source: http://www.theveterinarian.com.au/features/article647.asp
Doing it Tough In Timor Timorese veterinary practice is a world away from what we're used to in Australia. ANNE FAWCETT
Being the only small animal veterinarian in a new nation is one way of ensuring you have an audience with the President. When Timor-Leste President Xanana Gusmao became concerned that his children may contract disease from playing with their dogs, his secretary contacted the Minister of Agriculture. Doktor Hewan (animal doctor) Antonino Do Karmu was dispatched. He had a long consultation with First Lady Kirsty Sword-Gusmao before vaccinating and worming the dogs. “We also talked about the veterinary system in Timor and how the vaccinations work and now every time they need a vaccination they call the Minister who calls me,” Do Karmu said. He constitutes a big part of the veterinary system in Timor, which boasts all of two Timorese veterinarians to serve a population of 954,000. Becoming a veterinarian Antonino graduated with his veterinary degree from Joga-Jakarta University in May 2002 after a tumultuous seven years. Getting to university was a big deal in itself for a boy raised in the mountains of East Timor. In 1999, after five years at university, his studies came to an abrupt end with the militia uprising in the former East Timor. He returned home because he feared for the safety of his family. “I returned from Jakarta to be with my family for that time. When I got back with my younger brother we went to my parents’ house, but there was no house there. The very small kitchen was still there because it was outside but everything else was burned. We lost everything we had for 24 years.” Do Karmu’s in-laws were able to furnish the pair with two plates and two spoons, and an international body provided some food. The brothers walked for eight hours to another village where they found their parents and sister. “I was surprised they were still alive. There was a lot of crying there.” Like many Timorese families the Do Karmu family battled to re-establish themselves, rebuilding their house and living largely on home-grown vegetables. In 2001 Do Karmu was able to resume his scholarship and complete his veterinary studies. A double life From 8am until 5:30pm, He works as a government veterinarian for the Timor-Leste Agriculture Department . He oversees 13 districts, an area covering roughly 19,000 square kilometres. He is involved in the surveillance and diagnosis of economically important diseases of production animals including classical swine fever, haemorrhagic septicaemia in cattle and buffalo, and Newcastle disease in poultry. Zoonotic diseases like brucellosis and Japanese encephalitis also occur in Timor. One obstacle he continues to fight is ignorance about animal health. “People in Timor are not really familiar with the idea of a doctor for animals because for them animal health is not important. Human health is important,” Do Karmu said. But human health, already sub-optimal in the developing country, could be devastated by emerging diseases like rabies and avian influenza. Without public awareness, rabies, now confirmed on the nearby island of Flores, may not be detected until long after appearing in Timor. “Right now we have avian influenza in Indonesia, but in Timor we already have Newcastle disease. The clinical signs of avian influenza and Newcastle disease are quite similar and we have no reporting system in the field to give information about these diseases as early as possible.” Generating public awareness about the implications of an avian influenza pandemic is difficult in a country where less than 50 per cent of the population can read. His monthly salary is $US145.60. In Timor-Leste this is a small fortune, but it doesn’t go far when you’re supporting an extended family of nine in a rented house. From 6pm until midnight on weekdays, and all day on weekends, Do Kormu runs a private small animal practice. He does house calls on his motorbike, or occasionally on the local bus. Despite his modest consultation fee ($US5, not including travel), most clients are foreigners, as locals cannot afford the luxury of veterinary services. A dog castration costs $US60, a spay about $US100. He charges $US30 for the first vaccination and $US25 for any thereafter. Vaccination and desexing are the bread and butter of his practice. Not because the local animals are healthy – far from it. The local dog population is plagued by malnutrition, sarcoptic and demodectic mange and parasites like the hydatid tapeworm. But Do Karmu is simply not equipped to perform complex diagnostic work-ups or major surgery. The best he can do for is provide IV fluids and bandages. The most advanced diagnostic equipment he has is a microscope, which allows him to assess skin scrapes and faecal floatation tests. During the evening the Do Karmu family guest room doubles as his surgery. Procedures are performed on the ironing board with his wife and 13-old cousin assisting. There is no national power grid and even in the capital Dili electricity is not always available. “I have to worry about the electricity. Sometimes we have none at night, so sometimes I have to wait for the morning to do my surgery,” Do Karmu said. Sterility is a pipe dream but he does his best to keep things clean. Gowns and drapes are boiled before use and instruments, donated by Australian veterinarian Stephen Dunn, are soaked in chlorhexidine. “I did an amputation once with a boiled kitchen knife, and I have done some desexings under trees,” he said. The anaesthetic protocol is rudimentary. Patients are premedicated with a combination of atropine and xylazine and induced and maintained with intravenous ketamine. Ketoprofen is the only analgesic at Do Kormu’s disposal, and is not given routinely for desexing. Thus far his post-neutering infection rate stands at zero. Do Kormu has access to some antibiotics – notably norfloxacin and trimethoprim sulfa. But the current President of the Timor-Leste Veterinary Association admits he has much to learn. During a recent visit to Australia, sponsored by Tanya Carter of Haberfield Veterinary Hospital, he was able to see practice in a variety of settings including private practice and at the RSPCA’s Yagoona shelter. He was perplexed by a range of health conditions rarely seen in Timor, including pet obesity and age related conditions like hyperthyroidism in cats. “You don’t see that in my country,” he said. Upon learning that he could not afford to protect himself against tetanus or rabies, RSPCA staff passed the hat around and paid for vaccination. Vet’s vision Antonino Do Kormu hopes to establish a centre for animal disease to disseminate information to the Timorese. “I want to make a place where people can go and learn how to detect diseases and learn about zoonotic disease and how to protect our country,” he said. He is also trying to raise funds to produce an educational magazine for school children. “The children can teach their parents about animal disease and about animal doctors.” He continues to lobby the Timorese Government about the need for public awareness. The most helpful thing Australian veterinarians can do right now is support Timorese veterinarians furthering their education, he said. “It would be very helpful if Australian vets could provide scholarships for one or two Timorese veterinarians to learn epidemiology,” he said. “If we have experts in epidemiology we can make health programs, and if we protect Timor we can protect Australia [from animal disease] as well.” | 
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