With a protective arm wrapped around her sickly daughter, 24-year-old Domingas Dos Reis was reluctant to explain how she wound up in a clinic in Dili, the capital of Timor-Leste, with her husband and young toddler. But it didn't take too long for her to pluck up the courage to speak. "She suffers from diarrhea, fever and a bad cough. The doctor said she's malnourished," Dos Reis told ucanews.com at Bairo Pite Clinic where the couple's 1-year-old daughter, Juliana Suares, was awaiting treatment. The clinic was founded in 1999 by Daniel Murphy, an American doctor. Every day it takes care of more than 300 patients suffering from a range of ailments and complaints. Pregnant mothers and young kids receive free treatment, making this one of the busiest health facilities in the country. Access to healthcare is a major concern for this impoverished nation
of less than 1.2 million people, 97 percent of whom subscribe to Catholicism despite there being a shortage of priests
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Three-quarters of this former Portuguese colony
tacked on to the southern end of the Indonesian archipelago live in rural areas, and contend with a chronic lack of healthcare professions. The nation existed in relative obscurity for decades before the world woke up to its plight. Experts say the majority of cases that turn up at clinics across the nation could be prevented with more funding to buy vaccines for contagious diseases, and to improve hygiene, nutrition and water supplies
in general. Juliana seems to fit squarely into that category. Dos Reis lives in the capital with her husband, Elicio Suares, while Juliana stays with her grandma about 30km away in a district called Ermera. They had to part ways when the child was just six months old so the two adults could continue their studies at the National University of Timor Lorosae (UNTL) in hope of landing better-paying jobs later on. "When we were told our child was sick we went home, took the baby and rushed her to the clinic," Dos Reis said. Domingas Maia de Deus, who is in charge of malnutrition cases at the clinic, said the baby was severely malnourished because she was not breastfed for a long enough period. Every month at least 25 undernourished children are admitted to the clinic, she said, adding that the majority of cases are "severe." "I suspect there are many more malnourished children out there that are out of our reach," Maia de Deus said. The clinic treats moderately malnourished patients for a period of three to five days on average while those with more severe cases require up to four weeks' care before they are sent home.
Children tuck in during a feeding program held in Cocoa village on Jan 20. (Photo by Michael Coyne)
Children who show little or no sign of progress are referred to Guido Valadares National Hospital, formerly known as Dili National Hospital, for intensive care. Based on the 2015 census, Timor-Leste has over 460,000 children aged 14 or under. The World Food Programme (WFP) says over half of those aged from six months to five years suffer from chronic malnutrition. From January 2015 to November 2017, 47,916 children under the age of five were treated for this, in addition to 68,160 pregnant and nursing mothers, the WFP reported. It has distributed food supplements for women and trained more than 200 staff and volunteers on the importance of good nutrition, behavioral change and counselling in several districts. A multi-spectrum problem
Inacio Do Santos, who manages the Bairo Pite Clinic, said the scourge is hard to rub out because malnutrition has its roots in the nation's chronic poverty levels, poor availability of resources and relatively low level of education resources available nationwide. "When we delve deeper into malnutrition, we soon stumble upon a network of problems," he said. "In dealing with this, we can't just focus on providing improved nutrition. We also have to educate the parents, the communities on nutrition," he said. While poverty aggravates the issue, most locals can afford a healthy diet of vegetables, meat, fish, rice and corn — they just don't know exactly what a healthy diet is, he said. "People don't have enough knowledge about food, about nutrition. They think if they don't eat rice, it means they have not eaten well," Do Santos said. "So they pick the fruit and vegetables to sell, and then use that money to buy rice or noodles," he said. "It's sad but true." The clinic strives to educate them on how to better utilize the food resources at their disposal. This aims to supplement government
-run projects that critics say fall short of the mark despite being well intentioned, such as the ongoing school lunch program for undernourished kids. Since mothers play such an important role in their children's health, arming young mothers with a better understanding of the role different food groups play can literally mean the difference between life and death. To help improve their lives, the clinic runs a program to train women in rural communities on important issues like nutrition, sex education, reproductive health, childcare, and so forth. According to the World Bank, the factors that lead to poorly fed children and mothers in Timor-Leste are numerous and span various sectors. In a report last year it stressed the importance of educating the public about child care, feeding practices, reproductive health, household hygiene, dietary diversity and food insecurity. It expressed concern about the poor access to high-quality health services in the country and soaring levels of household poverty. Moreover, it said macroeconomic issues, politics and sociocultural factors all compromise the move to usher in a reasonable standard of nutrition in the national diet.
Members of the Congregation of Sisters of St. Paul of Chartres teach catechism to kids in Cocoa village. Faith formation is done along with extra nutrition program provided by the local Jesuit mission. (Photo by Michael Coyne)
The government of Timor-Leste has outlined its efforts to remedy this by providing better nutrition in its 20-year National Strategic Development Plan (2011-2030). One of the protocols involves setting up a National Council for Food Security, Sovereignty and Nutrition, a coordinating body that guides a multi-spectrum response to food insecurity and malnutrition. The Ministry of Health has also outlined its five-year National Nutrition Strategy (2014-2019) but critics say the clock is ticking and officials need to shift gear to stave off more unnecessary or preventable deaths. "We can't wait for the government to solve this complex issue," said Dos Santos. Jesuit feeding program
In rural areas it's not uncommon for relatively young parents to have large families, creating an onerous challenge to ensure their children are well fed. Take the case of Filomenta Esposto. The 27-year-old mother of five from Cocoa village said all of her offspring have now joined a local Jesuit-run feeding program because the difficulty of feeding them all sparked fears they would eventually succumb to malnourishment. "We can't afford to provide nutritious food for all of our kids," she said. "We could only muster two small meals a day. But since joining the feeding program a few years ago they all look much healthier now." A similar thing happened to Magdalena Madera: The 26-year-old said all six of her kids have put on weight — in a good way — since signing up for the program. The program has helped hundreds of local kids who otherwise would have suffered, said Christina Haryunika, 43. She coordinates the Jesuit program that currently caters to 276 children in three villages — Cocoa, Caitrahae and Lebdodon — in the parish of Jesuit-run Our Lady of Fatima Church. "It's common in Timor-Leste that families have many children, and parents find it hard to feed them to an acceptable standard," she said. Haryunika heads to each of the villages on an almost daily basis to deliver meals, helped by volunteers and local nuns from the Congregation of the Sisters of St. Paul of Chartres. "We provide porridge, boiled eggs, milk, rice, vegetables and meat," she said. Health education is incorporated into the visits. And maybe the occasional faith lesson, too.