Wednesday, February 29, 2012

Learning a little about forgotten East Timor

Hello, friends. It's been a long time. I'm here in East Timor. I'm going to assume you don't know where that is, since most people don't. It's a little island just to the north of Australia. If it makes you feel any better, this is what I knew about East Timor before deciding to come here: it's a small island in the South Pacific and something bad happened there about 10 years ago. So let me give you the quick and dirty summary of this poor country's history...

The Portuguese came around about 300 years ago during their days of colonizing everything that moved, and they took over this half of the island. The other half is part of Indonesia. In 1975, the Portuguese government had a major overhaul (too long a story for here) and with the support of various people they decided to grant Timor its independence. Well, it didn't take long for Indonesia to decide it wanted Timor for its very own, and they brutally invaded, aided by the superpowers of the world, who wanted to be on Indonesia's good side for the economic advantages. Well, they ruled Timor with an iron fist till 1999, when, prompted by increasing international pressure, the UN supervised a referendum where the Timorese overwhelmingly voted for independence from Indonesia. Now despite the fact that everyone had warned this would happen, and the US and Australia and others not only knew it but sold tons of arms to Indonesia in the meantime, as soon as the results were announced, Indonesia left Timor with the intention of leaving no Timor behind. They set fire to everything, raped, pillaged and killed, until they had truly laid waste to this country. Many, many thousands died. After a few days, an international peacekeeping force was assembled and sent in, but major damage was already done.The country was handed back to the Timorese as an independent nation of East Timor in 2002, but the UN had to come back a few years later and are still here. They are set to leave at the end of 2012, but we'll see if that's a good idea or not.

So now it's ten years later, and although there are signs of the extreme damage that was done here, they have largely rebuilt. Infrastructure is rudimentary at best, with no medical care available to the vast majority of the population, but I'll get to that. There are lots of UN trucks running around everywhere and a fair number of foreign aid workers, all of whom have crazy interesting life stories -- you don't end up in East Timor without doing some pretty cool stuff first. Outside of Dili, the capital, the country is largely undeveloped - basically jungle with a few roads running through it. So far I've found the people quite nice and welcoming, and since there really aren't any tourists here, it's not too spoiled the way other southeast Asian countries can be.

But now to the medical system, which is where I am working. You may be surprised to know that East Timor has the third highest rate of child malnutrition in the entire world. They are also almost at the top of the list for infant and maternal mortality. It's pretty dire, in fact. They have not only an epidemic of tuberculosis, but also of several tropical infectious diseases. Babies are almost all born on dirt floors of rural huts, and traditional medicine holds that you should put dirt on the umbilical cord, not touch the baby till the placenta comes out, and put water on the mother's breasts to help the milk come in. You can see how this might lead to infections. Or consider this - if you get a huge burn from, say, falling into your cooking fire, the way to treat it is to fill it with ashes and bird feathers. So there is a long way to go in this country.

In Dili there is a national hospital, which is staffed mostly by a collection of various foreign doctors, majority Cuban, and a few of Timor's first crop of doctors. They have one CT scanner, which apparently was donated by the Japanese, who specifically did NOT donate any money towards maintenance, so the scanner broke and beds have been brought in to use the CT room as a dengue ward. There is at least an x-ray machine, though, although apparently they only know how to do films from one angle.

I'm working in a little clinic called Bairo Pite, founded by an American doctor with a pretty inspiring story. He has been here for something like two decades and is trying to run his clinic with a model of sustainability - teaching locals to bring skills to their remote villages so that he can reach more than just the folks who turn up in the clinic here in Dili. There are midwives who are semi-autonomous (the first night I was here, there were six births in the clinic), two TB wards, an emergency area, and a lab with basic facilities including a donated PCR machine that can be used to identify drug-resistant TB - pretty fancy for East Timor!

One of the initiatives of the clinic is mobile clinics, where we drive out into the mountains to some extremely remote village and see a bunch of patients. The idea is not just to treat whatever issues they have but to form relationships and start to introduce them to the idea of western medicine. I went out on one, and maybe 30 skinny, scruffy kids came out from every nearby village to see me - not to get medical help, just to check out the "malae" (foreigner).

The patients at our clinic are a huge mix of your basic aches and pains with the most advanced presentations of TB you'll never have read about in your textbooks. There is a dengue epidemic going on here, so in addition to seeing patients in the clinic, I end up making house calls to westerners who are getting sick as well. We have several medical mysteries and some very tragic cases of cancer that we just don't have the facility to treat anywhere in this country so we are left basically with palliation. We've got a selection of psychiatric patients that are a huge challenge as well. So I'm seeing a bit of everything, and I'm given a huge amount of responsibility, which is scary and challenging, but generally very rewarding.

Anyway, that's probably more medical information than most of you wanted, but it's most of what I'm doing here, and I'm working 7 days a week, so I haven't gotten any chance to travel around at all. It's a fascinating country with a history that I think is really important to know because it has important lessons about how powerful countries value the lives of some people over others or value most the oil that they may get from the nearby waters. There are some excellent books written on the history of East Timor by first hand observers, and I'd be happy to share the names with you or tell you more about it if you get in touch with me. That's all for now. Hope you are all enjoying your winter while I battle my heat rash and the mosquitoes down here in Timor-Leste!

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