“Klinik ASRI is a place like no place else. A haven where the most caring providers and staff come to work, it provides access to quality medical care to an under-served and impoverished population hidden in this remote corner of the world. The ASRI staff faces daily challenges including lack of medical supplies, limited medications, and at times, even prolonged periods of loss of power. Providers here are challenged, unlike anywhere in America, and are made to prove themselves as true clinicians, using their physical exam skills to reach a diagnosis and select appropriate treatment plans using their eyes, ears and hands. They are experts at the physical exam, an art which seems to have been lost back home, where conclusions are rarely made by clinicians without confirming lab studies, X-rays, or CT scans.
ASRI functions without many of these advanced studies, and yet, their patients appear to get better. Their diagnostic modalities (aside from their skilled exam) are limited to the most basic of bedside blood and urine tests or other studies that can be done by looking through a microscope and counting cells, or describing their appearance. You want a chest X-ray of a patient you think may have pneumonia or tuberculosis? Or you want to the know the electrolyte levels of a patient with kidney failure? You’ll have to ask the patient to drive themselves two or more hours by motorcycle to the nearest facility, pay full-price out-of-pocket for these tests, and then come back. This is after, of course, the patient has already traveled incredible distances, sometimes as far off as six or seven hours on the back of a motorcycle, trekking over unpaved roads, to be seen by a provider with medical training.
And as if that wasn’t enough, they always arrive with a smile. The endless smiles here may be the most remarkable feature of the people I’ve met. Whether they are welcoming you to have lunch with them, introducing you to their family, or instead describing how severe their pain is, or that they cannot afford treatment for their father with terminal colon cancer – they persistently portray a smile. It seems they find contentedness and gratitude in a place where others might feel anger or despair; but not here. And ASRI’s physicians reflect this positive quality as well. Following their medical school education, mostly received in Java, the most metropolitan of the islands in the Indonesian archipelago, these physicians have chosen to serve in this community of need prior to continuing on with their residency training. Years of service in the Klinik ASRI appears to have fostered a very capable set of young physicians. They are thoughtful, thorough, patient, and inquisitive. Though their mastery of the English language varies, this does not obscure their clear mastery of the medical sciences and their clinical skills. I continue to wonder if my input regarding patient work-up and management is helpful or educational, if it isn’t me who is learning the most from our case discussions. Beyond their strong medical knowledge, these special providers also demonstrate exceptional empathy; a caring, patient-focused approach which permeates through this place. It is clear to me that this environment cannot be created by reeducating a facility’s staff, or by simply declaring a set of institutional values. Instead, perhaps this focus and philosophy exists within the people who make a place what it is, or it doesn’t. I am loving my time here in the clinic and am excitedly anticipating next week’s schedule of patients. I don’t doubt that my experience here will continue to alter the lens through which I view the world back home.”