EAST TIMORESE PATIENTS (OBSERVATIONS SO FAR - Week 2)
The East Timorese patients (at BPC
at least) seem a lot less “medicalized” (in the Modern Western
sense), and are more “innocent”. This is clearly in part due to
less exposure to health information. For example, not everyone has
heard of Diabetes or Anaemia. A lot of them understand the concept of
blood/urine tests, X-rays, and measuring blood pressure, but consider
the other investigations (including ECGs) to be rather
“alien/exotic”.
Sometimes they give unusual
responses to medical questions. I asked a lady with shortness of
breath, “Do you exercise?”, and she said “Yes”, and when
asked to clarify she said she “works at the market selling fruits
and vegetables”. I said “that's not really exercise, I was
thinking of activities like running, swimming and basketball.”
- Given the high prevalence of
poverty and malnutrition, I suspect obtaining regular exercise isn't
a high priority for her and many others, especially when they're not
getting enough food to begin with, and are often scraping by to make
a living with little free time at the end of the day.
Another example, there was a
patient who had ?Delirium, and I was trying to screen his level of
consciousness by asking “what day is it today?” “what month is
it now?”, but his friend initially answered those 2 questions
without realizing my intention. I had to tell him to stop answering
for him.
There's also some interference from
traditional folk medicine (“Aimoruk Timor/Tradisional”), like one
of the patients putting hot garlic on her forehead for a headache,
but creating a light burn instead. I'm more concerned about any
traditional Timorese herbs that can interfere with metabolism of
other drugs, like the St. John's Wort that a handful of Australians
use for mild depression.
A lot of them view the physical
exams with curiosity, and seem to be most amused by the Neurological
Exams. Every time I physically examine a patient, most of the other
patients and families inside the room start staring at us (if not
already so during the history-taking process), like I'm doing a magic
trick. Occasionally it gets to the point where I had to use the portable partitions on a man for even a non-sexual physical exam, simply because he was embarrassed by others looking in our direction.
"Lucinda"
"Lucinda" was the patient I most fondly
remember that week, who was
still depressed/really upset over father's death, and claimed to feel
limb weakness after a headache. I wasn't sure if she was
“somatizating” (expressing mental/psychiatric discomfort via
physical symptoms etc), but was worried she had a Subarachnoid
Haemorrhage etc, and did a Neuro assessment.
When I proceeded to the
Cranial Nerve Exam, I asked her to stick her tongue out and move it
left and right. She did it for a short while but then smiled/blushed
and stopped after other people in the room quickly started laughing
out of amusement.
I felt good being able to
make an unhappy person smile, but I find that I can't force people
to laugh if I try, but have to just continue behaving like my
normal self and let them “find” the funny bits in my behaviour
(if they find it “funny”). I've noticed that the things that I do naturally, that some find funny, is often annoying to others.
-----
The “Medical Innocence” of East
Timorese people seemed “refreshing” to me. Hardly any of the
patients here take antidepressants, even if they have access to it.
The Clinical Medicine at BPC is overwhelmingly for organic
conditions. It's not “holistic” under the biopsychosocial model,
but the patients all seem grateful and respectful towards the doctors
and nurses. I haven't seen a single "Code-Grey"-like incident (patient aggression) so far.
I wondered if East Timorese society would overall become unhappier
and more demanding as their health literacy (esp. awareness of all the diseases
and risk factors) improves over time. Given
the urgency of dealing with their TB and HIV/AIDS crisis in East
Timor, it would probably be selfish for me to say this, but being
exposed to the Australian system, I briefly felt like “ignorance is
bliss".
No comments:
Post a Comment