Recent elections in Timor-Leste and the civil unrest that followed resulted in restrictions on travel to unsafe areas on the mainland. This necessitated Australian Aid International's (AAI) reassessment of alternative areas of operations as part of the AAI
- Oilex Partners in Health Initiative Program . Based on a request by the Timor-Leste Ministry of Health (MoH), AAI commenced operations on the remote island of Atauro located 30km off the coast of Dili .
This remote area has been historically under-serviced in terms of healthcare, but this has become more pronounced since 1999. When compared to nation-wide Timor-Leste health standards, Atauro suffers more than most other parts of the country. The most significant short-falls on the island are the lack of adequately trained staff, functioning healthcare facilities, suitable emergency transport to Dili Hospital and medical supplies and equipment. Atauro's remoteness and isolation from the mainland is a major contributing factor to this inferiority.
Many population centres on the Island are only assessable by foot or boat. The most significant villages are Atekru, Baruana, Maquili, and Bequili. The vast majority of the island's inhabitants have not had any healthcare service for over 12 months, with some areas suffering from chronic neglect for nearly ten years.
Earlier this year AAI, in conjunction with staff from the local NGO Bario Pite Clinic, visited the island to conduct health assessments. The Bario Pite Clinic and AAI began servicing the community of Macadade on a monthly basis. Simultaneously, AAI commenced a project in conjunction with the Atauro Sub-District Health Service (DHS) to support further mobile outreach clinics to other remote communities and provide health promotion activities. AAI and DHS staff are now beginning regular outreach mobile medical clinics in some of the most urgent locations throughout the island.
A new road project has recently been commenced on Ataruo that will eventually make the Macadade village more accessible. AAI staff originally accessed the area by hiking for six hours up a steep mountain track. Macadade is located at both the highest point on the island and on its windward side, with cold temperatures at night and frequent gale force winds. The residents of Macadade have to walk 3km along steep mountain tracks to the only available water source, a spring, transporting all water by hand.
AAI also supports health services at Atekru and Baruana. Both of these villages are only accessible by canoe with bamboo outrigging and motor, with AAI providing the necessary fuel for the outboard motor. It is currently the only water transport available for the mobile medical outreach clinics. The transit to Atakru usually takes two hours. The mobile clinic is conducted at the local school where approximately 100 patients receive medical assistance each day that the clinic is operating.
A major concern for the Island is the lack of suitable watercraft that can quickly respond to emergencies and evacuate patients to secondary healthcare facilities that are only available in Dili. The MoH has asked AAI to assess the National Ambulance Service capabilities. The ambulance maritime capability for open water transits from Dili to Ataruo and for island coastal services will be included in the assessment.
An example of the desperate need for this maritime capability is the case of Nema, a local woman who died due to complications during her first pregnancy. Her husband Barry, an Australian, is the owner of a small guesthouse on the island. He has been very generous in his support of AAI in recent months.
Nema and Barry married in 2004 and Nema soon became pregnant. Sadly, Nema developed eclampsia (a serious complication causing high blood pressure during pregnancy) when she was 37 weeks pregnant. Nema was found fitting on her bed and despite the best efforts of three English doctors staying at the guesthouse and a Cuban doctor who was based on the island, the fitting could not be controlled. After fifteen hours, Nema and her unborn child died.
This tragedy highlights the desperate situation on Ataruo Island . Nema urgently needed to be evacuated to Dili National Hospital , but due to the Timor-Leste Ambulance Service's lack of suitable watercraft they were unable to perform the journey.
AAI's healthcare project for the people of Atauro has been supplemented by working with other MoH and WHO programs. This collaborative work that has been extended to the island is further enhancing the local healthcare staffs' skills and knowledge. This has enabled local staff to readily recognise such diseases as scabies, Yaws (associated with Syphilis of the skin), fungal infections and leprosy, which is endemic on the island.
AAI's collaboration with the Atauro District Health Chief, Mr Lucas, the MoH, local village leaders and ministers has resulted in large numbers of patients attending our mobile outreach clinics with AAI treating approximately 400 patients from our last weekly visit which comprised of five separate clinics.
AAI have been able to provide health promotion information sessions to local communities on subjects that are important to their specific needs. AAI intends to increase these health promotion activities on future visits as well as conducting important on the job training with existing health providers.
AAI has been funded to support Atauro until December this year. As a result, we must begin implementing our exit strategy in the very near future, which will mean difficulty in providing a long-term sustainable health solution for the island's community. Although the work that is currently being performed is of great benefit to the community, to achieve project objectives operations must be maintained for a further 12 months.