosus. I've asked Dr. Dan to show me any Patients with Janeway Lesions & Osler's Nodes (from Infective Endocarditis), so hopefully he'll score one for me to see next time.