East Timorese Patients (Observations
so far)
It's now clear to
me that the East Timorese patients are most amused by the
Neurological Exams, by far. When I used the tendon hammer to do knee
jerks on a patient, the other patients and relatives were looking on
in amazement. Natalya was with me and she said that after I left,
some of the patients were hitting their knees with their hands,
trying to elicit the jerk (so cute)! A few patients were quite strong
for knee flexion, and when I was trying to stop them from pulling
their feet towards their bottom, stumbled over to others' laughter.
Then there was the grandmother, who when asked to touch her nose,
ended up putting her index finger up her nostril (lol), with her
children “cracking up”!!!
We got to debride
the dead/macerated skin from the Leprosy Pt's feet. It looked quite
gross, and I pulled off his toe nails, but he didn't feel pain. I was
very worried about causing pain if cutting too deeply, and “jumped”
when his foot suddenly shifted for easier viewing by another student.
It almost felt as if I was having more pain than him, and he was
laughing so much the entire time.
It made me happy
that the patients etc took joy in taking part in physical exams. I
couldn't tell if it's because of their “Un-Medicalized” state, or
coz they take humour in little things, perhaps because they'd
otherwise have little to be laughing about (in light of poverty and
hardship). In fact I think their threshold for humour is very low by
Australian standards, to the point of finding “slapstick” content
hilarious. I imagine they'd love the classical Charlie Chaplin
movies. Even outside the clinic, I've seen children laugh at me when
taking big bites out of an ice-cream cone, or when my head hit a
low-lying branch whilst walking. Adult strangers have laughed just
coz I was walking fast / running from one place to another in a
hurry. It seemed Aspie-ish, in that they perceived these little
details with more value, and don't overlook it automatically. But I
strongly suspect that this “Humoural Sensitivity” will gradually
fade away if they become wealthier, and progressively de-sensitized
by the deluge of Western media and culture.
(In fact, maybe I
could make a list of things that have amused the East Timorese
patients, or amusing responses by them...)
It was touching
for me to see a Heart Surgery Pt return from Australia, and donate
his remaining Oxycodone to the Clinic's Pharmacy for other patients
in severe pain coz he didn't need it anymore. I've never seen such
“medication” generosity in Australia, where Oxycodone and
Morphine have a reputation for being overprescribed and abused or
diverted for money.
Unfortunately,
part of the “Medical Innocence” manifests in a lot of patients as
being rather “poor” historians (even taking communication
barriers into consideration). It's not uncommon for a patient to say
one thing, and then say the opposite several sentences later. I
thought they were lying, but seemingly according to my Tetum Language
Book, it states that East Timorese people will state something as the
truth even if they're not sure that's the case – the usage of
modifiers such as “perhaps”, “maybe”, “if I recall
correctly” is less prevalent than in English. If they've had a
certain issue for several years, they often just say “kleur ona”
(a long time), without specifying the years. I have to “prod”
them to state how many years. And then there are a handful of
patients who misunderstand Asthma, thinking that it means shortness
of breath (from any cause).
It doesn't help
that Tetum has several deficiencies in facilitating history-taking.
Despite the inclusion heaps of Portuguese loans for
scientific/technical terms, the core Tetum actually misses several
grammatical points that would've facilitated history taking. For
example, you can't ask “How long have you had this pain for?”
Instead, you have guess the units of time, ie “How many
days/weeks/months/years have you had this pain for?” There were
others but I can't think of it for now.
My observations
so far are that they're most accurate when it comes to discussing
medical issues that are very recent onset (eg abdominal pain startig
last night), with progressively less accuracy for more chronic
issues.
The “Medical
Innocence” is quite interesting at times, especially the
heterogeneity in medical knowledge amongst the East Timorese
patients. There was a village girl who had Pneumonia, and I told her
mother that she'd be receiving “antibiotika” (antibiotics). She
didn't know what antibiotics were. I then said it was a medication
that helped eliminate certain “bakteria” (bacteria), but then she
didn't know that word either. Then there was another patient who knew
what bacteria was, but never heard of a “virus” (virus). I had to
get the interpreter to explain to her that a virus was a bit like a
bacteria in that it can cause infections, but it's even smaller, and
you can't kill it with antibiotics.
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