My summer in Timor has come to an end. I am happy to say that during my time at the Bairo Pite Clinic I did meet most of my learning goals. I’ve talked in my previous posts about the DTS program and how rewarding it has been to see how a program is implemented almost from the very beginning. I’m ecstatic to say that the program is up and running and is already reaping the rewards of all the hard work staff at the clinic have put into it.
The other facet of my internship at the BPC that helped me meet my learning goals, which I haven’t spoken about yet, is the clinical side of my experience. Though I’ve always been interested in medicine and health care in general, I’ve never been certain about whether or not I want to actually practice medicine. One of my hopes for this summer was that my time at the clinic would inform my future career choice and I am happy to say that it has done just that. This summer I observed a number of fantastic doctors as well as medical students at work. It’s admirable how dedicated they all are to trying to deliver the best care they can despite all the obvious obstacles they have to overcome on a day to day basis. I learned a lot about the compassion and patience needed in order to be a good physician which I’m sure is a constant no matter what setting you’re in (developed vs developing country for example). However, I also learned a lot about practicing medicine in a developing country where every step of obtaining health care is more challenging than it would be here in the United States. For example, the difficulty begins with accessing care in the first place, to obtaining a diagnosis, to actually having the resources to treat a condition once it has been diagnosed, to then completing treatment obtained. I’ve seen and experienced myself how frustrating it is to have to fight for your patient to get an x-ray or a CT scan and to fail or to not be able to help a patient who is in such terrible condition because he/she did not have adequate access to care to begin with. There were instances where it didn’t matter how much we wanted to help, we simply could not. In the end you just do the best you can, which is what I saw the physicians and med students do at the clinic.
After this experience, I am more determined than ever to do the best I can in my studies in order to achieve my career goals and also to help PP1 grow and develop as a club. After this internship I feel I want to gain more experience both in clinical medicine in the U.S and in other developing countries. Perhaps I’ll look for an internship at a hospital or clinic and apply for health-related programs abroad for my upcoming gap year. For anyone who may go to Timor to work in health care I would advise they pay close attention to the national health system there and why it is exactly that Timor is struggling with such low health outcomes in many different areas of health. I think anyone in this field should at least consider an experience abroad that will help broaden your perspective of health care and help learn what makes one system more efficient than another.
All in all, my concept of social justice as it pertains to health care equity has been strongly reinforced. We know health disparities are present within the U.S and other developed nations but they are less striking (though not less important) compared to global health disparities I think that the most important thing to keep in mind in order to address this issue is that no life is more important than another. As long as you believe that some people deserve better care than others, health disparities will continue to prevail.
This, is a short documentary filmed during my time at the clinic. It does not adequately represent all of the work done at the clinic or go too much into the struggles within the Timorese health system as a whole but it does give an idea of some of the cases the BPC encounters.
It’s been a very eventful couple of weeks for the TB department at the Bairo Pite Clinic. The TB team and I have been working to create training materials for our 4 new health care workers who will be carrying out the Doorstep Treatment Support (DTS) program. As I mentioned in my previous post, the DTS program aims to increase adherence and completion of TB treatment for those with active TB and to provide preventative treatment for children under 5. I have learned so much about program implementation; how difficult it is to translate an idea onto paper and then into a practical setting, and then how time consuming it is to translate all this from English to Tetun.
One of my goals for this summer was to apply what I have learned in the classroom as an HSSP student in a more practical manner, particularly as it pertains to implementation of community health projects. First, the needs of the community had to be gaged. Given the high incidence of TB in Timor, it was clear that there is a need to reduce the incidence and prevalence of TB by identifying those with TB more efficiently, by increasing adherence to TB treatment, and by trying to deliver more preventative treatment (http://www.who.int/countries/tls/en/). Then, the clinic had to determine what resources, in the form of money, facilities, and human capital were available for the program. Foreign grants were obtained and 4 new workers were hired for the program. Once we knew the program had proper support we began creating materials for a 6 day training for the new workers. My colleagues and I created scripts and videos, scenarios for role play, and other written and verbal activities for the two days of training that pertained to effective communication. Learning points included recognizing verbal and non-verbal signs, and active listening through paraphrasing, summarizing and reflection (http://www.skillsyouneed.com/ips/nonverbal-communication.html). We collaborated with many wonderful Timorese volunteers who were willing to act in the videos, translate the work we had done and then deliver a lot of the materials in Tetun. Working as a group was essential for the success of the training and it was also a great opportunity to build new friendships.
I think one of the most important things I’ve learned through all of this is that if you want anything to be successful you must be able to keep the big picture in mind while being extremely detail oriented. Every little detail matters and you must try to go the extra mile with every assignment you are handed. I am very proud of myself and my colleagues, particularly our ring leader, Paul, and all the hard work we have put into our work. We have been forced to do things we have never done before that have taught us to be more resourceful and also to draw from each other’s skill sets. I hope to take back everything I’m learning here related to teamwork, planning and program implementation to PP1 so that we can grow together as a club and organization.
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.