BAUCAU, Timor-Leste -- On the dusty wood-paneled floor of the old gymnasium here, school kids usually play soccer and basketball or practice judo and karate during the rainy season.
With the bleachers empty and the floor swept clean, from Sept. 7 through 11, Baucau’s gymnasium was not the site of playful bouts of ballgames, but of a health service outreach (HSO) event that provides free medical care to the people of Timor-Leste, as part of Operation Pacific Angel 15-2.
Many individuals heard of the clinic days before through word of mouth, and travelled often by foot and bus for a chance to see military doctors, dentists, optometrists, physical therapists and pharmacists from the U.S. Air Force and Navy, New Zealand army, along with their military and civilian counterparts of Timor-Leste. Waiting in a long line, people queued in the morning and patiently waited to enter general processing, where their overall health information and history was recorded. Then they entered the gym, where they visited the clinic that met their most urgent health need. The clinics responsible for the most patient smiles were optometry and general dentistry.
“Optometry is a great spot to be in as a provider during PACANGEL,” said Capt. Davis Staley, optometrist with the 673rd Medical Group. “We’re able to provide lasting care in a very short amount of time. Some people come here and receive prescription and sun glasses they have never had before. Even if that is the only thing they get from us, this new-found vision can last years until they break the glasses we give them. That’s very gratifying.”
The first challenge for patients was to read letters of varying sizes on a traditional vision test chart. With illiteracy rates of the rural population well above U.S. standards, many patients used the “E” chart, or a chart with recognizable symbols instead. Then the patients got one-on-one time with trained Air Force optometrists.
“We do a basic refraction to see if they need prescription glasses for distance,” Staley said. “Pretty much everyone over the age of forty receives a pair of reading glasses and every eye patient, young and old, receives a pair of sunglasses to protect their eyes from the harsh, near-equator sun.”
About a third of the patients also were examined for eye health. From red eye to severe inflammation and cataracts, the team treated a variety of eye ailments.
“The experience we gain here is invaluable,” said Master Sgt. Robert Shaw, NCO in charge of optometry services 141st Air National Guard, Spokane, Washington, who has been working in eye care since 1995. “A lot of things we see here are unique. We may have seen them in textbooks, but never in person. As a traditional guardsman, I take that experience and take it back into the civilian world.”
To get people with severe problems into follow-on care, the team prepares a referral list that will allow patients to see a group of eye surgeons that are scheduled to visit the area in November.
“There are no established facilities in the area that meet our standards for eye care,” Shaw said. “For us to be able to at least give them protection and acute care is rewarding. I get so much joy from seeing the little kids smile when they can see a tree for the first time, or from the older gentleman who smiled from ear to ear when he could see clearly the paper in front of him and his own hands.”
The PACANGEL team included an international, civic and military team of dentists and support technicians. On camping tables and plastic garden chairs, the team created an improvised dental clinic behind the privacy of a suspended tarpaulin.
“The care we provide here is different, of course,” said U.S. Navy Lt. David Sandberg, a general dentist. “This is the down and dirty. We’re trying to get the job done and I don’t pay much attention to the nice ergonomics of sitting right in my chair. We provide acute care services with a limited scope of what we can do, but we try to do the most with the limited amount of time and tools we have available. We’re focused on getting the patient out of pain. It’s hard work, but it needs to be done and is very rewarding at the end of the day.”
Sandberg worked closely with U.S. Air Force and New Zealand dental technicians who cleaned, prepared and handled essential dental equipment as one patient after the other arrived to receive treatment — with little room to pause for the multi-national dentistry crew.
“The patients are very, very grateful,” said New Zealand army Lance Corp. Shaye Campbell, a dental assistant. “Obviously there is a language barrier, but we can see a change in them. They are very nervous coming in and a lot of them haven’t seen a dentist before, so the experience and instruments are very foreign to them. But when they leave they often smile and are probably quite surprised how easy some of the procedures really are.”
Jesperiaka Vero-Lemos, 16, visited the HSO clinic to get a dental check up and travelled most of the morning over rough gravel roads on the outskirts of Baucau with her grandmother and younger sister on two separate days to get examined.
“I’m glad the doctors came to help us and provided these free care days,” Vero-Lemos said. “My grandmother got reading glasses and help with her aching back. I hope that is going to get her out of pain. I’m happy this clinic came to Baucau.”
In addition to providing modern medical care to the citizens of Baucau, the exercise also offered crucial hands-on training and the opportunity to exchange knowledge and build partnerships between U.S. service members and its Indo-Asia-Pacific partners.
“I like to work with U.S. Air Force and New Zealand doctors because they have a lot of experience and there is a lot of exchange of knowledge and skills,” said Falintil - Forças de Defesa de Timor-Leste 2nd Lt. Anabela De Cruz, who previously served in her capacity as a general practice physician during PACANGEL 15-1 held in the Philippines. “Likewise, we can share some of our experience with diseases like malaria, dengue fever and others Americans don’t often see. I became a doctor because I wanted to help other people - here and around the world. And that’s exactly why I’m here.”
For U.S. doctors the exercise was a chance to work with foreign medical professionals and gain an insight of a different medical system, said Maj. Kimberly Caldwell, a physician in the family practice section.
“We work with our Timorese counterparts to do the best we can to address patient’s issues and provide preventative guidance,” Caldwell said. “Having our Timorese partners has also been a huge help because they help us plug into the local clinic, which can provide some critical follow-on care. We actually have the opportunity to work side-by-side and gain knowledge from each other while providing some necessary care to people in need, which is definitely awesome. This is what I wanted to do with my life: help others who don’t have anything. And to help and see other doctors do the same in their own country is even more rewarding.”
Since 2007, PACANGEL missions have improved the lives of tens of thousands of people and helped local government and international aid agencies respond more quickly to emergencies. It enables them to assume control of recovery efforts in their wake by enabling them to more efficiently use equipment, training and connections they already have to provide medical and engineering assistance to local citizens in need.
The medical teams admitted and treated more than 400 patients each day, yet despite the demand, maintained a focus on quality of care over quantity, said Lt. Col. Paul Conroy, lead PACANGEL 15-2 public health planner.
“Pacific Angel is a program that gets Airmen to work with their counterparts from other nations to prepare disaster response and humanitarian relief capabilities,” Conroy said. “It is very important to us to integrate with the host nation’s military and civilian medical system as much as possible so that in the event of a real humanitarian response incident, we can integrate seamlessly … This is not just about us coming in and seeing patients. It is a true partnership and about us working without international counterparts. At the end of the program we learn about as much as we have taught.”