East Timor Medical Elective - Week 1 (Part 4 / 5)

Thursday morning was when I got to skip the Ward Rounds and help accompany some patients to GVNH to have their X-Rays done (for ?TB). This is because GVNH has Dili's ONLY “free” X-Ray Machine, and the country's ONLY CT-Scanner (there's NO MRI)!!! I felt sorry for patients who have strokes outside of Dili, coz Doctors wouldn't be able to clarify if it was the Haemorrhagic or Thrombo-Embolic subtype to determine treatment...

The weird thing was that apparently GVNH didn't want the patients' medical details (HOPC and past medical history) as documented at BPC, and would assess them independently for eligibility.

I went with an intelligent pre-medical student (who starts Med School next year) called “Natalya” (not real name). It was quite a sight to arrive at the GVNH, long queues of people waiting outside in the courtyard, and we had to wait for ages just to get the patients registered for an X-Ray. Some of the patients actually didn't know their complete date of birth, so we had to get them to make it up. GVNH actually has a lot of Cuban Doctors due to an exchange program, but unfortunately I forgot to bring my camera to snap them. The patients were supposed to receive an X-Ray request form but even when I told the doctor that all these patients were coughing blood for > 1 year, he forgot to give us the form, and I had to beg another doctor to do so.

Natalya was accompanying the female patient who was at her Obstetrics outpatients appointment, so I ended up leading the other patients to the radiology department. The female Cuban Radiologist said that they were closed, and we had to come tomorrow morning, but it seemed a bit suspicious given that their official morning break was at 11 AM, and we came at about 10:30 AM. I got annoyed/frustrated, and said to the Radiographer in Tetum that they've been coughing blood for a long time and it's really important they have the X-Ray done to check for TB and that they weren't technically closed yet, but neither of them budged.

When Natalya finished the Obstetrics appointment after 11 AM, she came over and I explained the situation. She went up to the radiology counter and begged them in a soft “charismatic” manner, begging them in English, also mentioning how she loved Cuba and wanted to stay there for a holiday, and lo and behold, the Cuban Radiologist agreed and called the Radiographer to take the X-Rays.

I was simultaneously impressed and envious of Natalya, and pissed off at that Cuban Radiologist and Radiographer. Natalya said that you had to restrain your anger/frustration, and talk in a way that doesn't sound like you are demanding their services, because they'll think it sounds like you are “bigger than them”. I realized that I was disinhibited at the time due to being annoyed by them breaking the rules, and instead should've made myself seem “smaller” than them, as much as you had to “swallow your pride”.

I discussed this issue with one of the BPC staff, who agreed with my hypothesis that it was a “supply vs demand” issue, that because they were the only public radiology providers in Dili, that they have the ability to throw their weight around and act superior to those who need their services, ie to stroke their Egos by feeling needed. It was apparently less important to emphasize the patient's clinical history and indication for the X-Ray, but to emphasize how good and important (and “G-d-like”) they (radiology staff) were and that you needed their help really badly, all without sounding demanding.

“Ahhh you get it now!” she said.

I understood the situation in retrospect, but it really disgusted me that in the pursuit of getting one's Ego stroked, that it would come at the expense of patient care. Healthcare Systems in developing countries are already underfunded and under-resourced, it doesn't help that those who provide those limited services can possibly restrain it any further to make themselves feel superior over others. I imagine that medico-legally, this would be unacceptable in a Western Country as such actions can delay treatment.

It was a lesson learnt, but it left a sour “taste” in my mouth. I see now that it's important to have more “soft skills” to deal with various contexts. I didn't wish to go back to GVNH again for a while, so hopefully the next time I go to the radiology department, they might've forgotten my face.