Winter 2007

Chloe Smith: An East Timor Elective Experience

Late last year, Monash student and MDA National's 2006 Elective Essay Competition 2nd Runner Up, Chloe Smith under took her medical elective at Bairo Pite Clinic in East Timor. Chloe kept an email diary of her experiences helping casualties of a developing country ravaged by political unrest - all the while keeping her sense of humor. In this Student E-News we share a snapshot of her experience...

Thursday 14 December 06

Hey! Well, I've finally made it to Timor and it all feels a bit surreal, but I'm thrilled to be back here...

While a lot has changed in Dili (more burnt out houses, more UN and police vehicles, more aussie troops wandering the streets with massive guns, helicopters at night, etc), it is much more 'normal' than I'd expected it to be and I do feel safe... especially with the army of little kids that live in my street and look out for us 'malae' (foreigners).

The heat is taking some adjusting to and I can't wait for the rains to come, although having seen the state of the Metinaro IDP (refugee) camp, that's a fairly selfish view to take. That place is just going to become a muddy mess of dysentery and malaria as soon as the wet season hits. Nice. The IDP camps are really sad - tarps and tents set up in whatever open spaces used to be available around Dili. The only camp Bairo Pite Clinic looks after is Metinaro, which is ~40min out of Dili and home to about 6,000 internally displaced people. It's dry, dusty, has NO drainage and there are no signs that anyone is planning to leave the camp, despite the government's threats to cut food distribution early next year (…is that legal?!?!). Quite the opposite in fact - one family has had the foresight to raise their tent on mini-stilts, so they won't flood as quickly as the others but will probably spent the wet season living on stagnant water, while another family has started building a moat around their tent.

It's great to be back at the clinic and it's proving to be a wonderful refresher after a year out of clinical med (although I'm meant to be here training local staff in outbreak management… a topic that I'm trying to train myself in first which will be tough to do in just 5 weeks!!). There have been plenty of interesting cases so far, with yesterday being a big day for trauma and minor surgery. Thankfully all the trauma was self-inflicted (eg. dropping things on feet, falling off the top of a bus etc) and not due to people fighting.

Thursday 21 December 06

Clinic life is busy, with 65+hr working weeks, full of challenges and rewards. Yesterday was pretty awful - a 12hr working day, no lunch break and three patients died. By far the hardest one to watch was a two year old girl with hypo plastic right heart syndrome. She was just gorgeous. Five minutes after she died Dan (the doctor who runs the clinic) had to go on a mobile clinic, so suddenly I was in charge of finishing the last 60 patient consults for the morning. Madness. The translator went into hiding half way through the consults, just when a pregnant woman with malaria came in extremely unwell and having a miscarriage. I could kill him.

Dili is pretty quiet at the moment - the fighting flared a bit earlier in the week and I learned how to remove shrapnel and stitch up machete wounds, but things are back to normal at the clinic, with the bulk of cases being TB, malaria, pneumonia, funny-looking rashes and fungal infections. Hopefully it will stay that way for a peaceful Christmas ...

Sunday 11 February 07

... My last week in Timor was awesome. I went on a Red Cross field trip as the only medical staff member - they wanted me to assess 7 children in a remote village who have been identified as having 'critical malnourishment' - that sounded do-able... however, when I arrived I was told that the village chief had arranged a sort of paediatric outpatient clinic, I ended up consulting til 8.30pm and saw over 100 kids... most of whom had skin infections, viral diarrhoeal diseases or conjunctivitis, but 11 sounded like they definitely had TB. I couldn't believe how much TB there was... and I was only seeing the children!! The next day I hiked an hour to another village and the state of paediatric health was just as alarming.

The other highlight of my week was being in Dili to see the traffic lights get switched on. Some overpaid NGO employee decided it would be a great idea to set up traffic lights across Dili... yep, traffic lights are apparently a priority in a city where a significant proportion of people can't access clean water, where traffic runs moderately smoothly with no lights or road rules and where there has been no driver education about what red and green mean. So all the malae (foreigners) and about 50% of Timorese are stopping and the other half of the Timorese are treating the roads as though nothing has changed. It's madness... but VERY funny (and a little bit scary).

I'm already trying to plan my next trip back to Timor...

Love Chloe


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