Plenty of room to make a difference

by Seth Mydans International Herald Tribune

SATURDAY, MAY 21, 2005

Dili, East Timor

"Manuela, good afternoon."

He rolls his chair toward her until they are sitting knee to knee, almost forehead to forehead, and peers at her from under the bill of a dirty white cap.

"Your ailment?"

She talks and he presses his stethoscope against her chest, palpates her abdomen, then swivels quickly away. Bent over a small desk, he scribbles a prescription, murmuring instructions. "You understand?"

As she leaves, he swivels again with a squeak and sits back, hands flopped in his lap, for one empty moment. Then the next patient enters.

"Carmenita, good afternoon."

Knee to knee, almost forehead to forehead, he peers through large glasses that seem to perch just above his white briar patch of a beard.

"Your ailment?"

The man in the chair is Dr. Dan Murphy, a 1960s radical now turned 60, who came from Iowa to this wretched little land in 1998, ideals intact, still trying to make a difference and still, he says, seeking some kind of redemption.

This is his life now, every day, 200 times a day in his tiny clinic: listen, palpate, turn, scribble, murmur, squeak, sit back for just a moment, then lean forward again.

When he first arrived, East Timor's struggle for independence from Indonesia was entering its final convulsive months. He immediately began risking his life to help the rebels, hiking into the mountains to treat gunshot and machete wounds and sheltering these patients at a local clinic.

As soon as the Indonesian soldiers left, in September 1999, he founded the bare-bones Bairo Pite Clinic, where he works today, offering free medical care, supported by a thin patchwork of donations.

When he leans forward in his chair, he confronts a medieval parade of misery that is rarely seen now in the West: yaws, leprosy, tuberculosis, malaria, vitamin deficiencies, dengue and rheumatic fever.

When he leans back, in that small moment of emptiness, he says, he is besieged by personal demons of guilt and ego that cloud his judgment and make him doubt himself.

"Every day there are two or three times when I say, 'I'm too close to the edge here. I've got to rein it in,"' he said over whiskey late one recent night. "It's hard to know what's right and wrong sometimes."

Some of his doubts have to do with the makeshift medicine he is forced to practice here, but mostly, he said, they come from some tormented place inside him.

"I think of Kurtz in the 'Heart of Darkness,' doing all kinds of things," Murphy said, referring to the Joseph Conrad tale. "In a way I have to struggle like Kurtz. I don't have anybody watching me and judging me. What if I fell off the edge?"

There was a divorce and two grown sons who once needed his help, but beyond that, Murphy retreats into enigma. "The ego is a formidable foe," he said. "It's amazing how that primitive part of our minds can easily dominate our cerebral hemispheres."

Like Kurtz, he said, his torments were palpable but their causes were buried and unexplained.

With each new case of dengue or malaria, the demons are made to wait in line like everybody else.

"Octavio, good afternoon," he says in the local language, Tetun, and he leans forward once again to listen.

Like Octavio, each patient gets a minute; sometimes two or three. Some of them have walked for days from the mountains and have stood in line in the sun for hours.

Without a good laboratory or modern equipment, and with limited medications, all Murphy has to offer them are these few moments, a scribbled prescription and a word of hope.

One after another his patients file into his stark little room with its sink, its rattling air conditioner and its shelves of medical books and medicine bottles. Sometimes whole families come; each one of them brings an ailment.

"They get a slip of paper with a couple of pills on it and they think it's worth it," he said. "Most people have episodic things that you can't cure, so you practice the adage, 'Do no harm.' I hate to take away hope from someone. You do what you can."

Octavio is a bright, active 12-year-old boy with nephrotic syndrome, a kidney ailment that is almost impossible to treat without a biopsy and targeted drugs, and there are no biopsies to be had in East Timor.

As he has for the past four years, Murphy prescribed a diuretic to ease Octavio's symptoms. "He's in a horrible situation," the doctor said as the boy stood smiling. "I don't know what else to do with this kid."

That feeling seems to be an echo of his father, a country doctor who, like the son, lacked the best of today's medicines and was forced to watch helplessly as patients died.

"There wasn't much he could do but hold their hand and go through the process with them," Murphy said. But he is resigned to that. "Eventually, we lose everyone, don't we?"

As a young man, he was a rebel - like many Americans of the Vietnam War generation - and after graduating from medical school at the University of Iowa he refused the military draft. A judge gave him a suspended sentence and he went to work as a doctor, for seven years, with Cesar Chavez, the Mexican-American farm labor leader, and Chavez's farm workers in California.

He then made his way to Mozambique for three years, where the violence was a foreshadowing of his experience in East Timor. At home again in Iowa he opened a private practice that included a methadone clinic serving mostly immigrants working at a meat packing plant.

Eight years ago, still restless, Murphy sold everything and, as he put it, "escaped from the middle class." This utterly poor and devastated land, a former Portuguese colony occupied for 24 years by Indonesia, was as far away as he could get from everything and everyone he knew.

And that was as it should be. "We live and we die 'as we dream - alone': Joseph Conrad," the doctor said.

Here he has created his own self-enclosed world, this tiny room where, rocking backward and forward in his chair, he can spend his days immersed in suffering. "It assuages a lot of guilt," he said.

The patients are an endless stream.

"Nikola, good afternoon" - a woman with tuberculosis.

"Margarita, good afternoon" - she and her three children are all coughing. Each takes a turn in the gray plastic chair and each departs into the sunlight carrying a small white slip of paper.

Murphy leans back in his chair for just a moment, his hands flopped in his lap, and sighs.