Impressions of Timor Leste
- Deren Pillay - medical student from Sydney Medical School, undertook an ILA in Timor Leste in 201213
- Colin Tuft - medical student from Sydney Medical School, undertook an ILA with the Ministry of Health, Timor Leste in 201112
Being one of the youngest countries in the world, Timor-Leste is facing healthcare challenges common to many developing countries. Uniquely, some of these stem from the decades-long struggle for independence from Indonesia. While the majority of problems are associated with a lack of both medical and human resources, others are related to communication and cultural barriers.
During my month-long visit I had the opportunity to experience medical practice in both hospital and community settings. My first week was predominantly spent at the Dili National Hospital. The hospital is the only major healthcare facility in Timor-Leste, serving its growing population of over one million people. Here I spent most of my time with the incredibly welcoming and helpful St. John of God (SJOG) nurses, particularly in the ICU, Paediatric and Neonatal wards. I also shadowed ED doctors who were keen to teach clinical and procedural skills such as venepuncture, cannulation and catheterisation.
Also based at the hospital is the Royal Australasian College of Surgeons (RACS) who introduced me to the Timorese surgical team. Seeing and participating in a surgery for the first time was an exhilarating experience. In one day you could see quite an extensive range of surgeries – hernia repairs, caesarean sections, tumour excisions, hysterectomies. Although the operating rooms were not as well equipped as those in Australia, the surgical team was amazingly resourceful; a useful trait for working in medical facilities throughout Timor-Leste.
Apart from Dili National Hospital, I volunteered at Bairo Pite Clinic. The clinic is a free medical service headed by an American doctor who the Timorese affectionately know as Dr. Dan. Ward rounds run every morning where Dr. Dan reviews inpatients while imparting his medical wisdom to students. Most students volunteering at the clinic were in their final years, so they were better equipped to dealing with clinical dilemmas than a first year such as myself. Nevertheless, I was still able to assist with minor tasks such as monitoring vital signs, transporting patients to the hospital to receive X-rays and blood tests, and researching treatment options for complex cases.
The University of Sydney has ties with Klibur Domin (KD), a Tuberculosis and Rehabilitation centre west of Dili. Although not as high-paced as the hospital or Bairo Pite Clinic, KD offers the opportunity to become more involved in the community. KD is involved in outreach programs where staff members are transported into the districts to serve rural communities through education, TB and malaria testing and other medical and support services. Not only were the outreach programs great for observing community medicine; it was also a fantastic way to take in Timor-Leste’s rich culture and natural beauty.
Culture has a significant impact on medical care in Timor-Leste. Traditional medicines are often given priority over western medicine. Thus a large proportion of patients present with advanced stages of disease, leaving palliation as the only treatment available. Sadly, this means that for the Timorese, the hospital and other western medical facilities are associated with death, therefore perpetuating the cycle of avoidance and late presentation.
While Timor-Leste is an ideal location for medical tourism it offers equally as much in the way of regular tourism. Atauro Island, just off the coast of Dili, serves as a getaway destination for both locals and expatriates. A couple hours ferry ride away; Atauro has beautiful, almost untouched, white sandy beaches as well as breathtaking snorkelling and dive sites. I spent an incredibly relaxing weekend here with a group of intriguing medical students I met at Bairo Pite Clinic. Apart from Atauro, Timor-Leste has a range of other great locations see – Jesus Backside Beach, Jaco Island and Mt. Ramelau to name a few.
Although immensely frustrating at times, spending a month in Timor-Leste was the most rewarding experience of my life. I expanded on my repertoire of clinical and procedural skills. I gained a deeper insight of the healthcare challenges faced by developing countries – tropical communicable diseases (TB, malaria, dengue), poverty, malnutrition, communication, a lack of resources and medical personnel. I learnt a new language (Tetun) and became engrossed in a unique culture. And most of all, I was inspired by the Timorese people, their charm, humbleness, resilience and national pride. For these reasons, I highly recommend Timor-Leste to anyone wanting a unique but challenging experience of medicine and healthcare in a developing nation.
"Few things in my life beat the four weeks spent in Timor-Leste in hospitals, clinics, rural villages and hanging out a 4WD's sunroof. The medical experience was unique, set in a country only a decade old with a fledgling health system staffed by people from all over the world. The culture is fascinating and charming; the people are open and friendly yet still personally impacted by the decades of brutal Indonesian occupation. And the country is stunningly beautiful, with Australian, Caribbean, South-East Asian and German landscapes all within a tiny 200 by 40km nation.
Something that should be known before applying for Timor is that everything in the country works on a very relaxed organisational system known affectionately as 'Timor time'. Despite insistent and later desperate attempts at communication very little was organised by the time we landed in Dili. Thankfully this proved to be no problem, as the hospital was very welcoming and the expat community helpful and generous. We spent most of our time at the National hospital in Dili, under the wing of the generous and lovely nurses of St John of God. Our time was divided between assisting the nurses and doctors in the paediatric and emergency wards. On several occasions Australian surgeons from RACS arrived to do an intense week of surgery, so we saw a number of interesting operations and enough cataract surgeries to last a lifetime. The resources in the wards and theatres are limited (the surgeons found it surprisingly easy to adapt to regular power failures), and the patients often present in advanced stages of disease. The majority of cases would not be seen here, with much TB, malaria, dengue and countless malnourished children. The work there was confronting, but infinitely valuable from a clinical point of view, with a vastly different pattern of diseases to what is seen in Australia.
In order to gain a comprehensive perspective of health in Timor-Leste we visited one of the district hospitals in Oecusse, and spent time in a free, charity-run clinic in Dili. We also managed to tag along on an outreach clinic to a rural area which provided education, registration of births and medical services to people far from any health facility. Apart from the clinical experience accrued from our time there, the most valuable understanding I gained was of public health in developing nations. I found it fascinating observing how the hospital system worked with so few resources despite the fact that patient notes were written in 4 different languages. Equally fascinating was learning about Timor's development from the ashes of 1999 from the welcoming and friendly expat community of NGO volunteers, UN workers and military personnel (I wish there were pubs like the Dili Beach Hotel in Sydney).
Lastly, in order to gain a truly comprehensive perspective of life in Timor-Leste we travelled the entire length of the island with some vital med students we met in Dili, dived spectacular coral gardens and taught orphans in a mountain village how to play the didgeridoo. How can you expect to understand the intricacies of medicine in another country if you don't understand the culture and environment.
I would recommend Timor-Leste highly to anyone interested in a career in developing world medicine, and would be more than happy to answer questions about the charming fledgling nation."