3/8/2010

Last entry for this trip…

The week of 2/22-2/26 was filled with mobile clinics. Eva and I were able to go to a number of them together which was great. We loaded up in the 4 wheel drive after rounds and got out of Dili for the day. The majority of complaints at mobile clinic are things like headache, backache from working in the fields, cough/runny nose, diarrhea/vomiting, a few fevers, and skin infections. As far as treatment that can be offered to the patients at mobile clinic, we tend to give out Tylenol, ibuprofen, multivitamins, vitamin C, occasionally antibiotics, and albendazole (for all of the little kids with intestinal worms). We are also able to do rapid malaria tests and take sputum sample to evaluate for tuberculosis. While only the antibiotics and the albendazole are actual therapeutic treatments by western standards the majority of these patients are satisfied by the placebo effect provided by the vitamins and the like. It is important that these patients not leave the consult empty handed and feeling as though the visit wasn’t worth their time (this could deter them from seeking care on other occasions when they may be affected by more serious illness). Patients are always encouraged to return if they do not feel better and given that all services are free the system seems to function rather well. Recently a midwife was added to the mobile clinic staff which is great as the majority of women in more remote locations receive no pre or post natal care.

The week passed by quickly and on Friday the 26th we all got together to celebrate Dan’s 31st birthday (or the 10th anniversary of his 21st as we referred to it, side note- While turning 21 is a big deal for Americans due to the legal drinking age this is not the same for Australians who can drink at 18. However, turning 21 is significant to them for a different reason. In Australia, when you turn 21, you get the keys to your parents’ house… symbolizing you are old enough to come and go as you please….?. This tradition is still a bit puzzling to me as I wonder why one is living at home at 21- Dan suggested it is just an old tradition and admitted it doesn’t make a whole lot of sense. (Crazy Aussies.) Anyways, we went out for Indian food and surprised Dan with a chocolate cake with candles which read, “Parabeins Maun Dan” (Happy Birthday Brother Dan in Tetun). Dan was still not feeling well (turns out he got dengue also) but put on a good face and even joined us for a couple of beers after dinner. We said goodbye to Liam Friday night before heading home as he left Timor Saturday morning. Eva and I are so thankful for all of the people we have met here in Timor and have found the goodbyes a bit sadder than we anticipated.

The remainder of our last weekend in Timor was rather uneventful. We rounded in the mornings, enjoyed a few cups of café Timor (organic coffee grown in the mountains of Timor is one of the country’s most promising sources of income- it is soooo good), went to Hotel Timor for lunch and dessert buffet, hunted for internet, and had an afternoon by the pool. The weather continues to be extremely warm and humid. While it is currently wet season… the rain has not been overly impressive as it has been a “dry wet season.” The increase in dengue on the island has been attributed in part to this- a dry wet season means more standing water and thus more mosquito breeding ground (when there is more rain the rate of water turnover in the rivers/fields/puddles is greater).

Eva and I worked at the clinic on Monday and Tuesday of last week. We took Wednesday and Thursday to see a bit of Dili, wrap of loose ends, and pack before flying to Darwin on Friday. Unfortunately our last two days of clinic were disheartening. On Monday, we received news that a 15 year old boy who had been at BPC for well over a week passed away after being referred to Dili National on Sunday. It was again another example of referring the patient on too late in the disease course leading to a bad outcome. The boy had come for consult, was found to have significant lung disease (likely tuberculosis with a superimposed infection), received less than adequate care due to resource/staffing issues at BPC (we couldn’t provide oxygen by face mask for this patient), he continued to decline, the suggestion of transfer to a more appropriate facility was made several times by several people, these suggestions were dismissed, the patient declined further until his oxygen saturation on room air was in the 40% (normal is over 90%), at this point he was transferred …. He died shortly after leaving our clinic not because he received poor care at Dili National but because we waited too long to send him. It was unnecessary and frustrating.

On Tuesday, we returned to clinic with mixed emotions- relieved it was our last day but not looking forward to saying goodbye to some of the great people we have met/worked with. After morning rounds Eva and I went to separate mobile clinics which were both within 30 minutes of Dili. We were back to BPC by early afternoon. I did a few dressing changes in the “emergency room” and drained a rather impressive abscess (about the size of an egg on a man’s neck). On AM rounds we had heard of a patient which was being brought in from the mountains in labor- she was pregnant with twins, had delivered the first twin at 6:30 AM in her home, and was unable to deliver the second twin which was breech (feet first). After finishing up in the ER the ambulance arrived with this woman (about 8-9 hours after the delivery of the first infant). Eva and I followed the patient in to maternity unsure of what had occurred since the AM. While the first twin was doing well, the second one was still in the birth canal and no longer alive- the body was almost entirely out but the arms and head remained. Dr Dan went through the steps of delivering a breech infant with us. With the assistance of suprapubic pressure he delivered the second twin. While the deceased infant was cleaned, dressed, and given to the family, Mom was encouraged to breastfeed the first twin to avoid further complications. It was a sobering moment for all of us. Eva and I finished afternoon ward rounds, took photos, exchanged e-mail addresses, and said our thank yous and goodbyes to the staff and volunteers at BPC.

On Wednesday morning Eva and I, accompanied by Luis (a Timorese friend who lives in Switzerland and was staying across the hall at our hostel while visiting family), went shopping. We visited the local craft market in Dili and wandered through downtown. Tais, which fill the craft market with color, are impressive traditional woven pieces made by the Timorese. We had a wonderful morning and Luis was of tremendous help guiding Eva and I with his insider knowledge. He has become a great friend and resource for us. Wednesday evening Dan cooked dinner in honor of our coming departure… we had vegetable curry with rice, wine, and fresh baked chocolate chip cookies with ice cream (we brought the dessert). Again there was a large group of people at Tracy’s (where Dan lives) for dinner- two Japanese, a middle easterner (didn’t get all his info), an Aussie, a Swiss, a Welsh, and us two Americans.

Our final day in Timor was wonderful! Eva and I set out relatively early in the morning to hike up to a statue of Jesus which overlooks the city of Dili (given by the Portuguese to Timor- for those who don’t know Timor was a Portuguese colony, the vast majority of Timor is Catholic). The views from where Jesus stands were beautiful. We then proceeded to “backside beach.” This is a beach just on the other side of the mountain from Jesus (from the beach you can see his backside… thus the name). To get to the beach we took a foot path which heads down the back of the mountain- backside is supposed to be one of the nicer beaches in Dili because it is a bit harder to get to- less crowded and dirty. We trekked down to a completely empty, completely beautiful beach! It was just Eva and I and a few stray goats for the afternoon. We lazed around, read our books, ate a picnic lunch, and enjoyed the sun. After we had had our fill we trekked back to Dili… it was oh so sweaty!! We met Maggie, the Australian physician who is now working at BPC, for an iced coffee to say goodbye and then headed home to pack. The day ended with Thai food, Bintang (Indonesian beer… the best we have found here), and saying goodbye to Dan (he still has 2 weeks left in Timor). Through all the ups and downs of this experience I think both of us agree we are glad we came. We have both learned a lot… (maybe not what we anticipated learning) and met some wonderful people.

Friday morning our flight left Dili at 8 AM and by 10 we had returned to the developed world… it was a huge culture shock! Generally, in my past experiences anyway, it has taken at least a day of travel to go from somewhere as underdeveloped as Timor to somewhere as developed as Australia. Eva and I checked into our budget hotel (clean white sheets, AC, and our own mosquito free bathroom!!), ate lunch at Subway, and wandered downtown Darwin/the grocery store/shops with wide eyes. It is just so crazy… we live in such excess. Again we headed down to the water front for dinner. Eva was adventuresome and tried a kangaroo burger…. I stuck with a Greek salad- less exciting but still good. Our weekend in Darwin/The Top End (as the Aussies call it) was spent exploring two national parks- Litchfield on Saturday and Kakadu on Sunday. While I won’t go into all of the details we hiked, swam under waterfalls, saw crocodiles/other wildlife, visited Aboriginal sites with rock paintings, and just enjoyed ourselves. The days were long but well worth it.

Currently we are on our flight to Sydney and should arrive early afternoon. A friend of mine from undergrad, Zack, will be flying out of Sydney today so I am hoping we can meet for a quick coffee before he leaves… the plan is for him to be at baggage claim when we arrive. We will then explore Sydney as cheaply as possible (we are staying with a friend of a friend and then Eva’s family). We will be back in Iowa in no time… both of us are anxious to see friends, families, Matts, and our dogs. I think we are also a bit anxious given that Match Day is only 5 days after our return… being in another country is like living someone else’s life for a bit… soon it will be back to reality (which is a mixed blessing). Anyways, hope you have all enjoyed reading the blog and I apologize for being a bit inconsistent in my posting. Much love from somewhere over Australia, Kim