This week, I began work at the Bairo Pite Clinic (BPC) in Dili, East Timor (http://bairopiteclinic.org/). 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 (http://www.projectplusone.org/). 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.
See you later, East Timor! The 9 weeks I spent in East Timor went by so quickly. I cannot believe that summer is over!
Over the course of my internship, I shadowed many of Bairo Pite’s staff. I followed the doctors around during their rounds and when they went to examine the patients. They discussed treatment plans amongst each other and let the nurses know of any changes on the patient’s status chart. This is how rounds typically run in the morning and in the afternoon. Some days I hung out with the laboratory staff. I watched them run lab tests. I have also worked with the clinic manager at the clinic organizing in her office and the stock room so we know what supplies we have.
At the clinic, I learned how to use an EKG machine. I admit that I cannot truly read the EKG results, but I know where to place the electrodes and run the test. With the medical students, I also learned and practiced taking blood pressure with a stethoscope and blood pressure cuff. Sometimes to check on a patient, I took their blood pressure. Sometimes I helped take patient histories; I asked them how they were doing and ask if they have certain symptoms in Tetun. I learned how to assess the patient by looking and examining the patient’s hands, face, and just getting a general look at the status of the patient to see if they are breathing heavily or any other acute problems that needed to be looked at. Other tasks I did included taking patients to the National Hospital to get chest x-rays or to get consultations with the specialists working there. I let the patient know where we were going and accompanied them for their visit.
To build off of this experience during the rest of my time at Brandeis I will continue to promote the Bairo Pite Clinic with Project Plus One on campus. I will share my experiences to club members and to members of the community at activities such as the Millennium Campus Conference. I am continuing to pursue a career in healthcare and learning more about global health. I want to learn more about the politics involved and examine the differences. I also want to learn more about the current policies of disease treatments such as the WHO guidelines for tuberculosis (TB). I hope to return to East Timor to the Bairo Pite Clinic (in the processing of becoming a hospital) with more knowledge and education.
If a student is interested in an internship at the Bairo Pite Clinic, I advise them to take advantage of the opportunities available. Because a lot of people visit the clinic, there are a whole range of cases to learn from. There are also mobile clinics (scheduled doctor visits and health education to villages in East Timor) which students can go on. The people that organize the mobile clinics do really great work and it is a great opportunity to see how and where most people of East Timor live. I believe they will have the ability to really make the internship their own at the BPC. My advice for a student interested in this field is to not be afraid of saying no to things that they are not comfortable doing or that they do not know. They do not want to cause more harm than good and it is important to be honest.
My concepts of social justice have been enforced. With the sad and violent history of East Timor, they need healthcare to repair some of the damage and to help East Timor rebuild and stand up strong again. Listen here for an interview Dr. Dan, the founder of the BPC, recently gave a few weeks ago during a trip back to US about his experience. However, I have learned, like with all things, change takes time. It would take time for East Timor it implement changes and to learn what would work for their country and what would not.
Alice Luu ’14
Diak ka lae is used in Tetun, the local language of East Timor, for “How are you?” The literal translation is “Good or bad?” In response, people usually reply “diak”, meaning good, or “lae”, meaning bad. Diak ka lae is one of the many Tetun phrases and words I have learned here in my time in Dili. Although I am far from being fluent, I know enough phrases to understand some of the patients and to get a basic patient history. As I go on rounds with the doctors and follow up with the patients, I am getting more comfortable in a health care setting. Most importantly, I am also getting comfortable interacting with the patients. Being familiar with the language is one big step in communicating and interacting with patients and their families at the clinic.
After spending over a month at the Bairo Pite Clinic, I am definitely seeing how a health clinic in a developing country like East Timor operates. I work almost daily with the staff and volunteers in providing health care for its patients. I observe and interact with a variety of staff members vital in running the clinic. However, the BPC is steady changing as health care in East Timor progresses. As I am working, I am witnessing the failures of the system and the improvements being made. I believe this knowledge I am gaining is important in becoming better informed as a future primary care physician.
Since I have started working at the clinic, I have been exposed to many medical procedures used to diagnose and evaluate patients. As I am picking up the language here, I am also becoming familiar with the medical techniques and tools being used during these examinations. I am able to understand why these techniques are being used when a doctor uses them and I am able to provide these tools when a doctor needs them. These skills would be useful in the future for work in a health care setting and for facilitating patient care.
I am most proud of everything that I have learned so far at the BPC and the fact that I am able to make myself useful around the clinic despite my lack of knowledge. Most of the volunteers at the BPC are medical students with some medical experience. In the beginning, I was worried that I would not be able to get the learning experience I need or be able help out. However, the doctors and medical students have been very willing to explain and teach me if I had questions. This in return helped me understand what was going on and be able to help them and by extension, help the patients.
Alice Luu ’14
The Bairo Pite Clinic (BPC) is a community health center founded after East Timor’s struggle for independence from Indonesia that left the nation’s health service infrastructure severely damaged. The BPC strives to provide primary health care to some of the poorest people in the world. Every day they serve over 300 patients from all over the country, and they are open until every patient is seen. The clinic is established and financed entirely by contributions and at times is aided by governmental and non-governmental organizations.
At Brandeis, I am a member of the Project Plus One Student Chapter, which supports the Bairo Pite Clinic. Being involved in the club, I became familiar with the clinic and its efforts to empower the local community to provide healthcare for its members. I also met with a few Brandeis students who have volunteered at the clinic in the past with the organization and I wanted to get more involved by travelling to the clinic. I applied to the clinic through their application process and was invited to volunteer for the summer.
At the BPC, I participate in rounds every morning at 8:00 with Dr. Dan, the director of the clinic, Dr. Simon and other volunteer medical doctors and medical students to see the in-patients. I spend time with the volunteer doctors overseeing assignments and assisting with the application of treatments, making sure the appropriate medications are taken as prescribed and helping nurses take vital signs and record information. I facilitate in patient admittance, in recording patient history, and in communicating and relaying information between doctors, nurses, laboratory technicians, and other staff members at the clinic.
After my first week of the internship, I am finding myself falling into a routine at the clinic. In the beginning, it was a bit disorienting trying to figure out the system of the clinic, locating which ward was what or where, and trying to help out in a capacity that I am able to. Now I find myself able to introduce and explain the clinic to new medical volunteers and understand some of my limitations and capabilities at the clinic. Every day I observe rounds in the morning and in the late afternoon. After rounds, the medical students are delegated tasks or follow-ups with patients. This week I was able to observe a few Ziehl-Neelson stains, which is a method to test patients for tuberculosis (a common illness in East Timor), a lumbar puncture, several electrocardiograms (EKGs), and diagnostic tests for malaria and Dengue fever. The medical students and doctors have been very kind and supportive, explaining many of these procedures to me and the results of these tests. I feel that just by being here for only a week so far, I have learned quite a bit.
For this summer, I want learn more about how health care in a developing country operates, and how it faces its problems, such as a limited supply of resources. Already by observing the doctors and the clinic, I am seeing the pieces to this puzzle. In addition, I hope to continue to observe and learn more medical procedures and medical techniques used at the clinic and be familiar with the tools used by these providers.
Alice Luu ’14