Back to Basics in Borneo: Why Rheumatologists Are Meant for Medical Missions

Among the clinic staff in both Borneo and other developing countries where Dr. Albert has served, he said he was impressed by the depth of knowledge about the common local diseases among the physician and nonphysician medical staff alike. Thanks to their expertise, "it is more important for you to share your expertise in your specialty than for you to be an expert on indigenous conditions," he said.

The people in Borneo actually are quite well nourished, and diseases of malnutrition are rare in Indonesia, according to Dr. Albert. The Health and Harmony program where he cared for patients is located in a fishing village, so the local residents have a good diet, consisting mainly of rice and fish, and fruit, which grows plentifully in everyone’s yard, he said.

"I think volunteering at a remote medical clinic is a far better way to get to know a country than traveling there as a tourist."

However, there are waterborne epidemics because of diseases due to poor water sanitation, but otherwise people have pretty good baseline health.

The Health and Harmony program consists of a walk-in clinic in the village called Sukadana and outreach clinics in remote areas. The Klinik ASRI would look familiar to most internists because it is similar to any other walk-in clinic, with three or four exam rooms and an urgent care facility, half a dozen nurses, and three or so general practice trainees. The job of supervising the clinic and its staff falls to the visiting physician from overseas.

Health in Harmony is a very well organized volunteer organization in a very pleasant part of Borneo, so it is considered a very desirable residency that attracts the top students. When Dr. Albert was there, he worked with three trainees. They were in their first year out of medical school, which is certified by the government as a residency.

Most of the time, the patient comes to the clinic alone or with one member of the family. But very sick patients may arrive with several relatives. And if they are very, very sick, they may come in with a substantial portion of their village. "It can be pretty interesting in clinic when you have large numbers of people accompanying a patient in a relatively small space," Dr. Albert said.

The journey to the outreach clinics is made via a van that carries a doctor, nurse, and driver to the remote location. This team usually stays in the home of a local chief there. Traditional healers are part of the culture in Borneo, and "the interface between traditional healers and Western doctors" occurred without tension or distrust, he said. "I hope to participate in the outreach clinics on a future trip, but did not do so on this visit. Traveling to the remote clinic, caring for patients, and returning takes 3 days, which was not possible for me on this trip," Dr. Albert said.

Clinic care runs smoothly. Staff collect demographic information from each patient at intake and enter it into donated Apple computers, along with short patient notes and the patient’s picture. Most of the medication at the clinic is donated, largely by the humanitarian association AmeriCares and volunteers who often bring medications with them to stock the pharmacy. The Indonesian government also provides some medicine.