et health at the clinic

Working at the clinic is addictive, so much to do, lovely people to work with and for. Not possible to describe the setting as beautiful, desolate and poor would be more appropriate. Very well regarded and trusted by the local people, principally perhaps because of the work of the doctor in charge who has been here since 1999 through the highs and lows of this young country.

My initial reaction was to judge by the standards of the comfortable Australian health system - yes it has its problems, but by golly, not like this. I wondered "why don't the nurses do this or that? are they lazy or incompetent?" But I have never been the sole nurse looking after 46 patients, and I am used to having a pretty regular supply of goods, and back up and training. The nurses (and patients, and other staff) are understaffed, under-resourced and under -trained. They have recently been given oxygen cylinders but no training and incomplete delivery devices. Apart from the language barrier (the nurses' English is way better than my Tetun) it took days to obtain proper delivery devices, then the main valves were too tight so we had to go back to the central supplier to have them fixed, no spanner at the clinic to tighten connections so I had to find a hardware store and buy one (tetun for adjustable spanner is kunci inggriss if you are wondering and the hardware store has the most effective ceiling fans I have come across in et, a pleasure doing business there though staff were surprised to see a malae woman as a customer.) Anyway I have now taught a couple of nurses how to safely use an oxygen cylinder, a wonderful colleague from my last job is sourcing some training materials for me, and this task at least, has progressed. Also need to find a safe but accessible storage space so a passing member of the public doesn't stub out a cigarette near a leaky valve.

The patients of all ages, male and female, are on beds or trolleys side by side. Only the TB patients are segregated but I wonder who is as yet undiagnosed - the clinic does have the lab facilities to test for TB and malaria but often lab staff are short of gloves and masks. Sheets and especially pillows are optional and there are few plastic mattress protectors for anyone to wipe down between patients. the power supply can cut out at any time, the windows are small, high and closed. Some rooms have ceiling fans, and a few floor fans.

The national hospital is cleaner and better equipped but the clinic remains popular. Care, medication and meals are free to patients - I am not sure what the system is at the hospital. The clinic is certainly friendlier than the hospital.