Jailolo - Days 4 and 5

Day 4& 5 – Both Wednesday and Thursday were very busy days and I picked up the pace (somewhat) seeing patients, partially because there weren’t as many tough or dramatic cases as in the first two days. Still there were certainly some including more patients with active TB, patients with partial paralysis from strokes looking for a cure to make them like they were before the stroke, hernias in need of surgical repair, inability to get pregnant, and others. For some reason on Thursday I had 3 women who all came in with signs and symptoms of Grave’s disease including anxiety and tachycardia. All I could offer was a small supply of metoprolol and a rec for them to go to the public health clinic. Even if we could treat their hyperthyroidism, it would be a major issue trying to treat their subsequent hypothyroidism. Even giving metoprolol for symptoms was a dilemma because as was the case for all chronic diseases, we could only give a short supply of medications and it was very uncertain what would happen when that supply ran out. Also, I knew that propranolol is preferred for symptomatic hyperthyroidism, but we didn’t have it and our formulary was Indonesian so probably wasn’t available locally anyway. I took the path of treat then firmly explain the need to take the meds every day, to never miss a day, to get more before ever running out, and to never stop taking the meds even if they felt well. Others took the path of referring them to the local clinic and give no meds on the sound rationale that short term treatment was worse than no treatment and those motivated to be treated correctly would go to the clinic. Wish I could do a study to see which led to better longterm outcomes. The most memorable patient was a women who was very shy and obviously scared who spoke in a whisper. She said she had suffered from hoarseness for over a year and it had started soon after she found a lump on her left throat area. She said she went to have it checked and was told it was nothing to worry about but that her hoarseness had just kept getting worse, the lump kept increasing in size, and now she was tired all the time and was losing weight. She had a large firm discrete palpable mass that was not goiter as I had seen in a number of previous patients. My interpreter, a medical student here in Indonesia, let her know that we were both very concerned about this and that she needed to be seen right away but I think we all knew what was likely happening and what the outcome would be. Both the interpreter and I had to fight back some tears as she quietly left. Certainly we saw many, many patients whom we were able to do something positive for and I do need to point that out. There were many people with acute infections of varying types that we were able to effectively treat especially since we had alternatives to the amoxicillin which is so often used (and misued) here. We had treatments for worms, malaria relapses, pneumonia, cellulitis, sinusitis, middle ear infections, and on and on. There were many, many more such cases than the difficult cases I have described but I think medical professionals expect to be able to help everyone so we most often remember those patients we couldn’t help much medically (although hopefully we helped them in other ways). I was exhausted by the end of the day Thursday but the good news was we were going out for a night on the town. Okay, so there wasn’t really a town but there was a restaurant with karaoke. Wasn’t sure what to expect but the place was very clean and comfortable and the food was amazing. Fresh local fish grilled, lotus leaves (I think) sautéed (think greens), the best chicken sauté I have ever had, a hot pepper salsa, rice, and beer. The karaoke was fun, and no, I didn’t sing.