Since the last post my main project has continued to be developing a malnutrition program at Bairo Pite Clinic (BPC) for the children that continue to come into Dr Dan’s office looking emaciated. The hope is to develop a program that can be maintained by the volunteers and clinic staff after we leave here. It sounds like there have been several attempts at this in the past always ending with a similar story- volunteers come, set up a program, leave, and the program falls apart. Candice, the Australian intern, actually helped establish a malnutrition program here on her first trip to BPC over a year ago. I feel a bit uncertain about how to set up a malnutrition program and I also feel a bit uncertain about how to ensure that it will last.
As a general rule here is Timor-Leste, as in most developing countries, infants receive adequate nutrition as long as they are breastfeed and can avoid illness resulting in diarrhea, vomiting, or poor feeding. That being said when children transition from breast milk to whatever food Mom and Dad are eating many run into trouble. Whether it is the frequency of feeds (which need to be more than 3 times a day like the parents), the quality of food/food preparation, the quantity of food, or any number of other factors malnutrition can become a problem quickly. The majority of the children we are admitting with malnutrition also have complaints of diarrhea, vomiting, and in several cases worms.
With the use of several resources, including the WHO malnutrition guidelines, the advice of two Australian pediatricians, the advice of several volunteers, my fellow medical students, and the clinics nutritionist (that’s right there is a clinic nutritionist…. not sure what else she is all responsible for but I question how you can have a nutritionist on staff and have children dying of hypoglycemia… frustrating) I think we have come up with a pretty good system. It is far from perfect; there just isn’t the staff at BPC to monitor the kids and their feedings as closely as should be done. That being said the kids are eating and gaining weight.
One of the volunteers, Grace, a 19 year old who has recently graduated from high school and is hoping to get a scholarship to study medicine outside of Timor-Leste, has been the best of help. She has been our partner in crime. We weight the kids everyday and hand out packets of what looks like powdered milk called F100. The parents just mix the F100 with 100 mL clean water and feed to their kids every 3 hours. The premixed formula is distributed by the WHO and has all the essentials in the appropriate proportions. We have had several children discharged looking a bit plumper which is promising. One of the children passed away during the night. Dr Dan was not informed until I found out when I had one less kid to weigh and asked the other mothers where she was. Again… frustrating and sad. Really… unnecessary. We have several children in the malnutrition ward that would likely be better served at Dili National where they have a well established malnutrition program with the appropriately trained staff but continue to meet resistance when the suggestion is made to transfer these patients. So we just keep suggesting… and hope for the best.
Now for life outside of BPC… at the end of last week I was sick with what I thought was just a sinus infection (of all things). I was congested, had a headache, pressure/pain over my right maxillary sinus, purulent drainage, and a fever. I started a course of antibiotics, which I brought from home, and stayed in bed except to run to clinic to get tested for malaria just to make sure. I was anxious to feel better so I could accompany everybody to Mt Ramelau for our weekend getaway. By Saturday morning, when we were to depart Dili for the three hour drive south into the mountains, I was feeling a bit better so I loaded in to our rented 4 wheel drive with the other med students. The roads were horrible!! I don’t get motion sick but this trip was enough to put both Eva and I over the edge- up and down, winding through the mountains, avoiding pot holes/sections of washed out road, and just about everything else you can imagine.
We arrived in Maubisse mid afternoon and pulled up to the Pousada, a Poutugesse guesthouse, where we were spending the night. The plan was to hang out Saturday afternoon, enjoy the view of the mountains from the Pousada, wake up bright and early Sunday morning, climb Mt Ramelau, and head back to Dili Sunday afternoon. The Pousada was a beautiful guesthouse tucked in the mountains with gardens and great views all around. Unfortunately, I was feeling rather rotten by the time we arrived so spent all day laying in bed. Eva, the Australians, and the New Yorker played Frisbee and foosball. The air was cool, quiet, and clean in the mountains (very different from Dili). We ate dinner at the main house and I again returned to bed hoping to feel well enough to climb in the AM.
Sunday morning Eva, one of the Australians (the other one was feeling ill), the New Yorker, and I headed for Mt Ramelau at 5 AM. We were able to find the trail head with only a few wrong turns and were hiking up the mountain by 7:30 AM. The hike was wonderful, I was feeling better, and it was so nice to be out and get some exercise. The views on the way up were remarkable and thankfully it remained clear the majority of the way. We reached the top around 10:30 AM by which point clouds had rolled in and we weren’t able to see much unfortunately. The top is marked by a 3m high statue of the Virgin Mary- we took in some sustenance (cheese and crackers, oreos, and bananas) in her presence before heading back to our vehicle. Upon returning to the Pousada we ate lunch and again loaded into our 4 wheel drive for the painful drive back to Dili… this time it rained the entire way. Feeling ill once again by the time we got home Eva and I were in bed and asleep by 8 PM.
This week started just as any of the others have… we were up and headed to clinic for rounds at 8AM. Monday turned out to be a pretty typical day. We went to the grocery store in the evening as we were going to have dinner at Dr Dan’s on Tuesday because the New York medical student was leaving on Wednesday. Eva and I went for Monday night dinner at the Indian restaurant across the street and for some reason I wasn’t feeling quite right. I figured maybe I was still recovering from my sinus infection… so showered and headed to bed when we got home. Tuesday morning I wasn’t feeling much better (dizzy, weak) but again got myself together and headed to clinic with Eva for morning rounds. As I put on bug spray that morning for the millions of mosquitoes I thought maybe I was poisoning myself with DEET (turns out I was wrong). While in the maternity ward I started to feel faint so excused myself and took a seat outside. Dr Dan sent me to the lab to again get tested for malaria and this time dengue as well. Surprise… surprise… I have dengue fever.
For those who don’t know dengue fever is a mosquito-borne virus which is relatively common throughout Asia and thus Timor. There is no vaccine available and they only way to avoid it is to avoid mosquito bites- easier said than done here. Symptoms include high fever, headache, body ache, diarrhea, and some get a rash. Check to all of those. There is no specific treatment for dengue- just rest and take Tylenol for the fever. The other key is to have your platelet count checked daily to ensure they are not falling as dengue can become hemorrhagic. So this is what I have been doing all week... (having the true Timorese experience as many have said). I have been laying in bed feeling lousy and weak, taking Tylenol to try and control the fever, Eva has been drawing my blood every morning to have my platelet count checked at the hospital, and the Australian doctors who round with us on Sundays have been doing home visits to check on my every day. For this I am so thankful!! I have been reading some great books during the day when I am awake to keep my mind occupied. I’m starting feel a bit more like myself but being sick in a foreign place really makes me miss home.
I’m not sure what day I will head back to the clinic… hopefully tomorrow if I feel up to it as I am going a bit crazy in our little room. Eva and I are going to try and go to Hotel Timor (the nicest hotel in the country) sometime this weekend as we heard rumor they have free Wi Fi and an all you can eat dessert buffet… I’ll try and post this blog and maybe a picture or two at the time. Hope everybody has a very Happy Valentine’s Day!
Subscribe to:
Post Comments (Atom)
No comments:
Post a Comment