Jailolo- Day 2

Day 2 – We awoke, or I should say got up as I never really went to sleep, at 6 am to prepare for our first day of work. Despite my bird bath I was already feeling pretty grimy and we hadn’t started working yet. Breakfast came (arrgh! No coffee. I don’t drink soda but Coke became my morning beverage this week). We mustered early (roll call) and packed up our medical gear as our first medical day was offsite at a rural school. Anytime we went somewhere it was a caravan of SUVs with a police escort. You would have thought we were important dignitaries. I was glad though that we were doing this today as I wanted to get some idea of what the local area was like. I’m not sure what I expected to see but I think I was surprised somewhat by what it is like here. I expected poor but in a different way (the more romantic poor with huts, and little gardens, etc). It turns out that much of poor today is filth mingled with modern touches. By filth I mean open waste, trash everywhere, smoke from burning things, etc. Such a weird contrast between the tropical beauty when you look at things from a distance. The modern was the abundance of satellite dishes. If nothing else, many people have TVs. Other than our SUVs, there are almost no automobiles. However, lots of scooters. I saw a family of five (mother, father, 3 small children) all on one scooter. I saw both mosques and churches on the way but they were not in the same locations. It was indicated that Christians and Muslims here don’t mix and further discussion of this issue was discretely ended. We arrived at the school and there were already many people waiting in line. Okay, now the medical part begins. I already knew that we would be seeing 60, 70, or even more patients each, each day, (something I have never come close to experiencing) and we would see all sorts of things whereas my NP experience was almost exclusively in cardiology so I was a little anxious about this. Vanessa and I set up in a large room with two tables and we each had an interpreter and a few instruments and some bags of vitamins and Tylenol. Then the day began. We saw people with active TB, relapsed malaria, interesting derm issues, allergies to fish, or meat, or eggs (I soon learned to be skeptical about such allergies), COPD (smoking is epidemic here, shame on the tobacco companies), diabetes, hypertension, asthma, things I had no idea what the problem was (between lack of education and different dialects the translator’s had difficulty with it was often hard to get a good history), and many other things. Also, no vital signs were taken at intake so we only took those if we really thought they were necessary. So in 5 minutes and with basically just a stethoscope (otoscope if indicated) had to diagnose and treat. We had a limited formulary based on meds the Indonesiam government allowed us to obtain here as they wouldn’t let us use our own. Oh, have to stop here to give a high 5 to our military med techs Lisa and Jessica. They were fantastic as were all the other personnel on our team. The defining moment of the day is when Vanessa and I at the same time were seeing dramatic cases. She had a woman with by far the largest goiter I have ever seen. One of those textbook pictures (we have pictures so hope to post it and we did get patient’s okay before taking them). I was seeing a woman who stated that just over a year ago she developed a lump in her right breast. Now it was this huge, seeping tumor jutting out and her lymph nodes were huge and she had weight loss, etc. Think you can guess what that meant. Both very sad situations for us. For the goiter (we saw a number of other cases over the days) surgery and then thyroid hormone replacement would be the treatment but our surgical schedule was already full and we didn’t take such cases anyway as there would unlikely be followup to provide synthroid postop. Chronic diseases were a really tough issue for me over the days as while there are meds available, almost everyone who has a chronic disease only takes them sporadically, mostly because of cost, but also, like at home, the mistaken notion that you don’t need to take the meds if you feel well. As for the breast cancer patient, about all we could do was clean and dress the tumor, give some pain meds, provide some comforting words, and refer her to the local clinic. I would say that there were at least one or two patients each day that caused me to tear up. The other such case that day was a woman who had severely burned her left hand 4 years ago. It was badly scarred and deformed. Her wedding ring was still imbedded in the scar tissue and she just wanted the ring taken out and her hand straightened. Many people came in with M/S complaints such as low back pain and when I found out what they did for work (e.g. an elderly woman who chops wood everyday) it was no wonder they had such issues. Taking time off to rest isn’t really an option so depending on the patient, it was either Tylenol or ibuprofen. There were many, many patients who had pretty vague complaints or who outright stated their purpose for coming was to see us and get meds. One medicine that is readily available and everyone seems to take for everything is amoxicillin. Apparently it cures low back pain among other things. Tried to do teaching on the misuse of antibiotics but as we know, even at home, people want antibiotics for viral infections even though they are told it won’t help. So in about 7 real clinical hours I saw 60 patients. Turns out I was one of the ‘slower’ providers. Overall though I really liked being in the clinical setting and was happy to really be working. After dinner that night I sat out back where it was quiet. The evening call to prayer began. So beautiful and exotic. I thought how truly lucky I was to get the chance to experience this. That night I slept like a log despite the heat (and my roommate’s amazingly loud snoring). Okay, I confess, I had earplugs in and on top of that my noise canceling earphones. I like my sleep.