AFTER weeks of frustration waiting for the “all clear”, husband and wife couple David and Margaret Hall have returned to Atabae in East Timor to continue the work interrupted by the recent violence in the country.
For Margaret, a public health specialist nurse, that means an emphasis on preventive health measures aimed at the community. These include women and children’s health, the investigation of prenatal care issues, antenatal health, health assessments at various schools, data collection of individual health status, and the training of a project manager and head midwife to take over when Margaret’s time in Atabae ends.
For David, the priorities are access to water, sewerage and electricity.
The Broome couple are in East Timor with the global volunteer assistance group Palms Australia (formerly the Paulian Association).
“Initially, I will concentrate on antenatal health as the first three years of a child’s life are so important,” Margaret said. “Then the focus will be on school health and women’s health.
“Although there are endemic diseases such as malaria and TB, my concerns are that women have died leaving young children and we don’t know what they died of.
“Also, infant mortality is dreadfully high, mainly because of a lack of facilities in the villages. There is a lot of basic groundwork needed and the high death rate in these populations makes them an urgent priority.”
“Child birth and antenatal care are both high risk.
“There needs to be early detection and a good antenatal program so the problems can be picked up early and more easily.
“Anything that is not right with the mother affects the baby – it could be the position of the baby or, because of lack of nourishment, babies not being fully developed.”
While Australian Aboriginal death rates stand at 25 deaths per 1000 births, in East Timor these rates are 85 per 1000 births.
“Then I want to begin with school health – test hearing, vision and perception,” Margaret said. “The general health information I will start to collect will have its initial focus on testing the children’s eyes, hearing, fine and gross motor movements, blood pressure and general health.”
Margaret has already established a good relationship with the three midwives and two doctors in Atabae and will train one of the current midwives to take over her own position within the remaining two years of her stint there. She also wants to teach health workers in the more remote villages.
With little or no communication with the outside world, very few health programs come to these villages, although there are clinics for general health checks – blood sugar readings, urine testing and BP testing.
Two of the villages have two health workers each, but most villagers have to travel to Atabae for their health needs.
On the positive side, the eight radio transmitters installed in Atabae last year by Connect East Timor (CET) have proven “very useful for health matters”.
But there are a number of barriers that have to be overcome. The previous Alkatiri government had allocated no funding for child and maternal health to the two western provinces of Atabae and Bobonaro.
“Atabae has not been getting any help from the government as many of the militias came from the western districts,” Margaret said.
“But there is hope now that with the new Prime Minister (Jose Ramos-Horta) this will change as more money for the poor has been promised.”
But that doesn’t address the area’s current needs and the only other possible local source, the Alola Foundation, whose chairperson is First Lady Kirsty Sword-Gusmao, is stretched far beyond its resources and can offer no help.
So the funding given by organisations such as Friends and Partners with East Timor (FPET), who work in partnership with the people of Atabae, is crucial.
Lack of essential equipment is another issue. Clinics have few medical supplies and Margaret would love to have a haemoglobinometer which would allow testing of each villager’s haemoglobin level – a good sign as to how they are functioning. But again, funding is the issue. In addition to lack of equipment, basic resources at clinics also forms a barrier.
Damlaren, one of the villages, is typical. It has a very good clinic but there is no toilet and no water for washing hands.
Then there is the issue of access. Because of the state of the roads, travel and the time taken to get to any village is a real factor.
It can take more than four hours to travel just 40 km, and some sections of the road are not accessible even by four-wheel drive.
Margaret is determined to start data gathering for the area so she is in a better position to assess what the health priorities should be. Another priority is to start a community committee, which includes women.
“This will ensure they are working with the people and that they will have ownership of programs and initiatives. It will be very exciting and will get a lot happening,” Margaret said.
One of the real problems that daily affects the work being undertaken by Margaret and David is access to villages. Travel within and to Atabae is a problem.
“There has been no major maintenance of roads since the Indonesians left in 1999,” David said.
“The roads are very narrow, twisty and mountainous and, although the local community does many repairs with rocks, roads are in such bad repair that vehicles are often in danger of going over the edge. And they are often bogged.
“Travel over only short distances takes hours and, in many cases, is only possible by either horse or on foot.
“The roads continue to get worse and worse and most of the culverts are broken. Even four-wheel drives have problems and need repairs on a regular basis.
“Access to the river villages is particularly difficult. At times there’s hardly any indentation in the grass to tell you where the road exists. Often, walking is the only form of access to villages – and this can take days.”
Another problem is electricity supply. Atabae has no electricity and the nearby villages only have a limited supply.
Although generators, used for limited periods each day, have been installed at the school and presbytery complex and a few houses in the village, most villagers have no access to a supply.
But perhaps the major difficulty is access to water as this affects the people’s health as well as building construction, cooking and life generally.
“The villages need 30-40 new tanks and there is a proposal to try and get funding to install galvanised tanks to be assembled on site,” David said.
“While villagers are happy to have bores, there is a big question mark over the amount of water available in Atabae. Some of the current bores have a good supply, but others are bone dry.
“So you see kids as young as three and four walking backwards and forwards from the viable bores many times a day. Nor is there any pumping system which would help with the supply of water.
“Lack of access to water is the major thing holding up development and self-sufficiency for villages. If there was better access, they would be able to grow more crops and increase the size of crops.”
Although there are major difficulties, there is one project that holds real hope for the future – a community plantation.
With the help of FPET money, the community is embarking on planting and fencing an initial two hectare area.
“The proposed plantation is to include mangoes, avocados, cashews and timber-producing trees, as well as vegetables, to bring in income while the trees are growing,” David said.
“But at the moment there is the problem of supplying water to the plantation. So it is proposed that channels be dug to bring water from the river which may allow further planting of the total 25-hectare area available for the project.”
Despite the difficulties, the East Timorese are “quite happy with their village lifestyle”, David said. “They have learnt to ‘make do’ with what they have.
“They use palm fronds to make walls and to thatch roofs because access to normal building materials is expensive.
“Only about 10 per cent of buildings have brick or cement walls and they all have dirt floors. But houses are very clean, tidy and neat.
“The East Timorese are very meticulous and take a lot of effort to keep their environment clean.”
So while the economy might suffer from the people’s lack of money and therefore ability to buy, there is hope.
They are developing the tourist industry and a manufacturing industry of sorts. And the East Timorese make very good quality furniture which may prove a lucrative export in the future, David said.
But they are very dependent on the development of the Timor Gap oil and gas fields and the help given by non-government organisations (NGOs).
Glen Caitlin is a freelance journalist specialising in foreign affairs and health and is a member of Friends and Partners with East Timor, a community based NGO with connections to Atabae.
