BACK DOOR Newsletter on East Timor

A collection of items about rebuilding the health system following the massive violence and destruction of infrastructure committed by militia groups trained and supported by the Indonesian army.

NEW = Added to BACK DOOR Website since last Monday's Emailout

see also Water and Sanitation

Jan 17 HTLee: Asbestos epidemic in East Timor, but UNTAET negates its responsibility  Article added Jan 18
"There is a big asbestos problem in East Timor. UNTAET has been made aware of it since December 1999. However, UNTAET has failed to make the removal of asbestos a priority and has not notified the East Timorese and the thousands of foreigners working there about its dangers. ... Asbestos is a silent killer and there is no safe level to its exposure. The victims do not even know they have been attacked until 10 or more years down the track. By then it is too late and the victim suffers an agonising death." HT Lee, freelance photojournalist

Jan 17 Lee, McKinley King, Shaw: Asbestos problem in East Timor  Report added Jan 18
"The removal of asbestos using Australian NOHSC standard must be made a top priority. The East Timor Constituent Assembly can and is in a unique position to make UNTAET accept this fact and act on it. The cleaning up of the asbestos will be a huge task which will require additional funding from donor countries as well as additional assistance from abroad. Many organisations including trade unions in Australia would be more than happy to provide the assistance ... Finally, the clean up of the asbestos would require the importation of large quantities of disposable asbestos overalls and masks. These items could be manufactured in East Timor as a cottage industry to provide local employment." HT Lee, Julian McKinley King & Andrea Shaw

Tetum:
La'o Hamutuk nian Surat Popular: [PDF formatu]
Hari sistema saude foun:
http://etan.org/lh/PDFs/surat/surathealth.pdf

Dec 30 Yale: Health Care in ETimor  Overview added Dec 31
"Summary & Conclusions: The development of an effective health care system in East Timor requires that the following issues be addressed: a) coordination of various health care programs ... b) complete the basic training of the East Timorese medical students who have completed some training c) develop longterm educational goals for the country, in terms of strategies to train physicians, nurses, para-medical personnel d) development of programs to train village health care workers ... " Fredric O. Finkelstein, M.D. & Susan H. Finkelstein, MSW, Yale University

Oct 30 UNSC: ET women: ‘Arria formula’ meeting  Speech added Nov 2
"We also call for a return of East Timorese refugees in West Timor, where women and children under the control of the militia are often sexually attacked and suffer from malnutrition and poor health. ... East Timorese women call upon the UN to provide resources for cost effective and community managed health promotion projects that cover reproductive health, communicable disease control and environmental health." Natércia Godinho-Adams, on behalf of East Timorese women’s organizations

Portuguese:
Out 15 OTL: Saúde - a retirada das organizações internacionais começou  Report added Nov 1
"Muitas das organizações internacionais ou ONG nacionais que entraram em Timor Leste em Outubro de 1999 estavam ligadas ao sector dos serviços de saúde. Vinham numa perspectiva de ajuda de urgência ou de apoio à criação dum serviço de saúde que pudesse servir a população timorense depois da fase de urgência. Dois anos depois algumas retiram-se e outras preparam-se para o fazer. Como se encontra a saúde dos timorenses e em que medida esta intervenção internacional terá contribuído para fortalecer o serviço de saúde do novo país?" Observatório Timor Leste

Oct 15 ETO: Health - international agencies withdrawing already  Report added Oct 30
"Many international organisations and Timorese NGOs operating in East Timor since October 1999 were involved in the provision of health services. They came to provide emergency healthcare and/or to support the creation of a health service that would adequate address the needs of the East Timorese after the emergency phase. Two years on, some agencies are leaving and others are preparing to do so. What is the health status of the Timorese now, and how has international intervention helped to consolidate the new country’s health service?" East Timor Observatory

August 2001 LHB: Childbirth: A Major Health Concern for Women  Article added Aug 22
"Three newborn babies recently died in our village, ... It is not uncommon for either the mother or child to die during childbirth here.” a village chief
"East Timor faces many serious health problems; for women, childbirth is one of most pressing. ... It is critical that these programs empower women as well as reduce heath-related problems. And it must always be understood that women’s health problems are deeply related to their socio-economic situation." La'o Hamutuk: East Timor Institute for Reconstruction Monitoring and Analysis

Jun 15 ET NGO Forum: Economic and Social Development Issues  Comment added June 18
"We want to see East Timorese health professionals and community representatives actively involved in developing a strategic plan for the health system. If the transition from a post conflict response to a viable health system is to be successfully achieved, performance indicators must focus on the development of the management and technical capacity of Timorese health sector staff in a realistic timeframe." Forum Nacional ONG Timor Lorosa'e / The East Timor National NGO Forum

Jun 13 ET NGO: Donors’ Conference: Health  Paper added June 15
"The pace of transition and the resources required for an effective transition from the post conflict situation to the development of a sustainable health system needs to realistic. ... [East Timorese] NGOs recognise that sufficient time is needed to consolidate and ensure the transfer of both management and technical skills to East Timorese both within the DHS employed staff and other civil society organisations." Forum Nacional ONG Timor Lorosa'e / The East Timor National NGO Forum

Mar 17 Lancet: Growing Pains of ETimor: Health of An Infant Nation  Report added Mar 19
"Let us not be tempted to build and develop modern hospitals that are costly and in which only half a dozen people benefit from good treatment. Let us concentrate above all on planning intensive campaigns of sanitation, prevention, and the treatment of epidemics and endemics for the whole population." Xanana Gusmão, de-facto President of East Timor

Portuguese:
Mar 12 OTL: Sistema de saúde: sustentável no futuro?  Report added Apr 14
"O sistema de saúde actual corre o risco de ser pautado por metodologias e equipamentos inadequados à realidade timorense, sobretudo após a retirada dos técnicos e organismos estrangeiros. O desenvolvimento não tem de passar obrigatoriamente pela implementação de sistemas sofisticados de topo de gama. A preocupação deverá ir antes de encontro às reais necessidades e capacidades da população, de forma a poderem ser os timorenses a criarem as suas própria instituições e a definirem as suas prioridades. Provavelmente, os resultados seriam mais lentos e menos brilhantes a curto-prazo, mas com certeza mais sólidos e duradouros." Observatório Timor Leste

Mar 12 ETO: The health service: sustainable in the future?  Report added Apr 13
"The present health system is in danger of being hindered by methodologies and equipment that are quite unsuited to the Timorese context, particularly after the foreign technicians and agencies leave. Development does not necessarily have to involve implementing sophisticated state of the art systems. The focus should be on addressing the population’s real needs and building its capacity, so that the Timorese themselves are able to create their institutions and set their own priorities. This may mean that it takes longer to achieve results, and these might be less spectacular in the short-term, but they would certainly be more solid and long lasting." East Timor Observatory

Nov 30 2000 TimAid: Health and Nutrition in Coleate Leotelo  Added Dec 17
"This report shows that the people of Coleate Leotelo are not only vulnerable, but already suffering from widespread illness, weakness, and lack of nutrition ... Organisations responsible for health and nutrition (such as WHO, WFP and INGOs) should take seriously their responsibility to publish in their monthly reports not only their activities (mobile clinics, data collected, the rebuilding of clinics, etc.) but also those health problems in their districts which they have not yet addressed, or which they doubt they will be able to improve." Mr. Borges, Mrs. Fernandes, Mrs. Santos, and the people of Coleate Leotelo

Nov 22 2000 KY: Danish survey highlights trauma, torture in E. Timor Added June 24
"Many people in East Timor have been tortured during the island's recent violent history and are now suffering post-traumatic stress disorder, according to a survey conducted Copenhagen-based International Rehabilitation Council for Torture Victims (IRCT). The study found that 57% of 1,033 East Timorese residents questioned in June and July this year said they had experienced some form of torture. ... The organization said too often the psychological needs of post-conflict countries are ignored at the expense of the physical rebuilding of a nation." Kyodo News Service

Nov 18 2000 Lancet: Torture & trauma in post-conflict East Timor Added June 24
"Our study also found that East Timorese people look primarily to family members, the church, and the local community for assistance, although they are willing to approach a doctor or community nurse for problems that they perceive as being health related. Psychosocial and rehabilitation programmes are therefore likely to be most effective if they are family and community oriented." International Rehabilitation Council for Torture Victims (IRCT)

Tetum:
Novembro 2000 BLH: Hari Sistema Saude Nasional iha Timor Lorosa’e  Overview added Nov 1 2001
"Ema barak nebe iha interse maka’as atu evolve sistema saudi nian fo kritika bar-barak kona ba dejenvolvimentu iha aspektu ida ne’e. Kritiku nebe ema barak hatene (Common) mak kona ba konsultasaun nebe ladun to’o ho populasaun lokal, ONG internasional no partner lokal sira nebe involve iha sektor saudi. Nune’e mos ema barak ladun fiar katak fundu la dun adekuadu atu bele fo garantia ba standar saudi minimu no sustainabilidadi praju-naruk em termus provisaun servisu saudi nian. Iha linha nebe hanesan iha mos concerns kona ba sasan tekniku nebe la to’o iha fatin atu hala’o treinu ba." La’o Hamutuk, Instituto Timor Lorosa’e ba Analiza no Monitoring Reconstrucao

Tetum:
Boletim La’o Hamutuk: [PDF formatu]
Vol. 1, No. 3, 17 Novembro 2000
Hari Sistema Saude Nasional iha Timor Lorosa’e:
http://www.etan.org/lh/PDFs/LHbul3tm.pdf

Tetum:
Nov 17 2000 BLH: Saude, Oekusi, Deskulpas, no Mina: Koneksaun Timor Lorosa’e ho Australia  Editorial added Jan 23
"Tanba ne’e maka Lao Hamutuk husu ba Governu Australianu atu halo kotu sira nia tuntutan ba direitu ruma kona ba mina no gas natural iha Timor Gap. La haré ba meritus legais nebe Timor Lorosa’e iha (ne’e be makas tebes), justisa basika haruka atu Canberra rekonhece no husu deskulpa tan sira nia passadu nebe halo moe tebes. Manifestasaun konkretu kona ba akto ida ne’e sei fo fatin ba Timor Lorosa’e atu menikmati, tanpa sanksi, beneficius hotu nebe sei hetan husi depositu mina no gas natural iha Timor Gap." BLH

Nov 17 2000 LHB: Building a National Health System for East Timor  Feature article added Jan 27
"the lack of significant inclusion of local businesses and organizations in the construction of health centers is a manifestation of a larger problem: the marginalization of local interests in the development of the national health sector." LHB

Nov 17 2000 LHB: Health, Wealth, Apologies and Oil: The East Timor-Australia Connection  Editorial added Jan 20
"La’o Hamutuk calls upon the Australian government to cease its demand for any rights to the oil and natural gas in the Timor Gap. ... basic justice requires that Canberra recognize and apologize for its shameful past. A concrete manifestation of such an act would be to allow East Timor to enjoy without sanction the full benefits of the oil and natural gas deposits in the Timor Sea. Such a gesture would be good for Australia’s political health." LHB

Nov 17 2000 LHB: Lessons from Indonesia’s Health System  Added Dec 26
"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)

Nov 17 2000 LHB: Vision for a People-Centered Health System in East Timor
"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

Nov 17 2000 LHB: Health Care and Privatization: Lessons from Mozambique
"It is unlikely that East Timor will be able to sustain any of its social programs on its own for many years to come, and will have to rely on foreign aid. The major question is whether that aid will be used to eliminate resource constraints in order to build a free, strong, universal health care system, or will it be diverted to a plethora of foreign agencies and privatization schemes?" James Pfeiffer, Case Western Reserve University in Cleveland, USA