The remnant (part 2)

(Continued from part 1)

It’s fair to say that we’ve struggled at times, since launching Maluk Timor in the wake of our inglorious departure from Bairo Pite Clinic, to restore our credibility and elevate our rebranded organisation into the collective consciousness of our Timorese health partners. There are many other better-funded health NGOs in town and we’ve often felt like the new kid battling to make his mark on the world.

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Yep, this looks like our new HIV centre… bit of a fixer-upper but we’ll make it work.

It wasn’t self-doubt: we always had confidence in the quality and sincerity of what we were doing and forged on ahead trusting that some day someone might notice us and see the value in what we do. The long and winding campaign to secure our MoU with the Ministry of Health was the defining story of 2018 and 2019 for us, so we began 2020 with fresh optimism that finally we could move forward. Maybe we’d be allowed to eat at the grown-ups’ table.

477320e9-85f9-416b-96d5-69a9f22cd3deThen there was COVID-19 and the hurried exodus of internationals, with the result being that Maluk Timor became almost an overnight sensation, the new darling of the health sector. It was a recapitulation of the Steven Bradbury story to some extent: as all the other speed-skaters slipped and fell it was the last man standing who carried off the gold medal. But we mustn’t forget that he still had to be good enough to be in that race, and so did we.

As I recounted in part 1, we had retained a strong, highly skilled and committed team in the country when others had been forced to retreat. Somewhat fortuitously, we had been preparing and drilling that team in precisely the skills that were needed for this crisis, so we were ready to respond when the call came.

Suddenly we were headlining the Australian Government’s aid response in Timor-Leste, and we were ‘besties’ with the senior directors of the government’s health response. I think my recognition of our new standing really struck home during one of many lengthy meetings with the Ministry of Health. I have attended my share of these and, as sometimes happens, on this occasion I had been summoned forward to sit at the main Boardroom table amidst the various national directors. During this five-hour-meeting news filtered through that the State of Emergency had been declared and that we would no longer be able to drive in Dili without a freshly laminated ID card from the Ministry of Health. We were shut down.

Impossible! We had a full training schedule underway!

The Whats App feed was going crazy as everyone scrambled to send their staff to the appropriate government department in a nearby building to compete for these ID cards which were evidently in very short supply. We tried to sustain our attention on the heavy discussions at the table but all of this was proving very distracting.

1F3AE79E-7550-4DAF-8050-A44CE68A8423 (2)To my astonishment a senior government official – a man who had arm-wrestled me for two years as part of our MoU process – messaged me from across the room to ask how many ID cards I wanted. Trying not to be greedy, I responded with a request for twenty. Minutes later he very conspicuously manoeuvred himself through the formally-assembled meeting and deposited a pile of lanyards on the Board table right in front of me. Some of my friends from other health organisations looked on in horrified envy, while all I could manage was a sheepish smile, like the pimply nerd who had just been kissed by the belle of the ball. We had never been on the end of such privileged treatment.

Maluk Timor was now being referenced daily by political figures in the press, on social media, and at every meeting we attended. Having thrown our team into the field at a time when so many others had been forced to recall theirs our collective expertise and enthusiasm for this work began to speak very loudly for us. This was aided by a newly-formed but very active Communications team who were lighting up Facebook in Timor-Leste on our behalf.

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Designing the COVID-19 isolation facility

The tempo behind the scenes was absolutely furious. We were thrashing out new training programs, brokering new deals and partnerships, advising on all manner of emergency preparations, and trying to sequester and protect a group of recently-returned cardiac surgery patients from Australia. We doubled down on training, clinical and non-clinical, including taking the lead on a Psychological First Aid package that was in heavy demand.

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Perhaps our best (or most ambitious) idea was to equip 43 Timorese doctors – the registrars from the Family Medicine Program whom we’d been training these past years – as educators who could take the COVID-19 training materials we had freshly developed to every health centre in the country. That’s the thing about Timor-Leste – almost everything we do as expats revolves around Dili, yet three quarters of the population live in small villages scattered throughout the rugged and forested mountains, with very difficult road access. Reaching the seventy or so government health centres outside of Dili is an enormous challenge, especially during a State of Emergency when travel is restricted.

We didn’t realise when we first dreamt up this scheme how critical this work was going to become. Our team worked day and night to create and translate a curriculum of COVID-19 training materials that were tailored to suit remote Timorese health centres. Our logistics team trawled the shops of Dili, many of which were closed down, to find buckets and taps, tarpaulins, gazebos, plastic twine, rolls of tape, and all manner of other oddities that we thought might be useful in spawning pop-up triage booths all over the country.

Four days of training, a few days of prep (including a factory-line of printing and laminating of posters, flow diagrams and signs), and some maddening last minute phone-calls as one of our partners withdrew their offer of nine 4WD vehicles, and the government announced another surprise public holiday… we were ready to launch.

Pulling together half a dozen partner organisations and manufacturing 17 teams to fan out across all 13 municipalities to reach literally every hospital and community health centre in the country in the space of ten days… it was a coordination nightmare yet a monumental achievement for everyone involved.

Our intrepid Timorese doctors braved the horrific roads of the wet season, the police checkpoints, and the frustrations of trying to run trainings in hospitals and health centres with either no power, no projector, no wall upon which to project, or no people to train. They were extraordinary: armed with their basic supplies they threw up triage booths and handwash stations wherever they went, in blazing sunshine or pouring rain.

We almost couldn’t believe it worked. Of course it was only a beginning, and it only raised the expectations of what we might do next.

Tempering those expectations were the growing challenges at home. With the school closed and school holidays over we were facing the same sense of dread afflicting working parents across the world: home-schooling.

We love being with our kids, but we’re really very happy not being their school teachers. And this particular point in our lives didn’t seem to be crying out for a lack of purpose, nor for want of something significant to do. My stomach churned as I flicked through the correspondence from the school which mapped out the 26 new profiles, log ins and passwords we needed to get our four children connected to this new reality. I felt like I was going to scream. This was clearly not going to just take care of itself.

Bethany, in her usual pragmatic way, got stuck in and created a homeschool corner. Levi, our self-appointed computer nerd, delighted himself with these new opportunities to download, install, sign up and log in to each of the 26 platforms on behalf of his siblings. Actually we’d have been a bit lost without him. Gradually, inspite of painfully slow internet and a general inability to watch anything that the teachers sent through in video format, Bethany gained a kind of functional ascendancy over the situation, admittedly with a bit more cussing than the children were accustomed to hearing. They’re learning all kinds of new things at home.

Worryingly though, their imaginative play has changed. Now the toys sit around Boardroom tables and have crisis meetings.

On the weekends we would try, when we could, to get out and about. Taking a few of our Maluk Timor volunteers with us, we went for hike up a river valley to a freshwater weir. Micah counted his falls along the way and registered double figures. On the way home we were intercepted by an afternoon storm which soaked us and every possession we carried, and made the car smell like ‘wet dog’ for a week, but it made the excursion all the more memorable.

We narrowly missed out on the ultimate memory-making experience of being either cut off or swamped in the river-crossing on the way home. That would have made for a more compelling tale.

Notwithstanding the sense of impending tragedy that troubled us night and day, these weeks were perhaps the most rewarding that Maluk Timor had ever enjoyed.

However, the uneasiness was unrelenting. The case numbers of COVID-19 slowly climbed in Timor-Leste – ten, then twenty – as returned Timorese students from Indonesia brought the infection home with them. The government’s quarantine and surveillance processes largely held back the tide but the likelihood of leaks seem to increase each day. I braced myself for what was coming, but was utterly unprepared for what was about to unfold.

On a Tuesday morning, swinging my Kluger around in a U-turn exactly as I’d done hundreds of times before, I saw some oncoming motorbikes coming up the dual carriageway toward me. This was hardly unusual and, at the typical low speed of Dili traffic, one generally just nudges the car forward slowly and everyone else makes way. However, with fewer vehicles on the road than usual, one of the motorbikes was eating up the open road between us at great speed, closing in on me. I aborted my U-turn and halted, leaving an avenue a-lane-and-a-half wide in front of me, through which he could easily pass by adjusting his course just a few degrees. However, his head was turned to share a joke over his shoulder with his female passenger. He didn’t even see me until the impact was unavoidable.

His motorcycle thundered into the left side of my now stationary car, forward of the front wheel. The motorcycle went virtually no further, other than lifting its rear end to catapult its two riders over the handlebars and on to the road. The laws of physics dictated that the greatest leverage was applied to the rear passenger who, after being propelled high through the air, landing grievously on her unhelmeted head.

If you prefer to avoid grisly descriptions of road trauma I would suggest skipping down to the next photo.

I leapt out of the car and ran to the woman, finding her convulsing on the road, her face covered in blood-soaked hair. ‘She’s caved in her skull’, I thought, ‘and she’s going to die in front of me.’ I swept the hair from her face and positioned her to breathe, for what good it would do her. But then her seizure subsided, and she lay still, eyes open, breathing haltingly. It didn’t look good.

I attended the other passenger and found him conscious on his back, his helmet on the road nearby, and his right thigh swollen and shortened. That was a broken femur for sure, but he appeared otherwise intact.

The next thirty minutes were utter chaos. This particular road is the major artery of Dili and this tragic scene now occluded it entirely. It was around 8:30am and traffic was building up on all sides, and so was the crowd. The practice in Timor-Leste is to stop at an accident and, rather than rendering assistance, compete to capture the most horrific footage available to post on Facebook. In spite of my many attempts to stop people from recording the action, I knew I was being immortalised for the nightly news.

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It felt like an age before either police or ambulance arrived, though some of my staff arrived at the scene to support me long before then. A Good Samaritan in the form of an unknown Timorese nurse was my strongest ally, phoning emergency services, providing basic care, and keeping the crowd at bay. These scenes can become combative here, but thankfully there was no hostility on this occasion. To my relief the young woman’s condition continued to steadily improve, and she began moaning and trying to get up. Soon afterward she was carried into the back of a ute and hurried to hospital. Then the ambulance, police and military all arrived in force, and order was quickly restored.

My car was impounded, I drafted my statement for police, and then I received the surprising news that the woman was apparently in good condition, with only a minor graze to the forehead. She was being discharged from hospital. I was stunned and relieved. My kids took it as an answer to their prayers which they had been faithfully sending heavenward since the minute they had heard about her. The young man would need time to recover from his broken femur but could also be considered to have cheated death on this occasion.

Rattled and distracted, I left work early and returned home. For four years I had safely endured the chaos of Dili roads… until now. I felt a range of emotions but mostly I feared for the wellbeing of the two riders. I would be made to pay – irrespective of fault there was only one party with any means to make reparations – but that could not have concerned me less. I just hoped everything would turn out all right.

Meanwhile, through the afternoon we began receiving hundreds of photos from our teams in the field. The photos detailed unheralded success in running trainings and setting up COVID-19 preparations simultaneously all over the country, some of them almost 12 hours drive away.

That evening I cobbled a few photos together into a Facebook post and shared it with every senior health figure I could think of. Maluk Timor was on the main stage now and I was inexpressibly proud of what was going on in our name.

Having posted my news and begun answering some early responders something else broke through into my social media feed. It started as a whisper, just a rumour… but within minutes Facebook and Whats App exploded with the revelation that Timor-Leste’s ultimate warrior-physician, Dr Daniel Murphy, had died unexpectedly in his home, in his mid-70’s.

If you know us, or you know this blog, then you know something about Dr Dan already. I won’t attempt to eulogise him here as there are others who will do that far better, but suffice it to say that Dr Dan was an American physician with a lifelong track record of serving the underdog who had given the last 21 years of his life to the people of Timor-Leste. He is a national hero, having done more for the health of the Timorese people than anyone else in their history. In the midst of the conflict in 1999 he threw together an impromptu clinic in Bairo Pite, a crowded and lowly suburb of Dili, and it grew to become one of the busiest hospitals in the country. It was where Bethany and I began our work in Dili in 2016.

Right up until his death Dr Dan toiled relentlessly for his patients and was revered as a saviour of the Timorese people, particularly the most vulnerable. His death was met with an overwhelming outpouring of grief from all quarters, just as the crowd at his cremation and funeral violated all of the country’s social distancing rules.

Many of you know that our own relationship with Dr Dan was complex. Having worked as his Medical Director in 2016 and 2017, I would say that he was a man much easier to admire from afar. However, in spite of a troubled working partnership there was never any lack of good reasons to respect him and his extraordinary work, and I can honestly say that he deserves his place within the highest echelon of Timorese heroes.

84d3c6d4-8122-4338-8a03-2eef07ce9b32The death of this towering figure has brought a deep and pervasive sadness to the country and comes at a time when heroes are in short supply. What will become of our old stomping ground, Bairo Pite Clinic, without him? Where will the people of Timor-Leste turn when all other hope is lost? Their champion is gone, though he will surely never be forgotten.

It rounded out a very strange day for me personally. I don’t think I’ll ever be able to find a way to unpack the swirling maelstrom of emotions that I experienced through that period of 24 hours.

That was only a week ago, yet it feels like it all happened in a distant age. The inconsistency of our perception of time has never been more apparent to me than in these past months during which some days have felt like they’ve contained a month’s worth of action, yet a week can slip through my fingers with such rapidity that I can scarcely tell you what it contained.

This week the focus has been about launching our new smartphone app, called ASTEROID. This app was supposed to be deployed in September or October as part of a project to strengthen Timorese health centres in detecting and mitigating infectious threats. This was long before we knew about COVID-19. Then suddenly, when we needed a way of providing clinical training to clinicians all over the country with no time to lose, the app was on hand.

IMG_2860Our partners, Catalpa International, had powered into action and launched the app a full six months early. Now I’ve got a whole team working on uploading content in English and in Tetun, and we’ve got hundreds of Timorese health workers from the remotest corners of the country signed up and connected. This tool is going to overcome the expected obstacles of tightened restrictions for travel and meeting in groups. It gives us a conduit through which we can reach clinicians everywhere with the most up-to-date information as the pandemic changes.

But I’m a little weary, and my back is sore from the constant muscle tension that comes from perpetual urgency. I can only hope that all the nervous energy will amount to something and that Timor-Leste can withstand the coming storm.

 

 

The remnant (part 1)

The beginning of this story goes back to when life was normal, or at least relatively so. Late January.

Like all of you, we had made plans for the year that now seem laughable. I was closely watching a poorly-understand epidemic gathering speed in China, but I had absolutely no idea of how dramatically the world was about to change.

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Normal things were still happening. Babies were being born and people thought nothing of cuddling them. Interminable meetings were carrying on in crowded airless rooms without a face-mask in sight.

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Even visas were being approved: after almost four years after arriving here we finally became the proud owners of the elusive Special Stay Visa.

To be perfectly honest, it becomes hard to remember precisely what we were doing back before all this, but I’m sure it must have been dreadfully important.

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We’d been able to continue strengthening our team in Dili, including the welcome addition of two friends from Geraldton joining us. Nathalie, who had come to us as a teenager shortly after Levi was born to be our very first au pair, is now an accomplished social worker and arrived to undertake her thesis; and Dr Nikee, a longtime medical colleague of ours, surprised us with a late change of plans. Neither of them could have imagined they might find themselves marooned with us indefinitely.

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I follow a number of infectious diseases experts on Twitter so was getting more frequent reminders about the trouble in Wuhan than most. I was absorbed by this macabre, other-worldly story that was unfolding. I sent our staff shopping for PPE, sensing that something unprecedented might be on the horizon. I sent messages to family members and warned them that this one could be big but to be honest I had no unique wisdom about all this that wasn’t commonly reported in the media.

As we ran deeper into February the heaving swollen wave heading toward us became more easily seen and could no longer be ignored by even the most foolhardy denialist. Trouble was coming, and we had to act.

As you’ll see below (and in part 2) we are very fortunate to find ourselves in rare and peculiar circumstances.

We were enormously fortunate that Timor-Leste’s relatively inconsequential international air-traffic spared the nation from being an early casualty. The government responded rapidly by closing down some of the highest risk routes, stemming the flow of potentially infected entrants.

We were enormously fortunate that as an independent organisation we were able to nimbly adjust all of our programming and throw virtually every resource we had into COVID-19 preparations.

We were enormously fortunate that we had won a major grant late last year to provide training and support in the rapid detection and mitigation of infectious diseases, and that the approval to commence finally came through to us on 2nd March. We had funding, we had a mandate, we had a team on the ground, and we were ready to move.

Almost instantaneously we went live with a flurry of trainings, social media campaigns and infrastructure projects. Some health centres in Dili had as many as 20 hand basins out of order, and we were able to jump straight in and repair them all. Our nursing team, with two years of recent experience of setting up triage systems in Dili health centres, were able to immediately fly into action and throw up COVID-19 triage tents all over Dili. We deployed doctors to write guidelines and training materials, to oversee construction of the first COVID-19 isolation centre, and to train other NGOs in COVID-19 prevention. We were absolutely everywhere.

Dili was abuzz with COVID-19 preparations too, but all of this was stunningly interrupted by a catastrophic deluge late on a Friday afternoon in mid-March. The sudden heavy rain on the hills above Dili took advantage of some drainage imperfections to produce a flood unlike any in living memory. All across the eastern end of Dili homes and offices were inundated or washed away. School children were rescued from atop their desks, perched above swirling silty waters, and carried to safety through a furious torrent of muddy water. The video footage is quite terrifying with streets transformed into cascading rivers, and the rivers themselves running like overfilled speed-slides at a waterpark that you would never want the misfortune of visiting.

Massive floods hit capital Dili, destroying nearly 200 homes and ...

Our HIV Centre was inundated with mud and silt, along with 200 homes. COVID-19 would have to wait, as half the city was under a foot of thick mud and someone had to clean it up.

The government declared two days for clean-up and our team did their bit.

After the flood came the fire…

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…and after the fire came the plague.

There was great tension in Dili as the first suspected case was announced. Madness ensued when the nationality of the man was publicly announced, after which he simply became known as ‘The Italian’. There was such a furore about where this man was to be isolated while awaiting his results (no testing was available in-country, and specimens were sent to Australia) that a riot broke out in a neighbouring town when locals discovered that the Ministry of Health intended to move him to a secluded facility there. The fear was palpable, and people were twitchy. Random foreigners were being accused by locals of being carriers of the virus – perhaps not unreasonably. Where else was it going to come from?

The Italian tested negative, and so it proved to be nothing more than a very useful dry run for what would follow.

Several days after the flood Bethany and I received a surprising message from a person whom we knew only distantly. Knowing us to be doctors, this person contacted us to  report respiratory symptoms having recently returned to Dili from abroad. The story sounded very concerning, and every bit like COVID-19. What to do? If we turned this person in for testing they would almost certainly become the next ‘Italian’, risking a possible lynching or harm to friends and family. There was simply no guarantee of anonymity, and the mood on the streets was that an infected person was someone to run out of town, not someone to be cared for or supported.

The person involved had been extraordinarily careful, taking every precaution to protect others. There was a very strong likelihood of complete containment and no immediate risk to the public. The symptoms were relatively mild, and the person was low risk of serious illness. Was it better just to keep it all under our hats to protect them?

Of course that was never really an option. To conceal what was likely to be the first COVID-19 case would have been an indefensible breach of the public interest, even for the sake of protecting the patient. We had to proceed, and we all knew it. A secretive visit  from the National Health Laboratory followed and the diagnosis was confirmed. Timor-Leste had its first COVID-19 case.

The result was announced in the media and the town promptly went mad. Rumours swirled and accusations flew, with speculation about the nationality of this person rife at every level of society. Within hours it was clear that at least some confidential information can been leaked and we were bracing ourselves for a full exposé on Facebook. But it never came. A series of heroic interventions by some of our friends and colleagues preserved the relative anonymity of the patient and provided for their every need. There was no lynching, and pleasingly, there was no spread. Timor-Leste stayed stalled at one case for a number of weeks.

There’s a much more detailed version of this episode that I would love to reveal to you all one day, but it’s a little too soon to give away so many clues. Suffice it to say that we felt as though we were part of a Hollywood blockbuster: a witness-protection-scheme-gone-wrong cliffhanger that ended with a remarkable twist… but that story will have to wait.

The announcement of this first case was great, in many ways, because the country flew into action. Plans that had been discussed ineffectually for weeks were suddenly actioned and the people of Timor-Leste strengthened their preparations and defences. Many stocked up on basic foods and took to the hills – not such a bad thing when social distancing is a major public health strategy.

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Social distancing in Timor-Leste

But then the internationals departed too like a spectacular flock of migratory birds sensing the imminent arrival of winter. Businesses and cafes closed, projects stopped, and the international school hurriedly closed its doors. There was scrambling and panic as new travel bans and flight cancellations were announced daily. People felt like all the exits were being cut off so they dropped everything and boarded whatever planes they could. In their defence, many of them really didn’t want to go but were compelled by employers, insurers or advisors to do so. It was a remarkable exodus, all over in a matter of a couple of weeks. We felt as though a net was closing in around us, and that if we didn’t go soon we could be caught for months… years… who could know?

The final Airnorth flight (or so it seemed at the time) departed, and door slammed shut. No more flights to Darwin. No flights to Bali. No flights to Singapore. Marooned.

We were again enormously fortunate. We were able to stay and we retained almost our entire team of internationals: fourteen of them! Against all odds, we had somehow kept the band together. We had to walk everyone through the worst case scenarios: what would their insurance cover, what would they do if severely unwell with COVID-19, what contingency plans did they have? We went through all the scenarios but not a single one of my clinical staff left when they had the chance. Nine doctors (seven Australian, two British) and two nurses (Australian and British) chose to stay on and stand with the Timorese against this threat. I was immensely proud, if not a little concerned. And again, I don’t mean to disparage the migratory birds, many of whom would have stayed if they’d been given the choice.

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“Hey, where’d everybody go?”

Why did we stay, when so many others went? I don’t have a single answer to that. I think partly we felt that all the circumstances of the past four years have in some strange way built to this terrible crescendo. I think that we felt a responsibility to stand with our sixty Timorese staff, and the thousands of other health staff who we’ve been urging to stay in their posts, though the historic practice in Timor-Leste is to run to the mountains in times of disaster. “What would we say if the army ran away in a war,” we asked them, “or the firefighters ran away from the fire? This is a health crisis, and if health staff don’t stand and fight it, who will?”

Additionally, we had just won a grant to help Timor-Leste prepare for and resist infectious threats… should we take the money and run away? Of the thirty or so recipients of major Australian grants for health security in the Asia-Pacific we appear to be among only two who have boots on the ground, ready to respond to this crisis. That gives us a very particular opportunity that many others wish they had.

But we’re not here as mavericks, or as COVID-19 vigilantes. I don’t want you to imagine us conducting some kind of rogue operation, off the grid, risking our children’s lives against the advice of our government. That would make for a better blog entry but it simply isn’t true. We’re here very much with the blessing of the Australian government who have taken active steps to ensure that members of our team are able to stay.

Even so, our ongoing presence has been noted. A couple of weeks ago Sr José Ramos Horta messaged us personally to thank us for staying and even referenced us in a Facebook post as following in the footsteps of Mother Teresa! You don’t become an international keynote speaker without a bit of flair for rhetoric and hyperbole.

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(To be continued…)

Reverse culture shock

9e3c535c-27ef-43b5-9f66-e1ba363ca0d4In early December I received an unexpected message from a friend alerting me that I was going to be on Channel Nine News in the subsequent moments, ‘after the ad break’. This timely advice was very much appreciated, not that we have TV at our home in Dili, nor a live feed of Australian news channels. Over the following minutes more messages came in from other well-wishers, friends and family from across a number of different timezones.

This was followed by a familiar feeling of slight queasiness and dysphoria. Knowing that my family had been profiled on national television without having seen the piece myself was disconcerting. Though my anxiety was almost certainly groundless – it was unlikely to be “a shocking exposé of a conniving Australian family exploiting the impoverished people of Timor-Leste, keeping alive a proud Australian tradition dating back to the 1970’s” – it was still an uneasy feeling knowing that so many people had seen what I hadn’t.

I was eventually able to view the news piece myself online – I’m hoping you’ll be able to view it https://web.facebook.com/plugins/video.php?href=https%3A%2F%2Fweb.facebook.com%2Fjeremy.beckett.10%2Fvideos%2F543219156459221%2F&show_text=0&width=560“>here.

Unsurprisingly it was utterly benign and the glare of the Timor sun even gave my thinning grey-blonde hair an almost angelic halo.IMG_1458 I needn’t have worried. The footage had been filmed months earlier when a news crew (and Prime Minister Scott Morrison) visited for the 20th Anniversary celebrations but we’d heard nothing further as to when it might be aired, if ever. I’d forgotten about it entirely and was initially confused when the alert first arrived. The truth was that my mind had been rather occupied with other matters.

The signing of the historic Maluk Timor MoU with the Ministry of Health along with the simultaneous expansion of a couple of key programs had triggered an avalanche of activity for Bethany and I. Our days were long and filled with meetings and foul scheming of all kinds, and our evenings even longer as we ploughed through administration, budget proposals and project design documents.

We hosted our international Maluk team for a Focus Weekend and farewelled our much-esteemed Chair of the Board, Ross Taylor, celebrating his ten years at the helm of a ship that experienced the full range of maritime calamities: being tossed about in wild storms, being becalmed in the sweaty doldrums of tropical bureaucracy, and even a shipwreck in 2017. He was always a steady hand and we thank him for steering us through to much better waters.

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Ross Taylor (right) and Dr Chris Fenton (centre) present a gift of medical equipment to our friends at Gleno Community Health Centre

Amongst all this we managed to escape for two nights to the small city of Baucau, Timor-Leste’s second largest metropolitan centre.

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Life on the edge – perched above the ocean on route to Baucau

Baucau was a verdant oasis even though much of the nation was still awaiting the first rains of the summer. Elevated in the hills, it is much cooler and quieter than the noise and dust of Dili. It’s hard to call it a city at all as one has the sense that there are only a few winding streets converging at a single intersection. The hills and lush tropical foliage ensure that only see a handful of buildings can be seen from any single vantage point. A short walk from the Pousada is the public swimming pool which is being constantly refreshed by a flowing spring – no chlorine required.

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Returning from Baucau we plunged back into a final frenzy of labours, such as leading our intrepid gang of international volunteers… IMG_1760

…training and supporting our Timorese colleagues…

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…and making Christmas play-dough. I’m not even going to attempt to explain that.

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And then it was time to hurry back to Australia for Christmas.

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Christmas is both the best and the worst time to return to Australia. Obviously our children love being in Australia for Christmas and it’s a rare and treasured opportunity to see (almost) all their extended family in a single day. But it’s also a time when reverse culture shock can be most pronounced.

If culture shock is what happens to you when you go to live in a radically different culture with four small children in tow, reverse culture shock is what happens when you come home again. You know the experience yourself: when you walk into an excessively air-conditioned room it can feel like a blast of arctic wind at first, yet within minutes your body adjusts and it feels altogether normal. In fact it feels like all is as it should be. And then you step outside of that room again and what had felt a totally comfortable ambient temperature before now feels like a Saharan summer. Reverse culture shock is somehow similar.

When we return to Australia it is exhilarating but also confronting. The extent of our acclimatisation to life in Dili is only truly revealed upon re-entry to Australia.

Our first encounter this time was the QANTAS lounge. We happened to be travelling with eminent dignitaries of far higher standing than our own, and by a quirk of good fortune we found ourselves being invited into the uncharted realm of the Darwin QANTAS lounge for our four-hour connection. Our children were overcome. Micah dove headlong into the fridge of eternal fruit juice. Annika ravaged the fruit-bowl of perpetual harvest. Levi dispatched 14 slices of champagne ham. It was a kind of wonderland that belonged in an Enid Blyton fantasy story. I don’t think any of us were bothered about reverse culture shock at that particular moment.

But the supermarket was quite a different proposition. In Dili it’s essentially a binary matter whether Weetbix can be found at better than A$15/kg, in which case it should be purchased in vast quantities. In Australia we stand overwhelmed in the breakfast cereal aisle wondering just how many different superfoods a breakfast cereal should really contain. Is it safe to have so many? Don’t the quinoa and açai eventually come to blows in their bid for nutritional supremacy?

My complete lack of mastery of how to place my purchased items into the automated check-out bagging area is also a source of much infuriation.

Choosing a wine is equally perplexing. In Timor it is fairly simple: stay away from anything you can’t read the label of, and try not to buy yellow wines. (The white wines don’t perform so well after a few months in ambient temperatures of almost 30 degrees, and often look more like a specimen than a beverage.) In Australia it is altogether more complicated.

At Christmas time it is the sheer volume of everything that is overwhelming. To give a point of comparison, the blurred photo below was taken in the home of our dear friend Estela in the distant town of Same. This is one of the two rooms of a house that accommodates eight family members, and in this photo it boasts the first Christmas tree they have ever erected. They would have far fewer possessions in their entire home than I have in one of my children’s wardrobes.

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Then there are the road rules to contend with. It’s not that the rules are difficult to comprehend, no, it’s their very existence that feels unfamiliar: in Timor the highways and byways are as ungoverned as the prairies of the 18th-Century Midwest.

The roads in Western Australia are as smooth as the mirror-like surface of the Dili shallows on a still morning – it’s enough to put a driver to sleep – yet even the smoothest of Australian roads are inexplicably torn up and replaced. Never mind that the road at our front gate in Bebonuk is steadily subsiding into a drain – no one is going to come and fix that.

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Then there are birthday cards. It’s simple enough in Dili: they don’t exist, or at least not in a form that any of us recognise. In Australia there are thousands of them to choose from. However, I’ve realised now that they only come in three distinct varieties. There are feminine cards with flowing script and the gratuitous adornment of floral emblems, there are cards without words that bear only pictures of animals wearing anthropomorphic facial expressions, and then there are cards about ageing that feature a fart joke. One store had what seemed like an entire wall of cards about farts. Is it any wonder that people’s far-fetched tales of alien abductions so often feature instances of rectal probing? The aliens are trying to work out what all the birthday cards are on about.

And lastly, there are the changing styles of the day. When I’m on holidays I quite often sport a salt-and-pepper beard that speaks more of homelessness than it does of fashion, but on this particular foray home I found myself to be thoroughly outbearded. Beards are rarely seen in Timor-Leste so I was surprised to find that in Australia there was scarcely a bare male chin to be found, and that the beards were of a terrifyingly impressive nature. Again, extraterrestrials comparing footage of our species from even five years ago would be very concerned about the possibility of either a malignant fungal pandemic or else the rising of a small but superior marsupial that has rather suddenly overthrown the dominion of men by clinging to their faces and domesticating them as beasts of burden.

But even the new overlords of mankind didn’t stop us enjoying our summer in Australia. Our children are developmentally delayed when it comes to riding bikes, with no flat territories upon which to practice, so the footpaths of the Geraldton foreshore were a fine opportunity to broaden the types of injuries they could sustain.

We visited the beach often, sometimes feeding expensive frozen seafood to the local marine life using our fishing rods. On one memorable morning I took all four kids with me and swam out to one of the floating pontoons gettyimages-545881731-256x256only to find that a large banded sweep had claimed the ladder as his own territory. We named him Big Toby, and though his unexpected appearance immediately in front of Levi’s face had initially scared the boy half to death, we subsequently delighted in his company. He was strangely unperturbed by the presence of four enthralled children swimming close enough to very easily reach out and touch him. When he eventually became fed up with our capers and began swimming away I managed to swim after him and entreat him to return, promising not to be so intrusive thereafter. He reluctantly conceded and made his way serenely back to the ladder whereupon he resumed reside

Then Annika drew our attention to some newcomers behind us, as a couple of docile sea lions surfaced just a couple of metres away. They stayed and played for a while too – it was altogether idyllic. We enjoyed a number of fine days in the turquoise waters of our coast and I was at pains to remind the children that many people travel for hours to reach a crowded stony beach not half as impressive, and that they should not take such a pleasure for granted. 

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Thankfully our children are not generally in the habit of taking much for granted. It is the great paradox of their lives in Dili: what they miss out upon are the very same deprivations that makes them richer. They seem to view life through a different lens, highlighted by the travails of a beloved friend of theirs in Dili.

Almost a year ago I wrote of a young girl afflicted by encephalitis – a classmate of my daughter Miriam. It’s hard to describe how unwell she was: weeks of uncontrolled and relentless seizures (status epilepticus) that didn’t respond to therapy, and a subsequent coma. Remarkably she began to slowly wake but when we were visiting her in hospital it appeared that her prospects of any significant neurological recovery were close to zero. Several Australian paediatricians had reviewed her in hospital and agreed that her outlook was extremely poor. She was down to less than 14kg, a tragic and emaciated skeleton of a girl, and her only responses to our company were noted to be shrieking and drooling. Our kids prayed so earnestly for her that it almost broke our hearts, as we felt that what they were asking of God was simply too much to hope for. But on a subsequent visit she offered a faint smile of recognition when Miriam sung her a song that she recognised from school. At the next visit they had her up and out of bed, bearing some weight unsteadily on her misshapen legs of skin and bone. Then she walked. Then she was discharged from hospital to her family’s care. Sometime after that she returned to school.

The next time I can recall seeing her was the morning of the school family concert in December. She greeted me in the schoolyard with a warm smile that day, and though I returned the smile I couldn’t initially recall who she was. A moment after I had walked past it dawned on me who she was and I found it suddenly difficult to breathe. The same evening I watched her perform on stage with her classmates – she sang and danced with such spunk and timing that her complete recovery was fully on display. How could this be? As I remembered the face of her mother, smiling bravely at her daughter’s bedside for months… and remembered the family’s decision to re-enrol their severely impaired daughter into the same expensive international school in-spite of it costing the family’s entire earnings… to realise that they had never given up on her… and then to see that hope realised… people must have wondered why tears were streaming down my face at the school concert.

 

My kids have been part of her journey for this past year. They know how good they’ve got it and they don’t take it for granted.

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A new year sprawls out before us and we approach it with a determination to hold some balance in our lives. Maluk Timor continues to grow and the future is bright, but it won’t do anyone any good for us to work ourselves into the ground. The challenge in front of us is to share the load more effectively by strengthening the team around us and ensuring that Maluk Timor well and truly outlives us.

It means a lot to us that people like you still follow our journey and read this blog, especially given the saturation of social media that all of us face. We hope that somewhere in these tales you find reasons for smiles, grimaces, misty eyes or perhaps even reflections on the beauty, comedy and tragedy of life – not just in Timor-Leste but everywhere on this earth.

Happy New Year.

 

Darkness before the dawn

There are some things in Timor-Leste that are so easy.

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Yep, so easy.

Catching mosquitoes is easy. You just leave your car window down about four inches overnight and by morning you’ve caught two hundred of them. Buying phone credit, or ‘pulsa’, is also really easy. Every supermarket entrance is heavily fortified by a ring of hyper-vigilant sentries, lying in wait, ready to spring their ambush of pulsa vouchers as soon as you’re within range.

Finding the correct luggage carousel at the airport is really easy. There’s only one of them and it bears the unlikely distinction of being the only thing in the entire country that moves faster than it ought to: bags come flying off at the corners like toy race-cars from a vintage electric racetrack.

There are a few other easy things. It’s easy to park in the street because it’s generally considered acceptable to double-park and obstruct an entire lane of traffic. It’s easy to tell when it’s been raining because the ocean is stained with brown silt. And it’s easy to fall into a street drain or open sewer, if you’re not paying attention.

But most things in Timor-Leste are really not very easy at all.

 

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Even getting through doors can be problematic.

On the World Index of ‘Ease of Doing Business’, Timor-Leste ranks a lowly 178 out of 190. It sits in esteemed company amongst other entrepreneurial wonderlands like Syria and Congo.

 

That feels like an horrific exaggeration of Timor-Leste’s difficulties to be perfectly honest, but I would concede that it is generally not easy to get things done around here.

 

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Ease of Doing Business: “What can I get for ya?”

If you’ve been following this blog at all you know that I’ve been more than a little fixated upon the unfinished and rather troublesome matter of our MoU, or Memorandum of Understanding, with the Ministry of Health. And that has most definitely not been easy. As the CEO of a health NGO whose entire raison d’être is to work in partnership with government-run health services, I have been more than a little concerned by the delay in achieving the government’s formal agreement to work with us. Without an MoU we’re a bridegroom left standing alone at the altar. It makes for an awkward wedding ceremony.

In the previous post I described my somewhat harrowing experience of presenting to the Health Minister’s Council of Directors. It really didn’t go well for us, despite indications before the meeting that it would be a very positive and collaborative final step before the MoU signing. I came away from that meeting in genuine doubt as to whether our MoU would ever be signed, and that line of thinking precipitated a particularly dark night of the soul.

Perhaps we have come all this way for nothing. Perhaps we won’t ever break through. Through deep and uncomfortable introspection that night I arrived at a possible conclusion: perhaps we’re not meant to succeed. As a Christian I have a sense that God offers His hand to me – to us – to share in His work on earth, but I don’t believe for a moment that success is ever promised to us in this partnership. Sometimes all that is asked of us is to fail well, to bear up faithfully under frustration and defeat and not let that change who we are nor the motivations that drive us. Defeat doesn’t have to bring bitterness nor despair. There is such a thing as failing well.

Those were my thoughts that night and though they sound morose and depressing they carried no such weight of melancholy for me. I was lifted by these realisations. Yes, I can fail well.

ScoMo came to Dili. Even Australia and Timor-Leste – so often uneasy bedfellows – had managed a signed agreement, but there was still no news on our MoU.

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In 1650 a man named Thomas Fuller wrote prosaically that the darkest hour comes just before the dawn. It’s almost certainly nonsense, scientifically speaking, but it’s a fine description of human experience which was how he intended it. For us it seemed to be a night that might never end… but then dawn did break. And it was glorious.

It started as a rumour. The MoU would be signed next week. We’d heard that before and knew not to assume anything yet. Then more rumours from different sources, each confirming a similar story. It would be signed on Wednesday. We were advised to make preparations: a lavish afternoon tea would surely be required for the occasion. Then written confirmation arrived and we knew we were in good shape. We began planning the party for the Friday night too, but held the invitations back. It’s no good having an MoU party with no MoU as my kids reminded me, singing an adapted version of Dorothy the Dinosaur’s song about tea parties:

“To have an MoU party (an MoU party), you’re gonna need an MoU (you’re gonna need an MoU)…”

Late on the Tuesday afternoon we were interrupted by a peculiar omen. Maun Bo’ot (literally ‘Big Man’) was wandering up our street. Maun Bo’ot is Xanana Gusmao, Timor-Leste’s most famous freedom fighter, leader of the resistance, former President and de facto master of the current government. He was wandering down our street, mingling among the people in one of Dili’s most troubled neighbourhoods. We’d never seen him here before. On Bethany’s prompting we hustled our unwashed kids down the street and joined the throng and were quickly ushered through the pack as rather conspicuous outsiders. He was all too happy to pose for photos and reciprocate Micah’s crisp high fives.

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What did it all mean? A visitation by Maun Bo’ot on the eve of the MoU signing? Surely a portentous sign? The next morning we received a call of confirmation. It was really happening. “Bring afternoon tea and two blue pens.”

I was very nervous. Going back there meant I would have to give another speech, in the same room and to virtually the exact same audience as my disastrous stuttering oration only weeks earlier. At least this time it seemed that the stakes were reduced. The MoU would be signed however miserable my speech might be.

Our delegation arrived early and waited. We all looked happy and relaxed. Well, almost all of us.

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Our catered afternoon tea was an impressive spread. We had blue pens. All was in order. As the dignitaries gradually filed in my heart was racing faster. I really just want to get this speech done.

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The speech came and went. It was not good, but neither was it the twelve-car-pile-up that I delivered last time around. I got through it with minor scratches and a broken headlight, metaphorically speaking.

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Then there was much initialling and signing to do. Documents in English and Tetun were thrust in front of me and I signed each page as quickly as I could, trying to keep pace with the Acting-Minister. I’m pretty sure I beat him. Gotta take a win where you can get one.

Then there were hand shakes and photos, backslaps and that peculiar strained laughter that comes with the relief of prolonged suspense. Unbeknownst to us, one of our team had a mole at the ceremony, through a family connection. Someone was spying on us – taking photos and sending them through to our staff back at Maluk Timor headquarters as events unfolded in real time. While I was signing our staff were cheering.

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Sweet relief. Invitations went out and we threw a tremendous party at our home for staff and supporters.

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The staff are happy.

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The family are happy.

Even these kids are happy! All though I think that’s more because we let them in every Saturday morning to play in our pool and on our trampoline. They’re kids from the local neighbourhood and we sometimes have as many as forty of them in the yard throughout the morning. It gets pretty frenetic at times but it’s hard to resent kids for their enthusiasm and delight. I guess we’ll continue to grow our crowd of Saturday morning visitors.

Speaking of visitors, Bethany’s parents returned to Dili in late September with eleven friends from CWA (Country Women’s Association) to fix floors, build benches and paint murals for Dili’s various health centres and clinics. It’s great to see their work but I think my favourite part is watching my own kids take a genuine and sustained interest in helping out with these projects – a very constructive use of school holidays.

Back at Maluk Timor, we considered our months of imaginings that the signing of the MoU would be like the uncorking of a bottle, allowing Maluk Timor’s activities to really flow. Would it turn out to be true? We didn’t have to wait long to know the answer. In the ensuing weeks we’ve seen a number of our projects rapidly expand and we’re now enjoying something of a Golden Age.

The Family Medicine Program (FMP), which we deliver under the umbrella of the Royal Australasian College of Surgeons, has increased from ten trainees to twenty-four, necessitating a major expansion in the number of clinical placements and the size of our team of clinical supervisors. It’s a terrific opportunity for us to intensively train a group of this size: one of the biggest cohorts of Family Medicine trainees in the Asia-Pacific.

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24 Timorese doctors squeeze into our training room for orientation

Our TB program is launching out on three new projects after a long period of treading water. Timor-Leste has the highest tuberculosis mortality rate in the Asia-Pacific, and the highest rate of catastrophic cost anywhere in the world. Catastrophic cost refers to the situation in which a person who becomes ill with a particular condition (in this instance tuberculosis) is forced to either give up their job, sell their goods or go into serious debt to pay for the treatment and its associated costs. In Timor-Leste the rate of catastrophic cost for tuberculosis is quoted as 83%: five out of six people diagnosed with TB will also be afflicted by life-altering financial hardship or even ruin. There is no shortage of motivation for us to work toward better quality diagnosis and care, and better support to those who are undergoing treatment. We’re delighted to finally have our TB projects up and going.

Then we received extraordinary news that our proposal to the Australian Government-funded PIDP grant was successful. We named it ASTEROID, or Advancing Surveillance & Training to Enhance Recognition Of Infectious Disease, and it’s the biggest project our organisation has ever been funded to deliver. For the next three years we will be rolling out infectious diseases training to more than 400 health staff right across Timor-Leste – all thirteen districts – and also equipping them with a fantastic new smartphone app to further their ongoing learning and help them maintain up-to-date clinical practice. We’ll be expanding our team yet again, and we find ourselves in previously uncharted territory with respect to our partnership with Australian Aid. Actually it feels a bit like we’re a minor division football team that just got promoted to the English Premier League.

That’s all well and good but as far as the kids are concerned the big news is the hatching of our 20 chicks. There had been a long build-up, with plenty of time spent scrutinising the incubator and ‘candling’ the eggs to see what was growing inside. When they finally hatched it was a festival event, and as they’ve continued to grow they’ve become the favoured pets of one and all.

Amidst the flurry of activity at Maluk Timor our kids remain a (mostly) soothing and levelling presence in our lives. They keep us grounded. They have a way of making incisive observations and drawing us back to what really matters, and they unwittingly hold a mirror up to each of us that reveals both the best and worst of who we are.

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Our hope is that Timor-Leste infuses into them a different sense of what life is all about, as we share the ups and downs of the Timor Seesaw. And we’re very thankful to those of you who also share this journey with us, inspiring and encouraging us as we go.

 

Almost

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It was the cheese crisis of 2019. It was not the first crisis of its kind in Dili, where the sudden unavailability of a vital commodity can drag the expatriate community into a downward spiral of acute withdrawal.

In 2014 it was the milk crisis: apparently almost two months with no milk. In 2016 there was the tonic water crisis. Gin and tonic – that crisp and refreshing salve of the tropical colonialist – is the dam wall that holds back the waters of pent-up and thinly-veiled insanity among some of the under-employed international inhabitants of Dili. When the tonic water runs out what follows is an indescribable torrent of madness engulfing the city.

There have been less severe but no less inconvenient crises. The onion hiatus of 2017. The bacon crash of 2018. This time it was a cheese famine.

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Taking it to the streets: the people cry out for cheese

As a parent of four Australian children living in a country with frustratingly limited culinary options the end of cheese is no laughing matter. Of course some would dispute that this crisis occurred at all because there was technically still small amounts of cheese to be found. There were rubbery slices of processed yellow plasticine from Indonesia. There were tiny packets of imported cheeses fetching per-kilogram prices normally reserved for rare minerals and illicit drugs. Those options only tantalise you and remind you of how much you miss being able to buy a one kilogram slab of the good stuff for under ten bucks.

 

It was a relief this week to finally receive a cooler bag from Darwin containing two kilograms of yellow contraband, and the resulting nourishment of body and soul has lifted me at last to make another attempt at updating this blog.

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Warning: consuming excessive cheese can lead to obesity

It’s been quite some time since I wrote. I would make the weak claim that the delay is due to busyness but in fact it has been more a case of not knowing quite what to write. Thinking on it now, the best way I can explain these past few months is through the analogy of motorsport.

I never watch motorsport, which is saying something because I’ll watch just about anything else. I would watch two toddlers fighting over a broken plastic mallet if only there were expert commentary, insightful statistical analysis and an occasional super-slow-motion replay. But motorsport remains incomprehensible to me. Those cars and motorbikes go round and round, make a huge amount of noise whilst doing it, and yet to the untrained eye of a distant observer it looks like nothing very much is changing from one lap to the next.

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However, I imagine if you’re within or atop one of those vehicles that it must be a rather different affair. Clutching the wheel and pumping the pedals, soaked in sweat and experiencing the extremes of acceleration through both your body and your vehicle – I’m sure each lap must feel uniquely different and that a driver could easily spend hours describing every little detail of what transpired in any given race.Image result for jamie whincup

It’s a fairly long stretch to make comparisons between my life and professional motorsport, especially as my life unfolds at a somewhat less spectacular speed.

Even so, I feel like I’ve been sweating at the wheel, hurtling around the track as fast as I can handle, swerving to miss potentially fatal obstacles and trying desperately to get the upper hand. Disappointingly, to the distant observer it must look like I’ve just been cruising around – rather noisily and pointlessly – in circles. For me to explain otherwise without inducing unbearable boredom would require a much more incisive literary mind than my own.

I can at least explain the basic lap pattern, I suppose. You all know I’ve been relentlessly pursuing the signing of Maluk Timor’s Memorandum of Understanding (MoU) with the Ministry of Health as the quintessential step in formalising our partnership with them. Our whole mission is about working shoulder-to-shoulder with government health staff in government health facilities so it is very difficult to for us to achieve our objectives without this agreement in place. This MoU has been the obsession of my last 18 months. It is the chequered flag that I’m racing for and it has led me round and round in laps ever since the race began.

Each lap begins with news that the MoU is very close but that we need to launch one final push to the line. Feeling that victory is within reach we accelerate down the straight and into the first corner. Around this corner comes a slow-down with the drafting of another new document, and around the next bend there is some slippery track with the need to arrange a crucial meeting. We always seem to hit the next hairpin bend a little too fast, as it turns out to be a lot tighter and narrower than expected. The meeting is generally cancelled or postponed, or the crucial person doesn’t attend and sends a representative in their place.  Regathering ourselves, we accelerate again. There are more twists and turns: documents, meetings, rumours, false hope, and then ultimately as we round the final corner and approach the line we discover that it wasn’t actually the last lap. We need to go around again.

I could write pages on each one of these little details which have been endlessly fascinating, thrilling, devastating and character-forming to me personally but it would make for some very tedious reading. So you’re going to have to accept your lot as the distant observer with the untrained eye who finds it hard to appreciate why we’re still driving furiously in circles around the same old track.

IMG_0895Needless to say, as I write this we are accelerating into the beginning of another lap with victory again in sight. I’m sure this is the final time around.

In spite of this perpetual circling we are still very much at work on our projects. Back in June we completed another 12 months of the Family Medicine Program. We deliver most of the training for this course, working under the Royal Australasian College of Surgeons. Bethany oversees our program while Drs Lindsay and Dianne Sherriff are the leading clinical supervisors. It was the end of our second cohort and saw another ten Timorese doctors achieve their Diploma of Family Medicine. These ten doctors have come a long way and will take the lessons learned into the next thirty years of their respective careers, hopefully teaching others as they go. It’s a very satisfying achievement.

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Drs Dianne & Lindsay with Dr Teo

I was the examiner for their final oral exam. Anyone who has ever had to sit an oral exam knows how extraordinarily stressful they can be. I remember back at medical school that some students would vomit before this exam while others had to take medication to control their heart rate or else face disabling palpitations and lightheadedness. But none of them had to face the unexpected difficulty encountered by one of our Timorese candidates in June. He was seven minutes into his exam when the room began to shake.

A few weeks earlier I had experienced my first earthquake, though hadn’t initially realised what it was. It was over so quickly. It just felt like my office chair had momentarily lost its balance, lurching ever-so-slightly to one side and then returning to equilibrium. I thought I had imagined it but others detected it too and the news reports confirmed their suspicions.

This time there was no doubt. If there had been cups and saucers they would have been rattling and tumbling from the shelves. Everybody very quickly vacated the building. We waited outside, smiling and laughing about it, unsure how long one is supposed to wait after an earthquake before re-entering a building. We decided a couple of minutes was more than enough. Our poor candidate, who presumably had been thanking his God for divine intervention of the most spectacular kind, had to sit himself down and carry on as though nothing had happened.

IMG_1108It was reported as magnitude 7.5, but was later revised down to 7.3.

A few days later we were back in Australia taking a pitstop from the endless circling. Adjusting our tropical thermostat to winter – even the mild Western Australian winter – is always an experience for us. This is a photo of the kids getting prepared for Australia.

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And this is us on our family’s first visit to the Perth Zoo. It was 24C.

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No that’s not true, it was actually pretty cold. And it was cold at night when we were camping by the Murchison River, though gloriously sunny during the days. Camping with four young children takes a lot of investment but it pays a terrific dividend.

We count ourselves so very fortunate. We live an exotic and fascinating existence in a raw and beautiful country called Timor-Leste…

…and then twice a year return to friends and family to enjoy the idyllic holiday life of Australia. Admittedly Bethany works quite a lot when we’re back and I find it hard to disconnect from Maluk Timor, but there’s enough of the good times for it to feel like a holiday. There’s no doubt about it as far as the kids are concerned.

The contrast is stark. We held several birthday parties for our children in Dili back in June and watching our Timorese friends participate was surely the best part. They have never played party games before. They’ve never had birthday cakes. Estela once described her own childhood experience: when it was her birthday her family would allow her to eat the entire boiled egg, instead of having to share it with her many siblings as was usual. That was her birthday present and party all in one.

If only you could hear the shrieks of delight and cries of laughter from our friends as they experienced their first ever games of Musical Chairs.

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Of course life here isn’t always delight and laughter any more than it is anywhere else. We have our struggles. I had a recent encounter with an old nemesis of mine that returned very predictably at a most unwelcome moment. My stutter.

Many people don’t believe me when I tell them I have a stutter, though anyone who knows me well is left in no doubt. As a six-year-old I could scarcely get a word out. Even with my parents’ persistence in engaging a speech therapist (against medical wisdom at the time, which advised waiting until I turned ten), I was very much afflicted throughout school. I have vivid memories of standing in front of my Grade 4 class trying hopelessly and unsuccessfully to deliver my lines during a rehearsal of Rinse the Blood Off My Toga. I can only imagine it was as painful for them as it was for me.

Even into adulthood I carried a lasting weakness: I avoided answering phones, was often unable to speak my own name when introducing myself to someone and suffered countless other social and professional humiliations at the hands of this old enemy. With the passage of the years I’ve generally gained the upper hand but having to learn Tetun has left me once again exposed. In English I’m well-practiced at substituting words in a split-second to avoid the blocking of my speech: I have a sense of anticipation of where the pitfall of the block or stutter will be, so can sidestep it by rephrasing my sentence at the last moment. In Tetun I am much less nimble, crippled by a very limited vocabulary and my heightened anxiety at being on unfamiliar ground. I walk straight into the traps and get stuck.

I was asked to give an impromptu thankyou speech at a ceremony at Comoro Community Health Centre. Having no time to sweat on it I got up and delivered a fairly effective if somewhat blundering and uninspiring address in Tetun.

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However, in late July I had to address the Acting-Minister for Health and his entire Council of Directors. Virtually every senior figure in the government’s health sector – many of the people I’d spent the last two years trying to impress  was sitting attentively around a large horseshoe of tables. I knew that all I had to do was to get through a handful of introductory sentences, mostly just paying respects to the various dignitaries in the room, before I would hand over to my General Manager who speaks Tetun fluently. She would carry the rest of the presentation. I had rehearsed over and over in the car on the way there. It was easy. I could speak those words fluently and accurately. If only they would come out of my mouth.

And they didn’t. Suddenly I was in Grade 4 again trying hopelessly to deliver comical lines about Brutus and Julius Caesar. It was horrible. I could see them glancing uncomfortably at one another wondering what to make of this hapless mute foreigner. There were smiles and an audible gasp of relief when one of my sentences finally came unstuck and flowed but the verbal constipation soon resumed. My face was burning hot as my staccato words eventually staggered and stumbled their way to their painful conclusion before my General Manager took over and delivered her polished address. I took shelter and hid under the desks until it was all over. I didn’t come out again until mid-afternoon.

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Sometimes you can only shake your head. Who knows what to make of such an experience? Maybe it helped us – the aftermath of that meeting seems to have been a change in attitude toward us, a change for the better. Perhaps I should have burst into tears and soiled myself too: they might have signed the MoU right there and then.

For now we live in the land of ‘almost’. We’ve almost got the MoU, we’re told. Apparently it’s on the Vice Minister’s desk, approved by all of his departments and ready for a signature. We’ve almost got our Family Medicine Program extended from 10 trainees to 24 for the upcoming year, though nothing has been confirmed. We’ve almost got the news on whether our major funding application to the Australian government was successful – it was supposed to be revealed in July but I guess they’ll announce the winners when the Prime Minister makes his first visit to Dili at the end of this month.

My Kluger – broken down since December – is almost fixed, they tell me. The final missing part has arrived from Australia and the repairs are almost complete. I had the chance to view the car last week.

I tried not to be discouraged when I found that it still looks like a prop from a sci-fi film about a dystopian world, after the nuclear apocalypse.

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You can’t let these things get you down. There are so many other good things going on. For example, today our Maluk Timor rheumatic heart disease (RHD) team is in the hills of Ermera with Menzies School of Health Research conducting echocardiography (ultrasound) screening of school children for RHD. For the next two weeks they will be scanning around 2,000 kids and finding new cases, each of whom will be followed up with penicillin treatment that should prevent an early death.

Better still, this particular study (RECARDINA) is setting out to prove that Timorese ‘rookie’ scanners – having only been trained in basic echocardiography over the last few weeks – can reliably detect children with abnormal hearts and send their images for review by cardiologists. If this is successful it will be of worldwide significance and will usher in a new era of national screening by indigenous Timorese, moving beyond the reliance on occasional visits from international teams of specialists. There are at least 300,000 children in Timor-Leste in need of screening, so developing local capacity to begin that work would be a major leap forward.

We wish the RECARDINA team well and hope they can blaze a trail that will ultimately save thousands of lives. We’re almost there.

 

 

 

When the rain comes

Human beings are incredibly adaptable to their circumstances and surroundings. Things that are at first surprising and unfamiliar are soon taken to be normal. I suspect our lives in Dili are not nearly as remarkable as some of you imagine them to be but nonetheless it is strange how one’s perception of things can change so much.

Very often it’s incremental, creeping up unnoticed. It’s hot here much of the time so the drinking of hot coffee becomes far less appealing. I tend to let it sit. Daily distractions ensure that the coffee cools to ambient temperature anyway so, just as many of you surely are, I am accustomed to swilling down my coffee cold.  Time passes and the foul bitterness of cold coffee becomes part of its charm. Giving in to defeat I have taken to brewing my coffee cold and I now rather like it that way.

It’s also evident in our adaptation to speed, or lack thereof. We become very used to things moving slowly here so when they don’t it can be both surprising and exhilarating. You recognise that a change in perception has occurred because the occasional sensation of hurtling along a Dili street at 45km/h provides an adrenaline surge normally reserved for F1 racing. Hard to believe I know, but I’m quite serious.

The children of course adapt faster than any of us due to their highly plastic brains that adjust to almost any situation. You know your kids are different from their cousins when you see them point at four stationary cars queued up at intersection and hear them exclaim, “Look! Traffic!”

I’ve noticed now that I neither flinch nor pause when the power goes out: I simply finish my sentence as though nothing unusual has happened. I’ve also appropriated the local habit of trying to catch mosquitos in a single hand – the trouble being that it’s very hard to tell if you’ve crushed the pest or only interned it within the hollow of your fist. Very often the opening of the fist in hope and anticipation yields great frustration as the savage creature free once again, but at least then the sport can continue.

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It’s been harder and harder to get back to this blog in recent months. As if life wasn’t busy enough, I’ve started studying a Master of Health Administration and it has chewed into my evenings and creative opportunities. I’m still not entirely sure why I started such a thing but it seemed the logical approach. One day I’m going to return to Australia and look for a job in some kind of health leadership and my mysterious adventures in Timor-Leste will make little sense to someone reading my lightweight CV. I hope that bolstering it with an MHA will make sense of what I’ve been doing, undergirding my experiences with some theoretical basis. Perhaps it will help me do a better job here in Timor-Leste? It’s too early to know.

IMG_0862As I write this section I am travelling again, viewing Dili from the air. And it’s a picture – colourful roofs sprinkled among the verdant green of a landscape washed and revitalised by six months of regular heavy rain. Not visible from this height is the damage wrought by that rain: the destruction of mudslides, the washing away of roads and the flooding of homes. I lay in bed one night in February listening to the rain pounding upon our roof. It was unusually heavy and, unlike the typical pattern of the late afternoon downpour that quickly passes by, it was very much sustained. It was 3am and I told myself that if it didn’t ease off in the next five minutes I would get up. It didn’t, so I did.

Heading outside with a torch and a Dora the Explorer umbrella that wasn’t quite up to the task I found the entire yard in at least 15cm of water. The water was just lapping at the doorstep of our rear apartment. The tarpaulin awkwardly slung over our pool was burdened like an overripe pregnancy, with perhaps 100kg of water in it. One of our electrical cords was running through a pool of water. I worked in the dark to remedy some of these problems and though the rain didn’t abate for another half hour, during which time our power understandably went out, major flooding was averted.

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Our HIV care centre at Vera Cruz was not so fortunate. A thick coat of mud inundated the building. How many other homes in low-lying Dili, with its blind-ended city drains that don’t always lead to the sea, must have been flooded that night? Beds are a luxury in Dili: for many people it’s a floor mattress or a bamboo mat, on a concrete or earthen floor. You can imagine how well that fares when the rain comes.

The heavy rains bring sickness too: I see my Timorese colleagues sharing knowing smiles about the inevitable stomach complaints that accompany the overflowing of city drains. The rains give the mosquito populations a sizeable boost too.

Over the summer one of Miriam’s Timorese classmates had suffered a terrible bout of encephalitis and was hospitalised with seizures and coma for many weeks. She was not expected to survive and Miriam was understandably distressed. Against all hope she began to recover and Miriam was the first student from the class to visit her in hospital. It was pitiful to behold her emaciated little body, down to perhaps half its healthy weight, but to see her smile as she recognised Miriam and then on the next visit get out of bed and walk, was truly heart-rending.

 

IMG_6024In early 2017, our first wet season, our entire family contracted dengue so we’ve had to be careful about mosquitoes. A second bout of dengue can occasionally be much more serious, presenting as either shock (with generalised swelling due to leakage of vascular fluid into the tissues) or haemorrhage (due to falling platelet counts).

During school holidays, after fixing the play-pool and building a chicken coup, we took the family back to Atauro Island and had a much-needed break for a few days. Micah, aged five, went for his first snorkelling venture at ‘the drop off’, where the stunning coral reef plunges sharply into the depths. Levi played with his school mates who were also there, including an unusual game involving a partially submerged fibreglass dinghy and a competition to see who could remain in the boat longest while it was rocked from side-to-side by the inimitable Barry (of Barry’s Place, the Atauro eco-resort).

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We took a surreal boat trip to the remote northern-most beach (Akrema), notable for its clean white sand, but we were overtaken by a surprising turn in the weather. After a hair-raising 90-minute voyage in a motorised fishing canoe in decent swell we ended up huddled near the beach trying to find cover from the unexpected heavy winds and drizzle, and roasting marshmallows on a fire.
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But then Levi burned his foot on a hot coal and I was stung by a scorpion. I was cursing our decision to leave the idyllic beach at Beloi. It felt like one of those bad nights out when you’ve found a perfectly good nightspot but there’s some restless fool among the group who convinces you all to leave it and line up outside some other seedy overcrowded club that turns out to smell of urine and vomit, with music loud enough to make your ears bleed. That’s probably a little unfair to the picturesque beach at Akrema, but we definitely didn’t see it at its best. It might be the scorpion bite talking, which along with a perforated eardrum was making me more than a little irritable. With the high headwinds and mounting swell we were dreading the voyage back down to Beloi in our rickety canoe. Thankfully the winds dropped away as we prepared to leave and by the time we were back at Barry’s Place we were once again bathed in warm tropical sunshine and my foot no longer hurt: it was as though it had all been some kind of strange dream.

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Miriam was having strange dreams of her own, having developed a fever on the first evening on Atauro. She was clearly not herself and upon returning to Dili we were pleased to find the explanation with what appeared to be a positive test for a urinary tract infection. It was not her first, and we were confident that a course of antibiotics would mop it up quickly as usual. However, the fever remained and she developed a rash the following evening. She was tested for dengue and to our dismay it was positive. Her platelet count was down to about half of the lower limit of normal but she was not yet into serious danger. Specialist advice suggested we could wait and repeat the test the following day but we had the insurance company on standby for a medevac to Darwin just the same. Ironically, by this time Levi and I were both in Darwin for other reasons and it was left to Bethany to help Miriam through the daily blood tests. Thankfully the fever abated, her platelet count stabilised and recovered, and the trip to Darwin was rendered unnecessary.

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On the beach, celebrating my birthday

Bethany and I both had our birthdays, either side of Easter. I turned 41, which seems to be a very large number in the minds of our children. Micah drew me a lovely picture for my birthday: I’m a hulking bald blob of a man with a monobrow.

IMG_0774The picture shows him jumping on my enormous shapeless belly. He assured me that the very large protuberance from the left side of my head was a good thing, it is my ‘lucky ear’. If by that he meant that in a couple of weeks’ time that same ear would be so full of fluid that it would burst the drum then he was truly prophetic.

Meanwhile Levi created a Minecraft ‘skin’ for me, though why he had to go to such detail to include ‘lots of sun damage’ and my bald spot (complete with a mole on top) is a little unclear to me.

He then proceeded to create me a character in FIFA Street soccer: a 41-year-old grey-haired man weighing 209 pounds, attired in a polo shirt and baggy tracksuit pants (while everyone else in his team was a chiselled athlete in slick sportswear). I guess there’s no hiding from the realities of advancing age. My children see it how it is.

Birthdays aren’t really all that spectacular in Dili, it has to be said. It’s close to impossible to buy a decent birthday present, though Bethany has certainly crafted some fine gifts for me since we’ve been here. The kids know that birthdays are less exciting than homecomings: that time when one of Mum or Dad returns from a trip to Australia. We’ve had several this year for various training courses and conferences and the kids’ excitement about seeing us on return is quickly overshadowed by the question bursting from their lips: “can we open the suitcase?”

The suitcase contains all kinds of wonders. Cheerios. Gingernut biscuits. Packets for making yoghurt. Socks! “Hallelujah praise the Lord! I’ve been waiting for this day!” exclaimed Levi, overcome with delight that he would no longer have to go ransacking the dirty clothes basket each morning looking for socks. New bathers. Colouring in books. Easter eggs. Sometimes a few gifts and toys. It’s like Christmas. The kids are usually a bit disappointed that half of the space is filled with medical donations or laptops but they’re used to that now.

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The socks were good. The cricket bat is better.

I’ll have to bring home the goods when I return from this visit. I’m on my way to Sydney to speak at the IMPACT Christian Medical & Dental Fellowship conference.

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For me it’s like a homecoming: 17 years ago this annual conference connected Bethany and I with a community of Christian doctors and dentists who have become our lifelong friends, and who played no small part in the trajectory our lives have taken since that time. Before coming to Timor we were inspired and mentored by others who had gone before us, having undertaken similar ventures in Africa, Asia, or the Pacific. It’s a privilege to be going back to see old friends and to meet the next group of students and recent graduates embarking on their careers.

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This photo above is from last weekend when we had the chance to meet with the leadership of the Medical Association of Timor-Leste. It was a great opportunity to hear their objectives for the next three years in developing a Medical Council, a membership database and a structured program of CME (Continuing Medical Education) to support the 950 doctors scattered across the country.  They’ve asked us to help support them in these aims, which is very pleasing because these are exactly the kinds of things we’ve come here to do.

Above is a photo of a colleague of ours training Timorese doctors in ECG and another of Bethany assisting Timorese doctors in learning ultrasound. It’s a really exciting time for us as the opportunities continue to open up: there’s so much to do and we now just need to be wise in how much we attempt all at once. Thankfully we’re not alone, with a great team of internationals (a dozen in Dili, and many more outside of Timor) and 46 Timorese staff that make Maluk Timor what it is.

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I have been delaying the publishing of this blog, in part because I had really hoped that I would be in a position to announce at least one of the following:

(i) we have signed our much-awaited MoU with the Timorese government (we haven’t, though there’s possible movement coming up this week); or

(ii) my car with the dismantled engine stuffed in the back of it is finally repaired and back on the road (it isn’t, but I remain hopeful); or

(iii) my TEDx talk is finally posted online (it’s not).

So, with no big finale up my sleeve, I’m just going to have to distract you with a cute photo from the Mothers’ Day morning tea at Annika’s school.

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Inside the disarray

Every year life in Dili gets a little bit easier, and it’s not only because we’re now used to it and know where to find the help we need.

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The city is changing in front of our eyes and the goods and services at our fingertips are ever expanding. This is, after all, a nation rising from the ashes. The difference between Dili and Australia remains stark, especially to our children. Over the summer we were generously treated by a member of the extended family to a day at ‘The Maze’ on Perth’s outskirts. Miriam was in her bathers and knew we would be swimming there, but when she rounded the first bend within the park and beheld the towering waterslides in front of her (which are only moderate by today’s standards) she was overcome: “We’re going to swim on that!? This is too much!!”

 

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Perth Waterpark
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Dili Waterpark

Though Dili continues to develop and improve, there is always a surprise just around the corner. We arrived at the airport back in January amidst a tremendous tropical downpour.

IMG_0454To get to the car, which was only 30m from the cover of the terminal, it was ‘shoes off’ to splash through the ankle-deep puddles in bare feet. Arriving home a few minutes later we were stunned to find the smouldering ruins of our guard hut at the front of the house, which had burned down only moments earlier, presumably due to an electrical fault.

An inferno in the torrential rain was unexpected, to say the least. The hut is only a metre or so from our house, so we were pretty relieved to have escaped without serious loss. The downpour did its work.

The next surprise was to see my Toyota Kluger again, which had been in the workshop since early December. Evidently that particular workshop had been unable to source the required parts so I had arranged to have the car taken to another workshop that I hoped was more likely to succeed. IMG_0485When it arrived at the second workshop I was there to witness the gasps of dismay as they inspected it.

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Ummm… where’s the rest of the engine?
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Oh. There it is.

As a doctor it’s hard not to think of this being like transferring a patient to another hospital with an enormous open abdominal incision and most of the organs tucked in a grocery bag hanging from the side of the gurney. That’s not usually how it’s done.

The surprises continue here in Timor-Leste. Last week a bus tried to traverse a section of makeshift road through the Comoro River after heavy rains and was washed away, with several lives lost. The next day the local airline lost a plane which crashed on a roadside just out of Dili – thankfully all passengers were unharmed.

Less dramatically, this week our bore pipe slipped from its connection and plunged down into the bore-hole. So we had no water. Before that it was the electricity being off for three evenings running (and again today). Then it was two of our international volunteers going down with dengue. But life meanders on: this is the everyday disarray of Timor-Leste. We are relatively shielded because of our affluence and international connections. We can buy our way out of most problems and protect ourselves when we need to. Not so the locals, who face the flooding, the mosquitoes, the sickness and disadvantage with no buffers nor insurance.

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The War on Dengue

And this is the sad truth for Timor-Leste: though life in Dili is improving all the time, it is mostly improving for those of us at one end of the spectrum. For the average Timorese person, especially for those outside of Dili, life remains the relentless struggle that it has been for many decades.

These struggles have been weighing on us as we wrestle with the question of how Maluk Timor can be most effective with our limited resources. The challenges here in healthcare delivery are all around us and sometimes it is hard to know where to begin.

One recent paper published by the Lancet Global Health Commission has brought this into sharper focus for us. This paper argues that around 8 million people die unnecessarily each year in low- and middle-income countries of treatable conditions. Worse still, of those 8 million deaths, it is estimated that 60% of the deaths are attributable to poor quality care rather than lack of access to care. Stop and consider that for a moment: that would mean that in countries like Timor-Leste, people have been dying not so much because they couldn’t get to a doctor, but because the care they received when they got there was of such poor quality that it was unable to save them anyway. And that’s only accounting for the deaths from treatable conditions: conditions that people shouldn’t really be dying from at all.

46150745475_884ffeaa1b_kThis realisation came just in time for me as I received a last minute call up to give a TEDx talk in Dili. Several of the first choice speakers had pulled out, so like that wedding reception guest who gets a second round invitation and is flattered nonetheless, I gratefully accepted. However, with less than 48 hours until the event, I was at a loss as to what I would say: TED talks are supposed to present innovative ideas that inspire people and transform the way they live their lives. The talk should be on a subject in which the speaker has some expertise (that at least shortened the list), and have some factual evidence behind it. It should be locally relevant to the largely Timorese live audience yet still be meaningful to an international audience online. It must be less than 18 minutes, non-religious, non-political, and not simply an informercial for a product or organisation. After sweating on it for a day or so, I decided I would say something about my observations of health in Timor-Leste, and how the people of this country can take matters into their own hands. I’m yet to see the video as it hasn’t been uploaded to YouTube yet. I’ll post a link when it goes live and you can find out whether or not I pulled it off.

But this realisation – about quality healthcare – also tells me so much about what we need to do and why we need to do it. It makes sense of what we see around us here everyday: that there is a skeleton of a health system now in place, but everything that should be covering those bones is yet to materialise. The muscles that should allow those bones to move and respond to challenges: not there. The nerves that communicate messages from one part of the body to another: not there. The arteries and veins that distribute crucial resources and supplies to the distal parts of the body (and carry away the refuse): not there. The skin that gives everything its pleasing appearance and makes people want to take hold of what they see: not yet.

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Bethany (right) and Nurse Dea (left) presenting new equipment to our local health centre

In time we will see this frame covered in flesh and brought to life but until then there is so much to do, and we’re just glad to be right where we are, with a frontline opportunity to do it. If you want to find out more about what that looks like, check out our new website which has had a major facelift. There should be a lot more content with videos and stories appearing on there each month throughout this year.

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Some of our Maluk Timor gang

Planes and Drains

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Dr Bethany, in our minor operating theatre (kitchen)

 

 

 

We were attacked tonight! It’s late on New Years’ Day as I write this. I’ve driven home this evening with Bethany and the kids in the car and have been pelted by large rocks from unseen assailants in the roadside bushes, causing some significant damage to the car. Disenfranchised youth in Dili are often known to hurl rocks at passing cars under cover of darkness. There isn’t a lot of other entertainment to be had. There are certain roads best avoided at night.

However, on this occasion it was the youth of a far more dangerous place – Geraldton – who have had their fun at our expense. I am thankful that we spend most of the year in the relative safety of Timor-Leste.

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Perils of Timor-Leste: another fatality on the backyard slippery slide

We arrived back in Australia just before Christmas, after some airport difficulties.

Have you ever missed an international flight? Probably… many of us have. We missed a flight out of Heathrow in the winter of 2014 with three very sick kids and 150kg of luggage despite having made it to Check-In with what seemed like plenty of time. That’s a story all of its own, ending with us arriving into the wrong Swiss city in the middle of the night without our luggage. Actually I was somewhat relieved when it didn’t arrive – I could carry it no further anyway.

 

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Airport Farewells: Alico is going to Australia. Annika is not pleased.

I was having flashbacks of that memorable evening as we were trying to fly out of Dili before Christmas. Again we had arrived at Check-In with plenty of time, many kids and much luggage. I was expecting trouble with Passport Control as I had knowingly overstayed my visa by three days and would surely be taken aside to pay a fine. What I hadn’t predicted was that we would be denied Boarding Passes because my two sons both had passports with only five months of remaining validity. I protested of course – we were flying to Australia, why did we need six months validity to go home? Ahhhh… because we were flying through Bali and, due to the quirks of the Denpasar Airport, would be forced to go through Passport Control before checking in again for our flight to Perth. Indonesia would deny us entry and we would be stuck. I explained that we were only in Bali for three hours and showed them the itinerary to prove it.

Hmmmm… the previously impassive airline attendant now looked perplexed. She decided to phone Denpasar Airport for clarification, so told us to wait. And wait we did, as every other passenger passed us by and proceeded to the departure lounge. Still we waited. I anxiously searched for alternative flights on my phone. Yes, potentially I could stay back with my two offending sons, aged nine and five, and send Bethany ahead with the girls. Those of us remaining in Dili could take a later flight through Darwin but there were none available for two more days and we would be facing additional costs of $3,000-4,000 all told. Bethany and I, parked with our luggage and four bewildered children next to Check In, formulated strategies about which suitcases would go and which would stay. Every few minutes I checked in with our impassive airline attendant, who shrugged and asked us to keep waiting.

An hour passed. Check In was closing. There were no more passengers, only us. It was now likely that our entire party would miss the flight and that those costs would rise higher still. Just as it seemed all was lost the impassive airline attendant broke into an enthusiastic smile and said we had been approved. We loaded the luggage on to the conveyor and waited for our Boarding Passes. The remaining airline staff looked delighted to see our relief and we weren’t surprised when they began taking photos of us. We’re quite accustomed to this, being something of a novelty here.

I sent the other five through Passport Control and, with my heart in my mouth, placed my own passport on the counter. The clerk spent what felt like ten minutes flicking through the many pages, decorated with years of Timorese visas and stamps, trying to confirm his suspicions that I had indeed overstayed. Nonchalantly he reached his eventual verdict and directed me away with another attendant. I was led through the airport to a remote office and asked to wait. I had expected this. What I hadn’t expected was that I would already be so late, and that from my particular vantage point at the office entrance I would be able to view my wife and four young children walking out on to the tarmac and boarding the plane without me. They had been hurried through by the stewards.

For several minutes it wasn’t clear what I was meant to do. The attendant had disappeared down a corridor with my passport and I had been left standing unattended in a doorway. I paced about, looking this way and that for any clue as to whether I would be processed in time. I couldn’t see anyone, nor any activity. Actually from there I could have run on to the tarmac and climbed on to the plane, but it would have been madness without my passport. The minutes passed and I widened my search, wandering into a few different corridors and offices desperately hoping to see someone – anyone – who might be processing my passport. Finally, through a heavily tinted window I caught a glimpse of an older man with a painfully slow hand scratching out details on to a carbon copy sheet. It was the receipt for my fine. Moments later he was done, and I took the receipt as briskly as I could without succumbing to the almost irresistible desire to snatch it out of his tremulous hand. Turning to run back through the airport I found the clerk at Passport Control and he quickIy stamped my passport. Beyond that I could see everything was now closed. The X-Ray machine in security had been turned off. I thought I could sneak through but a security guard with his back turned swung his head around and noticed me, and insisted on restarting the machine to scan my shoulder bag. Precious moments lost. Departure lounge was also empty, so I ran straight through it and out on to the tarmac.

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The front door of the plane was already closed. The rear door was ajar, and Bethany was standing in the doorway with a broad smile on her face and a phone in her hand, recording the moment for posterity.

It was upon arrival in Denpasar that the photos taken earlier made sense. The staff in Dili had sent photos of our family ahead to Denpasar where we were intercepted by airport staff and whisked straight through transit to avoid Passport Control altogether. Sweet relief.

Running across an empty tarmac in a sweaty fury is not really suitable behaviour for a man of my standing. After all, I am a dignified gentleman in Dili. Not only am I one of the tallest men in the country, at almost six feet, but I have a very smart oiled leather shoulder-bag and distinctly silver hair to prove my exceeding wisdom.

My staff at Maluk Timor treat me with great deference: they insist that I speak first at formal events, that I eat first at meals, and they never allow me to carry anything heavy. They don’t like me riding a moped because it is unbecoming. Even sweating is beneath me.

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Maluk Timor Christmas Party

However, even the most respectable gentlemen are prone to mishaps. The cheap doorhandles in our office have caused their share of problems and just recently I spent an uneasy twenty minutes locked in the toilet at Maluk Timor. The staff were mortified at the indignity of it all and gathered around the door to try, one after the other, to open the door where others had failed. It was one of those great comedic moments, as I waited with a smirk on my face, sensing the extent to which they were all horrendously embarrassed on my behalf. The urgency in their efforts was quite palpable, and it ended with the complete destruction of the offending doorhandle (a fitting punishment for such impudence). As I eventually emerged it was smiles all round, though I can only imagine that my reputation has taken something of a trashing after such an event. I don’t walk quite as tall as I once did.

We celebrated our 18th Wedding Anniversary at the Hotel Ramelau. Some couples get matching tattoos, but we preferred to mark the occasion on our son’s forehead. He swam into the submerged pool ledge you can see in that photo. 

The contrasts in Timor between the haves (who are very few) and the have-nots remain as confronting as ever they were. Sometimes I have to really stop and deliberately notice what I see all around me. As I drive each day along my street, from our relatively affluent home toward the premier shopping precinct in the country, I am struck that those contrasts are very much on view.

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This is a photo I took from my car window while driving along our street. This is the intersection nearest our home where microlets (minibuses) very often stop to collect passengers before turning the corner. It’s a narrow, busy four-way crossroad that has been undergoing drainage works for the last two years: note the concrete drain at the bottom right.

It’s hard to tell from this photo but that large puddle you can see is more like a pit. I’ve walked past and peered into the murky water enough times to know that it is at least fifty centimetres deep. It’s been like that for approximately 18 months since it was dug up for the drainage work. The drains are being dug either side of our street, running toward the ocean, but this particular section remains a drain to nowhere, and the water that accumulates from farther up the road stops and make its home right here.

Timor-Leste is a tropical country with distinct wet and dry seasons. The dry season runs for six or seven months through the middle of the year. During this time a pool of water like this will stay stagnant, as a general hazard and breeding ground for mosquitos. During the wet season it frequently overflows, capturing the drainage from the street which includes whatever trash and detritus is gathered by the running water from a city with serious litter and sanitation problems. You can see that it wouldn’t take a lot for the rising water to create additional problems, and this photo was taken before the tropical rains arrived.

This particular corner is actually a shopfront. It sells fresh vegetables and a range of other foodstuffs. On a busy corner like this I expect it did a decent trade until someone dug a moat in front of it. Moats are not typically good for business. Version 3If you look closely you can see tubs of legumes and chilis on a table behind the moat – how exactly are the customers expected to access these? Who knows what effect this has had on the livelihood of this family, who may very well be squatters anyway.

Look at the green vegetables on display. These are sold for 25c a bunch. They are delivered several times a day by growers and the vendors splash them with water every few minutes to keep them moist and fresh. Water from where…? Clean drinking water is expensive, so it’s unlikely to be that. Very likely the water comes from somewhere very nearby, where it is pooled and easy to scoop up. You join the dots. It was unsurprising when in 2017 almost all of our Maluk Timor staff contracted cyclospora from eating salad greens such as these. At least I lost four kilos.

It’s easy to joke because I’ve got four kilos to lose. The children – and most of their mothers – most certainly don’t, and diarrhoea is still a major cause of preventable death in Timor-Leste.

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Speaking of children, look again at the photo. Where do the little children play? A single roomed house squeezed in against a busy road has no yard to speak of, and this is the common predicament of many who live in Dili. The children spend much of their playtime in the roadside gutters. Timorese children typically can’t swim, especially these very little ones. Fifty centimetres of sludgy water is more than enough should one of them slip and fall, particularly in the darkness of night when they are still very often at play and the noise of the passing traffic obscures any sounds that might alert the family. Who knows how many Timorese children drown each year? No one does, but we know of at least two who died in our neighbourhood last year.

Version 2And then there is the man on his motorbike. Aside from being a hazard to the kids nearby, he is in danger himself. Not now, in the daylight, but at night when these streets are in darkness. Many motorcyclists ride without headlamps, even with their unhelmeted family aboard the bike, because they believe it saves fuel. At a busy crossroads like this a simple misjudgement in trying to avoid a pothole or stray dog could send a motorbike plunging off the road and into this water, potentially striking the partially submerged concrete drain in the process. The injuries being tended by Bethany in the first photo were those of a friend, sustained during a motorbike accident at night – he hit a stray dog. Thankfully he didn’t end up in this drain.

The point of all this is that life can be very marginal here for your average Timorese. A simple shopfront on a busy corner is not an exceptional example – I single it out because it is utterly unexceptional, so unexceptional that I almost don’t notice it myself in spite of driving past it each day. This is normal life here, where the poor are waging a constant battle against the uncertainty of low income, disease, injury and exposure to the elements.

We can respond with feelings of pity but that doesn’t get anyone anywhere. Bethany and I are still learning, but the only way we know how to help is to roll up our sleeves and get in alongside our Timorese healthcare colleagues and work with them, shoulder-to-shoulder. The responsibility is theirs and the solutions will need to be theirs too, but we can offer ourselves in support along the way. We’ve got another year of Maluk Timor beginning, and let’s hope we can help Timor-Leste provide the quality healthcare that her people so sorely need. Happy New Year!

Our Family Medicine trainees have graduated at last. Now they’ve been sent back to their district health centres to put their knowledge and experience to use. 

Order & Chaos

Last week I opened my smartphone and began to type a question into Google:

“Can you use 1% lignocaine for eyes?”

A friend had a fleck of steel in his cornea and we didn’t have the usual amethocaine anaesthetic drops available. Then I noticed that the previous webpage saved in my phone contained a similar search:

“Can you use transmission fluid for power-steering fluid?”

And then it dawned on me just how often I ask Professor Google these kinds of questions in Timor:

“Can you use coconut cream for pasta sauce?”

“Can you use household bleach for pool chlorine?”

“Can you use superglue for wounds?”

“Can you use beach sand in a pool filter?”

“Can you use cable ties for fixing… well… everything?”

(If you’re wondering about the answers, they are: yes, best not to, yes but it’s not great, yes, yes, no – it blasts straight back into the pool, and absolutely.)

DSC_4601I’m not exactly MacGyver but I am learning that there are a lot of things you can do without, and a lot of things that can very reasonably be substituted for others. Your kids’ finger-paintings make great gift-wrap paper, cream plus lemon juice makes sour cream, and a pair of smartphones negates the need for genuine marital conversation. For a while at least. However, there is no substitute for a good doctor.

IMG_9830I’m not doing any medical consulting here at the moment, which might be for the best because I’m not a particularly good doctor, but occasionally I am asked to see a patient as a favour. Bethany sees many, and reluctantly provides an informal Facebook Messenger pregnancy helpline.

This particular patient, a young Timorese woman, came to see me with a thick folder of medical records and test results which she had accumulated in Indonesia at great expense in trying to find an answer to her symptoms of tiredness and headache. I spent quite some time thumbing through the notes. It seemed she had ultimately diagnosed her with angina – a very serious condition – and she had been commenced on six very potent, even dangerous, medicines which she was told she needed to prevent a premature heart attack or death. She was understandably anxious, tearful, and wasn’t sleeping. Her headache and tiredness were both worse as a result.

Having interviewed and examined her and then reviewed the results I drew the conclusion that this woman was in fact suffering from the utterly mundane affliction of tension headache, probably due to sitting at a computer all day. I found no evidence whatsoever of any heart condition and I instructed her to stop all but one of the medicines. She burst into tears in relief, and insisted on hugging me.

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She should have saved her money and just asked our magical Fairy

As she left, I was struck by the harrowing thought that people like her are being misdiagnosed, mistreated and overcharged for the privilege every day, all over the world. Even in Australia it’s rare to meet someone who hasn’t got a story of having been completely misunderstood and misdiagnosed by a doctor, and having been put on some needless or even harmful treatment. It should be surprising that this is happening in a country where doctors have each had at least ten years of high-quality, closely supervised training, with rigorous examinations and professional standards imposed. Every doctor in Australia is also compelled to maintain a high level of ongoing education, and yet still there are quite some number who are simply not very good, and even the good ones make mistakes.

 

In fairness, it’s not all that easy being a doctor. I would guess that in my own experience as a GP and emergency doctor  I’m not certain of the diagnosis in at least one third of my cases. This means that often I end up having to focus instead on what the diagnosis is not – i.e. making sure I’m not missing something really serious – and then making my best guess and tentatively suggesting some kind of low risk treatment whatever it might be. And that’s with the very best of medical technology at my disposal.

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“So… what you’re saying is that you don’t know?”

The trouble is that patients don’t much like it when the doctor doesn’t know what’s wrong. And as the doctor, I don’t much like it either. Over time, one develops all kinds of different manners of explaining it to patients in a way that preserves one’s dignity, but sometimes it just has to be an honest shrug of the shoulders: Sorry, I don’t know.

It’s even worse if you have to admit that not only are you unsure of what their problem is, but you are pretty confident that it’s not important and that they shouldn’t worry about it. Now you’re not only incompetent, but you’re insulting: invalidating their illness that they thought was serious enough to justify missing a farewell party at work, waiting for an hour reading gossip magazines from 2012, and putting up with your nonsense.  If you really want to upset them, you can give them the triple whammy: no diagnosis, your problem is not important, and I’m not giving you any treatment.

“And by the way, that’ll be eighty bucks. Be sure to leave a tip.” (wink)

It’s much easier as a doctor to pretend you know even when you don’t, and to prescribe a treatment that they almost certainly don’t need. You save face, they walk away feeling validated with their antibiotic script in hand, and whatever the heck was wrong with them doesn’t really matter because they’ll be over it in a week anyway and they’ll then assume you were correct. You’ll be their favourite doctor. Everyone wins, right?

This temptation becomes much more pronounced if you happen to live and work in a culture where shame and honour, or the sense of preserving ‘face’, is of the highest concern. It’s generally accepted that this is case in most Asian cultures. If I explain something to an Asian colleague and then ask if he understood me, he will say ‘yes’. To admit otherwise would be embarrassing not only for him, but also for me, as it would mean that my explanation must have been inadequate. Everyone is better off if he just says ‘yes’. In such a place, if you tell the patient that you don’t know what is wrong with them it is bad for everyone. Everyone loses face. It’s not an option. You can see where this might lead, when it comes to an uncertain diagnosis.

In Australia, everyone has a story of misdiagnosis. We might then wonder how much more commonly it occurs in countries with lower quality medical education, countries that lack well-established professional standards, and particularly those countries that value ‘face’ above honesty.

We are working hard in Timor-Leste with the local doctors to improve the quality of their medical care. Even so, a colleague of mine remarked recently, “We went around the ward and found that every one of the patients had a diagnosis of gastritis and a bag of IV fluid hanging up. As we took our Timorese doctors around and re-assessed each of the patients together we discovered that none of them needed IV fluids, and that none of them had gastritis.”

I don’t tell this anecdote to denigrate my Timorese colleagues, who are quite simply remarkable to have learned Medicine in their fourth or fifth language, and who now practice without any of the resources or support that an Australian doctor expects to have at his or her disposal. I tell it to illustrate the scale of the task. It is no easy thing to train a good doctor – we know what we are aiming for will take many more years than we can possibly offer. But we hope to make a start.

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As you can see, I’ve grown approximately eight inches in height since moving to Dili. I think it’s the Timorese coffee – it’s amazing. 

When we look around us we see chaos. There are many people trying to make a meaningful difference – it’s not only us – but the chaos remains. However, I have been reflecting lately that I should take this to mean that we are in exactly the right place.

I just finished Dr Jordan Peterson’s book, 12 Rules for Life, and in it he has a lot to say about order and chaos. He draws heavily on an idea from Daoism (or Taoism, if you prefer), that will be familiar to most of you in this image:

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The Yin and the Yang.

First, my disclaimer. I’m no Daoist, and I’m going to be writing a paraphrase of a paraphrase. What I know about Daoism would fit on the back of a napkin. What follows may not be entirely accurate, but even so, what little I’ve understood has some utility.

Dr Peterson explained that the Yin and the Yang represent, among other things, the balance between chaos and order. And he explained that when it comes to living a life of meaning or significance, the very best place you can find yourself is to be walking along the curved line between the two, with one foot on either side.

Too much chaos and we are overwhelmed, our lives unravelling around us. Too much order and we are stunted and stifled, without challenge and without growth. We need battles to fight and opportunities to exert ourselves in trying to set things straight. This is where we find purpose, meaning and fulfilment.

I’m a Christian and not about to become a Daoist, but I find this picture vividly describes the life I’m trying to live right now. Used in this limited way, I don’t find this concept to be at odds with my own beliefs. Christians live with the God-given imperative to seek and promote truth, justice and mercy where deceit, injustice and cruelty prevail. It might be described as desiring God’s will to be done on earth as it is in heaven, or establishing righteousness (order) where evil (chaos) reigns. The only place that this can really happen is where order and chaos meet.

When Bethany and I moved here we consciously attempted to balance order and chaos, though we wouldn’t have described it in those terms. Work was clearly going to be chaotic, so home had to be a refuge for us. We set our life up so that it would be just that. We chose to keep one foot planted in Australia – heading home twice a year, and sending our kids to an international school with a strong Australian flavour – whilst planting the other foot firmly in the mayhem of Timor. Even the way we designed Maluk Timor includes an orderly headquarters from which we send our program teams out into the chaos.

The chaos is easy to see. There are no street addresses, and no postal service. The electricity supply is unreliable. There is no enforcement of road rules. Last week a guy on a motorbike came flying past Bethany (in the Prado), and got a little too close, scraping the side of our car and kicking off the mudguard. Last month they closed services in our bank, and we’ve had to try to open a new bank account. There are regular shortages of just about everything you can think of, sometimes minor (it’s almost impossible to find a diet soft drink of any persuasion here at the moment), and sometimes more significant (our health centre has had no IV antibiotics this month).

I think this might be partly why we feel so very fulfilled in what we’re doing here, even though to so many it must look like madness. We enjoy the stability of an ordered household (if you can call four children under ten “order”), and the support of a strong organisation (our Maluk Timor crew are terrific), whilst loving the challenges we face each day to establish order amidst the chaos all around us.

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One of our nurses setting up Triage services at Formosa Health Centre, so that patients are seen in order of need. 

Whilst thinking about establishing order, I’ve also been reminded that I am clearly an INTJ on the Myers-Briggs personality test. I won’t explain that in depth except to say that an INTJ loves strategic planning and problem solving, which is me all over. The downsides of being an INTJ are that the ‘I’ stands for introvert, and that INTJs tend to have the personality of a bowl of porridge. There’s always a Yin to every Yang I guess.

* * * * * * *

Bethany’s parents visited in October with a group of volunteers from the Country Women’s Association. They worked furiously for ten days on fixing, building and painting – thanks everyone.

Miriam can’t quite claim full credit for these grand murals in the health centres.
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Maubisse

We took the opportunity with her parents here to head up to Maubisse in the mountains. We’re nearing the end of the dry season, so it was brown and dusty for most of the way, but at least that meant the roads were in decent shape. We stayed at the Pousada, an old Portuguese residence set on a fortified hilltop. The hospitality was warm, the night air was cool, and the tranquility was refreshing… if you can ignore the thundering noise of the diesel generator that was needed once the power all went out.

 

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The next morning we visited a nearby waterfall, and plunged into a cold pool. We jumped from about half way up the rock wall, whilst the local kids leapt from the top.

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Yes, it was that cold…

 

On our travels through rural Timor, we were struck again by the simplicity of how so many people in Timor-Leste still live. We were also struck by how heavy our children are, particularly when being carried along a rocky river-bed, and how dependent they are upon travel sickness medicines. And these were the good roads.

Maluk Timor celebrated our one year birthday last week. Whilst we’ve often felt frustrated that things seem to take so long to get where we want them to go, this celebration was a timely reminder that we ought to be grateful for how far we’ve come.

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We started with a team of seventeen people in October 2017, having endured a traumatic and unanticipated change of course. We have almost tripled in size since then, with 46 staff and more to come. We had two and half programs then, now we have nine. I was on a teleconference recently in which I had to describe what Maluk Timor is, explaining our nine different programs. Having given my usual spiel I was then asked for our annual reports. Sheepishly I explained that we hadn’t yet turned 1, and that we therefore didn’t have any annual reports. It was a moment of a little embarrassment and a lot of pride, in that we really have come a long way in a relatively short time.

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And this is our team, or most of them anyway. These are the future leaders of health in Timor-Leste, and we’re proud to stand with them.

Running

You know you’re living in Timor when…

  • You convince yourself that you can judge the extent to which a tub of ice-cream has been pre-melted by rocking it from side to side, determining its centre of gravity.

  • You reach the point of accepting that the pale-coloured juvenile flour bugs (or weevils) that come in all your packet pasta, rice and flour probably don’t do you any harm, and resort to only scooping out the dark-coloured adults.
  • Driving becomes the ultimate multi-tasking activity, including texting, trying to clap mosquitoes between your hands, and occasionally watching the road.
  • Your internet-based phone-calls consist mostly of both parties repeatedly exchanging distorted and delayed enquiries of “Hello? Hello?”
  • Your alarm clock is the neighbour who pumps out ‘Despacito‘ (Timor’s surrogate national anthem) on his subwoofers every morning.
  • You see motorcyclists routinely cruising the pitch-dark streets without headlights, apparently ‘saving fuel’.IMG_9160
  • The closest thing you can get to a circus is your own backyard, and the best cricket ground you can find is a 10m stretch of beach…IMG_9065

Timor-Leste is hard to visualise without being here. We’ve lived here two years and have still seen so little of it. Last week we had a public holiday and attempted a rare road-trip into the mountains. Our goal was Aileu, only 20km away as the crow flies. The trip there took 90 minutes, on the good road. The return trip on the old road took more than two hours. Even at that speed, Annika got car-sick enough to bring up lunch.

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Annika’s face says it best. Awesome road-trip.  

We are so used to Timor now that we have stopped noticing how the people around us live. Well, almost. But when you try to see it again with fresh eyes, you realise how different our worlds really are.

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It’s hard to imagine the challenges of living up in these remote parts of Timor, as most of the population do. Below is a map of the country with the profiles of the new Family Medicine doctors we’re training. As you can see they literally come from all over the country:

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Some of them work in the larger Community Health Centres (CHCs), while others are based in Health Posts. Your average CHC in the districts might have four or five doctors and a cohort of nurses and midwives. They can do some very basic tests and have a very limited list of available medications. They may be 1-2 hours by road from a larger centre, or up to five hours from one of Timor’s few hospitals. If a woman needs a Caesarean section or someone needs emergency surgery, that’s how far they may need to go… on those same painful roads that claimed Annika’s stomach contents.

As for Health Posts, they are equipped with much less. One of our trainees works as a doctor in a Health Post with no nurse, no midwife… just him. He has no diagnostic tests nor even basic medical equipment. There is no oxygen. Quite often there is no power nor running water. He has a handful of medicines at his disposal. During the dry season, the nearest CHC is 60 minutes away, but during the wet season he can’t get patients out at all. So he has to deal with whatever arises in his community of around 800 people on his own. Geographically speaking he is 60km from Dili, but he might as well be on another planet.

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This is why we want to help train Timorese doctors, help support them in their isolation, and help supply them with basic equipment. You might remember our Doctor’s Bag project: setting up Timorese doctors with basic equipment and diagnostics that they need to practice independently. It’s something we hope to expand into the future. And, as always, we continue to partner with the Ministry of Health, who year-by-year are lifting the standards of the facilities and services being provided.

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The whole gang, after the climb up to Cristo Rei

If you’ve ever seen greyhound racing then you’ll know that those svelte, wiry hounds chase a mechanical rabbit around the track, luring them forward. The bait is always close but never quite within reach. It’s a fairly accurate metaphor for my life here in Timor-Leste these past 12 months. Except for the part about being svelte.

This time last year we were facing the shocking reality of having to leave Bairo Pite Clinic behind and start out with something new. It was overwhelming, and the first time that such a course of action was suggested to me it seemed genuinely impossible and not even worth attempting. But as our options narrowed and it became the only reasonable way forward we had to earnestly examine what such a process would ask of us.

The advice we received was complex but it gave us assurance that within a few months we could have everything back up and running, with all our registrations and licences back in place. We would then have the ability to rebuild a team and carry on. It gave us enough hope to put one foot in front of the other, and push through those really tough months at the end of 2017. But what we’d been told simply wasn’t true. Those months passed and the same registrations and licences we needed remained out of reach.

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I’m a regular-yet-conspicuous feature at Ministry of Health meetings…

At the beginning of the year we were filled with new hope that our processes were almost complete, and that our all-important Memorandum of Understanding (MoU) with the Ministry of Health was imminent. There always just seemed to be one final step we were waiting on, and then it would be complete. Somehow that one last step always had three other steps built into it, and then another last step would appear after that one. Followed by another final hurdle. Followed by one more little thing. Which would need one other document, which we almost had. We could get it if we could just get a particular meeting with a particular person. But then… uh oh… that person is no longer the Minister. But there’ll be a new Minister soon, right? Maybe. Well, not yet. Soon. Just one more step…

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Today: Talking with Dr Rui Maria de Araujo – former Prime Minister and Health Minister – a meeting I’ve been hoping for since 2016

And so it carries on, nearing the end of August. We’re so close, but that mechanical rabbit is always a few steps out in front of us, and it just never quite comes within our grasp. So we run harder. It’s been infuriating and I’m learning to draw from a deep well of patience that I didn’t know I had.

But when I think about it, that’s the only way it could have been. If I had known, 12 months ago, that the mechanical rabbit was this damn fast I would never have set out to catch it in the first place. I don’t think we would have had the strength of conviction to launch Maluk Timor if we’d know it would be this hard. We needed the bait right in front of us at all times, to keep our hopes up when our strength was failing.

A journey of a thousand miles begins with a single step, they say, and the God I pursue often only allows me to see the next step in front of me just as my foot falls on the ground ahead. Looking back, I’m not sure it could have been any other way.

What if I had known, 12 months ago, that it would take this long? We might well have packed up and gone home, thinking it was all futile. What becomes of the nine programs we now run as Maluk Timor? What would it have meant for the Timorese doctors we graduated in Family Medicine in June of this year, or the ones we’re training now? What would have become of the 100 children with rheumatic heart disease who get their monthly penicillin through us, keeping their hearts from destruction? And that’s just two of the programs.

What would it have meant for our 40 staff, who are now growing as leaders in health in this country, and many of whom take an income home to their whole extended families? They have 30 or 40 years of their working life ahead of them – how much impact will they have in this country over that time?

I’m grateful for the mechanical rabbit – the MoU that has been dangled in front of us for 12 months and has kept us running hard. After all, the greyhound is never meant to catch the rabbit. He’s meant to run. It’s the pursuit that is actually the good, not the achievement of the goal itself. So we keep running, and it’s not been in vain. While chasing that MoU we’ve still managed to assemble a great team, get our programs running, and impact a lot of lives.

Today Bethany attended a major ceremony for of a friend of ours being ordained as a priest. It was a colourful mixture of Catholic worship and Timorese tradition.

Young and old, the people of Timor face enormous difficulties. We’re glad we’re here with them, running. I wonder what we’ll do if we ever actually catch that mechanical rabbit?