ANZCA Bulletin June 2012 - final.pdf - Australian and New Zealand ...

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Lessons aboundon a Dili adventureVolunteer anaesthetist,Dr Jane McDonald,in Timor LesteI flew into Dili from Darwinat 8am on Saturday. Whenwe landed, a blast of warmand humid air hit me as Istepped off the plane. I noticedimmediately the smell ofburning wood from hundredsof outdoor cooking fires,reminding me of bushfiresback in Australia.This was my first trip to Timor Lesteand I was travelling with ear nose andthroat surgeon Dr John Curotta and nurseDanielle Doughty. We were volunteerscoming to provide specialist ear noseand throat surgery through the RoyalAustralasian College of Surgeons (RACS).I carried a large padlocked bright orangecase with me, containing a smorgasbordof anaesthetic drugs provided by RACS.We were cleared through customs andthen met by Dr Eric Vreede, a specialistanaesthetist and team leader of theAustralia-Timor Leste Assistance forSpecialised Services (ATLASS) program,which is funded by AusAID.Timor Leste is a small country only640 kilometres north-west of Darwin, andis one of Australia’s nearest neighbours.Colonised by the Portuguese in the 16thcentury, the predominantly Catholicpopulation is made up of people ofMalayo-Polynesian and Papuan descent.The population is just over one million,though a high birth rate means it isincreasing rapidly. In 1974 Timor Lestewas invaded by Indonesia and yearsof violence followed, culminating in amassacre of Timorese in 1991. This wasa turning point, and an internationalpeacekeeping force was sent in untilorder was restored.In May 2002, Timor Leste becamean independent sovereign state. Yearsof fighting have destroyed much ofthe country’s infrastructure. The newpresident was military-fatigues-wearingand bearded ex-Fretilin guerrilla leaderJose Xanana Gusmao. In 2003, Gusmaomet Fidel Castro at a non-alignednations meeting in Kuala Lumpur andon hearing of the young nation’s poorsocial indicators of life expectancyand infant mortality, Castro offered “athousand doctors”. Timorese studentshave since been training in Cuba onscholarships and more than 200 doctorshave graduated and returned to Timor.Also the Cuban Government has set up afaculty of medicine within the Universityof Dili, which has been running since2005. This has been the biggest Cubanhealth assistance program outside LatinAmerica.Since 2001 RACS has been providingsurgical services through the AustralianEast Timor Specialist Services Project(AETSSP). This has included facilitatinga continuous surgical service at Dili’sHospital Nacional Guido Valadares(HNGV) through the provision of along-term general surgeon, anaesthetistand emergency medicine physician.Local doctors have had their trainingstrengthened in areas of generalsurgical practice and there has been thedevelopment and implementation of acertified 12-month training course for 1534 ANZCA Bulletin June 2012
nurse anaesthetists. ATLASS is buildingon these achievements.After arrival, Dr Vreede looked afterour team. We collected a hire car andheaded towards our hotel. The roads werechaotic and crowded with tooting cars,buses, motor scooters, pedestrians anddogs, competing with each other for rightof way over the narrow and rough roads.We left our bags at our accommodationand made our way to Dili’s hospital tofind a large crowd of almost 500 patientswaiting to be seen by the ear, nose andthroat team from Australia.Communication is difficult in Timor.The official languages are Portugueseand Tetum though few people speakPortuguese. Many people also speakBahasa Indonesian. There are manyCuban-trained doctors who speakSpanish, and some Chinese doctors whospeak only Mandarin. An interpreterhelped us with the patients at the ear,nose and throat clinic.Mr Samento Faus Correia, the localco-ordinator and interpreter for RACS,wore a bright red Mao cap, which gavehim an appropriate air of authority. Hecontrolled the crowd and organised thepatients efficiently so Dr Curotta couldsee as many as possible. I became an“acting ear, nose and throat registrar”making notes and writing prescriptions.Australian volunteer and ear-care nurseJulie Sousness was able to triage patientswith the help of a surgical registrartrained in Fiji who worked at the hospital.There was a high incidence ofchronic ear infection and associatedcomplications. There were also patientswith chronic sinusitis, various untreatedcongenital abnormalities, sensorineuraldeafness, vocal cord problems andallergic rhinitis. Several patients hadoropharyngeal cancers caused bychewing betel nut, and one patient hadjuvenile nasopharyngeal angiofibromacausing severe epistaxis.We managed to see 280 of the patientsand identified 65 that would benefit fromsurgery. Unfortunately, we could notsee the rest. Prioritisation is difficult.We chose to concentrate on ear surgeryand gave priority to younger patients,those with bilateral tympanic membraneperforations, and those needingmastoidectomies.(continued next page)“ Several patients hadoropharyngeal cancerscaused by chewingbetel nut.”From top left: A view of Dili Harbour; Dr JaneMcDonald (left) puts a patient to sleep with thehelp of local Ear Care Nurse Julie Sousnessacting as interpreter; Halothane vapouriser;Dr John Curotta reviews a patient on the wardpost-operatively.35
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