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Timor Leste Programme Reports 


2007 - AAI continues returns to Timor Leste

On March 16th, 2007 AAI returned to Timor-Leste where it created and promote long term health activities in close collaboration with health authorities and with the funding support of Oilex Ltd, an Australian oil and gas exploration company operating offshore in the Timor Sea.

Serious concerns about the security situation have hampered efforts by NGO's and UN operations to improve current conditions. The current areas of concern are rice shortages, population displacement, lack of quality shelter, water and sanitation requirements, health, nutrition and education. Organizations must now also shift their attention to waterborne diseases and potential natural disasters.

MINISTRY OF HEALTH REPORTS

AAI in partnership with the Ministry of Health of the Democratic Republic of Timor-Leste (MOH) in the sub-district of Atauro started specialised medical operations in October, 2007.

AAI provided healthcare projects in support of the MoH and District Health Services (DHS) as and where the major needs arose. AtauroIsland is an area of current focus which is one of the most remote and needy communities in Timor-Leste. AAI have begun the foundations of a long term healthcare project on Atauro that aims at providing support and supervision for the District Health Service.

This project aims to provide a legacy for health support to the communities of Timor-Leste. This will be achieved through the development of existing staff to accomplish a sustainable relative autonomy of health management within the community without the need for outside intervention.

Click below to download and read AAI's report to the Ministry of Health of the Democratic Republic of Timor-Leste (MOH) every month:

For February 09 click here.

For January 09 click here.

For December 08 click here.

For November 08 click here.

For October 08 click here.

For September 08 click here.

For August 08 click here.

For July 08 click here.

For June 08 click here.

For May 08 click here.

For April 08 click here.

For March 08 click here.

For February 08 click here.

For January 08 click here.

For December 07 click here.

For November 07 click here.

For October 07 click here.


6 April 2009 - Community Health Centre Safe Water Project on Atauro Island

This report recommends constructing a SkyHydrant water filtration system

The most sustainable solution is to install a water filtration unit at the clinic in the location of the existing CHC reserve tank, making it easy to feed the filtered water into the existing piping for the clinic. A water tower will be constructed in the vicinity of the existing reserve tank, and a new 1000 liter plastic water tank will be placed on top. A small water pump will be required to pump the water to this header tank. The CHC does have electricity, but it is unreliable and usually only available for a couple of hours per day. A solar panel will be installed to provide the necessary electricity to operate the water pump. Water from the header tank will then gravity feed through the SkyHydrant filter and into a new 1200 liter plastic distribution tank that will be mounted on top of the existing concrete reserve water tank. This system will supply the clinic with a greater supply of clean water and increase the pressure at which the water is delivered.

Click here to read report the final report.


13 March 2009 - Funding shortage exposes thousands to disease

Thousands of people living on a remote Timor-Leste island will be put at risk of death and disease if an Australian-based aid program is forced to withdraw at the end of this month due to lack of funds.

Access Aid International is working with officials on AtauroIsland, about 30 kilometres by sea north of Dili, to deliver healthcare services and education to isolated communities affected by disease and limited resources.


7 February 2009 - Asian Disaster Reduction and Response Network Disaster Risk Reduction Training

According to the United Nations Human Development Index, the Democratic Republic of Timor-Leste suffers from substantial human insecurities and is therefore much more vulnerable to the effects of disaster than most other Asia-Pacific nations.

The capacity of the people of Timor-Leste to reduce their vulnerability to disaster is limited due to current social and economic factors including an estimate 40 percent of the population living below the poverty line and unemployment currently at over 50 percent. The United Nations estimates that only 20 percent of the population has access to safe water and only 15 percent to life sustaining sanitation facilities.

DRR initiatives and the development of community capacities must be ongoing and mainstreamed in order to reduce the affects of natural and human induced hazards. Reducible vulnerabilities are a significant contributing factor to the community's current human-insecurity.

In December 2008, ADRRN requested a funding proposal that would provide DRR training to LNGOs within Timor-Leste. In January 2009, a DRR training program was awarded to AAI, which was to be implemented by March 2009.

The Government of Timor-Leste released a National Disaster Risk Management Strategy in March 2008. The lead ministry of Disaster Risk Management (DRM) is the Ministry for Social Solidarity (MSS). The MSS received stimulus funding from AusAID to assist with development of DRR within Timor-Leste. This package included a managing consultancy group with advisory positions in the MSS DRM Secretariat and was responsible for the management of DRR funding allocation. To this end, a DRR working group, consisting of six international NGO's with local partners, via a managing consultant group, received funding by AusAID, to develop community based disaster risk reduction committees.

Click here to read the report.


1 February 2009 - Knowledge, beliefs, and practices regarding malaria control on AtauroIsland in Timor-Leste

The goal was to provide information on current knowledge, attitudes and practices related to malaria in the Atauro sub-district of Timor-Leste to help inform local malaria programs.

Click here to read report.


18 August 2008 - Senators Lyn Allison and Trish Crossin visit Timor Leste and AAI Program 

Vikki McLeod traveled to Timor-Leste in July 2008 in the company of Northern Territory ALP Senator Trish Crossin, former Australian Democrat Senator Lyn Allison, Independent Health consultants Dr Christina Richards and Dr Jo Dower.  The focus of the trip was reproductive, maternal and child health.  The findings and recommendations will be reported to the Population and Development Committee of the Senate. Below is her impressions of that visit

Image shows Marc Preston, Sen. Allison, Vikki McLeod, Felicidade Guterres, Sen. Trish Crossin, Dr Jo Dower in Dili

"The first impression of Timor-Leste is the poverty and the compelling need of the Timorese people.  The history of Timor-Leste, their struggle for independence and security problems are well known, but those who live in Timor say it is the most secure it has been for many years. 

There are still a number of IDP camps - near the airport and the churches. The T-L Government, the UN and international NGOs are working to improve the security situation and also to build governance and critical infrastructure.  Central to this aim is to improve the level and availability of both safe and widespread medical access. 

Timor-Leste has one of the highest maternal mortality rates in the region. Studies indicate that the causes are similar to those experienced in similar developing countries - newborn babies die or are experience injury because of birth asphyxia, trauma or infections. 

There is also low nutritional awareness.  Many households have access to balanced and nutritious diet but economic pressure means they need sell rather than consume themselves.  Rates of malnutrition amongst children are around 60%. 

Traditional cooking practices are over an open wood fire in the home and with no ventilation, resulting in respiratory problems particularly for the women and the children. 

The Timorese population largely rely on traditional medical practices. These are often based on spiritual beliefs rather than medical practices and some are unsafe.  There is a great deal of misinformation even amongst trained staff. 

The T-L government is concentrating its efforts on what is known as the Basic Services Package.  The emphasis is on providing local access in all 442 village areas to a basic set of health services.  The proposed structure is 1 doctor, 1 midwife, 2 nurses that is nearly a thousand trained health professionals to service a population of 1 million.   There is an aim to have basic and emergency obstetric care in all community health centres across the nation.  T-L government plans to be self-reliant in health professionals by 2020. 

The number one constraint is human resources.  There is a critical lack of health professionals in the country and not enough skilled people at all levels to do the work.  Training, skills development and capacity building is essential to meeting this goal.  T-L has an oil revenue of $200 million a month and a surplus of $4 billion.  But as a young country in the early stages of development it is facing the difficulties of developing budget processes, implementation and delivery programs. 

This is where organisations like AAI play a critical part in developing health infrastructure by raising awareness amongst rural communities of basic health, nutrition and hygiene.  AAI are also building capacity through their training and employment of Timorese nationals.  AAI's Safe Water project is also a key preventative health program that will create a healthy and thriving population."


16 October 2007

Recent elections in Timor-Leste and the civil unrest that followed resulted in restrictions on travel to unsafe areas on the mainland. This necessitated Access 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 DiliHospital 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 guest house 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.

  


16 September 2007 - AAI focuses on the island of Ataruo

As part of AAI's Rural Healthcare Project on Timor-Leste operations have now focused on the remote Island of Ataruo just off Dili.

Used by the Portuguese as a prison island from as early as 1520, housing criminals and political prisoners banished from Portuguese colonies the Timorese district of Atauro is separated from the rest of Timor Leste by 30km of an often ferocious ocean. Descendents of these prisoners over time have integrated with the indigenous population and still live on Atauro today. With a local Ferry visiting only weekly, the population of approximately 8000 are very isolated from the rest of Timor Leste.

The island is divided into five sub districts Biquely, Beloi, Vila , Maquili and the most populated Makadade. The average age of the population stands at nineteen with 41.5% under the age of fourteen. With one central health centre and only two of the four health posts open and operational, health care is a major concern on the island. According to recent data collection from the Central Health Centers' Director, Mr Lucus, leprosy and tuberculosis numbers have increased and under five, childhood morbidity and mortality remains a crucial problem.

Working with the Ministry of Health, Mr Lucus and Bario Pitte Clinic, Access Aid International has commenced preliminary assessments of the island to determine needs and the vulnerability status of the sub districts. 

Goal

Improve the level of healthcare to the Atauro population by providing essential health services, up skilling local staff and empowering the local community.

Purpose

Increase access to quality health care for the most isolated and vulnerable beneficiaries in the Atauro District.

1: Outreach clinic support

  • Provide access to healthcare for the most vulnerable and remote communities and high risk areas with the highest morbidity and mortality.
  • Assist in the provision of direct clinical services, as needed, to fill gaps in health care. Strengthen referral and pathology systems, and communicable disease control data collection as per MOH Standards.

2: Up Skilling, educating and mentoring of Local Health Staff.

  • Up skill health staff at the health facilities in Atauro sub district in line with the MOH standards and guidelines.
  • Strengthening of communicable disease control, detection and prevention while strengthen information system

3: Build, strengthen, sustain and empower institutional, community and human resource capabilities.

  • Increase knowledge and awareness of major health concerns specific to Atauro, and access to health information through community based teaching.
  • Increase health facility utilization by those sub-populations most at risk; children under 5 and women of child-bearing age.
  • Involve communities in preventative and environmental health programs. Ensure primary health facilities are equipped and adequately supplied for appropriate function in accordance with MOH standards.

11 September 2007 - Local Nurse Making a difference

Cesario Joao Amado Marques da Conceicao joined the Access Aid International team in June 2007. He was born in the Timorese District of Oecusse in 1977. Oecusse is situated in the northwest region of Indonesian West Timor and roughly a seven hour drive from Dili. Oecuesse is isolated from the rest of Timor Leste by Indonesian territory.

Cesario studied nursing in the District of Baucau finishing in 1996 and began working with the Dili public hospital (RSUP). From 1999 to 2001 he was employed by International Crescent of the Red Cross (ICRC) before moving to Dili National Hospital where he currently works part time as a staff member. 

                                                         

There are seven Internally Displaced Persons (IDP) camps in Dili, housing approximately 38,000 people. After his house was reduced to ashes in the May 2006 riots, Cesario was forced to live in one of these camps with his wife and three young children.

Specialized in neo natal care, pediatrics, childhood malnutrition Cesario also boasts extensive knowledge on Tuberculosis and Malaria. With his expansive knowledge and experience he has become an impressive educator and mentor to not only the AAI local staff but the community at large.

Ceaser has become an integral part of the AAI team sharing our mission and vision for Timor Leste health. His engaging manner with the neighborhood children has made AAI's project of interactive learning for children in Dili a very successful initiative. 

Crystal Brown and Emma Clemets - AAI Project Nurses

21 August 2007 - Education Is The Key

With a population currently estimated at just over one million, more than 46% of the population over the age of eleven have never attended school and are unable to read or write. The Democratic Republic of Timor - Leste Ministry of Health has highlighted that the community at large has a "lack of awareness of health problems, particularly among women and a general lack of health benefits." (Health Profile 2002).

The only way to ensure ongoing health progress during the present development phase in Timor is to offer more than just curative care. While acute medical care is always required to treat signs and symptoms of illness and mobile clinics offering patient doctor consultation is only a medicinal measure. To see an improvement in overall community health it is imperative that basic preventative measures are put in place. The only way to do this is to impart knowledge to the community, elders, nursing mothers and children alike. This education enables the community to become empowered and in control of their health status.

- 

Access Aid International has begun this preventative / educational process by conducting Community Based Training sessions in the sub district of Aileu Vila. A total of 105 people from the community of Fatubossa attended the training session, accompanied by the local nurse and the village chief.                                                    -

Access Aid International has begun this preventative / educational process by conducting Community Based Training sessions in the sub district of Aileu Vila. A total of 105 people from the community of Fatubossa attended the training session, accompanied by the local nurse and the village chief. 

Topics that were covered during this session were chosen in accordance with the current health needs and the new health program that is being introduced in the Aileu District. At the introduction of each topic current knowledge base was assessed through simple questions and answers. Staff were able to discover that the community had received no training on breast feeding or basic nutrition for infants, had little to no knowledge on tuberculosis and only very basic knowledge on malaria. The topics covered were exclusive breastfeeding and positioning during feeding, tuberculosis and malaria. Following the training sessions the AAI staff held a mobile clinic for those in need. 54 patients sought consultation. A second training session has been organised which will cover nutrition, safe drinking water, diarrhea and recap on malaria and TB. 


8 August 2007 - Burning buildings, political unrest and the reality of possible violent riots in Dili have escalated within the last twelve hours.

The previous week has seen the tension building as the announcement of the reshuffling government positions following the June 30 elections has been postponed three times. The government announcement finally made last evening has ignited anger in some areas of Dili.

          

Last evening the Access Aid International Medical Coordinator, Marion Brand, was evacuated to the AAI house from her accommodation complex due to fires ablaze alongside her room at the customs warehouse. The AAI house, selected for its secure location is protected with a ten foot metal spike fence and 24 hour security guards.

As smoke clouds appear in areas around Dili the information of organized political rallies are intended by the Fretilin party today.

With close monitoring of the streets by the International Security Force and United Nations Police, information from UN Security and the Australian Military have lead to the Access Aid International team being put into lock down. Local staff have been advised to stay home, an inward bound volunteer has been delayed and travel for AAI staff has ceased until further notice.

SMS security updates to the Site Manager and the Medical Coordinator are received from key security personnel in Dili and ensure we remain well informed of the changes in the current situation.

 Despite the emergent tension AAI continued to assist as planned in Aileu Vila with mobile clinics late last week. Monday morning lead to a call from the Bario Pitte Clinic requiring immediate assistance. The AAI staff supported Dr Namekia with patient consultation, dressings and nursing duties as a result of staff shortages due to the current situation.

The usual abundance of local taxis has ceased and shops are shut as the Timorese stand in waiting uncertain of the situation. The military black hawks and the UN choppers can be heard circling overhead as the AAI staff continue to work, while peering through the windows for changes outside. with grab bags packed and ready to evacuate if necessary AAI are awaiting further developments.

By Crystal Brown (Project Nurse) Photos: M. Barbedo, E. Clemets, C. Brown

 

 

AAI nurses upskilling staff

AAI nurse Emma with local villagers

AAI nurses completing self-assessments

AAI doing health promotions in remote villages

AAI nurse Sahba doing health promotions

AAI physical assessment training


28 July 2007

This past week local AAI staff continued to provide community based teaching sessions to communities on areas of health such as the prevention of malaria, tuberculosis and diarrhoeal illnesses, and information to assist in the promotion of nutrition in these communities. These teaching sessions were well attended and well received by local communities for whom much of the information is entirely new.

A local member of the Lequidoe community attending an AAI mobile clinic

Capacity building is a primary tenet of AAI's Rural Health Care Project. Central to achieving this has been an ongoing commitment to improving the skills of local AAI staff and those Timorese medical staff situated in rural areas who do not possess broad skills and who receive little or no additional training. This week, local AAI staff continued to deepen and expand their skills base through training by AAI's international staff in the areas of malnutrition assessment and maternal and child health care.

AAI Master Trainer Doca provides community health training at Kleta

AAI also continued its partnership with the Dili based Bairo Pitte Clinic, continuing to provide Mobile Clinics to the remote rural vila of Fatubosa in Lequidoe. The clinic treated 58 people from the community who otherwise suffer prolonged periods absent of access to medical treatment. Lequidoe Community Health Clinic was also host to AAI training of local nurses and midwives later in the week.

AAI nurse Eduardo Soraes provides community health training at Kleta

Daniel Tatton- Project Assistant (Timor Leste)

21 July 2007

This week the AAI medical team continued to fulfill its program objectives of improving maternal and child healthcare, improving health information systems, continuing to expand and deepen its outreach clinic support, and maintaining its capacity to provide basic emergency care.

AAI has continued to implement its medical program in the relatively cool highland province of Aileu, two hours drive south of Dili. Many of the health clinics in the district are only accessible via unsealed, dilapidated roads subject to seasonal flooding. Consequently many clinics are under-resourced and receive infrequent contact with medically trained personnel.

On Monday AAI medical staff provided over 100 members of the Aleu Vila and Fatubosa communities with basic information about breastfeeding, tuberculosis and malaria. Following the teaching AAI held a mobile health clinic at which Australian and local staff attended to 54 patients.

During the week AAI medical staff conducted training for local staff to better create a sustainable medical presence in the Aileu communities. Further training and assessment was also provided to the health supervisory team in Lequidoe to improve their capacity to address community needs.

The week also saw AAI partnering with the Bario Pitte Clinic to run mobile clinics in Aileu Vila as well as in an IDP camp in Dili.

Malaria, tuberculosis and respiratory infections continue to be the most prevalent problems across all of the communities.

Thursday saw completion of the AAI refurbishment of the health clinic buildings at the villages of Fahisoi and Fatubosa.

                     

Both buildings have long existed in a dilapidated state having suffered the effects of community unrest and a complete absence of necessary resources.

The resident nurse at Fahisoi, Luisa Di Costa, was particularly happy with the results. The refurbishment was undertaken by workers from the local community.

       
Daniel Tatton

30 June 2007 - Access Aid International supports medical product donations to the Dili National Hospital - Pharmacy

The Dili National Hospital serves as the only tertiary hospital in Timor-Leste receiving all refers from around the country and servicing a population of almost 1,000,000.

Like all major hospitals anywhere in the world the DiliNationalHospital can at times have supply problems and not have the available resources required for their population. This is compounded by the fact that the country is the newest nation in the world and is going through immense political changes which, at times, has an affect on the health infrastructure and re-supply into the country.

Appropriate medical donations are welcomed by the DiliNationalHospital as long as the process of donations is well managed with the Ministry of Health and hospital administration and that all necessary approvals are obtained prior to the items reaching Timor-Leste.

This month Access Aid International received necessary supplies donated from the Austin Hospital ICU department. These items have been gratefully accepted by the DiliNationalHospital and will assist in ensuring adequate health services for patients are maintained. 

                                          
     
                   

AAI facilitated the medical products as a donation to the Dili National Hospital on 28 June 2007. The medical products included oxygen and intravenous tubing and medical instruments. These products are humanitarian aid. The Dili National Hospital and AAI kindly thank the Austin Hospital for their contributions to the health of Timor-Leste.


29 June 2007 - A Child Forgotten

I first heard the cries of pain and moans for help coming from a room hidden around the back of the clinic during a dressing change. As I peaked around the door I was greeted with a truly devastating picture. I found myself fighting back the rising lump in my throat. The critically malnourished, stunted and gaunt face, staring up at me in desperation, the child looked no more than ten. The foul stench of the wound was suffocating, made worse by the humid environment.

      

The child was Jeka, a teenager in who could have easily been mistaken for much younger. 

Jeka, a sixteen year old boy, eventually found the medical help he was seeking at Bairo Pitte Clinic (a partner community based organization which AAI supports) four months ago. The second youngest of seven had extensive and prolonged ill health with complaints of fever and cough sustained while in an Internally Displaced Persons (IDP) camp in Laoru Mata, Dili. 

His admission diagnosis consisted of stage 3 and 4 pressure ulcers to his left upper thigh and sacrum with major infection and severe lower limb swelling.

     

Jeka has endured a long, painful four months consisting of excruciating daily dressing changes, agonizing wound debriding, intravenous antibiotics, nutritional supplements, and complete bed rest. All this he has faced alone, as his family is unable to visit him more than monthly.

Confined to a make shift chair, constructed from a plastic patio chair tied to an ancient wheelchair base on metal rims, he now has gained the strength to push himself around the clinic grounds.

It has been a very long time since this young boy has walked and extensive physiotherapy has begun to try and regain his strength and movement. He will now give a shy smile as you walk past as he knows he is one of the lucky ones.

This is just one story of many, unknown and forgotten to most. It is only through donations help can be offered and children like Jeka can have the future they deserve.

Donations can be made through the Access Aid International website at www.aai.org.au

Crystal Brown - AAI Project Nurse 

25 June 2007 - AAI delivers donated medical supplies to Bario Pitte Clinic in Dili, Timor-Leste

Direct Relief International (DRI), a long term partner of Access Aid International, have once again supported us by providing essential drugs and medical supplies for our Rural Healthcare Project in Timor-Leste.

DRI aims to improve the health of people living in developing countries and those who are victims of natural disasters, war, and civil unrest by providing essential material resources - such as medicines, supplies and equipment. DRI sourced all high quality pharmaceuticals and supplies from the USA and also provided the airfreight expenses for the delivery to Timor-Leste.

On Wednesday the 20 June 2007 , AAI facilitated the donation of these supplies to the Bario Pitte Clinic (BPC) in Dili. The BPC was founded in 1999 after the Indonesian withdrawal that saw thousands of refugees returning with tuberculosis, malaria and malnourishment. Located in Timor-Leste's capital city of Dili , the clinic still operates today and provides free health care services to the local population with regular outreach clinics into the rural Districts.

The donation included items such as Amoxicillin syrup, Amoxicillin tablets, Azithromycin, Co-Trimoxazole and Erythromycin, vitamins, pain relief and gastric medications, Chromagen Forte, Pepcid, AC Tylonel Extra, topical creams, wound dressings and equipment, Clotrimazole Cream, Neosporin tripple anitbiotic ointmemnt, Blood infusion sets and Elastoplast tape.

Dr Ida accepted the donation of behalf of the BPC and AAI staff ensured that Mrs Anita, the head pharmacist, was fully conversant with the supplies being provided. As the BPC supplies of Amoxicillin had been completely exhausted, the much needed DRI donation was gratefully welcomed.

AAI staff will continue to support the BPC and regulary monitor and maintain the pharmacy and drug cold chain at the clinic.

AAI would sincerely like to thank the team at Direct Relief International for an outstanding job in arranging the donation of these supplies.

AAI Project Nurse, Crystal Brown distributes DRI donations to the Bairo Pitte Clinic


26 May 2007 - Healthcare Training in Aliue District, Timor-Leste

Health Information System (HIS)

Access Aid International (AAI), in partnership with Oilex and in collaboration with the District Officer of Health (DOH), Sr Magno, have begun implementing a HIS revitalisation project, which this week commenced in the Lequidoe and Alieu Vila Sub-Districts of Alieu.

                                    

Introducing the Health Information System data collection charts to the key health staff in location at Lequido

Newly designed HIS data collection charts and posters gained approval for implementation from the DOH. As part of the overall HIS revitalisation project AAI also completed translation of Ministry of Health (MOH) treatment protocols and education material.

                                                                      
Training staff on Health Information System data collection charts. Crystal, Aci, local healthcare staff & Cuban Doctor

AAI launched the HIS revitalisation project during a training workshop with local national healthcare staff and Cuban Doctors at the Lequidoe Community Health Centre (CHC). Training was conducted on the use of HIS data collection charts, the necessity and importance of health data collection, collation and transfer of health data to DOH. AAI's newly translated MOH treatment protocols, medical terminology, and recognition of common illnesses material was also distributed to the healthcare staff.

Maternal and Child Health (MCH) Training

AAI's recently arrived volunteer Nurse Practitioner, Heather Lorenzen provided training in MCH in the Sub District of Lequidoe. Ten healthcare staff (nurses and midwives) from surrounding rural health posts within the District attended the Lequidoe CHC for MCH training. The training was conducted over a two day period covering MCH, family planning and also included general medical issues that were requested by local healthcare staff.

                          

Heather teaching insertion of IUD , using diagrams of the female body. Encouraging local staff to perform insertion and assessing their capabilities

Heather also presented other topics during the two day training workshop including skin disorders such as leprosy and scabies. The differences between Upper Respiratory Tract Infections and common Lower Respiratory Tract Infections such as asthma and Tuberculosis were also discussed with local health professionals.

                        

Heather teaching about skin issues via powerpoint presentation to a group of health care workers

Feed back from healthcare staff who attended the HIC and MCH training has been very positive. With assistance from Oilex, AAI will continue to provide similar training packages over the coming months within Alieu District to ensure that all health training targets are met.


14 May 2007 - RURAL HEALTHCARE PROGRAM IN ALIEU DISTRICT

MATERNAL CHILD HEALTHCARE:

Health Coordinator Sasha Poll and Project Nurse Crystal Brown from AAI have been conducting a Maternal Child Healthcare (MCH) needs assessment with the District Health Officials of Alieu. The basis of the needs assessments is for the planning of training targeted at urgent gaps in the provision of MCH for nurses and midwives treating rural populations.

The AAI team with new vehicles for travel into remote areas

The District Health Officer, Mr Mango stressed the importance of AAI assisting with Basic Emergency Obstetric Care (BEOC) training and also made a new request for general emergency training, focusing on newborns and infants. AAI confirmed that our MCH Nurse Specialist, Heather Lorenzen, will arrive in country later this week and will immediately begin a training plan and schedule based on the detailed assessment results conducted over the past month by AAI. Furthermore, AAI have arranged for a medical specialist volunteer from the US, Dr Jason Ficshcer to come to Timor-Leste at the end of May to assist with the emergency medical obstetric training for rural healthcare workers.

Nurse Crystal Brown providing direct patient care during her assessments in the Aileu District

HEALTH INFORMATION SYSTEMS

As part of AAI's plan for increasing health information in the rural clinics, AAI in conjunction with rural health officials have developed a plan that will allow health information from rural clinics to be delivered to district health officials for analysis. The initial assistance with health information will include the development of wall charts for monitoring the health status identified in each clinic site. AAI's Site Manager, John Cindric will review maps, calculate distances and develop an implementation plan to deliver wall charts to each of the health facilities in the coming weeks.

A Timor-Leste rural healthcare clinic

The District Health Official, Mr Mango, also presented AAI with an urgent equipment request document detailing the need for malaria and pregnancy tests, blood pressure monitor and auto claves for health clinics. AAI are investigating whether this equipment is available for donations.

Project Nurse - Crystal Brown

25 April 2007 - The AAI medical program has begun in the Alieu District, which is located two hours South West of Dili by road. The area is typically mountainous and has limited road access.

AAI facilitated a meeting this week in Aileu with key health stake holders. Several key government officials attended including; District Health Officer, Head of the District Center for Disease Control; Head of the Maternal Child Department, Head of the Mental Health Department, Head of General District Health Promotion, and Head of the Department of Social Services.

During the meeting we discussed many of the matters requiring attention within the District and how they can be addressed. Some of the most salient matters requiring attention were;

  • Acquisition of accurate information (morbidities, mortalities, pregnant females, children under 5, malnutrition rates) for the population at each level of health service;
  • Health information management and analysis (epidemiologic);
  • Prenatal, intra natal and post natal education; and
  • Education for health staff on managing complicated pregnancies.

In response to this meeting, AAI has begun assisting the Department of Health (DoH) with community health analysis. It is crucial to understand the health statistics of the community in order to adequately plan appropriate and effective community health programs.

Medical

AAI is continuing to work with staff at the Biro Pite Clinic run by Dr Dan Murphy.

Security

The security situation in Dili has been relatively calm, although Bairo Pite remains a flashpoint for potential violence.

United Nations police (UNPol) and International Stabilization Forces (ISF) continue to conduct patrols throughout the country. Rock throwing, fighting, and possession of home made firearms and dart sling shots continue to be the main form of violence and crime here.

Non-government organisations have not been targeted by any violence recently.


17 April 2007 - AAI supports Bairo Pite Clinic in Timor Leste

After their return to Timor Leste to undertake a one year rural health care clinic, AAI have partnered with Dr Dan Murphy at his Bairo Pite Clinic (BPC) in Dili. The clinic was founded in 1999 after the Indonesian withdrawal that saw thousands of refugees returning with tuberculosis, malaria and malnourishment. Located in Timor-Leste's capital city of Dili , the clinic provides free health care services to the local population.

Doctor Dan Murphy received his MD from the University of Iowa and has worked in East Timor since September 1998. The Indonesians forced him out in early 1999 during the post-independence ballot destruction of the country. He returned in September 1999 and had been steadfastly working to provide primary health care ever since to over a million patients.

On average, the clinic sees 300 or more patients per day, with a strict policy that everyone must be seen. Originally, the clinic was set up to serve the immediate needs of a population affected by a humanitarian crisis. As the violence has subsided, BPC has adapted and transformed from an emergency medical service to a more comprehensive community health service. Primary health care is a top priority for the BPC and provides a variety of services, such as childhood immunizations, pre-natal care, dental work, emergency services and seeking diagnosis and treatment for the most serious health problems facing the country including malaria, tuberculosis, dengue fever, leprosy and child mortality. The clinic participates in many mobile clinics in the remote and often-neglected mountainous areas, and receives patients from all over the country.

In addition, the BPC operates a medical laboratory, pharmacy, kitchen and laundry. The clinic has a water supply system and a power generator to supplement unreliable local supplies.

After witnessing the excellent work perform by Dr Dan, AAI pledged to assist in uplifting the clinic and its surrounds, including cleaning the grounds and removing accumulated medical waste, redesigning the pharmacy, and refurbishing the maternity wing and delivery room.

Cleaning the Clinic Grounds

                                           
Clinic (Before)
                                                     

Clinic (After) 

       

                                  Maternity Wing

Marc Preston- AAI CEO

7 April 2007

Notwithstanding the security issues generated by the forthcoming elections and the Easter holiday period, AAI staff have been proactive and involved in various local health services.

                     

Dr Dan's Bairo Pite Clinic

 

AAI staff re-organising medical supplies

Friday 6/4/07 AAI staff attended Dr Dan's Clinic. Dr Dan Murphy is an American doctor who has been working in Timor-Leste since September 1998. His clinic, the Bairo Pite Clinic, acts as a primary care facility and sees hundreds of patients per day. Their maternity ward averages 60 deliveries per month and is staffed by a number of widwives many from rural regions involved in the national midwife training program. Inpatient beds are used for diseases such as malaria, gastroenteritis and pneumonia and a separate ward houses TB effected patients. TB is a major public health concern in Timor-Leste and with the looming threat of HIV infectious rates are set to explode. A basic dental service also exists as does an emergency room, pharmacy and lab facilities.

With recent security concerns and DFAT travel warnings raised to level 5 (Do Not Travel) the international medical volunteers, including medical students from Australia, have withdrawn from Timor-Leste and Dr Dan's is now at a skeleton crew. This coupled with Easter and the public holidays has seen Dr Dan struggle with his few die-hard local staff including Dr Ida, a US trained Timorese Dr.

AAI staff were able to lend a hand and began by helping to re-organise the pharmacy to regain its functionality and begin to sort through and arrange the various donations Dr Dan has received. AAI staff were also able to get involved in some patient care including basic wound dressings.

                                                 

Comoro IDP Camp

 

Comoro IDP Camp

Saturday 7/4/07 AAI staff attended Bairo Pite Clinic's first health service delivery to the Comoro district IDP (Internally Displaced Persons) camp. Many of the IDPs are afraid to travel to Dili National Hospital as rivalry between Timorese from the East and West is still rife. Many do not have access to medical services for this reason. The same issue faces the Bairo Pite Clinic and this has seen them try and deliver health care by setting up a mobile clinic at the camp. Several patients seen by Dr Ida at the camp who required higher level services and/or admission refused to travel to either the clinic or the hospital from fear of their safety. This area has been somewhat of a security hotspot over the last month but AAI staff observed the camp to be orderly and peaceful.

                                        

Comoro IDP Camp

 

Amanda Miller of AAI and Dr Ida

AAI staff were able to support Dr Ida in her delivery of primary health care at the camp and saw over 150 patients in 3 hours. This will now be a regular commitment of the Bairo Pite Clinic. Patient complaints ranged from scabies and tinea to gonorrhea, pneumonia and childhood infections such as otitis (ear infection) and conjunctivitis. Common cold viral infections were also very common amongst the group.

Shaun Francis - AAI

AAI in Timor Leste - JUNE - JULY 2006

AAI in partnership with AustCARE recently conducted humanitarian aid work in one of the worlds youngest countries and one of Australia's closest neighbours. AAI was assigned to 9 IDP camps to service the medical needs of those refugees. (see map below) and anything the Ministry of Health needs.

In early June 2006, a month of violence left 21 people dead and others injured and caused 100,000 people to flee from their homes, most ending up in IDP camps in Dili. Camps are overcrowded, sanitation and disease are a huge problem.

Rival gangs from the east clashed with gangs from the west, burning homes, shops and cars. Looting was rife and it is still not safe to be out on the streets.

An international force of Australian, Malaysian, New Zealand and Portuguese troops arrived on the 20th May to bting order in the capital. The current crisis occured when the government sacked 600 of its 1400 soldiers employed in the national army after demonstrations over pay and working conditions in February. Most of these were from western Timor. People in Dili took to the streets demanding Prime Minister Mari Alkatiri resign. Tensions were high as protesters surrounded the Parliament, but on June 22nd East Timor's President Xanana Gusmao and Foreign Minister Jose Ramos Horta (Nobel Peace Price and Independence leader) threatened to resign instead, but didn't, and finally after weeks of demonstrations, the man the people really wanted to resign, Mari Alkatiri finally did on June 26th. This then upset the Eastern Timorese and on 30th June, thousands of them decended on Dili to show their support for Fretilin and Mari Alkatiri. Again it was a peaceful protest but the divide between the Westerners and Easterners has split the country and needs to be resolved if Timor Leste is to find peace.

Map of East Timor

Map of Dili


5 July 2006 - SITUATION REPORT

AAI finished its work in Timor Leste today, 5th July 2006, and would like to thank AustCARE, Timor Leste Ministry of Health and everyone who supported us in our work. Below is a round up of our findings and work.

Access Aid International successfully implemented a medical response to the humanitarian crisis faced by the population. AAI, in a close relationship with the Timor-Leste Ministry of Health put in place a basic health program servicing 9 IDP camps. By the end of the four weeks, AAI mainly treated patients for:

  • Conjunctivitis
  • Dehydration
  • General Pain
  • Injuries
  • Other Skin Infections (other than Scabies)
  • Scabies
  • Upper Respiratory Tract Infection
  • Worms

The close conditions residents experienced in these camps were conducive to the spread of common communicable diseases. The population of Dili, of which some 100,000 people, or half the inhabitants, was thus placed in peril of serious medical disaster. The ongoing health of the residents hinged primarily on three factors; the provision of safe, clean water, nutrition and the monitoring and effective control of illness. During the reporting period AAI was able to appreciably improve the health of the residents of the serviced camps. Skin infections, parasitic disease such as scabies were prevalent amongst the camps before the team's arrival and subsequently decreased over the four weeks through regular clinics. Appendix 2 shows graphs of diseases over the four weeks.

AAI was successful in keeping a high level of health through thorough consultations with patients and monitored some earlier diagnosed illnesses to ensure they did not develop into acute conditions so refugees could survive this most traumatic experience in the overcrowded camps.

AAI was able to learn a great deal about IDP's health both physically and mentally. Living in such close quarters in bad conditions, diseases spread very fast and the changing mental state of camp residents added more stress to their overall health. AAI quickly learnt what the main problems were in the camps, which were standard throughout, and became very efficient in treating those illnesses. AAI staff were able to appreciate significant cultural differences and became proficient in treating the IDP's with respect and courtesy while carrying out medical treatment, in a manner acceptable to their circumstances.

AAI's brief was also to assist the Timor-Leste Ministry of Health as appropriate, and because of this, AAI took on the role of 24 hour High Risk Ambulance Service. AAI was on stand-by as an option for the Ambulance Service when their members were unwilling or unable to attend a situation because of possible injury/attacks on their staff. AAI, accompanied by Australian Defence Force personnel, were, in this role, able to attend to patients in dangerous situations, where the presence of local ambulance staff may have adversely effected the facilitation of medical aid. AAI's Disaster Assistance Response Team, in this case had a Victorian Rural Ambulance Service member attached, who was able to provide invaluable assistance, and important technical and liaison ability.


1 July 2006

On Thursday, thousands more protesters entered Dili, but this time it was the people from the Eastern Districts, supporters of Alkatiri and the Fretilin party. The streets were deserted the day before when news of this broke out as people did not know what to expect as they would not be welcomed in Dili and would clash with the Westerners already here. Alkatiri had earlier traveled to the Eastern Districts to rally the people and get them to march on the city, making inflammatory remarks and calling Australians Capitalists. For the first time rocks were thrown at International Forces. Luckily a deal was brokered and the protesters would only travel in trucks and buses along a pre-designated route around Dili. Everyone was to be searched for weapons and they would be allowed to conduct speeches in front of the Government Building, hand their petition to Xanana Gusmao, stay overnight but be contained and would leave the next day. Luckily this is exactly what happened but it was no mean feat. As the Easterners entered the city, they were heckled by Westerners but International Forces controlled them well. A replacement for Alkatiri has still not been found so the country continues on its route to an uncertain future.

The IDP camps continue and people are still refusing to return home in this time of uncertainty. AAI continued visiting its IDP camps and treated more infections. Chicken Pox is still on the increase and although UNHCR supply tents for contaminated children and their families, they refuse to stay in them. Malnutrition is also a concern as food stocks are getting lower and AAI has treated a few children for dehydration. Unfortunately many people do not drink enough water so complaints of head aches and fatigue are common. AAI is handing out Oral Rehydration and vitamins to combat this but it is only temporary.

Sanitation in some camps is getting better. When AAI first visited some camps there were feacies everywhere and people were spitting on the ground, only for children to step on and spread diseases. AAI has instructed people in camps to improve sanitation standards and are now seeing people wash what bathrooms they have and are keeping their living areas clean. AAI is also handing out soap.

Health problems have been on the decrease so 24 hour clinics will soon be scaled down to only 3 hours as IDP's shouldn't become reliant on them. The static health clinics and hospital are operating well and people will be instructed to go there. AAI finishes operations in Timor Leste on the 5th July and the health service of these camps will be handed to another organisation but as stated earlier, IDP's have been instructed to go to the local health clinics.

A new IDP camp is being set up at the Dili sports stadium which will cater for thousands of people who are in smaller IDP camps at the moment. IDP's from AAI's Palm Springs IDP camp (see no:7 on Map of Dili above) have already moved there or have returned home.

     

27 June 2006

In the last few days both President Xanana Gusmao and Foreign Minister Jose Ramos Horta (Nobel Peace Price and Independence leader) had threatened to resign but didn't, and finally after weeks of demonstrations, the man the people really wanted to resign, Mari Alkatiri finally did. The demonstrations on the streets finally changed to jubilation and celebration. The people now wait to see who will replace the Prime Minister and what will happen to Mari Alkatiri. This has been a great example of people power and peaceful protests.

On the streets thousands of people continue to drive around in large convoys, but it is no longer a tense situation. Even soldiers are waking around in less protection gear. Refugees are still refusing to return home and it is feared that the camps are getting too comfortable because they have access to doctors, food, water and security. But this can not be sustainable.

In the last few days, AAI has continued visiting the IDP camps (see map above) and has seen an increase in worms in children. This has easily been controlled by administering Mebendazole. In the harsh tropical heart most refugees suffer dehydration as they never drink enough and therefore we have been giving out Oral Rehydration Salts (ORS) and vitamins. Diarrhea and pneumonia have been on the increase compared to last week, up from 3% to 10%. There was also an unfortunate case of a child who went to hospital for treatment but the mother took the child home where he later died.

As stated last week, chicken pox is also on the increase and needs to be contained before it spreads, especially with so many children with low immunity in the camps. UNHCR can provide contamination tents when cases are detected. Else where in IDP camps, measil immunizations continue but only a third of children have been vaccinated. The target is 30,000 but as yet only 11,000 have been done. Malaria continues to be a problem with even NGO's contracting the disease. Fumigation and spraying continues. Nutrition programs are starting this week to detect malnourished children. Bad cases will do directly to the hospital in Dili using ambulances as some others find it to hard to get to. 

     

23 June 2006

With Xanana Gusmao still threatening to resign today, people stayed home rather than going out. Thousands more protesters joined the already large crowd massing at the Government Building and were getting more vocal but were staying very peaceful. Alkatiri is under more pressure every day to stand down and the protesters don't look like giving up until he does. The protesters have now taken to walking and driving around Dili instead of just staying outside the Government Building, looking for more people to join them.

AAI continued its rounds of IDP camps this morning, visiting the camp adjacent to the Australian Embassy. The population in the refugee camps has not changed, with people still refusing to return home in this time of uncertainty. AAI treated a patient with a large infection in his foot which had to be cut open, cleaned of puss and treated with anti-biotics.

AAI attended the bi-weekly health meeting at the Ministry of Health (MoH). Along with other NGO's and government officials, it was noted that all diseases in IDP camps were either the same or within normal ranges. These included; malaria, diarrhea, pneumonia and worms. There were reports of chickenpox and we were advised to be aware of any outbreak due to the confined spaces in camps. The effected children were not to leave their camps so as not to spread the disease.

AAI notified the MoH of the swimming pool near the IDP camp reported in yesterdays sitrep and they are going to lavacide the malaria infested water as soon as possible.

AAI also visited the Police Academy IDP camp where people were sleeping in grandstands on concrete floors. Patients here were treated for tropical ulcers, gum disease, eye infections and coughs & colds.

                                             

22 June 2006

Today was a day no one saw coming. After weeks of demonstrations, violence and reprisals, the people’s champion, Xanana Gusmao surprised everyone when he decided to stand down as President of Timor Leste. He will officially stand down tomorrow, 23rd June, sending the country into more night of uncertainty. People cried and started to worry as they watched Xanana Gusmao on television and radio announce his disgust at the government inactions.

AAI personnel have been in the thick of things as the peaceful protests continue outside the Presidential Palace and surrounds. Hundreds of trucks packed with people chocked the roads to get into the city to join the peaceful protests.

None the less, AAI continued their mobile clinics to a number of IDP camps around Dili. It was hoped that by this time most people would start returning home but that has not happened yet, keeping AAI personnel busy treating patients with chronic coughs, tuberculosis and other general health ailments.

International forces have made the streets a lot safer, but people are still too scared to return home. AAI try to convince people to return home as they get information from Australian forces of which areas are safe. During the day people go to their homes only to return to the IDP camps for the night. With AAI now being a familiar face in these camps, there are always patients ready and waiting to be seen.

At one of the IDP camps, AAI found a bed ridden patient with a broken back in a dilapidated building. Nothing to do but lie in pain, this patient needs to go to hospital for further treatment. Due to general lack of knowledge of what health services are available, and this man had no thought of a possible intervention for his injury. AAI is investigating a possible transportation and treatment for him, after recognising a gap in current health system, which has denied this man a chance at better quality of life. This particular IDP camp in situated around an abandoned swimming pool. The pool unfortunately has a foot of foul water in the bottom, a perfect ground for malaria infecting mosquitos to breed, endangering the hundred of so IDP’s living around it. AAI is has enacted a health intervention, aimed at killing mosquito larve in the pool, and potentially draining the Olympic sized swimming pool, to stop the spread of malaria.

Another problem has occurred that could further divide the city. The refugees that are leaving the IDP camps are not returning to their homes in Dili, instead they are going back to their country towns of origin in the East. This may leave a majority of Western Timorese living in Dili, which will further divide the people. It is Dili’s wish to be united under one flag, one country and one people.

At night, after the announcement of Gusmao’s resignation, AAI patrolled the area to get an idea of what was happening in case of more trouble and injuries. The streets had a very uneasy feel to them as no one knows what will happen next.

There are many uncertainties in Dili. AAI is, however, certain of their role of supporting the people of Timor-Leste, regardless whether from the east, or west, through this emergency.

                                                                       

15 June 2006

Today the AAI DART was pleased to provide a mobile clinic capability to a Ministry of Health immunization initiative. This required us to leave Dili, and drive to the close southern Dili mountain ranges, and then carry on, on foot up a steep mountain trail, for about 2 hours, to give primary health service to a village, with no road access. At the same time a number of personnel from the MoH traveled with us to carry on their important immunization program.

Once at the village, AAI members treated 33 patients with a variety of illnesses and conditions. Life for IDP's fleeing to the hillside villages surrounding Dili had been tense, and many people displayed their stress in the form of physical illness, as a manifestation of the frustrations of a displaced life. It was, however, a picturesque location, a hilltop overlooking Dili and the harbor to the north, and a traditional peaceful Timorese village. This village, Karau Maten, had operated as a safe haven for many IDP's escaping the threat of violence in Dili.

As we climbed back down to our vehicle, AAI medics were asked to visit a bedridden patient, off the trail. On attendance at the patient's house, it was surmised that the 20 year old man had broken his femur, and would require evacuation to the Dili Hospital for effective treatment.

AAI medics quickly set about splinting his leg and giving pain relief to the patient, and organized a group of porters to carry him down the steep mountainside. AAI volunteer, and full time ambulance officer from Australia, Tim Semple, ensured the correct care to the patient, and a calm authoritive method, while other members organized the local porters and the setting up of the AUSTCARE vehicle to facilitate safe transport to the hospital.

Representatives from the Ministry of Health were impressed, and supported AAI's efforts by organizing a vehicle escort to the Dili Hospital and access to the busy emergency department.

Today was a great example of the professional back up and management of AUSTCARE and technical skill and vigor of AAI combining to provide a terrific outcome for a community in Timor-Leste. It was also a good opportunity to involve ourselves in an event coordinated directly by the Ministry of Health.

Both AUSTCARE and AAI are glad of the opportunity to facilitate such aid to the people of Timor-Leste.


13 June 2006

Last week the AAI DART volunteered to operate as the response crew to high risk tasks that the Dili Ambulance Service would not attend. The director of the ambulance service asked for advice and support: AAI responded by initiating a 24 hour a day on-call emergency medical service.

AAI received a call at about 1300 local time, stating that an adult male had been badly injured in a machete attack at Maluana, a village outside Dili. After consultation with Australian Defense Force liaison officers, two Australian military vehicles accompanied AAI medical personnel to the scene of the attack.

The scene that confronted AAI personnel at Maluana was tense. About 60 villagers surrounded a battered and terrified man. The severely injured man and three others had gone to the village armed with guns in an attempt to promote fear amongst this village, which had thus far been able to remain separate from Dili's politically motivated violence. The injured man and his friends had been attacked with stones in a show of solidarity by the villagers and while his friends had escaped into the countryside, he was unable to escape and was subsequently detained by the villagers.

Many people in the village did not want the wounded man treated. ADF personnel negotiated with a village head the wounded man's release. AAI volunteer and full time Victorian ambulance officer, Tim Semple conducted a quick assessment of the man. The man had suffered a number of contusions and a laceration to the head. For his own safety his was bundled into a military vehicle for transport and left the village area for Dili Hospital where he received further treatment.

The liaison duties with the ADF, and subsequent attendance at the emergency by the combined AAI / ADF resources, were seen as a major contribution to the management of the current crisis, and were much appreciated by the Timor-Leste Ministry of Health.


12 June 2006

Today, AAI and AustCARE staff conducted an appreciation of the security situation in Dili, and further afield in Timor-Leste, and how we should react. The changeable political and civil climate in Timor-Leste has made preparing for the future, in the short and medium term a challenge. The dynamics of the situation in Timor-Leste have favored the organizational structures of AustCARE and AAI. The provision of a quality aid package to the people of Timor-Leste is a goal that both partners have as a clear vision.

One of our local staff supporters, Alfonso, from the Biarro Pite clinic, told us of a small enclave of villages where people had fled to on the outskirts of Dili. It was not a designated IDP camp, but Alfonzo had received information that the people who had fled to the area were too scared to return to Dili. Further information had been received that the people living in this area had received no medical aid or health monitoring since the beginning of the crises.

Once we arrived at the village, people began to arrive from the thick banana tree plantations surrounding the area. AAI staff treated 32 people with the ailments which have become common to the recent emergency. The short but effective clinic appeared to inspire confidence in the people of that area and remind them that they were still part of the community.

AAI members then attended the Timor-Leste Police Academy , where a further twenty-five people were treated for various illnesses. This camp is a model of co-operation: serving as the base for the Malaysian military component, while being run by the Timor-Leste Police service and simultaneously being attended by civil aid workers. The AAI team treated a further 18 patients at the academy. The team also gained an insight into the short term goals of the IDP's living in the camp. The IDP's in this camp are voicing their concerns regarding the current situation by refusing to return to their homes until they are satisfied with both the security situation and the Timor-Leste government's actions. These IDP's feel few options are open to them and in this way they feel that they can influence government in a timely manner. The academy is expected to remain full for at least three months.

AAI members left the Police Academy and traveled to a suburban clinic where they were greeted with a small but virulent scabies outbreak. This clinic had been visited only days earlier when no scabies had been evident. Now it had infected six young children, and threatened to spread throughout the small community of about thirty people. This common parasitic infection was treated with direct intervention by the AAI team, including important lessons to key members of the community in the ongoing treatment and monitoring of the condition. It was emphasized to community members that the condition is easily treatable, but requires a firm adherence to the management protocols.

It is still plainly apparent to AAI and AustCARE staff members that the children of Dili, while under obvious stress and restriction of freedom in IDP camps, are still joyful, cheeky and energetic. They continue to share their irrepressible smiles and laughter. This is a quality we hope they never lose.


10 June 2006

AAI staff was able to change the pace of operations in Timor-Leste today. The AAI DART had arranged to travel to a regional capital, Baucau, to assess, first hand, the health impact of IDPs moving through that area. Baucau sits on the north coast of Timor-Leste , and travelers choose between two routes to visit. The faster inland road, at this time is assessed as too unsafe to travel, as the base of one of Dili's trouble making gangs, lays on it's route.

The AAI team, therefore, thought it prudent to travel via the coast road, and was rewarded for their efforts with incredible scenery, and friendly, welcoming locals. Leaving at 0800, it was a three hour drive to travel the 140 kms to Baucau. Once at Baucau, AAI staff surveyed the township, and attended a meeting with the Director of District Health Services, Baucau, Senhor Jose Dionisio, to gain health information on the population, and ask whether he thought he could utilize an AAI team in the remote reaches of this mountainous region. AAI were welcomed, and asked to start a program as soon as practical.

On the long drive back to Dili that evening, the AAI DART put into place their security protocols, when they approached a fire on both sides of the narrow road they were traveling, creating an obstacle potentially intended to slow a vehicle's speed, for the purposes of ambush. Realising this type of action would not be directed at international visitors, the AAI DART, having recognized the potential danger from afar, were able to stop short, and re-arrange the seating in the vehicle, to remove a local female staff member, who was traveling with us, from sight. Then we proceeded through the fire area, at speed. We will never know what the intention of the fires was, but this arrangement is typical of the sorts of obstacles the gangs have been placing on roads.

AAI staff was happy that the rest of the journey was uneventful, and returned to Dili 1930, to prepare the next day's work.


9 June 2006

AAI DART members attended the Palm Springs IDP camp near the Australian Embassy in Dili. The Palm Springs camp was originally designed as a home compound for Australian Embassy staff and their families. It is well protected by a high fence and solid gates and has a clean water supply. While most Australian Embassy staff and their families have been evacuated, it is a great safe haven for IDPs. Many people previously inhabiting the camp have now decided that it is safe enough to return home during the day and return to the secure compound at night. Although the last two nights have brought relative calm, many people are still too afraid to stay in their own homes at night.

Most IDP camps in Dili are divided into those from eastern Timor-Leste, and those from the west of the country. Senhor Pedro Muniz, the community appointed spokesperson for the Palm Springs camp, is sheltering many Timorese from western provinces, though his camp is predominantly made up of easterners. Senhor Muniz takes a grave risk allowing this, but is steadfast in his belief that this should be a model for other camps and for reconciliation in general.

AAI medical personnel treated six patients before lunch and after lunch twenty more residents for illnesses and injuries related to the crisis. AAI were also able to monitor some earlier diagnosed illnesses and ensure they did not develop into acute conditions.

Today, the AAI DART officially took on the task of responding to medical distress calls, to augment the Dili ambulance service. On many occasions, the Dili ambulance service has been unwilling to enter certain areas, especially after dark. This has lead to patients with potentially life threatening injuries, not being attended to by ambulance services. The DART now remains on stand-by to attend to serious cases.

Concurrently the team continues planning for its mobile clinic that will see AAI push well outside of the Dili outskirts to the east near Beucau. Many of the teams Timorese interpreters are very concerned about venturing out of Dili for fear of injury or death. AAI thank AustCARE local staff Maria Fonseca who stepped into the role with confidence and will assist the team in communicating with Rural Health Workers to facilitate our aspiration to establish a rural mobile clinic in the east and provide health care to those in need.


8 June 2006

Access Aid International staff were to have a busy day today. The day started with the team learning of a medical case requiring urgent assistance. As news of the team's willingness to assist in unique or difficult circumstances has spread through the aid community and local health organizations the AAI team is being informed of incidences that have previously been put in the “too hard basket”. In this instance it seemed that there was a pregnant woman in one of the local IDP camps with a fever. The camp had received no medical help since the beginning of the crisis. The DART team immediately changed the day's scheduled arrangements to visit the woman.

Upon arrival, the medics actually found three cases that required attention. The most pressing of which was a full term pregnancy due any day. The woman was in good condition, but as a result of being displaced and the lingering anxiety associated with returning to the streets, she had no plans in place for the delivery.

The medical team found a second case, a lady 5 months pregnant experiencing some of the key symptoms of malaria.

Lastly a 7 month old child, lay limp in her mothers arms. Investigation, with the assistance of a local interpreter facilitated by our local partner, AustCARE, found that the child had had diarrhea for the past 24 hours and had lost its appetite – dehydration is a serious condition in a child of this age.

The patients were assessed and offered transport to a local clinic for blood tests, ongoing care and a safe delivery – an option they did not even realize was available since the country's recent difficulties had begun.

As the team assessed the health of 5 more IDP camps there was some good signs for the people of Timor Leste. As the team arrived at one camp they saw people loading a truck with belongings as they made plans to return, cautiously, to their homes. Several camps had been visited before and upon the team's arrival it was clear that the population of the camp and the number of individuals requiring medical treatment had decreased.

The children at these camps reserved an unflappable resilience to the stresses surrounding them. The AAI team enjoyed a spontaneous and cheerful game of soccer followed by traditional songs from the children as they visited the camps - children, who for all intents, are currently homeless and yet continue to smile.

Doors that were previously boarded up around town have opened today as small markets and retailers try to resurrect their business. The people of Dili seem cautiously positive, as everyone here knows that circumstances can change in a moment.

AAI hopes for the best for these people, and continues their work, coordination, back in Australia , and action here in Dili, to achieve that end.


7 June 2006

AAI staff in Timor Leste were in prison today. We had been asked to conduct a clinic at an IDP camp inside Bacoro Prison. When the violence began in Dili people rushed to any place they felt safe. For the people in the Bacoro region, ironically, that was the local prison facility. AAI yesterday liaised with prison authorities and were subsequently allowed to utilize the prison staff rooms for a clinic.

AAI staff quickly set up a makeshift pharmacy and set about treating the new ‘inmates'. Staff were able to consult with 20 patients including two late term pregnancies, five other women of child bearing age and treated patients, predominantly, for skin infections and gastroenteritis. Overall, the population was assessed as basically healthy. The isolated conditions inside the prison, and provision of good clean water, and utilization of prison amenities can account for this. The population, though, is still nervous about the prospect of returning to their shattered homes.

AAI members then attended the Dili District medical coordination meeting, convened by the Ministry of Health. AAI were introduced formerly to the assembled representatives, and put forward a proposal for a regionally based first aid program. AAI assumed responsibility for a further six IDP camps in Zone 3-4, Dili, for the short term.

AAI members then split up to conduct a clinic at Dili Acedemia Policia ( Police Academy ), but still retain a capacity to attend meetings with stakeholders.

At the police academy Tim Semple and Brian Chaffee treated 40 people with conditions as varied as dental health problems to the common cold.

Gavin Humphries and Nathan Mullins organized and attended a series of meetings designed to increase the impact of AAI operations in Timor Leste. Gavin and Nathan met with the Australian Army's civil liaison to discuss ways they could augment each other's operations. They met with the Ministry of Health, Policy and Planning Manager, Senhor Mesario, to discuss AAI's long term vision for working in Timor Leste, and met with the Dili Ambulance Service manager to discuss methods designed to strengthen operational procedures, and protols. AAI hope to advise the ambulance service, in the near future, in regard to treatment of patients and safety of local staff. AAI staff then spoke to UN representative in the Dili area, in the effort to get the UN to further support AAI operations.

AAI have developed a plan to visit Timor Leste's forgetten region, Oecussi. This small troubled district is bordered on three sides by Indonesia , with the last side being a sea coast, surrounded by Indonesian territorial water. People residing in this region have little access to health care, and are at the mercy of massive seasonal changes, making their subsistence farming lifestyle tenuous. Now the borders are closed to outsiders traveling to this area, but AAI are attempting to gain approval for a visit to this underserved community.


6 June 2006

Today the AAI DART crew were requested to attend an IDP camp adjacent to the Australian Embassy in Dili by the Director of Health Services. When the violence first began, people clustered in any area which made them feel safe, and the Australian Embassy was one of those.

This makeshift encampment houses about 70 families from the Dili district, and these people have had no access to medical aid since the crisis began, now almost two weeks ago. The Dili District Hospital is close by, but the families sheltering inside will not risk the short journey to treatment through the nonsensical mob on the streets.

A makeshift clinic, sheltering beneath palm trees, was quickly established and the AAI team were able to utilize local medical staff from the Biar Pite Clinic to help their work. These local members formed the important interpreting and cultural link allowing AAI's medical expertise to be realized in a practical manner.

AAI's staff were able to identify a worrying trend of upper respiratory infections within the camp. Clearly, a situation which could escalate into an epidemic in the close conditions and tropical climate, without intervention. Staff were able to treat a number of wounds that were infected, and recognized a serious outbreak of scabies, which required a management protocol involving organizing the whole camp community in the eradication of this infestation.

Unfortunately, for the people of Timor Leste, today was another day marred by political violence and thuggery. A large rally had been organized, and was reported to have been strictly controlled, and absolutely non violent. However, a party of international media from Australia was attacked and their local staff beaten. AAI team members, at the time visiting a local clinic, considered the situation safe enough, and decided to continue operations with restriction of members movements, deference to the UN security coordinator's guidelines and adherence to the AAI's robust security policy. AAI members conferred with local Australian Military personnel for information on safe travel in this unpredictable atmosphere, and developed a plan. Then AAI's DART crew, and a local adviser and staff member from AustCARE visited the Dili prison, which has also become an IDP settlement. There AAI members discussed with prison officials the possibility of placing a clinic in the prison surrounds, where members and IDP's would be safe from violence. This clinic is now planned for 07 June.

While at the prison, the local security situation worsened, and AAI staff decided to make it a priority to return local staff to their homes before late afternoon, and the usual onset of violence, which in this case, is predicted to be severe. With all local staff safely off the streets, AAI staff concentrated on the business of preparation for the next day's activities.

It is the first time local violence has hindered our ability to deliver fast, effective much needed medical care to the Timorese people. After some swift action and planning the DART team will see an early start tomorrow returning to the Dili Prison to establish a mobile clinic, then on to collect some requested medicines, antibiotics, and antifungals from Senhor Macario, Director of Health Services, Dili District. With additional medicines in hand, tomorrow's agenda will also see the team liaise with the UN and other local and international organizations.


5 June 2006

AAI members Nathan Mullins, Gavin Humphries and Tim Semple were joined by Dr. Brian Chaffee today, as operations in Timor Leste commenced. The team has now begun assessing the growing humanitarian disaster which was triggered by civil unrest centered in that nation's capitol, Dili.

Partnered with another Australian NGO, AustCARE, AAI intends on implementing a basic health program for the many people forced into makeshift camps located around Dili.

AAI members are now liaising with local health authorities, and planning an intensive period of treatment for outlying areas. Dili harbor is full of warships, the civil airport has military aircraft landing at regular intervals. Australian and Malaysian troops patrol formerly peaceful neighborhoods, now scarred with burnt out houses, cars and buildings. The tension in every street is as discernable as the smoke hanging in the air.

Timor Leste's local health care system is ill equipped to deal with disaster on this scale. About sixty thousand people are estimated to be displaced, and living under plastic tarpaulins in camps. Most NGO's evacuated their staff when the rioting began about a week ago. AustCARE however, recognized the growing needs of the people of Timor Leste, and strengthened their staff numbers to deal with the burgeoning crisis. AAI responded with a Disaster Assessment Response Team, all experienced in relief operations in difficult conditions.

AAI members visited the Dili district Hospital, to assess it's capability to accept more patients from the camps and had a meeting with the Director of Health Services (Dili District) Senhor Macario to negotiate a memorandum of understanding and outline the plan for AAI operations. The team then visited an existing organisation, the Biaropite Clinic, to offer assistance with conducting remote area clinics to diversify this existing community level program.

Last night, the only people visible on the streets of Dili were gangs looking for trouble, while Australian Black Hawk helicopters patrolled the night sky. Fire and smoke continued to fill air.

Nathan Mullins - Access Aid International

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