April is Volunteer Appreciation Month. Each week this month, we'll be featuring new perspectives on ASRI’s work from some of the people who know it best: our volunteers.
Dame Idossa is a Yale medical student who volunteered with the ASRI Clinic in late 2014. During her time on-site, she had a great deal of hands-on experience and took away many lessons on the realities of delivering health care in rural settings.
The ASRI Clinic is one of the most interesting places I have ever worked in. We were in from Monday through Thursday and were seeing about 30-40 patients on busy days. Fridays were reserved for taking care of in-patients and for cleaning up. The Clinic is designed to promote both health of the ecosystem and people. There is a lot of illegal logging around Sukadana because people surrounding this area are very poor. So to discourage this, the Clinic gives discounts to villages that have stopped or decreased logging. The organization also has a conservation arm where they train local people on how to plant different seedlings, organic farming, building wells, etc.
There were numerous learning opportunities for me at ASRI clinic. I got a chance to see similar diseases to ones we see in the states and saw patients with very late stage presentations of common illnesses. One case that really stayed with me was of a 6-year-old boy who came in with facial swelling that was worsening over 2 weeks. His father had initially taken him to a shaman and then later brought him to ASRI as his symptoms were not resolving. This is a theme that I saw repeatedly at ASRI. Patients would first go to shamans, then to the puskesmas (community clinic), and then would come to ASRI Clinic once the other treatments had failed. We found that the boy initially had what sounded like mumps infections (a lot of children are not vaccinated) and then subsequently developed a bacterial infection. When he came to the Clinic, the infection was so large that it had caused a facial nerve palsy and had also drained into his ear. We placed the young boy on IV antibiotics and drained the abscess as much as possible. He was in great pain during the drainage of the abscess, and we didn’t have any analgesics other than local lidocaine and Ibuprofen/Tylenol to give him. Multiple nurses had to hold him down while one of the doctors drained the abscess. We sent him home on oral antibiotics, but he had to return daily to the Clinic to get the abscess drained. Seeing the boy in that amount of pain really broke my heart. I kept thinking that if this had happened in the states, he could have gotten proper analgesia and had the abscess all drained at once surgically. However, I was also impressed by how well the doctors and nurses worked together to provide the best care they could to this little boy. By the time I left Sukadana, the boy was still getting daily antibiotics and wound care. The swelling had significantly decreased and the facial nerve palsy also seemed to improve. Because of the presence of ASRI Clinic in this community, the boy was able to get the proper treatment for his infection.
There are countless other examples of rheumatic heart disease, right sided heart failure from TB, severe cases of diabetes, dengue fever, and infections that we don’t see in the West (due to the large-scale vaccination programs), that I witnessed in Sukadana. Unlike my experiences in the United States, tuberculosis was on my differential for almost every single patient that presented to us. Although there were some cases in which our resources were not sufficient to deal with the patient’s problems, there were also many other cases in which our limited resources helped save some patient's lives. One patient that comes to mind is an 18-year-old boy that came in with 5 days of fever. The local doctors suspected dengue and asked the lab to check his platelets. While the lab was checking his platelets, the patient started to become hypotensive. Dr. Vina, one of the local doctors astutely recognized that he was transitioning into having hemorrhagic dengue fever and aggressively began treating this patient with fluids. The lab later confirmed that the patient’s platelets were indeed very low and he likely had hemorrhagic dengue fever. The patient received supportive care at the Clinic and was discharged home a couple of days later. Had this patient not been seen at ASRI and had Dr. Vina not quickly recognized the severity of the situation, he would have likely died from his disease. This was one of the many instances in which I witnessed the amazing work that ASRI Clinic was doing in this community.
Another part of ASRI's mission is conservation of the environment. During my time in Sukadana, I had the wonderful opportunity to participate in the conservation projects. Deforestation can lead to transmission cycles of vector-borne diseases transferring from the forest to the domestic environment, thereby increasing disease burdens for women and children in particular. Vector-borne diseases such as malaria, dengue fever, and rapidly progressive encephalitis can thus increase in incidence in areas such as Sukadana where logging and burning of the forest continues to remain high. During my stay in Sukadana, I saw the blue skies only twice -- both after a very heavy rainstorm. The skies were usually covered with thick smog from all the forest burning that occurs in and around Borneo. So visiting the reforestation sites and planting trees with the community gave me a glimmer of hope.
Poverty has the same face every single place I go to. Whether I am in the states or in the Dominican Republic, back home in Ethiopia or in Indonesia, it has the same face. The same face that has been robbed of so much in life, the same face that looks so much older than the stated age, the same face that looks hopeless, but also same face that continues to wake up each day and fight. Although much of this experience was very challenging and at times very disheartening, it has also been so encouraging and rewarding. Working and living in a developed country can at times make one forget about the conditions in which the majority of people in the world live in. This elective allowed me to once again be confronted with all the challenges of poverty in the world. It gave me an opportunity to work with people who are tirelessly working in such environments to help people. It allowed me to interact with likeminded people and reignited my passion to work in global health in the future. This was one of the most life-altering experiences of my medical school career thus far.
Dame's experience truly sheds light on the fact that while the ASRI Clinic is doing everything they can to provide high-quality health care, they are still in need of greater resources and a larger facility. We are working with ASRI to solve this problem -- we are now just $275,000 away from building ASRI's Community Hospital and Training Center. You can help solve this problem too. Donate today. To read previous Volunteer Voice reflections, click here.