|Subject: Rebuilding the Health System in East Timor
Page 14 The NSW Doctor April 2003
Rebuilding the Health System in East Timor
By Alana Nixon
Since The NSW Doctor last reported on Dili’s Bairo Pité Clinic in August 2001, East Timor gained independence after 24 years of Indonesian rule and centuries of Portuguese colonisation. The East Timorese are now free of Indonesian military occupation but much work is still needed, especially in terms of healthcare.
American Dr Dan Murphy has been working voluntarily in East Timor since 1998. He was deported and blacklisted by the Indonesian government before the independence ballot in August 1999. Dr Murphy promptly returned in September 1999 to treat patients while the Indonesian military carried out their post-ballot destruction of the country. One month later, Dr Murphy established the 24-hour, 7-day-a-week Bairo Pité Clinic. The clinic is beside a small river and bordered by a busy helipad on one side and a constant stream of cars on the other. Numerous animals graze in nearby paddocks and the roosters start crowing at 4am.
Dr Murphy was drawn to East Timor because, “of all the people in the world, the East Timorese have probably suffered more, with the least amount of justification, than any other people on earth. They were just blatantly taken over by a neighbouring country with the nod given by all the important western powers. In 1998 there was an opening for me to finally come over here because Suharto was finally removed from power in Indonesia.”
The UN is still there but in a much reduced capacity as the East Timorese start to take control of their own affairs.
Dr Murphy said the Ministry of Health was starting to “search for its own identity”, whereas it used to be dependant on the World Health Organisation and the World Bank.
“The World Bank is starting to do a lot of health-related consulting and giving loans and grants within the health field, so there are a lot of outside influences. But the Ministry of Health has been given a high priority and they’re trying to figure out what would be the best way to deliver healthcare,” said Dr Murphy.
Since the clinic opened, more than 6000 people each month have been treated by Dr Murphy and his team of about 30 staff, which includes nurses, midwives, dental technician, medical students and support people. In busy times this means as many as 300 patients per day. The clinic was built and entirely funded by donations and has been aided at times by government and nongovernment agencies.
“We aren’t tied into the national health care system as well as we would like, partly because we were here before they were and we’ve been doing many different things that don’t fit into their comprehensive health plan. They have a plan that they think will cover the whole country and it calls for small clinics here, there and everywhere. It all makes sense on paper, but we’re different because we’re by far the biggest clinic in the country and they really haven’t found a way to integrate that into their national plan,” Dr Murphy said.
Tuberculosis is the major health problem in East Timor, and the clinic co-ordinator, Australian medical student Clive Pickering, said other issues like HIV were not being addressed.
“The government is still learning how to implement a public health care system, so they’re not addressing the major issues like HIV. There’s a cultural problem with the treatment of HIV, because the East Timorese don’t talk about sexual relationships, so how can you bring up the topic of transmission and safe sex behaviour? These are issues that have got to be dealt with now, not when the health care system finally kicks in,” he said.
One of Mr Pickering’s greatest hopes for East Timor is a medical school.
“It’s definitely got to happen, even just at a basic level. If I could get four or five professionals to the clinic to start teaching our staff and bring them up to an Australian level I’d be over the moon.”
It is easy to see why more doctors would be welcomed. In a country of 850,000 people there are only 47 doctors - one doctor for every 18,000 citizens. In NSW the ratio is one doctor for every 267 people.
Mr Pickering said countries such as Australia had been generous in their support of the clinic, but funding was spasmodic.
Dr Murphy can only leave the clinic when he has time to undertake fundraising drives and has travelled as far as Ireland in search of sponsorship to keep the clinic going. The clinic needs surprisingly little money to keep running - US$2,000 per month for operational costs and US$3,000 for staff salaries.
Health in the third world has always interested University of Melbourne medical student and Bairo Pité Clinic volunteer Benjamin Namdarian, due to his father’s upbringing in a mud-brick village in south west Iran.
“I was given a 14-day visa for my month-long stay in East Timor, lived in a shipping container similar to a shoebox, heard cries of ‘Hello mister! everywhere, had near death experiences on the roads, slept with mosquito nets and ants, and ran with Dr Dan at 4am! I will never again take for granted the luxuries we have in Australia, not simply in terms of medical care and resources, but rather the complete setting of society that facilitates health care provision such as roads, sanitation, clean water and education,” said Mr Namdarian.
Alana Nixon is the AMA (NSW) Communications Officer
Assisting the Bairo Pité Clinic:
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