Dr Maria Lourdes da Silva (left) explains to expectant mother Maria Marquez how to effectively communicate with a midwife using her mobile phone (Photo by Siktus Harson)
What Maria Marquez wants is common among pregnant women. She would like to have regular health checkups, no complications or hemorrhaging, and easy access to healthcare facilities.
Instead, she hardly had any direct contact with a doctor or midwife and rarely received advice on her pregnancies.
“I already have three children and am expecting the fourth child. But I’m always worried every time I get pregnant,” Marquez, 30, told ucanews.com in an interview in Bandudato village, Aileu district, approximately 50 kilometers from the capital Dili.
Her anxiety is reasonable, because during her previous pregnancies she did not have much time to get assistance or advice from medical workers. Like most rural Timorese women, she stays busy cultivating crops and selling her produce at a local market.
With this pregnancy, however, Marquez has had rare access to healthcare thanks to a three-year-old, mobile phone-based program being rolled out across the country. Initiated by Health Alliance International (HAI) — an NGO that helps the Timor-Leste government in enhancing services to women and newborn care — Liga Inan (Mobile Moms) sends twice weekly messages that remind mothers to eat nutritious food, supplements or to see a midwife.
For Marquez, the service is like an answered prayer allowing her to receive health assistance without leaving behind home and work.
“The problem is that I have to help my husband, even when I am pregnant. And if I don’t help my husband farming we won’t have money to buy basic needs,” she said.
Lack of funds is the main reason why Marquez can’t see a nurse often, but the nearest clinic is also 5km away — making it a difficult trek to undertake.
Local leader, Armindo de Araujo, 51, said Marquez’s experience is typical of many Timor-Leste women, who are affected by a shortage of public transport, poor road infrastructure, a lack of health facilities, shortage of medical workers, shortage of electricity and clean water. “Thousands of women like Marquez do not get a chance to have assisted pregnancy,” he said.
According to Maria Lourdes da Silva, a doctor at the Aileu District Hospital, Timor-Leste needs a breakthrough in reaching out to pregnant mothers. The Cuba-trained doctor said the problems facing pregnant women are many-faceted. Apart from facing constrains over inadequate health facilities; they also cannot focus on their pregnancy because they are breadwinners for their families.
“So, telling expectant mothers what to do through mobile phones is effective, because it is not easy to have them come voluntarily to hospital. There is no awareness among women to have their pregnancy checked regularly,” she told ucanews.com.
Da Silva said the mobile phone service is “a doctor’s wish come true” in a country that is still in the process of rebuilding its health system. Most of its facilities were destroyed during the 1999 fight for independence that led to its freedom in 2002, after 24 years under Indonesian occupation.
Che Katz, country director of HAI, said recent developments in the country’s mobile phone industry are promising, and now about 60 percent of people are using mobile phones, including mothers.
Timor-Leste’s major mobile providers include Timor Telcom, a subsidiary of Portugal Telcom, Telcomcel, a subsidiary of Indonesia’s Telkom, and Telemor.
“We took advantage of progress in cellular phones to be able to reach out to as many pregnant mothers as possible,” said Katz.
Mothers play a key function in developing a healthy and sustainable community. But many mothers have risked their lives during their pregnancies or when giving birth. According to Katz, in 2010 — before Liga Inan started — Timor-Leste had one of the world’s highest maternal mortality rates at 557 per 100,000 live births. Its infant mortality was a staggering 45 per 1000 births.
“It was a huge problem that caught our attention,” Katz said.
HAI and technology group Catalpa International, in cooperation with the Ministry of Health, started Liga Inan in Manufahi district three years ago. It now has expanded to the districts of Liquica, Ainaro and Aileu, with a membership base of more than 4,000 mothers.
Paul Vasconde, HAI program director, said there is a possibility the service will be expanded to more districts. The program also works on training midwives and health workers in order to be able to give better service to expectant mothers.
“We continue to work with the government of Timor-Leste to improve the skills of health workers throughout the country,” he said.
The government of Timor-Leste has instituted a strategic development plan (2011-2030) to further improve maternal health so that by 2015, 70 percent of pregnant women will receive antenatal care and 65 percent of women will have assisted delivery.
Last year, the government allocated US$67.2 million for the Ministry of Health, up from $64.3 million the previous year to support the implementation of its health policy and the construction of 39 village health clinics.
According to Katz, amid a shortage of skilled medical workers, training is crucial to the healthcare system.
But problems with the highly centralized government pose another challenge to the implementation of health projects in rural areas, particularly in connection with the availability of ambulances and fuel to transport expectant mothers from their homes to health facilities.
“Sometimes we encounter problems when ambulances are running out of fuel or when they need repairing. We have to wait for fuel from Dili or in case there’s a need for fixing, ambulances have to be taken back to Dili,” said HAI’s Vasconde.
At present, parliament is drafting a decentralization law to give more opportunities for decision making at district levels.
Dr Daniel Murphy, the American director of the Bairo Pite Clinic in Dili, said there is a lot of opportunity for the existing government to improve the country’s healthcare system.
According to Murphy, many women in this country have no contact with the healthcare system and approximately half of women deliver unattended by skilled medical workers. “They go through the process of pregnancy and delivery without seeing anyone. This is what the government should pay attention to,” Murphy told ucanews.com. His clinic trains dozens of midwives across the country, many of whom walk day and night to reach pregnant women in remote areas.
Though admitting improvement in recent years, Murphy reminded authorities of the biggest challenge: “no attitude of professionalism and lack of dedication among government officials to improve the life of Timor-Leste people.”
“The most effective approach to improve the health of mothers and children is through community based initiatives, by involving mothers in every step from planning, implementing, and evaluation,” he said.