mobile clinic site: neighborhood boys, registration and patient room created with tarps

street of Nek Doyan, mobile clinic site

three weeks already

It's hard to believe I am halfway through my time here. My awe at the warmth of the people and the beauty of my surroundings continues to grow. Working at ASRI clinic has been life changing. I am usually working with my Indonesian counterpart (medical student, Anye), one of the Indonesian doctors and one of the Yale residents. I learn so much from their different perspectives, and Anye is my lifeline as my translator! It is amazing how much I can deduce from appearance and mannerisms without knowing the language. The look of someone with psychiatric illness, Parkinson’s disease or respiratory distress does not take verbal comprehension.

Many health issues overlap with issues common in the US, such as hypertension, diabetes, osteoarthritis and cataracts. Here, however, people tend to get these chronic conditions younger, perhaps from many years of hard physical labor in the sun and forest. Blood pressure and blood sugar are widely uncontrolled. Culturally, taking medications on a daily basis means you are very sick. Family members worry if someone takes medications for a long period. So there is the cultural bias against taking medications, in addition to the practical barriers, such as lack of money and transportation. It is not unusual to see multiple patients with systolic blood pressure in the 200’s during one day. Then there are pathologies that are so rare in the US-diffuse dermal fungal infections, whole families presenting with scabies, filariasis infected lymph nodes, dramatic ascites and caput medusa from portal hypertension secondary to schistosomiasis.

It is amazing how long people wait to go to the doctor, either until the pain is no longer bearable or they have a little money and time to finally seek help. This week, I met a father bringing in his sixteen your old daughter with profound mental retardation. She couldn’t speak or understand language. He wanted to know if his daughter would ever get better and catch-up to the other children. He has been dressing and feeding his daughter for sixteen years, and he had never been given the information that his daughter would never be “normal.”

The work at the clinic is emotional, as some people we cannot help or we have to give them a grim diagnosis. We had a man this week that came in for tingling in his feet, but we noticed he was hoarse, and then on physical exam detected large, rubbery lymph nodes—characteristic of metastases. He likely has advanced lung cancer. The prognosis for advanced lung cancer is not favorable in the US, let alone here. If this man (or anyone from this area) pursued treatment, he would probably have to sell his land and further impoverish his family to go Jakarta or Pontianak for care with a devastatingly slim chance of cure.

Going to mobile clinic has shown me life along the bumpy roads and in smaller villages in the rainforest. The two towns I have visited have been more poverty stricken than Sukadana. The residents of the first mobile clinic village in particular looked to be living in a state of poorer health and hygiene with children in bare feet and tattered, dirt-stained clothes. Yet, they were as playful as ever, running around the neighborhood and gathering around us to watch, exhibiting healthy childhood curiosity about the strangers visiting their town.

Day 3/ Hari tiga

Relaxed at home by myself through the heat of the day. With the fan on my face full blast, there was only one hour of profuse sweating. I studied some medicine–endemic tropical diseases, such as filariasis, malaria, dengue fever--and some Indonesian—Maaf, saya tidak mengerti (I’m sorry, I don’t understand). I met my new roommate, Anye, an Indonesian medical student from Jakarta, then I walked into town with L and B for chicken and rice at one of two small restaurants in the village. The town center is on a small river with a plethora of old, colorful wooden boats beached, marking the way towards market. We three very obvious Americans were greeted enthusiastically from doorsteps and motorcycles. The people here are absolutely lovely, amazingly friendly and warm. Tomorrow will be my first day at ASRI clinic. I am thrilled for this journey to finally begin.

Selamat tidur! (Goodnight)

Our house

It's rainy season.

We were not alone at the private beach. Men were busy breaking rocks for building materials.