Cristo Rei

High on a rock outcropping at the end of a peninsula here in Dili, Timor-Leste, is a 90-foot statue of the Savior Jesus Christ which overlooks the harbor.

“Cristo Rei” means “Christ the King” in Portuguese. The Christus stands atop a globe with outstretched hands. In 1995, the statue was given to the people of Timor-Leste (one of only two Christian nations in Asia) by the government of Indonesia (the most populous Islamic nation in the world).

To visit the statue, we rode a bus to the end of a peninsula and then climbed over 500 steps. Along the trail to the base of the statue are bas-relief murals depicting several of the final events of the life of the Savior.

When the “Mercy” hospital ship arrived in Dili, we were anchored closer to the Dili wharf. However, the sea was a little rough there, and the rocking motion of the ship was significant. The Commodore announced that the next day the ship would be moved a mile to the east toward the Cristo Rei to look for a calmer area of the harbor for us to set anchor. She joked that if crew members on shore happened to see the ship moving to the east that they shouldn’t worry that they were being left behind, it was just the Merchant Marine that runs the ship looking for smoother waters.

In the nightly briefing, which summarizes the accomplishments of the day and outlines the plans for the next four days, the officer said facetiously that the Skipper had just brought 1000 people closer to Christ.

For the rest of our stay here in Dili we have been just off the coast from the Cristo Rei statue. It is fitting to me that throughout this mission of mercy to the people of Timor-Leste, we have been watched over by this beautiful statue of the Savior. As I have interacted with the Timorese patients and interpreters, I have been touched by their humility and warmth as well as their lovely smiles. They are a beautiful and soft-spoken people. Each patient I have cared for has expressed heartfelt thanks to the nurses and doctors who have served them. Catarina, a woman with a large ovarian cyst that we removed surgically was so grateful to us that she sent back to the ship a “tais” cloth weaving for each of the GYN doctors on our team.

I have been equally impressed by the Christ-like love that our 30 LDS Charities volunteers have demonstrated as they have cared for the Timorese patients, supported and sustained each other, served in the various departments on board the ship, and even washed dishes for the crew on Wednesday nights.

Soon, it will be time for me to fly home to America. I now look back on my two weeks on board the “Mercy” with tender feelings despite the challenges of living on board a ship with a thousand other people from many different countries.

As each LDS Charities volunteer has attempted to express in his or her own way that we follow Jesus Christ, I have felt that the Savior has watched over our efforts and the contribution of every individual who has been a part of this wonderful partnership. It has been comforting for me to walk out on to the deck of the ship each day and see the Cristo Rei and to sense in a vivid way that Christ indeed is our King.

Jersicio Sees

Today on board the “Mercy,” 4-year-old Jersicio was able to see for the first time in his life.

He was born with a cataract in each eye. A cataract is an opacification or a cloudiness of the lens of the eye. This morning, his mother accompanied him in the pre-op area. He has never been able to see her face clearly.

The hospital ship eye doctors and nurses took Jersicio into the operating room, and after the anesthetic was given, Jersicio’s left cataract was removed. A small incision was made into his eye at the edge of the cornea. The phacoemulsification machine was used. It is equipped with an ultrasonic hand piece that has a titanium tip which vibrates 40,000 times per second and is used to remove the cloudy lens. Then a silicone intraocular lens was placed into the eye. It is about one-tenth the size of a pea. The surface of the eye was then closed with a tiny needle and very fine suture. I was standing right behind the eye surgeon as he put in the stitches using the operating microscope, and I could barely even see the suture.

For the next two weeks, Jersicio will wear an eye guard to protect the eye as it heals. If all goes as planned, Jersicio will return to the operating room before the “Mercy” departs in order to have the cataract in his right eye removed also. The new lenses will last for the rest of his life.

Thanks to the skilled Navy ophthalmologists and Pacific Partnership 2010, for the first time, Jersicio can now see!

MEDCAP in Dili: An Unlikely Debut in Electronic Medical Records for a Suburban American Physician

This photo shows three of our wonderful local Timorese interpreters.

Today I participated in a medical clinic (MEDCAP) for local Timorese adults and children in the capital city of Dili here in Timor-Leste. We left the ship at 5:45 am while it was still dark and took the “band-aid” boat to the port with an MRE (meal, ready-to-eat) in our backpacks. The stars were beautiful. It was comforting to see my favorite constellation (Orion) above me--even here in the southern hemisphere. As we arrived in Dili, dawn was breaking over the Cristo Rei (Christ the King) statue of the Savior that overlooks the harbor. We boarded buses and were escorted by a UN jeep with its siren blaring! A New Zealand army sergeant I met told me that there are about 2000 UN troops from 43 countries here in Timor-Leste. We drove to a local school across town dodging roosters, stray dogs, and the occasional pig. Once at the school, we set up our makeshift clinic. I worked as a primary care physician (and occasional Gynecology consultant) in a large classroom with several other providers. We each took a corner of the room and set up our “consultation offices” (3 chairs, a desk, a stethoscope, a penlight, and antibacterial hand gel). We each had a local Timorese interpreter to help us understand the people, as most people speak Tetum (a few of the patients did speak English). My volunteer interpreter was a 17-year-old high school student. He comes from a district which is on the opposite side of the island and attends a boarding school here in Dili. He is anxious to improve his English and hopes to get a scholarship to attend a university in the U.S. or in Singapore.

The Navy specialists set up a portable, battery-operated Wi-Fi network in the courtyard of the school aided by contractors from Global Relief Technologies, a New Hampshire company that specializes in collecting data in remote and austere locations.

I was issued a small PDA or minicomputer with a built in bar code scanner. The patients lined up and were registered by military personnel and given a bar-coded wristband. They then received a second color-coded band, which designated them either an adult, pediatric, dental, or optometry patient. The adult patients with the yellow wristbands lined up outside our adult clinic room and were invited inside as a provider became available. As recommended by my Timorese interpreter, I welcomed them with the Portuguese greeting “Bom Dia” (Good Day) or “Boa Tarde” (Good afternoon) and then with the Tetum phrase “Di’ak ka lae” (Good or not?). I scanned the bar code on the patient’s wristband and the bar code on my name badge while my interpreter asked them about his or her presenting problem. I followed up with some questions and then did a brief, dressed physical exam. I then entered into my PDA the problem by selecting the body system and the diagnosis with my stylus. Most of the patients had minor aches and pains or rashes and coughs. One lady had an egg-sized mass in her neck. I made arrangements to have her transported out to the ship for further evaluation by the ENT surgeon on board and probable surgery. After the history and physical, I made some recommendations to each patient, and when I prescribed medications, I selected the appropriate medication and dosing from the pharmacy menu on my PDA and then hit SEND. This information was then sent wirelessly to the pharmacy and the charting was backed up on the server.

In addition to prescribing the appropriate medication such as a high blood pressure pill, an antibiotic, an anti-inflammatory cream for rashes, or a pain medication (ibuprofen), I always prescribed a supply of multivitamins and discussed smoking cessation with each patient. Most of the men smoke, and most of the women do not. After several patients, my interpreter didn’t even need me to say anything, he automatically told the smokers, “The doctor says you should stop smoking right away. It will make you much stronger if you stop, and you will feel better, plus you will save a lot of money.” (My interpreter also promised to stop smoking!) After answering any questions, I wished them “Boa Sorte” (good luck) and “Adeus” (Goodbye), and we sent the patient to the next room, which was the pharmacy.

Once we got our rhythm going, we were able to see a new patient about every ten minutes. I saw about forty patients today, but some of the doctors, nurse practitioners and physician assistants who are more experienced with the MEDCAP system saw up to twice that many patients.

We had carried several large bins with about a hundred different types of medications with us from the ship. Our U.S. Public Health Service pharmacist then scanned the bar code on the wristband of each patient. The computer would then print the instruction sheet for the medication that I had prescribed for the patient, and the pharmacist would dispense the medication and remove the wristband.

In our medical practice in Lone Tree, Colorado, we have not yet converted over to an Electronic Medical Record system. It is a very expensive proposition costing tens of thousands of dollars per provider and requiring a significant investment in time during the conversion process. Nor have we yet adopted electronic prescribing wherein a doctor transmits a prescription electronically to the pharmacist using one of the available mobile e-prescribing services. Ironically, my first experience with seeing patients with paperless documentation and E-prescribing was here in Timor-Leste on the other side of the globe!

Surgery on board the “Mercy”

Patients who require surgery are shuttled out to the “Mercy” via the “band-aid boat.” On board the ship, they are prepared for surgery. Each patient comes with an escort, usually a family member. We also have Timorese interpreters who are staying on board the ship with us in order to allow us to communicate with the patients.

This little boy has a large cyst on his back that will be removed by a general surgeon on board who is a doctor in the Portuguese military. The anesthesiologist is a doctor in the Australian military.

One of the most frequent surgeries done here on the ship is cataract surgery. However, in order to perform this surgery, the eye surgeon needs to implant a special plastic replacement lens into the eye of the patient. “Mercy” had a limited number of these lenses available for this mission. Fortunately, LDS Humanitarian Services donated a significant number of these consumables so that more of the people here in Southeast Asia could receive this sight-saving surgery.

From the Cub Scouts to the Timorese

One of the service projects our cub scouts have done over the years is to assemble hygiene kits for LDS Humanitarian Services. These kits contain 2 combs, 4 toothbrushes, 1 tube of toothpaste, 2 bars of soap, and 2 hand towels. Many scout, church, and community groups or individuals and families around the world have put together these kits with donated items from family, friends, and neighbors and then sent them to LDS Humanitarian Services. They are then distributed to those in need throughout the world.

It was inspiring for me to observe the unloading of many pallets of boxes containing these hygiene kits here in Dili, Timor-Leste. 120 pallets (6 truckloads) of these donations were loaded on to the “Mercy” before it left San Diego. These kits have been distributed to each country that the “Mercy” has visited this summer. I saw the last of these donations unloaded by helicopter here in Dili. They are brought in 2 pallets at a time using a large system of netting. They are set down on the pier and then stored in containers for distribution to the Timorese people in the ship’s “Operation Handclasp” program that will occur in several days here in Dili.

Who knows? Maybe some of the kits we put together with Pack 665 ended up here!

To learn more about making hygiene kits, visit:

http://www.providentliving.org/content/display/0,11666,4598-1-3263-1,00.html

SURGCAP

Wednesday was surgical clinic (SURGCAP) day at the port in Dili here in Timor-Leste. We had several local high school students serving as translators. The students here all begin studying English (and also Portuguese) beginning in junior high. Their native language is Tetum, although--in this country that is about the size of Connecticut--there are 16 different dialects. The number of patients needing GYN surgery was small, however, overall 125 prescreened patients were seen, and 47 surgeries were scheduled. As medical clinics are held elsewhere on the island, other patients will be referred in for surgical evaluation. The hope is that about 150 total surgeries will be done on this leg of the Pacific Partnership. A beautiful little 3-month-old girl with a cleft lip was seen and will have surgery today by the plastic surgeon on board.

Underway

After flying to Darwin, Australia, via Salt Lake City, Los Angeles, and Sydney. I am now aboard the USNS Mercy. While in Darwin, we were able to visit the Litchfield National Park on Saturday and also attend Church in the Darwin Branch on Sunday. One of the Church members who spoke is a brother who is indigenous (Aborigine). His father was a "Bushman,” meaning that he lived in the outback and was a skilled hunter. The ship is now underway to East Timor. It is now Monday morning 8/9 here and we arrive in the harbor of Dili, East Timor, on Wednesday morning 8/11. Today I met with the other two OB/GYN doctors on board. One is a Navy attending physician and the other is a 4th-year resident from the San Diego Naval Hospital. They are both female physicians and are very professional. On 8/11, we will go on land and have a preoperative clinic where we will see which patients we are able to help with surgery. There will be an ultrasound technician going on land with us to help us decide who would best be helped with surgery. Typically the type of surgeries that we will do will include the removal of the uterus or one or both ovaries in cases where the patient has developed benign tumors or is experiencing persistent pelvic pain. On 8/12, the patients will come on board the ship. They must be screened for tuberculosis, and if they do have findings on their chest x-rays suspicious for tuberculosis, we are not able to bring them on board. We will have OR days on 8/13, 8/15, 8/16, and 8/19. Most of the surgeries will be open cases rather than laparoscopic cases, so they will stay on board the ship until they are fit and well enough to return to their homes. An escort such as a family member will accompany each patient. The escort will stay on board the ship the whole time with them. It sounds like we won't be doing any major surgery after 8/19 in order to allow the patients to recover and be discharged by the time the mission is completed on 8/23. The ship is so big that I can't really tell that it is moving. However, apparently, when the water is rough, there is a lot of movement of the ship, and all the equipment has to be secured.