Dili National Hospital

Cristo Rei, Dili

This morning, after our daily sunrise walk to the Cristo Rei of Dili a 27 meter tall statue of Jesus situated on top of a globe at the east end of the peninsula in Dili (one of the main tourist attractions in East Timor, claimed to be the second tallest statue of its kind in the world and was a gift from the Indonesian Government),  a quick bite to eat and a shower Dr Paul and I attended the Friday medical round at the Guido Valadares National Hospital, formerly the Dili National Hospital. In 2011 it was recorded as having 260 beds, with secondary and tertiary healthcare services.

The structure and surrounds of the hospital appeared similar to other third world hospitals which I have seen in Honiara, Solomon Islands and Nuku'lofa, Tonga. Additionally, while I didn't have the opportunity to speak to many staff members, I imagine that their are also parallels in levels of professional education, clinical skills and available resources. 

The Timorese men, women and children I saw had a range of clinical conditions, including medical, oncology, surgical, trauma, and burns. Some had chronic conditions like alcoholism, hypothyroidism and previous surgical amputations. Apparently mental health issues are not diagnosed or if suspected are death with more traditional methods.

The  medical round was chaired by a Senior Medical Consultant, facilitated by an Australian Dr, and attended by a team of Registrars and junior doctors. Their was a even distribution of female and male doctors. No nurses attended the medical round. The consultation occurred around the patients bed and in front of other patients and their families. The patients and their families did not engage in any discussions, were rarely assessed or addressed and not encouraged to ask any questions. The staff rarely touched the patients except to remove a dressing or expose a wound. Clinical reasoning and education of the Registrars was minimal. The attitude of the Senior Medical Consultant (Timorese) made a lasting impression. He appeared extremely affluent, was well groomed, spoke Portuguese, English and Timorese. He was also unassumingly arrogant, aggressive towards the Registrars, and appeared to lack any genuine compassion or humanity.

I was grateful for the opportunity to attend the medical round and the opportunity to look into the faces of these people and their families; and I was left with the impression of how much the Timorese people have (and continue to) suffered. I thought about our Australian health care system, the multi disciplinary approach to evaluating and addressing the physical, psychological and anticipatory needs of patients, and our resources. I thought about how much I value a nurturing professional approach, the use of touch, eye contact, a smile, the exchange of information etc. I would willingly volunteer to work within these conditions to help and care for these people, but I know that it is not about making a difference, changing/improving a system; it is about long term sustainability and commitment. And I know that at this point in my life, I can not make that sort of commitment. All I could do was look into their eyes and hopefully through my genuine smile and empathy, convey a sense of my humanity and compassion for them.