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.
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.