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Fifteen years after war, Timor-Leste must ready itself for a new fight

Prominent doctor warns that tuberculosis and HIV could soon 'bring the country down'

<p>Rofino lies in his bed in the TB ward at Bairo Pite Clinic in Dili (Photo by Siktus Harson)</p>

Rofino lies in his bed in the TB ward at Bairo Pite Clinic in Dili (Photo by Siktus Harson)

  • Siktus Harson, Dili
  • Timor Leste
  • July 15, 2014
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Rofino’s children look on anxiously as their father, all skin and bones, coughs away on his bed, his breath fluttering and weak. The 45-year-old has had tuberculosis for six years, and in early June was admitted to hospital after a spell of coughing up blood. Sharing the TB ward with him at the Bairo Pite Clinic in Dili are five smear-positive patients; in a neighboring ward, many more await test results.

Doctors here warn that unless conquered, TB could ravage the country. Its health infrastructure is weak, and still recovering from the 24-year conflict that engulfed Timor and ended only 15 years ago. Every month the clinic examines about a hundred TB-related patients, of which nearly half of them are TB positive.

Rofino, like many ordinary Timorese farmers, grows crops such as rice, corn and coffee, and earns US$5 a day at best. The income isn’t enough to feed a family of eight children, much less to buy medicine to treat his illness. Several years ago he checked into a hospital, but the high cost of TB drugs meant he instead opted for traditional medicine.

Another patient, Paulo, shares the ward with Rofino. “I came to this clinic after two months of severe coughing, fever, chest and back pains,” he explains. They however can be considered the lucky ones. Thousands more Timorese contract TB and fail to seek treatment, thereby spreading the highly contagious disease around their friends and relatives. In Timor, extended families often share one house – Paulo lived with 15 other relatives – meaning the risk of catching the disease is high.

Bairo Pite Clinic offers free treatment to patients. It’s founder, Dr Dan Murphy, a veteran US doctor who has worked in conflict-torn countries in Africa and beyond, set the clinic up in 1999 in the rubble of Dili. The war ended that year as Indonesian troops retreated, torching entire villages and leaving bloodshed and trauma in their wake. “There’s more sickness coming into this clinic than I’ve seen anywhere,” he says.

At the time the clinic was set up, 35 percent of Timor’s health facilities had been damaged. While one battle ended in 1999, another one quickly reared its head. “TB needs to be addressed here,” Dr Murphy says. “It’s in every village; we find positives every day.” He warns that if HIV, which currently has relatively low rates in Timor, is thrown into the mix, TB cases could multiply by nine.

Around half the country’s 1.1 million-strong population is infected with TB bacteria. Often however this doesn’t manifest itself in illness. But for many, the bacteria they pick up as a child will be activated in their thirties. A World Health Organisation (WHO) study in 2011 found that the highest prevalence of latent TB was found in 30-39 year olds living in crowded homes or informal settlements – par for the course in Timor.

It remains the country’s number one killer. Nearly 15 percent of deaths in 2011 were a result of TB, placing Timor second in the world behind Sierra Leone in terms of the impact of TB on the population. That said, according to Constantino Lopes, the manager of Timor Leste’s National TB Control Program (NTB), 91 percent of detected cases are cured.

Dr Murphy warns however that national health staff are not proactive in locating undiagnosed patients. Bairo Pite tries to counter that by sending mobile clinics to the hundreds of remote villages nestled in the mountains of this island state, attempting both to bring medicine to far-flung corners of Timor, and to get a more accurate reading of statistics. The WHO recorded 3,800 cases of TB in 2012, but Dr Murphy says the figures are much higher on account of the many cases that go unreported.

He emphasizes that TB is a ticking time bomb in Timor. The rates of HIV are currently low due to low rates of intravenous drug use, but this won’t last, and its compounding of the TB crisis could spell disaster. “HIV will take off, and smother us,” he warns. “It’s only a matter of time.”

He also talks of another impediment to progress on health and development in Timor, namely the impacts of the foreign aid that poured into the country after the war. “People get a handout and become dependent,” he says. “That survival instinct they [Timorese] developed during the war has been taken away by aid. This aid should be aimed at the grassroots, not at funding hospitals.”

Dr Murphy says that the many preventable illnesses that people bring into the clinic each day would be lessened were foreign donors to target the education sector, for example. But this isn’t seen as a priority. Instead, however, Timorese are not properly educated about health problems such as TB, and therefore preventable measures aren’t taken.

People like Rofino will stay quarantined inside the TB ward at Bairo Pite Clinic for several weeks. Once his condition is stable, he will move to a 50-bed halfway house, 20 kilometers away from the clinic, for an eight-month treatment period. He’s in it for the long haul, and while his chances of recovery are good, thousands more will come after him.

If Dr Murphy’s fears come true and Timor soon sees rising rates of HIV, then Bairo Pite’s team of doctors may struggle to cope. “This will bring the country down,” he warns.

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