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.
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"Preventative [health], rather than curative, strategies are at the center. Local involvement and empowerment is the key. Village women are the number one health resource of East Timor. They, more than anyone, exhibit concern for health in the community."

Dan Murphy, Bairo Pite Clinic, Dili

A Vision for a People-Centered Health System in East Timor

By Dr. Dan Murphy

Bairo Pite Site is

East Timor has suffered as much or more than any other country in modern times. We can attribute this to the inadequacies and designs of the Western world powers, as well as to Indonesia. East Timor is poor because for 500 years they have had a boot on their neck. Nothing can truly compensate the people for the tremendous loss of life and state of collapse in which East Timor finds itself. At the very least, however, these same world powers owe East Timor a huge debt.

A glaring problem facing this new country is the poor health of a population long neglected. The infrastructure is destroyed, qualified medical personnel are non-existent, resources scant. People have lost everything including housing, possessions, even clothing.

An overview of health reveals grinding poverty with all the attendant conditions, including infectious diseases worsened by complications of pregnancy and delivery, frequently resulting in the death of mother or child or both. Many villages have no access to any health care.

Tuberculosis (TB) is a particular example of the kind of challenge faced by East Timor. Prior to last September, TB was already infecting people frequently. After the post-referendum turmoil, however, it is even worse. As a result, TB is now at an all-time-high and is killing people at an alarming rate. Like so many of the other health problems, TB is at least as much a socio-economic problem as it is a physical infection.

The Bairo Pite Clinic where I work has been operational since September 1999. In that short period of time we have seen 100,000 patients. Maternity is very active and, as of yet we have not had a mother die in our care. We average 15-20 in-patients with conditions ranging from malaria, pneumonia, and diarrhoea to yaws, encephalitis, and leprosy. Visiting specialists are very helpful; a recent U.S. Naval eye team saw, in two weeks time, over 3000 patients. We have an extensive pharmacy, and an excellent laboratory. Kitchen facilities, laundry, and a new maternity ward will soon be operational. Ten East Timorese medical students help and learn at our facility.

Yet this is not at the heart of what must be done to improve the health of the country. Our patients may be well today only to return tomorrow with the same conditions. The only way to prevent this is to change village-level dynamics. For this reason, our next program will include going to the countryside to listen to the people, to learn what they see as their health problems. We will then discuss how the people can address these problems using local resources as much as possible.

We see ourselves as facilitators of this process, our clinic a referral source and training site for the village health worker. Preventative, rather than curative, strategies are at the center. Local involvement and empowerment is the key. Village women are the number one health resource of East Timor. They, more than anyone, exhibit concern for health in the community.

Through this process, a national network of local health advocates could emerge. People would choose and support their own local health representative, who would then learn and become the link to the system. The same principles could apply in the cities. Neighborhood groups could organize around health care issues, choose a worker, and join the network.

Imagine what will happen to health when each community has a representative actively working through a national program. I envision computer links to most places making communication much easier. East Timor has less than one million people and under 500 villages; these things are possible.

Of course curative medicine is still needed. Small clinics could treat several villages. Then larger polyclinics would be needed for the sub-district level, and hospitals with more surgical and specialty capabilities for each district. Dili has the national referral hospital. Links to foreign countries are needed for special cases such as open-heart surgery.

Training for Timorese doctors should take place locally. Again, computers could play a large role, supplemented by practical training at local hospitals and clinics as well as short courses by visiting doctors.

Dan Murphy is the head of Dili's Bairo Pite Clinic.

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