The Naked Doctor

1/4/2008

Three weeks left to the end of my term here in Timor. What I miss most about Singapore hospitals is the glorious abundance of new, inventorized, sterile plastic-wrapped equipment.

Our dinky clinic here is OK for the regular 'flus and diarrhoeas, but the squeeze comes with the small surgeries: abscesses to be poked, cuts to be stitched, wounds to be repaired.

[Do NOT poke me!]

[Post-poking.]

Greatly outgunned by the patients, I returned from the lightning trip to Singapore in Jan with a substantial armoury of dressings, syringes, IV sets... (thanks CM!)

Initially, the only anaesthetic available to me for some procedures was 'brutacaine' - 3 or 4 handy assistants holding down the shrieking patient while I sliced away. Not much more refined than a consultation with our local witch doctor. I've since got my hands on a stash of Ketamine (thanks S!) and Lignocaine (thanks G!), which have greatly decreased the pain and drama of our surgeries.

Dr. Daniel Murphy, a personal hero who's been serving in Timor for 10 years now, responding to an interviewer's question on high-end medical equipment: "You don't need all that stuff. Two hands and a heart, that's all you need. A stethoscope helps, though."

Agreed. But the syringes help too!

-raj

Saving Ballo's Bushes

31/3/2008

Abel Ballo's kids shall no longer abuse the bushes. The CHEs and I built him a toilet this morning. (See 'Penitence', 20/3/2008)
Not a particularly extravagant affair: just a big hole in the ground, overlying planks with a hole, stones for squatting, a bit of zinc fashioned into a cover. But not without its technicalities. Siting needed consideration of relationship to groundwater depth, distance from living quarters, surrounding vegetation and direction of prevailing winds. And digging a 1.5-metre hole was no small task.

'How to build an effective toilet' is a question that's weighing on NGO minds across the globe. A cursory Googling brings up an astounding array of technologies and philosophies, even a World Toilet Organization.

But only half of Timor uses any form of toilet a step above the ad-hoc hole, so we're still pretty proud of our big-hole-with-a-cover.

-raj

Kakrui

13/3/2008

I'm pooped. 3-hour climb to the Kakrui hills south of Vatunau this morning. Visiting homes with our volunteer Community Health Educators, five girls and one guy who've attended weekly health workshops for the last two years, and helped me run the clinic for these past five months.
We meet 6 am. Posters, flipcharts, stethoscope, a few meds. As usual, I'm the only dude geared up in boots, backpack and bottle of water. Our CHEs would bounce up Everest in their slippers and pyjamas.

The three-hour trek takes us along the river bed,

through the jungle path



and up the hills

A major adventure for me, but I'm episodically greeted by giggling kids heading the other way, daily walk to school. We arrive at the Kakrui cluster of houses, welcomed with smiles and cassava.

Brunch is followed by the main business of visiting homes. The CHEs teach basic health: nutrition, hygiene, mosquito avoidance, home treatment of children's diarrhea...

The main health problems here are still best addressed through simple education on prevention and improving living conditions. I count the time spent training and supervising our CHEs as my real legacy here in Timor - these guys will remain on the frontlines of the war against disease long after my Panadols are forgotten.

-raj

Penitence

20/3/2008

I've just returned from a 5-day trip to several villages in Los Palos on the eastern tip of Timor, to visit the resident missionaries, conduct community health talks and deworm children.

Gut worms are universal in rural Timor, mainly due to poor sanitation. When one infected child defecates behind a bush, rain and groundwater flow eventually carry the worms to the community’s well – everybody’s drinking water.
The government school health programme includes mass-deworming, but many places have yet to climb on board. So our plan was to carpetbomb our villages’ 2-5-year-olds with deworming meds.

Easier said than done.
Generations of threats from bulging-eyed mothers has left Timorese children with a deep confidence that if you’re naughty, the Evil Foreigners will kidnap you, and – depending on the creativity of your mother – beat/imprison/eat you, feed you vegetables, turn you into a goat or give you injections.
Predictably, being lined up to receive deworming medicine at our hands created much holy terror.
Some children gave wary assent:

Many went ballistic:

And this guy:

survived the ordeal with deworming meds everywhere except down his throat.
Exhausting. For all involved.

But rewarding. I’m told that entire villages are now abuzz about whose kid has passed out the most worms.
Let’s just hope it wasn't behind another bush.

-raj

Deficit

18/3/2008

I'm crunching statistics from the clinic records, in this last leg of my term here in Timor. An alarming 40% of the children I’ve treated are growth retarded.

Due to starvation.
Not the hollow-eyed skin-and-bones frank hunger that's familiar from TV images of '90s Ethiopia; but an insiduous, chronic lack of protein and energy foods that manifests itself in frequent illnesses and poor growth. The resulting physical and mental deficits are significant, and permanent.
Malnutrition here is rare in infants until about a year of age – when they’re abruptly displaced from the breast by a new arrival.

[Vexation]

The staples, cassava and corn, are both mostly fibre and water. So toddlers may fill their stomachs three times a day and still effectively starve.

[Breakfast/lunch/dinner: cassava, salt and chilli]

Concerned mothers stream to the clinic seeking ‘vitamins’ to fix their skinny kids, which I steadfastly refuse to dispense. The solution is upping the energy content of their meals. I’m on a campaign to encourage mothers to include a tablespoon of cooking oil in every meal.
Awkward. It’s exactly what I wouldn’t be advising back in childhood-obesity-smitten Singapore.

-raj

Ainaro district, in 10 photographs

11/3/2008

Timor is gorgeous.
I've just returned from a 5-day foray into villages in the central mountain region, running mobile clinics with a team from Singapore's CEFC.

Sunrise

Girl

Backside

Flowers

Daggers

Routine

Inn

Hut

Precarious

Aftermath

-raj

Steady As She Goes

14/2/2008

Things are better.
We're still wound tight. But Timor has been remarkably - almost supiciously - peaceful.
Regular updates on the radio (they've ditched the "remain calm" guy) and SMSed news clippings from friends in Singapore have made the story clearer.

From CNN.com:
[[DILI, East Timor (AP) -- East Timor declared a state of emergency Tuesday... assassination attempt Monday against President Jose Ramos-Horta and the failed attack on Prime Minister Xanana Gusmao.
The country's top fugitive, Alfredo Reinado, and one of his men were killed in the attack on the president. One of the president's guards also died.
...international soldiers and police patrolled the streets of the capital, Dili, where many shops and businesses were closed. There were no immediate reports of unrest.
Reinado was among 600 mutinous soldiers dismissed by the government in 2006 -- a move that triggered gunbattles between security forces that later spilled over into gang fighting and ethnic unrest.
At least 37 people were killed and more than 150,000 people forced from their homes in the unrest, which also led to the resignation of the country's first post-independence prime minister.
Reinado was arrested but escaped from prison after several months.
He was charged with murder in connection with the 2006 violence, but had remained in hiding and had threatened armed insurrection against the government.
The streets of Dili were calm after the attacks, and Gusmao said an overnight curfew was in place. The United Nations, which controls security in the country, said checkpoints had been set up on main roads.]]

I had to squeak through two checkpoints, getting to Dili today.
Just outside laid-back Liquica, it's all smiles, backslapping and "how-ya'-doin". But Dili's fortified checkpoint greets me with the less-than-neighbourly barrel of an M-60.
The Portuguese UN troops immediately single me out for interrogation - the only foreigner, and a bestubbled one with a fancy laptop computer at that. The furrowed eyebrows, unslung rifles and clipped tones quickly dissipate, however, upon a shameless flourish of my stethoscope. Ah, a medic! I'm merrily planted back on my truck with fresh smiles. And another backslap.

Timor's not out of the deep waters yet, but the crisis appears to be over. We're drifting back toward normality.

- raj