Maubisse

After a day in hot dusty Dili, I decided to head to the mountains for some cool air. The taxi driver left me on the side of some random road to wait for a bus going to Maubisse. After ten minutes no bus came along so I went to ask a random truck driver, who was quite enthusiastic and encouraged me to climb into the truck. Note to self, if climbing up the side of the truck into the back is rather difficult, it may be a sign from god that bumping down a pot hole track in a truck isn't the best idea.

But anyway I got in and ended up sitting on the floor next to a billie goat whose legs were tied up and it was forced to lie on its side. It bleated softly at first, but as the truck went around the mountains it got about as motion sick as me and started vomiting. Then it was screaming and gasping like it was having a stroke. It was just about how I was feeling too.

The truck was totally packed - the entire back cabin was taken up with women and children sitting on two wooden planks along the sides of the trucks, with men hanging off the sides and the back. Eventually I got upgraded to sitting on a bag of rice after a couple of vomiting girls got off, and about half an hour from Maubisse I even landed a seat on the planks, next to an old man holding his prized rooster like it was a baby.

The road was pretty rough, at some points leaving one wondering where the road actually was amongst the potholes. The steep winding around the hills made me want to vomit so I had to close my eyes. Intermittently when I opened them I would see lush green rice paddies, beautiful coconut and banana trees and the odd coffee tree. Children and animals played in the dirt, occasionally chasing the trucks down just for fun.

The main monument in Maubisse, next to a Fretilin flag

Four and a half hours later (depressingly, Maubisse is only 70km from Dili!), we arrived in a bustling market. But I felt so sick that I decided to go for a walk. The poussada (guesthouse in old Portugese building ) was set high up on a hill, overlooking Maubisse. The 10 minute walk up the hill was beautiful and one was rewarded with breathtaking views over the mountains. Halfway up there is a small memorial commemorating deaths in the local area, one of many I would see in Timor. The poussada is set amongst ruined walls of a Portugese era fort, and has a really abandoned feel to it.

 Steps up to the poussada

I went down to the market again but it was packing up for the day, everyone was getting into trucks to go back to their own villages, so I ended up having lunch with a bunch of UN police at one of the only eating joints in town. A strange old man who clearly wasn't part of the UN but was wearing some faux police jacket came up and started talking to me, then started shaking my hand vigorously whilst sporting a toothless grin. He insisted on buying me a bottle of water, which I guess was nice of him..

Man passing his chicken up the truck

There wasn't actually anything to do in Maubisse, which was just perfect. So I sat on my little verandah at the poussada, reading The World According to Garp, which reminded me of when I did anaesthetics last year and Dr Ferris was telling me about John Irving books. Dinner was served in the massive dining room (there's a lounge with old-school leather couches too) and I was the only guest. Rice, green beans and "Timorese steak", which was a steak marinated in tomato & onion salsa then grilled and served with the salsa reduced. It was pleasant enough though the steak was hard to chew.

 At the poussada

I woke in the morning to the sun casting a lovely soft light on everything. Breakfast was the most wonderful chewy bread rolls, still slightly warm.

I was happy after breakfast, so I dawdled down to the town to get the bus back to Dili. I sat in front of the market waiting for the bus to come, and vowed that I wouldn't go back to Dili on the back of a truck again (especially since the people at the poussada were adamant that no-one goes on trucks, everyone goes on buses!) I waited and waited, and eventually saw the "policeman" from the day before, who clutched my hand and semi dragged me across the road to a toothless woman with stained gums from betel chewing. I couldn't understand anything she said, but eventually (after trying to put me in a refridgeration truck) she shoved me on the back of an ute, and despite my vows that I wouldn't go back to Dili on a truck... I went back on the back of an ute which was probably worse...

Because when we went through several towns, there were convoys of trucks carrying lots of men, and lots of them had guns. I felt pretty exposed, the only foreigner on the back of an ute. But luckily I didn't get shot and made it back to the mindbogglingly luxurious hotel in Dili where I was to meet Namiko and Jade.

East Timor: random first day in Dili

I flew to Dili early one Saturday morning. The flight was just one hour and ten minutes, and it felt like we hardly had time to scoff down our pastries before we were landing. We walked out onto the tarmac and into the single square building that is the airport, waited at the only conveyor belt, and pretty soon I was in the "waiting area" which was just a handful of plastic chairs out in the open air.

I had no idea where I was headed, but on the flight I decided I would try to get to Atauro Island on the ferry that morning. It was early so I took a taxi to the wharf, thinking I'd just wait for the ferry there. When I got there, hundreds of people were trying to push their way onto the wharf, frantically waving their pre-purchased tickets. I had no hope of getting a ferry ticket, so I gave up and went for a walk instead. I wasn't carrying much stuff, so it was nice to walk in the early morning (relative) coolness.

Some deserted blocks later, I made my way to the only backpackers place in East Timor - the East Timor backpackers, run by a Pom and his Timorese wife. As I walked in, they were trying to chop down a tree full of beautiful yellow flowers, a rather strange activity for Saturday morning, I thought. After a short nap I spent the whole morning talking to some random guy working as a volunteer for Arte Moris, a local organisation supporting young Timorese artists. He had finished university in Brisbane and decided to move to Dili - he seemed like the archetypal wanderer, so by the time I finished talking to him I felt like I was back on the road wandering too.

Eventually I went for a walk around town in the almost unbearable midday heat. Near the water it was not too bad, but everywhere else the air was so still that it was almost suffocating. Everything seemed to be closed, and there were not many people walking on the streets. I walked along the waterfront where people hid under huge banyan trees and drank coconuts, then I had lunch of fried fish and fish curry at a padang style joint.

Dili was strange to walk around - most of the time it was just hot, dusty and unpleasant, but one would come across some strange surprises. Sometimes, turning a corner, one would suddenly see the hills that surround Dili, and it was actually pretty picturesque.

Also there were a number of colourful murals around the place, a lot of them with a Tour de Timor theme. I guess the bike riders or organisers must have painted them.

And once in a while there would be pretty trees and flowers, such as this one near the cathedral.

The strangest surprise for me was when I went back to the hostel and sat drinking iced tea. The men who had chopped down the tree with yellow flowers earlier in the day were busy building a shelter-like structure out of palm leaves. After laying down the layers of palm, they had to trim the shelter, which they did with a machete and a mango stick! Sitting under the palm cover once it was done, it exuded a sweet smell which reminded me of rain in the wet season.

So I drank iced tea, gazed at the sky and unwound. At sundown I went for another walk, but I was uncertain about the safety situation so I stuck near the hostel and had a masala dosa for dinner.

I saw lots of UN vehicles that day, both standard ones (so easy to spot white Landcruisers) and UN police vehicles. I had my first taste of the demonstrations - there was a peaceful protest in the city centre, where lots of people old and young marched through the streets carrying signs. At this protest I did not feel uncomfortable to watch (unlike others later), so I stood on a corner near the National University and watched the hordes of UN police carrying heavy weapons direct the protest away from the city centre. How surreal it was..

Outreach to Nguiu clinic

One beautiful sunny day, I went to Nguiu for outreach clinic.

I sat on the ferry reading Joe Cinque's Consolation, which was an intriguing tale of love, death and psychosis. I kept reading till I felt like I was going to vomit from seasickness, then I went to sleep. When I woke up the ferry was perfectly still, and when I looked out the window there was a small boat speeding away from the ferry. We are sinking! was first my first thought. But no, a group of unhappy youths had burnt down the jetty on the island and the little boat was our only way to land.

Once on the beach, there seemed to be not much other than red sand and coconut trees. I was picked up by the clinic in a brand new white government-issued 4WD which looked really quite out of place, and drove a few hundred metres down the road to the dialysis centre.

My consulting room consisted of a bed, a desk with broken drawers and two broken chairs (everyone sat on the bed). The clinic assistant drove off in the 4WD to "round up" the patients from all their houses, and soon there was a queue outside my door.

It was much like any other clinic in the NT, but the Tiwi islanders are really quite sweet (always smiling, they are pretty much my favourite group of patients!). I always have the most hilarious conversations with patients in clinic, for example:

Patient: Doctor, doctor, I need you to help me.
Me: What can I do to help you?
Patient, opening mouth real wide: Can you take out this rotten tooth? It's really annoying me.
Me: I'm the kidney doctor, not the dentist.
Patient: That's ok, you look like a nice one, take it out anyway!

Patient: Doctor, now I'm on this dialysis thing, it's really affecting my life, you know.
Me: Yes, I understand it's hard to come to dialysis three times a week.
Patient: No, no, I like coming to dialysis, all my friends are here.
Me: What's bothering you then?
Patient: Well, I've got to wear shoes... I don't like wearing shoes.
Me: Well, you've got diabetes and the feeling in your feet is not so good.
Patient: Oh, but I like going walking in the mangroves without shoes.
Me: If you go walking without your shoes you might cut your feet and it might get infected.
Patient, reluctantly: Ok, I'll put my shoes on once wet season comes.
Me: What's the difference between dry and wet season for shoes??
Patient: Well I don't want to die from soil sickness (meliodosis)

(See, even patients have their priorities straight).

After we saw all the dialysis and transplant patients, we had lunch on the verandah, looking out to the sea. The dialysis centre is in a really beautiful spot, right on top of a cliff, looking out to Melville island.

In the afternoon we went to the local health clinic for our other clinic, but no-one knew we were coming so it was cancelled. We ended up roaming down the street to the art centre where I bought a Tiwi bird carved out of wood and painted using pigments from the earth. Then I went back on the ferry and read some more Joe Cinque.

It was such a relaxed day, if only I could go on outreach more often....

 The Indigenous food pyramid!

The end of the dry

A lot has happened in the last few months.

The weather has been just beautiful. Dry crisp nights, not too hot during the day, clear blue skies everyday (bar the occasional burning). Often I went to work thinking that no matter how awful things get, it's impossible to be in a bad mood in this sort of weather. It's just anti- seasonal affective disorder, and makes me wonder how I'll cope with the Sydney winter when I go home. When I was in Sydney in August it was almost unbearably cold, and I wondered how I'd lived there for so long.

Now the dry has sort of ended, and the days are starting to get muggy. The mango season has started though, so it's somewhat compensating for the lack of good weather. The nights are still tolerable but we've had a few afternoons that were a bit choking. But I get to eat a mango everyday (at least), which I'm enjoying immensely.

And from the end of my time in GM5, to relief, to 3 weeks of annual leave, I've now been in renal for 2 months. The last three months have just warped away from me and I have no idea where they went. Part of the reason time has gotten away from me was because of the uncertainty about next year. I had originally planned to take a year off to travel and work for MSF, and in fact had already applied to work for MSF and even got an interview. But somehow it was not to be. The college released a regulation update that mandated continuous uninterrupted training, and though I could apply for "special consideration", I ran the risk of being unemployed (or stuck somewhere horrible) if the special consideration was not approved.

Like the last time I faced an uncertain situation, I decided to leave it up to fate. I applied for two jobs only and decided that if I were not to get either, I would just go to Africa. One could call it a win-win situation - either I end up in a good ICU where I want to be, or in Africa where I want to be.... or one could call it a lose-lose situation - either I'm miserable back working in Sydney and actually want to be in Africa, or I drop out of the training program! True glass half-full or half-empty ness.

I felt almost nothing when I got those interview offers, and almost nothing while I was doing the RPA interview. I still felt nothing when RPA called and told me I had a job (shouldn't I have been ecstatic? bouncing off the walls? after all this is what I wanted all along..). It felt surreal, I felt detached from it all.
Even now it hasn't really sunken in. Though with the weather getting hotter (and more like the weather when I arrived in Darwin), the realisation that two thirds of my time in Darwin has gone has slightly indented in my mind. I can't imagine what will happen when I go back to Sydney, it will be the biggest culture shock!

The strange thing is, I've almost stopped dreaming. Once I dreamt I was in a patient's bladder watching the fungating tumour (with lots of flailing arms sticking out of the giant cauliflower like lesion), struggling to keep afloat in a sea of urine. Another time I dreamt I was being delivered a curry, one cube of meat at a time. But my dreams have faded somewhat and are not really very vivid. It's probably just sleep deprivation, or maybe it's too hot at night now. But I miss my dreams...

七月

夏夜
狭窄的床
隐约的汗味
口中喃喃的絮语

无法言喻的心情
已经遗忘的约定
未曾实现的希望
走投无路的憧憬

Dream: death by oestrogen

In this dream I'm sitting in a strange man's black convertible. I don't recognise who he is at all, but apparently in the dream we are on some sort of date.

So we are driving around up and down a few highways, just enjoying the feel of the wind in our hair. Then we decide to go to this shopping centre, which looks a lot like Casuarina. We take a left at the KFC, much like the real Casuarina, except as soon as we turn I see a huge boom gate which is not there in real life.

He is still speeding along so I tell him he'd better stop at the boom gate. He says "why should I stop? I don't have any money". I am somewhat horrified and tell him that I'll pay for the parking.

"All right then." He says grudgingly and pulls up at the boom gate, where there's a little hut with a man sitting inside.

"Wait here," he says to me and ducks into the hut.
The next thing I know I look up and the man is no longer there.
"What happened to the man?" I ask him.
"Don't worry about it, let's go." He says.

As we drive into the parking lot I am overwhelmed by this feeling that he somehow killed the ticket collecting man, so I start asking him again and again, somewhat hysterically "What did you do to him? What happened to him?"

Finally he sighs and says "well, if you must know.."

He pulls out a tab of pills from his pocket and shows it to me - it has the Mon-Tue-Wed etc pattern written on it like the oral contraceptive pill. He turns it around and most of the pills are missing.

He says, "I made him take all these pills, and he died of an oestrogen overdose."


Then I wake up.

Random Darwin, part two

Darwin's one of those places where one sees strange stuff all the time, and despite the fact my phone takes really crappy photos, I often have the urge to pull it out and snap a random photo. My interns will testify that I frequently announce "Kodak moment!" on the ward round, for example when we were trying to find a ward in the private hospital (the public frequently overflows into various corners of the private), and the nurses helpfully directed us to this sign on the wall:

One day I finally went up to this ward in the hospital called "Constant Care", which is actually really a nursing home because all the patients in it are waiting for nursing homes, and found this sign at the entrance next to the fish tank (yes, all this nursing home has to entertain its residents is a fish tank)

 Back to the good old private hospital, they got a bit tired of the public staff using their things all the time, and even their bench space they were very protective of. So on one ward, which was half public and half private, I found this sign, reminiscent of primary school days...

Of all the random things I've taken photos of from medication charts, I thought this was probably the most hilarious. Fleet enema TDS, only in Darwin...

And I couldn't resist taking a photo of my intern Olivia who was so tired on our massively long ward round that she sat down on the nearest piece of furniture (of course we don't have chairs).. the patient's wheelie walker.

And here on a random antique scale....

On a different ward, a patient complained that she couldn't get hold of the nurses because there were no call bells.. so she was given one of those old fashioned ringing bells (here is Olivia again demonstrating its use). And of course our patient was an adult, just the hospital was so full they stuck her in the children's ward.

Away from the hospital, one day I went for a walk and found a dead snake just outside the driveway of the hospital... what can one say but Normal For Darwin?

A handful of really  random things have happened since I moved to Darwin, and this has to come close to the top of the list. One night I was meant to go with a bunch of medical students to Lee Point for a bonfire, but I　 ended up staying at home because I wanted to sell my microwave. Eventually I sold the microwave and made my way to Jacky's house for dinner. While bonfiring one of the boys, a 21yo French 1st year medical student, had burnt his foot trying to firewalk. So he sat in the bathtub sulking while running his foot under cold water, and Jacky went to look for his "special bag of medications" which he'd stashed in a cupboard somewhere.

It was actually two whole plastic bags full of medications, and it was the weirdest thing ever sorting through them! Aside from the obvious paracetamol, nurofen, antibiotics (half a dozen types, including ones I'd never heard of), anti-histamines and steroid creams, there was also clonazepam syrup (just in case one develops epilepsy, perhaps?), anti-fungals, a combination paracetamol-tramadol tablet (very bizarre), oxazepam (maybe to be taken if life in Oz got too stressful?) and an anti-depressant! All the medications laid out covered a whole side table, and I was simply amazed by what one's father would give an otherwise healthy 21yo to take to a developed country where medications are readily available!

Anyway.. I gave him some panadol and nurofen, and couldn't resist giving him half an oxazepam! Then we all crowded into the tiny bathroom to keep him company, eating kangaroo stir fry to the sound of running water.. Now if that's not random, I don't know what is.