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Timor Leste

Mobile clinic narrows healthcare gap in Timor-Leste

Jesuit priest travels to hamlets on hillocks, serves as a band-aid for state's medical woes

Mobile clinic narrows healthcare gap in Timor-Leste

Jesuit Father Antonio Martins Abad-Santos, a Filipino most villagers know as Father Bong, celebrates Mass before performing medical check-ups on his patients in Gmanhati hamlet, Ermera district on Jan. 22. (Photo by Michael Coyne)

Mountainous terrain, inadequate modes of transportation and shortages of medical personnel and facilities have all combined to hamper efforts in Timor-Leste to provide local people with adequate healthcare.

As a result many people, particularly children, women and the elderly in rural areas often struggle to access hospitals or clinics when they fall sick or are in need of a check-up. Even access to clean water is a key concern.

However, mobile clinics such as the one organized by a local Jesuit mission is bringing healthcare closer to home — even into people's living rooms.

Izabel Soares, 21, is among the residents of Gmanhati hamlet in Ermera district who are benefiting from the new service.

She recently took her 3-month-old baby to meet Jesuit Father Antonio Martins Abad-Santos, a Filipino doctor known here as Father Bong.

A certified medical practitioner, he runs the clinic and makes regular visits to a nearby village made even more remote by its hillside location.

Chronic back pain makes it difficult for Soares to stray far from home so the mobile clinic was a godsend on this occasion as her daughter was showing signs of malaria, running a fever and coughing.

"I don't have to go to the hospital now to collect the medicine and vitamins for me and my baby because Father Bong brings them here for us," she said.

Before the priest started the clinic, people had to walk to the nearest facility in Railaco about eight kilometers away.

"For young people that's not such a problem. But for senior citizens like me, or for women, it's a real challenge to cover such a distance by foot," said 75-year-old Alderiano Goncalves, who lives in the same hamlet.

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Goncalves has been afflicted with rheumatism for years and has to contend with seasonal migraines, fever and a recurring cough.

He met the priest for the first time eight years ago. Before the advent of the clinic he used to rely on traditional medicine supplied by local practitioners because the nearest hospital was too far from home. 

Izabel Soares awaits medical attention for her baby in Gmanhati hamlet on Jan. 22, in the hope that Father Bong can offer the toddler more than just headache tablets. (Photo by Michael Coyne)


Father Bong's visits serve as a beacon of hope for hundreds of villagers. Not only does he minister to their physical needs and ailments but also provides spiritual nourishment by celebrating Mass with them before providing treatment.

"We get both — physical and spiritual nurture," said Goncalves, who lives with his biological child and three adopted kids. One is preparing to work in South Korea, in hope of serving as a new breadwinner for the struggling family. The Northeast Asian powerhouse is a prime destination for overseas workers from Timor-Leste.

Plazida dos Santos, 22, from nearby Naisuta hamlet, also in Ermera district, said the Jesuit priest is now working on her second child's skin problems after treatments sought elsewhere proved ineffective.

"I've taken my baby to Gleno [the capital of Ermera] several times but the doctor just prescribed paracetamol and she's still sick," she said.

Now the wounds on her daughter's feet have rendered her immobile, she added.

And she is not alone. Many of the children suffer from skin problems and parents are at a loss when it comes to dealing with them.


A plague of infections

Father Bong's mobile medical clinic covers 11 areas in the two districts of Ermera and Liquica. He launched the service in 2004 as part of his pastoral duties at the Jesuit Railaco Mission.

Helped by two assistants, he heads out to local villages every Monday, Tuesday and Thursday, traversing treacherous trails that require a strong sense of adventure.

"We run a mobile clinic because we don't want to compete with the government clinic in Railaco,"Father Bong said.

"We target those people living in the mountains who cannot be reached by government clinics or medical workers," said the Filipino priest.

"Every year I see more than 5,000 patients," he said, adding that most cases involve an infection of some kind. He blamed malnutrition as this weakens the immune system and opens the door for infection.

"I meet lots of people with this kind of problem, such as respiratory infections, intestinal infections or upset stomachs," he said.

The villagers often fail to prepare their meals in a sanitary way while the elderly chew betel nuts. Smoking is commonplace.

According to the World Health Organization (WHO), lower respiratory infections were the second-biggest cause of death in 2012 among the Timorese people after tuberculosis.

Other major threats to their mortality include ischemic heart disease, strokes, birth asphyxia or trauma during conception, diarrheal diseases, neonatal sepsis and infections or cancer of the trachea, bronchus or lungs.

An assistant distributes medicine to patients at the Daniel Coelho Ornelas clinic in Railaco. The clinic was named after a Jesuit who worked in Timor-Leste from 1962-2009. (Photo by Michael Coyne)


The clinic cannot deal with all of these complaints and illnesses because it is part of an outreach program and not that well-equipped.

The doctor-priest is restricted to providing first aid or primary healthcare and trying to prevent people from getting more sick.

He refers serious cases to government hospitals or clinics with better facilities.

Father Bong, who was ordained as a priest in 1998 back in the Philippines, said the St. Canice Parish in Sydney, Australia has been providing financial support for the clinic's operations for years.

"In the beginning they only offered their help for five years. But when they saw the need was there, they continued," he said.


Healthcare challenges

Timor-Leste is struggling with a fractious young government but has achieved significant improvements in terms of its healthcare, according to a report by the World Bank in 2017.

For example, when the fledgling state gained independence from Indonesia in 2002 its healthcare infrastructure was decimated with only 20 doctors to tend to a population in excess of 1 million.

Fortunately that number has since multiplied significantly, with the government employing nearly 900 doctors as of last year.

People's life expectancy soared from a dismal 48.5 years in 1990 to 67 years in 2014.

Meanwhile, antenatal coverage has improved and the general population are now much more aware of infectious and non-communicable diseases, officials say.

This has been helped by a health budget that has curved upward since 2008. The government allocated $67.2 million for the Ministry of Health in 2014 to build 39 clinics, among other projects.

But Bolormaa Amgaabazar, the World Bank's country representative for Timor-Leste, has warned "the growth outlook for the Timorese economy during the next few years is subdued."

"As such, the government is attempting to put a curb on rising public spending," he added.

Father Bong said the nation's woes are widespread and even the National Hospital in Dili suffers from a lack of medicine.

"The current government focuses more on bureaucracy than the quality of healthcare that's provided," he said.

The country has sent nearly 1,000 young people to study as doctors in Cuba in recent years, and now many have returned to plant new seeds.

"But for them to perform their duties effectively and efficiently, the government needs to upgrade its healthcare equipment," Father Bong said.

"If the healthcare system was more efficient and the country had world-class facilities, people wouldn't need my help," he said.

"Then I could focus on my duties as a priest."

This article was first published 26.2.2018.

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