East Timor Medical Elective - Week 2 (Part 4 / 5)

HELPING EAST TIMORESE PATIENTS VIA PATHOLOGY?

 

I've already been humbled and privileged to meet East Timorese Patients, who have so far been very generous and patient (in spite of their poverty) to let me develop my clinical skills (after forgetting so much in my Gap Year) via clerking and physically examining them, with virtually no complaints or rejections so far. This week, I made a promise to myself, that if I pass internship next year, I'll try to return to BPC some time in the future to volunteer for 3 – 6 months as a way of repaying the East Timorese people.

 

But this re-opened my “Medical Careers” crossroads: pursuing Pathology vs GP training. The medical graduate oversupply means that any extra time taken off (beyond a Gap Year between Med School and Internship) would put you at even more disadvantage for applying to Training Programs. At the end of Med School, I considered GP training as a 2^nd option to Pathology coz I really enjoyed my rural GP rotation as a student, but then scrapped that idea about halfway through my Gap Year because of all the news and research I witnessed, which will essentially screw Australian GPs even further in both remuneration, working conditions, and medico-legal protection. 

 

GP Training is statistically much easier to get into than Pathology Training, and there are far more jobs available after completing training, especially in rural areas. This is in contrast to Pathology, where you're predominantly restricted to a handful of public hospital and private pathology labs in large cities, and setting up your own business would be nearly impossible unless you were already a billionaire, in which case you could just quit Medicine and pursue whatever you wanted!!! 

The increasing competition, and the seemingly much higher job security of working as a GP seemed appealing, but is that enough to sustain me in the long-term? Is being a GP (ie Family Physician, like Dr. Dan), the only practical way to help lots of East Timorese patients without pursuing even more grueling exams in Clinical Medicine (ie Physician's Training → Infectious Diseases / Respiratory Medicine etc)?

-----

This week, I started pondering the necessity & viability of Genetics Testing in East Timor.

I witnessed a few children with Haematological issues that weren't resolving. One of them has his DNA analyzed by Mater Lab in Queensland, and was found to have Alpha-Thalassaemia.

Genetics Testing in East Timor may be academically interesting due to their collectivist society (higher risk of inbreeding?). I'm also curious as to how the element of Portuguese ancestry influences them physiologically (apart from looks), and if there are any East Timorese people who have innately increased resistance to TB infection.

But realistically, how beneficial would it be to have Genetic Services set up here, when the public hospitals themselves are already heavily under-resourced in the basics (including medication)? Plus the fact that a lot of people outside of Dili live in the mountain/hill villages and have difficulty accessing the hospitals in the first place? The country roads outside of Dili are apparently full of potholes.

Yes, BPC has a TB-PCR machine that tests patients' sputum for DNA from M. tuberculosis (ironically in spite of not being able to perform Blood Cultures), but apart from that, Pathology testing as a whole is incredibly lacking here. An X-Ray machine for BPC (instead of having to constantly beg the Radiology Department at GVNH with their sole “public” X-Ray Machine in Dili) would be far more practical in the short-term, but even that apparently costs $250K.

Was this my “Ego” talking about wanting to help them in the future as a potential Pathologist?

There are probably even more sacrifices involved by working here, on top of infrastructural barriers that need to be overcome prior to establishing “proper Pathology”, as I've yet to perceive.

Apart from the above factors, I'm also aware that Abortion (apart from Ectopic Pregnancies) is still illegal here, plus life expectancy hasn't gone high enough for cancer prevalence (other than Lung Cancer, but that's more from smoking) to increase significantly + shortage of chemotherapy.

Even if a child was found to have a Genetic Condition such as Alpha-Thalassaemia, is it really going to change Management given the lack of Resources? Is there much help in being diagnosed with Cystic Fibrosis if your family doesn't have regular access to Treatments to help clear your airways and address other complications? I imagine that nearly all (if not 100%) of children with Cystic Fibrosis would've died before age 18 with the current resources.

Plus the whole of East Timor has a population of slightly above 1 million. In Dili alone, there are nearly 200,000 people. A lot of people don't visit Doctors or Hospitals until they feel sick. Many can't afford the $5 Doctors Fees (at private clinics), and just line up at the 2 “free” places (BPC and GVNH). In Australia, even with vastly greater access to GPs, a city of this size isn't large enough to merit a “proper” Genetics Lab. In Victoria state, my understanding was that Paediatric Genetics Testing is all funneled to Melbourne.

The life expectancy of East Timorese people can be increased from improved access to food, clean water, sanitation and certain vaccinations. I suspect they'll need to aim for this before considering advanced / super-specialized health services such as Genetics.

 

Maybe I'm just fantasizing and being unrealistic? I'll need to re-assess in the future...