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CHALLENGES BEYOND MEDICINE

The old toothless village woman peered thoughtfully into the depths of the water in the new well. When she saw me watching her, she ambled towards me, basket of coconut fronds under one arm and gesticulated at the well. “That is good,” she said softly to me in Bahasa Indonesia, “Very good. Thank you all for everything you have done.” With that she turned and walked away, a grateful smile on her aged face.

That response alone made the previous two weeks of sweat and toil worth everything. The 300 volunteers of Operasi Raleigh Batam, whom I was privileged to be expedition leader of, had worked tirelessly on eight community aid projects on Pulau Geranting, a kilometer square island some 34 kilometres west of Batam Island in the Riau Archipelago. The tasks included building a concrete well at the site of a muddy waterhole, restoring a village mosque, refurbishing the Islamic school, replanking the walkway of the sea village, constructing a playground for the school, draining a malarial swamp, constructing a reservoir and conducting a medical aid project including a malaria survey. There were four other doctors on expedition with me, three hospital medical officers and a general practitioner all doubling as medical as well as administrative staff for the expedition.

What makes young professionals such as my fellow doctors on Operasi Raleigh Batam give up weeks of their time to live on a mosquito infested island with no fresh water to bathe in, to work from dawn to dusk not only on medical projects but also on heavy construction and muddy drainage works for people they don’t even know? Certainly community service expeditions in arduous conditions is not for everyone, but there is a growing number of young professionals who feel a need to break out of their comfortable niches in Singapore to do more than their routine jobs and derive satisfaction from more varied challenges. Since Raleigh International (previously Operation Raleigh) started in 1984, a dozen Singaporean doctors including myself have seen it fit to break away from our careers for three months at a
 

It is not easy being a doctor anywhere, certainly not in Singapore what with pressures of work, traineeships and specialist advancement for those in hospitals, or the need to eke out a decent living as a general practitioner. It can be mind numbing to live out our working lives inside our professional ruts which carve deeper with time and have very high walls which are difficult to climb out of. I do not denigrate for one moment the marvellous work of dedicated straight-down-the-line members of our medical profession who serve their patients, conduct innovative research and surge toward the pinnacle of their respective professional careers. I admire them greatly. Not many doctors in Singapore however have the opportunity to lateralise their personal development and contribute as a doctor, or not as a doctor, to other areas of endeavour. Perhaps I view it a catharsis, a purging of the soul, to run away from stifling civilisation and an intensive doctor’s lifestyle to get back close to the earth, back to basics. In medical practice in undeveloped countries, this means dealing with rural patients without recourse to any kind of investigational modality, making diagnoses purely on clinical grounds and finding ways to manage patients within the economic, social and cultural constraints of the people we are trying to help.

I remember in Chile in 1986, on a remote island off Puerto Montt in Patagonia, I was working on a Raleigh project between building a wooden bridge over a swamp and a running makeshift clinic in a nearby shack. An elderly and bent woman with a stick walked slowly and painfully over a field to my clinic. When I saw her, I quickly discovered that she was in severe cardiac failure. My first reaction was amazement that she had walked the kilometre from her home to me all by herself, something I had never seen anyone back home do if similarly unwell. What a stoic woman she was compared to some of our patients! She desperately needed diuretics of which I had none. Through an interpreter, I explained that she needed to pass a lot of urine to expel the excess water in her body but I had nothing to help her with. In laboured sentences she said that if I needed her to pass urine, there was a parsley-like herb growing wild on the island and in her backyard which when made into tea, made the drinker pass enormous amounts of urine. My prescription to her was to plant that weed in her herb garden, drink the tea twice a day and eat the apples from her tree regularly (for the potassium replacement). We assisted her back to her home and three days later when I paid a house call, she was well and out of heart failure, active again and a perfect host for our visit! Such were local solutions to common medical problems in unfamiliar environments.

It has also been an eye opener for me to find that western medicine is not the final answer everywhere. In the summer of 1992, I was privileged to be the medical director of a Raleigh International expedition which was the first scientific, community service and medical expedition of its kind in Westem Mongolia. As part of the medical project, which also included a BCG vaccination programme for nomadic children, cataract surgery and health surveys for UNICEF, we conducted a study of the traditional medical practices of the Mongols and Kazakhs living in this part of the world. Roving the foothills of the Altai mountains on horseback over three months, we discovered that traditional herbal medicine was widely used where no foreign aid was available. Many herbs were unique to this part of the world and had rather non specific benefits related to a number of organ systems. Other practices related to elements of Mongolian lifestyle and food sources such as milk and its byproducts, yogurt and cheese. There were basic elements relating to the use of earth and animal dung and many practices though rooted in herbs or foods also had religious and superstitious overtones in the form of rituals and incantations added to the material cures. The following year, I found the same pattern of traditional beliefs amongst head hunting tribes in the unexplored and politically closed corner of the eastern Himalaya called Arunachal Pradesh, when I joined a scientific reconnaissance mission of the Scientific Exploration Society. People actually got well from some of these practices, which suggested strongly to me that I should keep an open mind about alternative medical practices.

The practice of medicine can be a window to the world if only we allow ourselves to use it as such. I rather suspect that young doctors today yearn for greater breadth of experiences, more than what medical practice in Singapore alone can provide but often they cannot find avenues to channel their energies. When I appealed for volunteer medical officers from my hospital to assist me in Operasi Bhakti, a Red Cross medical mission to four Riau islands in 1995, I was deluged with applicants and had no problem forming a medical team of 13 doctors. It was wonderful to see their wide-eyed amazement at the simple but happy lifestyles they encountered mere kilometers from Singapore and their surprise at the enormity of gratitude heaped upon them for the most basic medical and dental care possible to give under such conditions. The villagers’ attitude towards us was such a stark contrast to the frequent abuse we sustain from so many of our patients at home!

I believe that seeing the world through the eyes of a doctor, community service worker and expeditioner in faraway countries can give balance in our professional lives. Whether it is the experience of archaeology and bridge building in Chile, running military medical units in the Gulf War and Philippine earthquake disaster, or even cycling with wheelathoner Dr William Tan to Penang for charity, the important lessons I have learned are that all things are possible to do, and that no circumstance can be so dismal that I cannot find something positive in it or a way around it. The greatest discovery on expeditions is about oneself. I found out how I responded to different people and different kinds of situations, how good my problem solving abilities were and how much of difficult conditions I could tolerate. It was always intensely pleasurable, if a little masochistic, but there was a lot of joy in living with people from many countries through tough times and achieving something. I learned how to approach all projects with enthusiasm, even if it was digging latrines for a field camp and I learned how to thrive on change and not be afraid of it.

It has been a path of development that has diverted me through the less trodden trails and rare viewpoints of life. It has eventually brought me back to the mainstream, but with an openess of mind and keeness of heart that I hope will enable me to make a positive contribution to my profession and my society. 

The author heads the Gastroenterology Unit of Tan Tock Seng Hospital, which he joined in June 1995 after a six year career in the Singapore Armed Forces’ Medical Services and a 2-year stint in the UK completing his specialist training. He has been involved in ten medical, community service and charity expeditions overseas and he assists six youth service and adventure organisations in Singapore. Apart from a number of medals awarded for his leadership of SAF overseas missions, he was conferred the Singapore Youth Award 1996 for Community Service and Youth Development, and the Commonwealth Youth Programme Asia Award for Excellence in Youth Work 1997.