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"When the transitional period is through, the people should be able to stand on their own two feet and should not be dependent on other countries. For this reason, there must be more comprehensive training for indigenous health practitioners. We need the help of the internationals for this. We are very grateful for the INGOs coming to help us, but we must have the opportunity to improve our skills so that we are not constantly dependent on the international community." Maria Dias, Director of Pronto Atu Servir (PAS - Ready to Serve)
From:

The La'o Hamutuk Bulletin Volume 1, no. 3.
17 November 2000
Issue focus:
Building a National Health System for East Timor
Tetum edition as downloadable PDF files is available.
Feel free to reprint or circulate these articles, as long as credit and contact information is given for La'o Hamutuk. 

Lessons from the Indonesian Health System and Future Health Priorities

By Maria Dias

The many shortcomings of the Indonesian health system should serve as a lesson to us all. In order that our people become healthy and prosperous, indigenous and international health practitioners must try hard to identify, and then put an end to, the poor health practices introduced to us by the Indonesian system—many of which still continue today.

During the occupation, the Indonesian authorities tried to win us over with humanitarian assistance like rice, maize, milk, and medicines. They even built a new general hospital in Dili, opened health clinics in remote areas and a nursing school, and increased the number of local nurses.

But the brutality of Indonesia’s colonial project and the endemic corruption in "New Order" Indonesia undermined any attempt to do good, including in the health sector. The Indonesian doctors who came here were almost always more interested in their own financial gain than in improvements in the health of the people. They began by opening their own private practices and pharmacies. They then persuaded patients to visit these practices for treatment. Finally they would give out prescriptions that the patients would have to purchase at their pharmacies.

The more we study the health system during Indonesian times the more we can see that the health of the rich and the well-connected was, in practice, more important than that of the poor. The Dili General Hospital (Rumah Sakit Umum or RSU), for example, had four classes of rooms for patients to stay in (VIP and classes 1–3). For this reason, the quality of the service you received depended on the class that you could afford. Patients had to pay for everything—from simple plaster and medicines to operations. This system was so unfair, especially as the health service had a sizeable budget, and caused our people much suffering.

Throughout the transitional period, health services are available free of charge, but, as health workers, we still must be very careful to construct a system that empowers the most marginalized people within the community. We must avoid duplicating the Indonesian system which only allowed the rich and politically well-connected to receive adequate treatment. And there are concrete reasons why I fear this might already be happening in some ways.

Our clinic in Dili recently took in two East Timorese refugee returnees, for example. They had both just given birth in a local health facility under the IHA/DHS where they had spent four days. Nevertheless, the women were still full of blood from their deliveries. No one had bothered to check or clean the women at the previous facility. This reminded me of when I would visit patients at the hospital during the Indonesian occupation, patients for whom I would have to provide care because the hospital staff had abandoned them.

Perhaps the two women had not received adequate treatment because they had just returned from nearly a year away, living as refugees in West Timor with many pro-integration supporters. In other words, perhaps they were victims of politically-based discrimination. I know such cases occur. It is for such reasons that we health workers must be totally neutral and work to ensure that discriminatory practices in health facilities do not occur, no matter what anyone feels about the patient’s political, social or economic background.

International non-government organizations (INGOs) can help us by leading us by the hand and together form a framework which will allow the Timorese people to move towards their independence—in the full sense of the word. When the transitional period is through, the people should be able to stand on their own two feet and should not be dependent on other countries. For this reason, there must be more comprehensive training for indigenous health practitioners. We need the help of the internationals for this. We are very grateful for the INGOs coming to help us, but we must have the opportunity to improve our skills so that we are not constantly dependent on the international community. We must work together— whether we are service providers under the DHS structure or private clinics or local NGOs—with the international community leading the way.

For this reason I request that all the international doctors and staff, who have come to serve in our land, do so with just one common purpose: to help empower the community. They can do this by much more emphasis on:

  1. providing training for indigenous doctors and nurses (including health education); and
  2. providing education about important health issues at the grassroots level of the community.
Health practitioners must make an extra effort to provide preventative health education at the grassroots level. In general, the people are still blind when it comes to understanding preventative health concepts. Health education should be all-inclusive and not just focus on illness and disease. Our organization, PAS, for example, has incorporated the building of toilets and animal shelters, along with environmental education and first aid training into our program on Atauro island. Such activities will help decrease the number of visitors to the clinic. Indeed there is just as much work to do outside of the clinic as there is inside.

We also need to make greater efforts to help the most vulnerable people whose marginalization is often increased by their inaccessibility to health facilities or food distribution points. Such people are also more vulnerable to the political ambitions of others. The hamlet or suco where a chief lives, for example, usually receives its share of emergency food distributions whereas those who live in other hamlets of that village often miss out. This has happened in the area where we recently set up a clinic on Atauro island.

Finally, women must play a leading role in the day-to-day running of the health service, at the administrative, managerial and service levels. There are currently no East Timorese women involved in the central body of the Interim Health Authority, for example. As women are the primary caregivers in our society, and well over 50 percent of the population, such a situation is unacceptable.

Maria Dias is the director of Pronto Atu Servir (PAS - Ready to Serve), a grassroots health project. While providing treatment for medical ailments, PAS works to address conditions that lead to illness. PAS puts heavy emphasis on popular education, helping to train local health facilitators, with the goal of creating a sustainable national health system based on local resources. top


La'o Hamutuk, The East Timor Institute for Reconstruction Monitoring and Analysis
P.O. Box 340, Dili, East Timor (via Darwin, Australia)
Mobile: +61(408)811373; Land phone: +670(390)325-013
Email: lhproject@one.net.au
Website: http://www.etan.org/lh 
La'o Hamutuk: East Timor Institute for Reconstruction Monitoring and Analysis

La'o Hamutuk (Tetum for Walking Together) is a joint East Timorese-international organization that seeks to monitor, to analyze, and to report on the reconstruction activities of the principal international institutions. It believes that the people of East Timor must be the ultimate decisionmakers in the reconstruction process and that the process should be as democratic and transparent as possible ... 
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Website: http://www.pcug.org.au/~wildwood Email: wildwood@pcug.org.au