Dr Margaret has been volunteering and working at Bairo Pite Clinic for many years now. When she is not in Dili she is working at her practice in Australia.
This is her typical day…
The phone rings at 4:00 am –the BPC midwives are concerned about a patient who delivered a healthy baby an hour ago but has not yet delivered her placenta. This is a potential emergency -adrenalin has already kicked in and I’m in the car and at the Clinic within a few minutes. I quickly review the situation with the midwives then meet the patient and her husband (and baby who is cuddling skin-to skin with her mother) and assure them all will be well. I double check all the equipment and drugs we might need while one midwife inserts an IV line and the other encourages the new mum to breastfeed. Now for some gentle manoeuvering, some gentle manipulation , and 10 minutes later the placenta is delivered. Relief all round.
The notes are written up, I’ve done a brief review of the other patients in Maternity and am about to leave when I see the ambulance driving out —-going to pick up another woman in labour. I will wait just a little longer. This is a lovely time of the morning, cool and quiet. It’s not quite yet dawn but already several patients are up and about so I sit on the verandah chatting with the early risers, learning a little more about their families, their villages, their lives. The ambulance returns–our patient is in early labour only.
Home–I check my emails —good news from a pharmaceutical company we have asked to provide a humanitarian donation of drugs for a very ill 5 year old with a very rare disease—they will consider the request and have forwarded a lengthy application form. I’ll ask one of the hardworking volunteer students to organise all the required information -pathology tests, ultrasound, photographs, CT scan. I’ll let his parents know we have advanced one tiny step. So many parents in Timor show great courage when they have a seriously ill child with a difficult disease –trying to understand a strange disease, juggling wanting the best modern treatment -which is generally not readily available in Timor with family pressures and their own beliefs in traditional medicine, as well as supporting their child while they watch their deterioration. BPC tries to advocate for these patients as best as possible.
7:45am –back at the Clinic making sure that all is in order for the patients going to the National Hospital this morning for specialist appointments or radiology. Timorese Volunteer Mana Nanda and administration Volunteer Cristobal are well organised but sometimes need an extra volunteer to go with them so that all patients have a support person with them.
8:00–the start of the morning ward round–the team gathers on the verandah of Maternity –Dr Dan, the second senior doctor, all doctor and student midwives. We review each patient in Maternity and a baby check is done on each patient before they leave. One volunteer acts as the ‘scribe”, keeping notes on the jobs to be done later, while others update the patient notes.
From Maternity to TB –and the ward nurses join in along with the TB team. Patients are examined, results are reviewed, diagnosis and management are discussed, patients transferred to Ismaik at Tibar for ongoing TB treatment or discharged home.
Onto the main ward, known as Baixa. Sixteen patients here–the students present the new patients they clerked, progress is reviewed, case plans are developed. Patients are suffering from varied illnesses, some straightforward such as acute diarrhoea, pneumonia, skin infections, others complicated such as diabetes, HIV. For some patients we can only make an educated guess about diagnosis. Case plans may involve Sidalia, our Women’s health and Social Care Worker. or the Malnutrition team, or referral to the Specialist Clinics at the National Hospital, or organisations we try to work closely with such as PRADET (provides mental health and medical forensic services)or Centro National de Reabilitação (physiotherapy and rehabilitation services).
Then to the Isolation wards—today one patient is acutely psychotic—her father is very caring and tells us that his father was in the Australian Army. The other patient has terminal carcinoma –we are having trouble keeping up with her pain requirements as we have no morphine and only limited supplies of tramadol. I remember the many patients that have been through these 2 small rooms with cancer, some with very late diagnosis, some we have been able to provide limited treatment for, and Mana Virginia with a benign brain tumour who was successfully treated in Singapore last year.
Finally Malnutrition —with the team of Lidia, Elisa and Maia who told me a few days ago that all 3 agree they ‘just love to work’–and what fantastic work they do rehabilitating these small children. Today in the ward there is a 4 month baby with congenital heart disease limiting her growth, a child with Down Syndrome, a child with TB, a child with severe Vitamin A deficiency who has lost his vision in one eye–but the other eye has been saved, a little girl with severe malnutrition and oedema (used to be called kwashiorkor) and a 4 year old needing to gain weight before surgery. Despite the severe illnesses of these children this is always a happy ward and it is great to see the parents helping each other.
Dr Dan rushes off to OPD and I go with the volunteers to divide up the day’s jobs. All day we admit new patients, do minor procedures and attend to emergencies such as asthma, miscarriages, lacerations. I may be called to TB to see children coming on to our Isoniazid Prevention Program, or to HIV to collect blood from a baby born to a positive mother –this blood is sent to Australia to see if the prevention program in place for these babes has been successful.
Finally it is 6:30 pm and it looks like the busy part of the day is over. I sit down with the night staff to discuss the patients who will need special care overnight before doing a final check right around the Clinic. Reflecting on these long days my first thought is always what a wide variety of complicated cases come to BPC, and the following thought is always that the Clinic only runs because of teamwork, that the contribution of every worker, every volunteer, is essential to our service.