| Background
East Timor is the east half of the island of Timor, a tropical country, situated at around lat. 8th degree south and 130th degree east. The referendum on the question of independence brought the East
Timorese people the first liberation from foreign governments after around four centuries. However,the vandalistic behaviours of the pro-Indonesian militia and Indonesian forces for around two decades and especially just after the referendum left the profound ruin of the whole country and public welfare. What I saw in October 1999 were burnt houses and public facilities, exhausted and/or sick people, food shortage, lack of transportation tools, failure of electric supply, dead farm and commerce, etc. The medical and health services were almost not available in the whole country.
East Timor has an area of 14,874 square km, and a population of around 800,000, however, there are only a dozen local physician and two dentists. The Alliance of Friends for Medical Care in East Timor (AFMET)
A physician sister of the Visitation Sisters, Japan, alone or with some volunteers has been coming to East Timor, mostly to the easternmost town, Fiuloro, Lautem district, of East Timor, to see many sick people and administered them with remedies more than ten times since 1991 by courtesy of local Salesian fathers and sisters. Although her devotion for the local people was great and thankfull, we were becoming aware that her activities would be overwhelmed by the difficult conditions of this country. The resoluteion of the problem was studied by three parties in Japan: her supporter group, the Visitation Sisters, and the Japan Lay Missionary Movement. In the result, a third organization was established on May 31st, 1999, i.e. the AFMET.
First of all, the aim of afmet was to back up the people of East Timor, particularly Lautem district, so that they may work themselves for overwhelming tremendous diseases and for improving the poor conditions of health and hygiene. Unfortunately, however, the unbelievable violence by militia and Indonesian army, as above mentioned, were growing more and more, especially after the referendum. Facing terrible everyday reports from this country under murders and burnings, we were very impatient. We decided to send a medical mission to Fuiloro as a most emergent arrangements as possible at that time. A few members arrived the Salesian precinct buildings in Fuiloro and started an urgent medical servicee since December, 1999. Then tens or over hundred people visited our temporary clinic asking remedies or wound dressing day by day. The main complaints or illnesses were diarrhoea, malaria, upper respiratory infection, tuberculosis, scabies, etc.
Meanwhile, the AFMET staff was studying how to start the original activities: the primary health care primary health care. They concluded that the AFMET activities should be summarized as follows:
- Social Activities
- Referral Centre
- Building
- Activities
- Community (primary) Health Worker (CHW)
- Education and training
- Disposition and activities in villages
- Construction of CHW network
- Generalisation of PHW in wider area
- Establishing local Health Committees
- Medical Services
- First aid or simple clinical services with medicines on hand and injury treatment
- Transportation of the emergency and/or severe patient to hospital . The Research on the realities in village life
It is essental to know the realities of the local lives in order to construct the AFMET activity system. Then, as the first step, 5 neighbouring villages to our clinic were chosen as the subject of research. The total population of the villages was estimated at around 3,000 (400_1,155), but of these 177 persons (between 20 and 49 y. old: 81.36%) were subjected to the research.
The rate of school attendance was 65.0 %, and the graduates of primary, junior high, and senior high school was 14.1%, 15.8%, and 10.7%, respectively, and the graduates of university?college were only 3 persons (1.7%). The speakers of Tetum (the official language) were 78 (44.1%), of Fataluku (the local district language) 172 (97.2%), of Indonesian 105 (59.3%), of Portuguse 18 (10.2%), and of English 1 (0.6%). Persons who knew malaria was relevant to mosquitoes were 107 (60.5%), and the rest had some wrong knowledge. Lavatories were used by only 32 persons (18.1%).
Only one village could get water supply through aqueduct ( but partly in the other two villages). Almost all persons drunk boiled water, while 56 persons did not know why water should be boiled. Persons who ate meat and/or fish once one or two weeks and a month were 25 (14.1%) and 49 (27.7%) respectively; and 22 persons (12.4%) answered 'impossible' to have them.
Around 90% of the subjects answered children were delivered at home, and of them 57.1%, 15.4%, 9.1%, 7.4%, and 10.9% were midwived by mother, husband, traditional midwife, licensed midwife, and others. The umbilical cord was cut with bamboo, or knife or scissors only washed with water, but we have not experienced any tetanus case.
The people were asked in 4 villages (n=100) how much could you pay for medical service. Of them. 56 persons answered 'can not', and 23 can less than Rp 1,000 (=\10), 6 less than Rp 2,000 (=\20), and 15 can pay more than Rp 2,000. Community Primary Health Worker
There were but two local physicians in our sub-district, Lospalos, who were working for a tiny public hospital. As one of them engaged himself for administrative duty, the other doctor should receive out-patients. In order to compensate such a medical condition and the above-mentioned health and hygienic circumstances, we decided to bring up some villagers to community health workers. They should work as health caretakers of their own village dwellers without doctor referring to the AFMET Centre under volunteer base. In February 2001, we started the education and training of 19 health worker applicants who were selected from 5 villages by the Xefe, catechista, etc. The text-booklets of very simple style were provided on many topics about diseases, nutrition, health control, hygiene etc. with reference to and by courtesy of Dr. Tabella, Manila, Philipines. The students were taught by local licensed nurses and midwives under the supervision of the Japanese staff. On February 20th. 2002, the one year training course concluded, then, 9 new health workers were presented with the certificates. They are already working for their own villagers.
Since the same day, the second course started for around 25 new students. We are looking for seeing the next graduates as may as possible in February 2003. Referral Centre
We had settled the local activity base of AFMET in the Salesian Monastry. Together with primary medical work, the primary health care activities and the community workers' training require to have our own building (s). During 2000, three houses were built in vicinity to the Monastry courtesy of a luirai's widow: 1. control and dormitory house, 2. lecture house, and 3. medical house. The inauguration Mass was offered by Archibishop Jun Ikenaga, Osaka Diocese, Rev. Mario Belo, Vicar General of Baucau, Fr. Joseph, SDB, Fuiloro,and Fr. T. Yamaguchi, Yokohama, on February 17th, 2001. Medical Service
Since the medical mission arrived Fuiloro, the AFMET received many patients with varied complaints. From April 2001 to March 2002, 11,145 cases of patients visited the Referral Centre. Of them, upper respiratory infection: 25.1%, lower respiratory inf.:17.1%; malaria: 10.9%, skin disorder: 6.3%; diarrhoea: 5.2%; and injury:4.8%. In the same period, 284 patients were referred to the hospital: respiratory:17.3%; obstetric:13.4%; malaria:12.7%; injury:10.2%; fracture: 4.6%; dental: 1.8 %; dermatological: 1.4%; others 29.2%.
On the other hand, selected patients with tuberculosis (Gaffky positive) have been administered with two drugs under supervision according the protocol of Caritas Norway. Discussion and Conclusion
The medical and health/hygiene situation of East Timor was considerably poor under foreign colonial or occupation policies. Moreover, the conditions got more ugly after the referendum of August, 1999. From the beginning of the AFMET activity, we have received sick persons asking remedies, although our original activity should be the primary health care. This is very local work, and if our foreigners concern themselves directly in it, the linguistic problem must become a strong barrier, particularly in the easternmost district where we work. This was one reason why the local persons should be educated and trained for the primary health work besides their self-support. Therefore, we started the education of the literate villagers on the primary health care without doctor after the research on the reality of village life. Hereafter we should increase the students of communities health care, and distribute them in more villages forming a network of the primary health workers in the district.
The Ministry of Health of the East Timorese government has officially established, accordingly, we, AFMET, should work in concert with it, and support the health and hygiene of the local people. We hope the government may concretely construct a medical and hygiene administration system as early as possible.
The AFMET has been running by donation of Japanese Catholic people and non-Catholic people of good will and by subsidy of the Japan International Cooperation Agency (JICA). We should provide for financial problem, which may encounter in near future, because tragic incidents successively occur somewhere in the world, consequently the interest of people shift from East Timor to recent occasions. |
