Traffic

20/1/2008

We've had quite a turnover of assorted animals through our household lately.
The chicken population has exploded, thanks to new-year presents from several villagers. At its peak, we had fifteen chickens of various sizes running amok in the yard. It's down to a (slightly) more manageable 12 now. Two were curried, one fried.
Pak Leo, the village headman, has temporarily parked his scowling cow in our front yard, as the river that runs by his house is in danger of overflowing its banks.

[Picture: Scowling Cow]

Our two piglets have died. To be more precise, one died (malaria?); and the other looked moribund, so we killed and ate him. 'Tis life.

[Picture: Moribund Pig.]

Bagong, Pedro and Darling we picked up from the new litter at Pak Leo's. It's a challenge to get my slippers on every morning, with a trio of month-old puppies suckling my toes.

[Picture: Disgustingly Adorable.]

Sadly, two of our other dogs have met untimely deaths under the wheels of some 4WD hurtling along the road in front of the house. Chocolate, we buried. Taus, eaten by our neighbours. Ouch.

Of course with this many animals loose in the compound, the primary question to ponder is, 'but does it bite?' The answer, I've discovered, depends on the particular specimen's personality as much as on the species it belongs to.
So far, I have survived three chicken-bites.

-raj

It's a boy

18/1/2007

Deliphina De Nunes delivered her first child today in somewhat better surroundings than Maria did (see "It's a girl", 30/12/2007).
Labour began at about 5pm. Baby delivered at 8, on a couple of sheets thrown upon on the earthen floor in the corner of the bedroom. Mama Leonarda, the village chief's wife, was again by my side to help; but no sign of El Mustachio this time round. I walked her through the delivery and aftercare, I wonder if she'll be able to do this on her own when I'm gone.
The neighbours' wives gathered outside the door were an opportune target for my routine sermon on breastfeeding - a subject I've become a rabid advocate of.

Having learnt my lesson from the shock of being asked to name the last baby, this time I had come prepared with a list. Sadly, proud mum and dad had already thought of a name. Oh well.

'Reuben', Hebrew, meaning "see, a son."

-raj

Earth

18/1/2008

I had never really understood, back in med school, why so much time was spent learning about 'soil micro-organisms'. I think I do, now.
Earth, like air, is an ubiquitous part of life here in rural Timor. Most are born on the bare earth, spend their early years playing in it, expend the major part of their life working it... and finally laid to rest in it.

Not surprisingly, a significant proportion of the sicknesses we treat in our clinic are soil-transmitted.
Every other kid has a belly full of worms. The symptoms aren't too impressive: intermittent stomach pain, constant tiredness, the occasional disturbingly mobile bowel movement. The greater, more permanent damage lies in the stunted growth. The worms compete with the already malnourished kids for their limited food.
I dish out albendazole like candy. But the deworming meds don't stop the kids from running around barefoot and picking the worms right back up, the very next day.

Earth also features prominently - and frustratingly - in many traditional remedies.
I spent an excruciating hour last Saturday cleaning out the left ear of a resolutely noncooperative two-year-old. Her mum had packed it to the brim with soil and leaves, to treat a budding ear infection the week before. By clinic day, of course, the infection was positively fruiting. An unappetizing experience for all involved.
Traditional Timorese first aid for cuts while farming: handful of soil, dry leaves, hearty mouthful of spit. Mixed evenly, then slapped onto the bleeding wound before proudly presenting it to the doctor. Bad-tempered doctor then painstakingly cleans away the muck while delivering a long and animated dissertation on 'germs'. When the bleeding is controlled, I just dress the wounds - any attempt to stitch the skin after such overwhelming contamination would only worsen the infection.

Convincing a community that invisible germs exist, that earth is best left on the ground and not on or in their kids, is not an easy task. We teach, we teach, we teach. But until those ideas take root, someone'll have to continue cleaning the ears and the wounds, and dispensing the albendazole and antibiotics.

-raj

Skin And Water. And Skin.

9/1/2008

Nothing frustrates me more than the endless line of filthy kids with skin diseases that attend our clinics. Rashes, sores, pustules and abscesses in assorted combinations. Nearly all of them preventable with just one intervention: soap and water.

Timorese kids don't like soap any more than kids anywhere in the world. But the biggest factor contributing to the universally poor skin hygiene is the lack of water.

Vatunau has a population of 2000, five wells, and a patchwork water piping system from the two rivers that flow through our village. A few households have small tanks rigged to the pipes, but most families still walk several hundred metres a day to fetch water. A precious commodity, not often expended on extravagances like daily bathing.
Various NGOs and government bodies have assisted with the water piping system since the late 80s, PPH has contributed to significant improvements in the last two years. Work in progress.

I can't, however, attribute my own rashes to a want of showers.
Right now, my legs are sporting five dressings over sores of various shapes and stages of evolution. Annoying, but not comparable to the awful 'cellulitis' skin infection crawling up my left ankle over Christmas - resolving now, thanks to the self-prescribed antibiotics.
No thanks to the bug bites from the garden, which likely got the infection going in the first place.

In the balance of things, I should be grateful for my cellulitis - it's made me more sympathetic now to the unwashed kids.

-raj

Floods

7/1/2008

Unusually heavy rains for the last week. Several areas in the North-West of Timor have experienced landslides and floods.
Liquica market, five kilometres from our home, is a sobering scene of ruin. The overflowing river has wiped away several houses and damaged the market's permanent structures. A couple of electrical poles are down, those of us to the West of Liquica will likely be without power for a week or so.

The damage may not be dramatic in scale, but to those who don't have much, it is significant.
I'm worried.

-raj

Bernardo

6/1/2008

We buried Bernardo, age 19, today. Died of internal injuries sustained from a traditional martial arts class a week before. Not a common event.

But evidence of a troubling underlying phenomenon: the recent proliferation of violent youth gangs often associated with 'martial arts' groups. The weekend fights are drug-and-alcohol-fuelled mass brawls, featuring knives and machetes. 'Martial,' yes; but not much 'art'.
The gangs are concentrated in the capital Dili, 50 kilometres from where we live, but we do see episodic disturbances in neighbouring Liquica, and occasionally even in Vatunau. Gang insignia has recently shown up spray-painted on the village bridge.
The police have been asserting themselves, particularly the 'Task Force', outfitted with riot gear and building a fearsome reputation for breaking bones first and asking questions later.

Timor is awash with NGOs and churches seeking to cope with the concrete problems of a nation emerging from a long and brutal occupation. But we may not have enough labourers addressing the social needs of a traumatized generation, now coming of age.
We're losing the youth.

-raj

Singapore 26/1/2008-3/2/2008. Help.

Hello again, guys.
I'll be back in Singapore to attend a couple of church meetings, arrive 26/1/2008, depart 3/2/2008.
There are several items for the clinic I'll need to acquire then, to carry back with me to Timor. I'm planning to purchase these, but would be glad to take donated items. If you can help, do email me at rajrman@yahoo.com.

***

List of items to acquire for clinic from Singapore 1-2/2008
- MIMS drug directory x 1
- Pregnancy calendar/wheel x 5
- Latex gloves, medium size x 1 box
- Vaginal speculum
-- Medium x 5
-- Small x 5
- Urine Pregnancy Test Kits x 2
- Glucometer x 2
- Glucometer strips x 50
- Gauze squares x 200 pieces
- Alcohol swabs x 100 pieces
- Syringes
-- 50cc x 10
-- 20cc x 10
-- 10cc x 10
- Needles
-- Green (18G?) x 50
- IV cannulae
-- Blue x 10
-- Green x 10
- IV giving sets x 5
- Tegaderm Dressing
-- Various sizes x ?20
- Sterile sheets x 10
- Nonabsorbable suture, eg. Prolene
-- 3-0 x 10
-- 5-0 x 10
- Surgical ties x 100
- Micropore tape
-- Various sizes x 10

Acquire for clinic (meds)
- Paracetamol suppository x 5
- Emmolient cream x 20
- Pilocarpine 2-4% eye drops x 2 vials
- Becotide (Beclomethasone 50mcg/puff) MDI x 4
- Cloxacillin capsules 250mg x 400capsule
- Lignocaine/Lidocaine 2% x 20ml/vial x 10vials
- Ketamine for IM sedation