Week 1 in Dili: first impressions of Bairo Pite Clinic.
A typical day at Bairo Pite Clinic starts with 8am ward rounds with 'Dr Dan' - an American physician who has been working in East Timor since independence in 1999. Our first day coincided with the first day or two other medical students from UWA, a GP from WA, four midwifery students from ACU, and a midwife from Brisbane - so needless to say it was a bit hectic. This, combined with all consultations being conducted in Tetun (the national language of Timor Leste), the vast array of medical conditions unheard of in Australia, and the temperature sweltering at 40 degrees plus 98% humidity (and no air-con) made for a very overwhelming first impression. As each patient is seen in turn, jobs arise - e.g. assess this newborn for potential congenital heart defects; this patient with 3 months of cough, haemoptysis and weight loss has suspected TB and needs a chest x-ray at the national hospital; this pregnant lady needs to be monitored and treated for probable urosepsis (which cannot be definitively diagnosed). Following rounds, Dr Dan begins his outpatient clinic and the inpatients are managed by a small staff of volunteer doctors and medical students. Our job as medical students at the clinic can involve a wide array of things - clerking new patients, transferring patients to the national hospital for consults and imaging, assisting with emergency cases, rounding on patients, doing (many) neonatal checks and even some administrative work.
What has been the most eye opening in this first week is how much demand there is for what few resources the clinic has. In his outpatient clinic, Dr Dan sees close to 200 patients a day, on top of the 40-50 inpatients. Not only is there limited personnel to see all of these patients, their care is also limited to what the clinic has available. There is limited imaging available (X-rays and CT scans are available at the national hospital but require substantial work up and justification), limited specimen testing available, and no culturing of urine or blood available in the country(!!), so diagnoses rely almost entirely on ones clinical acumen and rationalisation of differential diagnoses. Once a diagnosis is suspected, resources again limit how you can treat the patient. We have seen countless abdominal masses this week that are likely malignant and their treatment is limited by needing to access the general surgeons at the national hospital, the sparse chemotherapy options available, and the lack of radiotherapy in all of Timor Leste. It is quite humbling what care can still be provided to these patients despite not having the luxuries of Western medicine.
Needless to say, this first week has been a steep learning curve into how things operate at the Bairo Pite Clinic in Timor Leste. I can only imagine what the next three weeks hold for us!
Tetun word of the week: malai (foreigner).
By Nicole Graves