A lone patient sits in a hospital in Dili. Asia’s newest nation is grappling to rebuild its health system
DILI, 29 March 2010 (IRIN) - Well before 8am, the reception at Bairo Formosa health centre in Dili, the capital of Timor-Leste, is bursting with people. The medical staff - a Timorese dental specialist, public doctor and six Cuban medics - see up to 600 patients a day.
Since independence in 2002, one of the biggest challenges facing Asia’s newest nation has been how to rebuild the health sector to meet the needs of one of the fastest-growing populations in the world, with women having, on average, six or seven children each.
Jaime dos Reis, chief of the health centre at Bairo Formosa, told IRIN: “In Dili, especially at this clinic, there aren’t enough Timorese doctors. The doctors cannot handle 600 patients. They just can’t.”
That is where Cuba, which prides itself on having a strong healthcare system, comes in.
As part of an agreement signed in 2003, Cuba agreed to take on hundreds of Timorese medical students whose return to Timor-Leste is hoped will relieve the strain on healthcare facilities in the fledgling nation.
The plan is to have one Timorese doctor per 1,000 of the 1.1 million population, said Diamantino de Jesus, the Ministry of Health’s national director for human resources.
“At that time we had many problems in the health sector. That is why Fidel Castro asked how Cuba can help develop the country. The president of Cuba then offered the scholarships,” he said.
A young boy in Timor-Leste. Almost half all children under five are chronically malnourished
In Timor Leste, about three-quarters of the population live in rural areas, where access to healthcare is often limited.
About 40 percent of people live below the poverty line and diseases such as leprosy remain endemic, the UN reports.
Illiteracy and poor sanitation are widespread, while almost half of all children under five are chronically malnourished, according to the UN Children’s Fund (UNICEF).
Rui de Araujo, senior management adviser with the Ministry of Finance, says up to 75 percent of all health problems in the country - contagious diseases and illnesses related to hygiene, nutrition, access to clean water, vaccinations - could be prevented.
“That was the basic rationale of why we started to bring in many Timorese young people to be trained in the general practice, basic medicine, to focus on community health, public health and health promotion so the country can tackle these problems,” he said.
During Indonesia’s 24-year occupation of Timor-Leste, people became accustomed to obtaining primary healthcare from doctors. When the Indonesians left in 1999, so did many health professionals.
The shortage of doctors means many people often go to hospital for basic healthcare.
“The primary healthcare facilities are not providing all the answers to the community and they will take themselves into hospitals and secondary healthcare settings to solve what is supposed to be solved at the primary healthcare centres,” De Araujo said.
Skill sharing At the moment there are 845 Timorese medical students, of whom 658 are in Cuba. They will finish their studies with internships back in Timor-Leste.
Eighteen students are already nearing the end of their studies and working in community health centres in the vicinity of one of the country’s six hospitals.
At the same time, another 250 students are studying in Timor-Leste, working under the supervision of the more than 200 Cuban health professionals in the nation. They will also study in Cuba for a year.
Within a few years, it is expected that there will be all Timorese medical teams staffing the nation’s 187 health posts, 65 community health centres and six hospitals.
Students were selected from each of the country’s sub-districts, so it is hoped they will be loyal enough to their roots to pass over the temptation of taking their newfound skills elsewhere to better-paid work.