In this guest blog post, Dr. Sarah Walpole reflects on her experience visiting our Indonesian partner Alam Sehat Lestari (ASRI) and participating in their Mobile Clinic program.
Our day started as usual with the 8 am meeting at ASRI in Sukadana. Then, Docter Ela, the driver and I climbed into the car and set out. We stopped to collect Efan, the nurse, and Aulia, the pharmacist, from their homes. Soon after, we stopped at a council office to collect a projector. In a village further on our car was joined by that of the team who would be projecting a film about orangutans and forest protection to the waiting patients.
Palm trees have a beautiful form, their long leaves splaying out evenly from the center. Yet the glow of warmth that I felt as we entered the outskirts of what I thought would be deep forest quickly faded as I saw that this was what has been described as a “dead forest”. The plantation was two-tone, from orange to a browny green with nothing outside of the spectrum. Even the sky seemed to take on a monotony that I hadn’t noticed before.
I dozed off, waking up as the car turned onto a path that was not made for four-wheeled vehicles. The car’s wheelbase could just about sit on the raised concrete walkway with half of each wheel jutting over the edge, a few centimeters above the bare earth to either side. “Are we here?” I asked, wondering if there was any way that we could proceed without damaging the villagers’ front gardens. Even our experienced
driver couldn’t direct our enormous load with such precision, and the car jolted heavily down to the left. A moment later, the car stopped, and I found out that “not yet” meant “not for another one hundred meters.” We had arrived.
We climbed out of the air-conditioned car into the heat of the afternoon. There was hardly a person to be seen, but the village felt alive. The walkway was built for people, not for metal boxes on wheels, and left homes on either side connected in a way that a road would not have permitted.
It wasn’t until we arrived that I understood the relaxed start to our journey. After unloading the boxes from the car, we met the house owner and learned that the clinic would not start until the evening. This left us four hours to relax and prepare ourselves. I encouraged Ela to come exploring with me but we quickly reached a river, with no bridge to cross it. Ela explained that this was the end of the road; the last village for miles.
After the short walk back, Ela and I spent an inordinate amount of time pulling leaves off what ended up being a very small quantity of ferns for dinner. Then, we rest and learn from large red blotches over Ela’s hands and arms that the mattress we were to sleep on that night had bedbugs.
So here we sit in a circle on the floor eating dinner. I look behind me and see that the television isn’t just playing the background, its reel is being devoured by the intense gaze of four individuals. “Patients?” I guess. “Yeah,” replies Efan, as he pulls the pan of stew towards him.
By the time we finish dinner, fifteen patients are already waiting. They sit clustered around Efan and Aulia, who have erected a fort out of the plastic boxes containing the medicines and medical equipment. The patients at the back lean on the wall, while those at the front drape their arms over the plastic boxes, leaning in to catch the details of Aulia’s movements and words.
An older man - the sickest, I can tell by his breathing - moves forward, giving up the wall’s support for proximity to the woman calling out names and the nurse. Seconds later, a younger man stepped in and took up the vacated space at the back. Aulia begins to work through the pile of medical notes, calling out patients’ names as she goes. Once a patient receives their folder, Efan takes their vital signs and writes the chief complaint on their card.
The first patient we see has extremely high blood pressure. She hasn’t taken any medication for two weeks, so Ela restarts her usual medication and invites her to sit for a while before rechecking her blood pressure. We are seeing patients at the back of the living room, where they sit on one of two curved benches perpendicular to each other. At the far end of our bench are two chairs, which make up the third side of a ‘U’ surrounding a low table. Ela tells the patient to sit on one of the chairs as the next patient approaches the bench opposite to be seen. I suggest to Ela that maybe the waiting patient could sit with the bulk of patients to allow more privacy. Ela gives me an exasperated look and begins to take a history from the next patient.
This patient is about thirty years old and presenting what sounds like gastro-esophageal reflux disease and constipation. As the patient tells her story, a third patient joins the queue, which starts on the bench right next to the patient who is currently with the doctor. Patient number three has to stand to allow for the examination to take place. The bench is just about long enough for the second patient to lie down on with her legs stretched out straight. When she does this, sure enough, Ela finds that she has tenderness just below her ribs, right over her stomach.