East Timor Medical Elective - Week 1 (Part 2 / 5)

Re: Pathology diagnostics, I was absolutely shocked/gobsmacked at how limited BPC's resources were. In spite of having the TB-PCR machine, the only blood tests BPC's can analyze for are CBC (FBE), UEC, LFTs and Blood Smears (via Microscope for Malaria etc). They used to be able to test for Hepatitis B Ag, but the country's reagents have apparently been fully *depleted* for some months : (

Little area to collect blood tubes and stain slides.

Microscopes (covered) + stained slides for looking at Peripheral Blood Smears.

Beckman Coulter AC T-Diff2, a mini Haematology analyzer (FBE at least).

They DON'T even have Cardiac or Inflammatory Markers (Troponins, CK, CRP, ESR)!!! The pathology report will show the serum creatinine concentration, but not the eGFR, so you'd have to manually calculate it using the “Cockcroft-Gault” equation using the patient's age and weight. They can perform Urine Dipsticks but not Urine MC&S.

List of Blood Tests available at GVNH. I'm aware that they don't perform TFTs (Thyroid Function Tests), but the lack of Cardiac Markers on this poster is disturbing...

Blood Cultures aren't available, so BPC patients with suspected septicaemia are just given empirical antibiotics. In fact, the WHOLE COUNTRY (inc. GVNH) DOESN'T have any microbiology culture facilities!!!!!!

It made me realize how privileged we are in Australia to have a far larger array of pathology tests available, that IMHO many patients (especially non-compliant ones) take for granted. On the bright side, the lack of diagnostics here meant that the medical students and doctors would have numerous opportunities to hone their clinical skills to greater depth, and learn to manage patients by “First Principles” without having a number for everything. For example, we knew that one of the patients was in metabolic acidosis (without having ABGs available) because he was performing Kussmaul Breathing.

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On the ward rounds, I finally got to meet multiple patients with TB, which was incredibly refreshing given that I didn't see any during Med School. It was also refreshing that virtually none of the patients were obese, so their heart sounds were quite easy to hear. Their X-Rays showed a few granulomas. It was good that they were commenced on combination antibiotic therapy, and to be given a decent supply upon discharge, although I was appalled that in the past, some of them only received a single antibiotic for 1 or 2 weeks at a time (!!!!!) in their villages from the mobile clinics. Everyone had to wear facemasks in the TBC and RTB wards, but soon afterwards I decided to wear my mask the whole day at BPC due to “paranoia”. Multi-Drug Resistant TB is a growing problem in East Timor.

As we saw more patients during the ward round, I felt sadness and pity in my mind, that a lot of the patients were having medical issues that would be less severe had they been caught and managed earlier, perhaps in a primary-care setting, which is obviously lacking in East Timor. The lack of resources doesn't help either. My impression was that most patients only saw a doctor in a hospital or clinic when they were quite sick and didn't have routine monitoring or follow-up.

I watched the medical students try to do history and physical exams in Tetum (or with a translator) after ward rounds were done and went home. It was a lot to take in that day, and I decided to take Wednesday off to go sightseeing with my parents.

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Add: If I can take a photo of the TB-PCR machine, I'll add it here.