One week of really good medicine

    I wasn't expecting to be so enthralled by the work here in Sukadana. Several media celebrities and a handful of academic physicians whom I admire have all spoken highly of this project, but I've been most impressed by the work I've witnessed over the past week in clinic. The director's vision was forged over 15 years ago as she researched orangutans in the nearby Gunung Palung National Park. Overwhelmed with the poor access to health care in the area, she returned to the States, became a family medicine doctor, and returned to create this organization, which provides high-quality, low-cost health care to local villages, additionally focuses on education and nutrition, and actively promotes conservation of the surrounding rainforest.

    In doing so, she has brought together a staff of over 20 men and women from nearby communities and from across Indonesia, who are just as passionate about linking and promoting the health of people with the health of the environment. The program is based on an initial assessment of the health status and interests that were voiced by local communities themselves, and continues to operate with their direction. Each project within the organization, ranging from organic agriculture and reforestation to emergent medical care, focuses just as much on building local capacity as it does on doing the work.

    I spent most of my time this week learning the ins and outs of the clinic, shadowing Indonesian physicians and becoming familiar with the medical records, laboratory, and pharmacy systems. We had a broad range of patients. A man in his 80s stayed a few nights with what is probably a peri-appendiceal abscess, receiving IV antibiotics and improving very well.  We enrolled another older man in our directly-observed therapy program to treat tuberculosis, with reasonable fear that previous treatment elsewhere was inadequate and is leading to a worse recurrence.  A young woman came to us in the midst of a first psychotic break, and we’ve begun visiting her at home where she can rest with her family. Another woman came in, 37 weeks pregnant, with her baby in breech position, which we’ll watch weekly and send 2 hours to Ketapang if it hasn’t turned when labor begins. Another gentleman will become very familiar to me over the next few months, as we debride an enormous ulcer on his foot and try to get his diabetes under better control. In each of these cases, significant morbidity, if not death, would have resulted if this clinic were not here.

    I’m glad that I’m here, even if the Indonesian physicians have it all under control. My clinical role will be strictly teaching, although the exchange will certainly be mutual.  I’m thankful for my training in family medicine, and the skills to care for each of these very different patients. Most of my initial work will be in improving clinic systems, in which I was also well trained during residency. Next week I’ll venture off with at least two mobile clinics, and look forward to visiting the more remote communities around Gunung Palung.