Doorstep Treatment Support at Bairo Pite Clinic, East Timor

This week, I began work at the Bairo Pite Clinic (BPC) in Dili, East Timor (  The BPC was established in 1999 by Iowa native Dr. Daniel Murphy in the midst of unrest due to Indonesian occupation of the country.  Thousands were killed and approximately 70% of the country’s infrastructure was destroyed, greatly affecting health care and health care delivery among other things.  The clinic’s general, malnutrition, obstetric and tuberculosis (TB) wards are run by a combination of international volunteers and Timorese volunteers and staff.  The facilities are very rudimentary.  However, the clinic does have on-site Zieh-Neelsen lab and a lab with a polymerase chain reaction (PCR) machine both of which are used to diagnose tuberculosis and resistance to tuberculosis medication. Tuberculosis is one of the leading health issues in the country.  Half of the population has the disease, either in its latent or active form and risk of infection is very high.  As part of my internship, I am working in the TB department where a Doorstep Treatment Support (DTS) program is currently being developed.  The goals of the program are to increase education about TB, increase adherence to treatment through home visits and retrieve patients who have defaulted treatment.  I am working with a Brandeis graduate, Paul, a volunteer from New York, Joon as well as other staff .  This past week we did some auditing of the TB program to determine how many patients have defaulted treatment (stopped taking medication) over the past few months and what the different outcomes of treatment have been.    We also began going through and creating training materials for the DTS program. Every morning, I also join in on morning rounds with the medical student volunteers and Dr. Dan.  We start out in the maternity ward which delivers around 200 babies a month. We then go through the TB wards, general ward and malnutrition ward.  This usually involves Dr. Dan reviewing charts, examining x-rays and ordering necessary exams.  Resources are frighteningly limited and a lot of the time a clinical diagnosis is the best the staff can get.  Even if the clinic could diagnose properly, the country does not have the resources to treat a vast array of cases at the clinic.  Cancer, for example, is untreatable here unless an outside party is kind enough to take on a case pro-bono (free of charge).  It’s very frustrating but the doctors and staff continue to do the absolute best they can. I first heard of the clinic when I joined the student chapter of Project Plus One (PP1) on campus (  PP1 is an organization created by Paul with the purpose of supporting the Bairo Pite Clinic.  I have been a member for almost two years and am so grateful to be part of a group that is 100% dedicated to seeing the BPC thrive.  We have a formal partnership with the clinic and are currently focused on supporting the DTS program in order to ensure its sustainability.  Like other PP1 members who have worked at the clinic in past years, I put in a volunteer application to the clinic.  Besides personal and professional development I hope to gain here, I am hoping to bring back as much information to my fellow PP1ers about the DTS program and help inform the direction of our activities.  I am very excited to learn about barriers to care and health seeking behaviors that affect the delivery of health care in a developing country.

Kathelyn Rivera, ’15
Timor 1 069