The Problem of Health in East Timor
Maria De Fatima Ximenes Dias
Director PAS Clinic
East Timorese people have fought to be free of the hands and chains of colonialism for the last 500 years - especially during the 24 years of Indonesian occupation. Both men and women, from small children to the eldest members of our society, fought the struggle for our freedom. We fought together against our colonisers who used many methods, including violence, destroying the children of East Timor in all respects, including the environment.
To speak about health and the environment in accordance with our ideals, we have to look at how all members of the community, including ourselves, “live healthily”; physically, psychologically, mentally, and spiritually. We have to assess whether the environment in which we live is clean, favourable, safe, calm, and peaceful. The issue of health is not separate from that of the environment.
Criteria for community health:
The following criteria are essential for the community to live in good health:
1. Land is the basis of our health. It is from the land that we take food and medicine;
2. Water is essential for all living animals, including humans. We cannot live without water;
3. Work strengthens our health - if work is divided evenly and all people have equal rights;
4. Food is our health. The worst disease in the world is hunger;
5. Medical care. Every human being has the right to receive adequate medical care.
Some of the problems occurring now in East Timor are listed below:
- If it is difficult to obtain money, people will move out of their district.
- Many problems are occurring in the city of Dili.
- Rubbish is piling up in the markets, on the streets, in the drains, and all of that is a source of disease.
- A shortage of accommodation means that many people live/sleep in the market.
- Many houses are very closely packed together, as they are in villages.
- Fighting, killing, illegal drug taking (marijuana, morphine) among the young people.
- A shortage in farm produce while the price of goods in the market is very high. This means that many people are hungry because they are not able to buy food. The result is that disease increases and becomes rampant.
I believe that we are all always looking out to see what is happening in the world that we live in. The following discussion includes my observations of the situation now during the Transitional Period in East Timor. All of the following problems have negative health impacts for the people of East Timor.
· Village farmers work hard, but their produce is left to rot, because there is no way to transport produce to the city, and no companies to buy farm produce.
· Many groups of people from the villages are arriving in the city of Dili.
· Many people are short of food.
· Many trees are being cut down to be used for firewood, and to be sold to provide a source of income.
· Forests and mountains are subject to erosion, and are burnt annually, particularly between June and September.
Water gives us life. Without water, we would all die. East Timor has many sources of water, and I think that there is enough here for all human beings. But the reality is that even in the city of Dili, there may be no water for one or two weeks.
· In many isolated areas people have to walk for 1-2 hours to get water.
· In the rainy season, people drink rainwater or ground water, and many officials from Water Supply and Sanitation do not pay attention to broken or damaged pipes where water is being wasted due to broken water connections.
· As yet there is no law or certainty of law that is clear and legitimate for the arrangement of water system installations (at the present time people install their water systems themselves).
· The insides of water storage tanks are not cleaned, people use wood or stones to block water pipe connections, and so people wear dirty clothes.
· The result is that people become sick with many diseases such as cholera, malaria, skin diseases, scabies.
· In the dry season, the people need to plant vegetables and other crops, but without water, they can do nothing. The government must not leave the community to live without water during the dry season.
· Work strengthens the health of the community, but now many people cannot find work, for example more than 1000 nurses do not have jobs, because UNTAET does not have the money to employ them.
· Many people do not work because they do not have skills.
· The wages for translators, drivers, sales clerks and attendants are not fair. There is discrimination between local staff and international staff.
· Many of those who do have work, do not take responsibility for others.
· All the nice houses with air conditioning and modern conveniences are lived in by internationals, whereas there are many people in the community who are sick because they do not have a good place to live, and we have to try hard just to find them a place to rest.
· Many mini markets and restaurants have opened up, but only foreigners and wealthy people shop and eat in them. For the general community and the poor it is hard enough to get one grain of rice. The leftover food from the restaurants and from rich people which is carried by truck to the rubbish tip at Tibar, is scavenged by the people, and carried to their houses to be eaten and to be sold again. Such as situation is very bad for the health of the community.
· The general community and the poor use wood to cook, for which many trees are being cut down, while foreigners and the rich use gas stoves. Wood smoke is bad for people’s lungs, and traditionally here women and children spend a lot of time in the kitchen, so it is they who suffer the most. We know that 75% of East Timorese suffer Tuberculosis.
· The worst disease is hunger - there are many poor people who are sick because of lack of food.
· Many pregnant women suffer from anaemia.
· Many children are malnourished.
· Many husbands and wives argue because there is not enough food for their children.
Food is organised for those that need it the most……………
- 12kg rice per person per month
- 6 kg of nuts per person per month
World Food Program provides
- 1 litre of corn oil for 7-10 people per month
- Corn meal for a child 0-2 years, 5 kg per person per month
- Beans, for a child 0-2 years, 2 kg per person per month
- Oil, soap, corn meal, fruit juice etc.
5. Medical Care
· The total population of East Timor is 600,000.
· There is a shortage of doctors, both general practitioners and specialists.
· There are approximately 30 general practitioners.
· There is one specialist doctor.
· There are approximately 3000 nurses.
· Much of the potential workforce has not been hired, with the excuse given by UNTAET that they do not have any money.
· Many community health centres, particularly in the districts, have had to close.
· Those from the villages that need to go to the community health centre may have to walk for 1-5 hours to obtain medicine.
· The public hospitals in Dili and Baucau are suffering a shortage of medicine, as well as medical equipment.
· Local doctors do not have a part in working in the hospitals.