Bairo Pite Experiences: Kobi Haworth

Dec 13th and 14th - Discovering Dili

The AIr North flight from Darwin to DIli was a short 1.5hrs with highlights including some great blueberry crepes and a very interesting chat with a bushy-bearded Victoran chippy heading to TImor-Leste to help build houses with an NGO (non-government organisation). As you approach Dili from the south of the island you get a sense of how mountainous the terrain is. Dotted along the peaks are small villages, accessed only by windy dirt roads that I'm told make for some very long and 'heart in your throat' 4WD adventures.

We (Angus from UQ and Tani, a student from UWA) spent the weekend exploring Dili (i.e. schlepping around dripping with sweat trying to acclimatise to the tropical heat). Some English-speaking Timorese  talk about Dili being 'Asia's Rio de Janeiro' because of the large statue of Christ that gazes down over Dili from it's far East. 'Going to see Jesus' (a local expat expression) and a swim at 'Back Beach' (named because of its location around the headland facing the back of the statue) were definite highlights!

Timor-Leste is a relatively new country with a long history, having claimed independence from Indonesia in 2002. The Bairo Pite Clinic was established by an American, Dr Dan Murphy in the remains of an abandoned military clinic after the Indonesian military departed. Since humble beginnings in 2002 it has grown into a very busy medical facility, run on a very meagre budget. Privately funded by international donations, Bairo Pite provides free medical care to the Timorese poor with Dr Dan ('Doutor Dan' in Tetun, the most widely spoken language in Timor-Leste), running an outpatient clinic for roughly 300 patients each day. In addition the clinic has roughly 50 inpatient beds, divided into a maternity ward, malnutrition ward, suspected TB and confirmed TB wards and 'Baixa', the general medical ward. International volunteer doctors and medical students provide medical care, however all of the nursing, laboratory and support staff are local Timorese. 

Tomorrow is our first day. I'm apprehensive, but keen to get started!

Three weeks later...

Time at the Bairo Pite clinic have flown by! 

Already perspiring heavily from the walk to clinic in the dense humidity, each morning we congregate on the concrete veranda outside the Maternity Ward at 8am. We are typically treated to one of Dr Dan's famous anecdotes or reflections on society before the ward round kicks off.

Having reviewed the overnight additions to the Timor-Leste population in maternity and congratulated the new (and exhausted) mothers, the ward round proceeds to the RTB (suspected tuberculosis) ward. TB is a massive health issue in Timor-Leste, making the differential diagnosis list for the vast majority of inpatient admissions.  Next stop is the TB ward, for confirmed tuberculosis cases. TB therapy is initiated at the Bairo Pite Clinic, with patients then followed up under DOTS (directly observed therapy) by the clinic's outpatient TB staff.

The ward round then progresses to the Baixa (inpatient) ward, where the presentations range from dysfunctional uterine bleeding, to hydronephrosis, to suspected sepsis in a two week old baby. Finally we make our way across the clinic to the Malnutrition ward, filled to capacity with small children being supplemented with F100 and Plumpynut in an effort to see them put on weight and thrive. The morning ward round concludes in less than 2 hours, and already we have seen over 40 patients!

Following the ward round, Dr Dan makes a beeline for his outpatient clinic, where patients have been congregating since 8am. Over the course of the day several hundred patients will find themselves sitting face to face with Dr Dan in his consulting room. Meanwhile, the medical students retreat to the main office with the inpatient Doctors, where the morning's task list is divided up. Typical jobs for a medical student include clerking new patients (assisted by wonderful volunteer Timorese students who act as translators), performing ECG's, escorting patients to the National Hospital for XRays and Specialist reviews and any number of other small patient care tasks. 

The clinic slows down for lunch from 12pm until 2pm. This is when we often brave the midday heat and walk to Solo - an Indonesian eatery 1km down the road. After lunch the inpatient Doctors run their afternoon ward round. The med students divide up the roles - afternoon hospital run, pre-rounding on patients and clerking new patients admitted from Dr Dan's outpatient clinic throughout the morning. The afternoon disappears quickly, and before we know it, 6pm rolls around and it's time to wander home.

Overall the days are a roller coaster of emotional highs and lows. Timor-Leste struggles with limited resources and the health of the population suffers as a result. We are seeing presentations and pathology here that are almost unheard of in Australia. However I have been overwhelmed by the warmth and the resilience of the people. This is typified by the standard Timorese greeting:

Diak ka lai? (How are you?)

Sempre diak! (Always good!)

By Kobi Haworth