The calm before the storm

This Saturday is the Parliamentary election in Timor-Leste. 21 parties are vying for seats, and the city of Dili is alive with flags and banners supporting the major players. Will the longstanding left wing powerhouse party of Fretilin sweep the day, as they did the Presidential elections, or will Xanana Gusmao’s CNRT win power?

Xanana still looms as a huge figure in this country. Then there are many smaller parties, such as the PLP, fronted by the recent President Taur Matan Ruak, that hope to make an impact. Or perhaps none of that matters because they’ll all band together for a unity government anyway?

It’s hard for me to judge just how important policy is in this election. In my opinion it’s largely irrelevant in the elections of most other countries, so I expect it’s similarly peripheral here. As far as I can tell, political campaigning involves loading up dump trucks with Timorese youth adorned in party colours, and driving them up and down the main streets honking horns and waving flags. 

Historically speaking, elections in Timor-Leste can be times of significant unrest. A few days ago we were in Australia, still wondering at the wisdom of reentering the country on the eve of such on event, but thankfully all seems relatively quiet, for now at least.  Perhaps it’s just the calm before the storm.

It feels like the calm before the storm at the clinic too. The few weeks I had in Australia were dramatically interrupted by a series of teleconferences relating to the critical financial strain being faced by the clinic at this particular time. Over the last 12 months we’ve been able to expand some of our services through projects which attract designated funding, but the everyday running costs of the clinic remain very difficult to meet each month. It’s very hard to attract funding for staff salaries, and even harder to cover electricity, printing costs, medicines and consumables, clinic maintenance, fuel and other less attractive budget items. So, unfortunately, it’s time for the razor gang. Yet trimming the fat from a lean machine like Bairo Pite Clinic is no easy thing.  The salaries of international staff (meagre as they are) are the first thing to be cut: at least patient care is relatively unaffected, and it means we don’t have to cut Timorese staff who would lose their entire livelihood, and put their families at risk. Many of them exist on the poverty line already. The reality is that we can’t run a clinic with money we don’t have, so there could be some very hard choices with very serious consequences for our most vulnerable patients. We are going to do everything we can to stand in the way of having to cut back our services. But all though I feel there is probably a storm coming, the rest of the clinic staff are getting about their business with their usual energy and courage.

I’ve been pretty quiet on this blog for a while. Part of that was family illness – again. In May we had a horrible run of respiratory infections through the household, with fevers stretching out to beyond a week in some instances. It’s an eerie feeling, caring for your own children at home. We have the pulse oximeter on at times: Micah’s saturations were sitting around 92% (should be above 97%), with a respiratory rate of almost fifty breaths per minute while he slept… he ended up with a chest X-ray. I wondered if he might have developed TB (consumption), but given that he weighs more than some Timorese adults at the age of four I’d have to concede that’s unlikely. However, the concern is always that one of the kids might get a little worse than what we can handle at home, and then you have to start thinking about medical evacuation to Darwin. Thankfully that was not required this time.

Meanwhile, Bethany was busy putting our house and yard back together. We had a string of maintenance issues with house and car that needed addressing, and then we were hit by a tremendous storm at the hands of tree-loppers from the national electricity company. Our landlords commissioned them to take down some of our big shady trees (which admittedly threaten the house with their enormous branches), but what followed was almost apocalyptic. The cool and verdant refuge that was our home became a internationally-recognised disaster zone, with colossal branches carelessly crashed down upon all quarters of the yard, destroying almost everything underneath.

Hmmm… where’s my backyard gone?

Those of you who know of Bethany’s love of gardening and outdoor aesthetics will understand that this was a knife through her heart: 12 months of creative nurturing destroyed in an afternoon’s chaos. Our Timorese landlords were left in no doubt as to our feelings on the matter, as Bethany lambasted them in a style to which they were clearly not accustomed (something of a cultural faux pas, perhaps). This is a country that mostly prefers a concreted courtyard to a tropical oasis, so they didn’t quite appreciate why we were so aggrieved to lose these troublesome trees and plants that had so seriously infested their property.

Back at the clinic, I have been busy kickstarting the Family Medicine Program. The Royal Australian College of Surgeons administers this course, but we’re now responsible for the content and clinical supervision. We’re the only trainers of family medicine in the whole country, so it’s both a great opportunity and a heavy responsibility.

We hope not just to teach them how to treat sore throats but how to be a doctor – how to make people wait for an hour, then charge them $75 for telling them their problem is all in their head.– how to build trust and develop the doctor-patient relationship, how to pursue the upstream causes of the diseases they’re seeing in their clinics, how to advocate for people and the difficulties they face beyond their presenting illness, and how to lead them into making better health choices in their own lives and for their families. We are in the midst of this great pioneering moment in time in which we can lay down a template for how family medicine is practiced in this country into the future.

It’s good for me to write such paragraphs to keep myself on track. When you arrive back in country to find the washing machine is broken, the gas has run out, the water mains pipe has been trodden on and broken, and then the power goes off in the middle of the night, it can be demoralising. That’s to say nothing of the perennially sick children.

Annika summed up our feelings on arriving home to Dili

If you’re sick of hearing about our sick children, let me say that SO ARE WE! This time it’s Australian germs we’ve come back with, and they don’t seem any more sympathetic to our cause than the Timorese varieties. We’ve never seen Annika so miserable.

I remind myself that were we still living and working as doctors in Geraldton, we’d still be struggling with exhaustion, sick kids, laptop failures (last week), car versus kangaroo incidents (the week before), and worst of all, Telstra. No one is spared such nuisances, the difference is only that we live somewhere that makes it easy to blame everything on the circumstances around you. The reality is that we are so privileged to be doing what we’re doing, with four beautiful kids who are coping well with their varied lifestyle, and we should be (and are) very grateful. We also have a lot of people supporting us in different ways, as is plainly obvious whenever we return to Australia and are blessed by the generosity and kindness of friends and family. We have nothing to complain about, really. Though I wouldn’t turn down an uninterrupted night of sleep.

One great development coming back into the country this time (other than the abolition of departure cards leaving the Australian airport – I’m so sick of writing them out six times over), was that we finally got our work visas! This means we don’t need to renew our tourist visas every month ($$), nor leave the country every three months ($$$). Of course the kids can’t get work visas, so they’ll still have to go to Bali or Darwin every three months, but that should give Bethany and I a nice break.

In October last year I posted on this blog about malnutrition in Timor-Leste, and suggested people might like to donate toward building an additional consultation room that could be used for extending our antenatal consultations to include education about how to prevent malnutrition (among other things). The response was jaw-dropping, and the final amount raised was A$32,573.40.

 

This was much more than I ever expected to get in response, and we were able to achieve a lot with this money:

• Refurbishment of an additional consultation room for antenatal care
• External works around Maternity and Malnutrition units
• Major office refurbishments and development of a new training room
• Finalise the purchase of a new ultrasound unit worth around $15,000 (mostly donated by a German colleague, but we needed to pay some costs at our end)
• Paying enrolment for three of our Timorese doctors in an international paediatric diploma
• Securing clinic-wide access to an online medical Tetun course for our foreign staff and volunteers
• Funding English lessons for groups of Timorese staff
• Repairs to water-damaged floor in the patient toilet block
• Other minor purchases of equipment and consumables

I’m enormously grateful for the support that came from readers of this blog, to make all this possible. Some of these investments will be career-changing for our Timorese doctors and staff, and life-changing for some of our patients.

And so, I’m back into the thick of the action at Bairo Pite Clinic, and it’s such a relief. My duties over the previous three weeks were as full-time house-husband, during school holidays. I’ve played Barbies, wrestled pony tails, held play-dates with seven children in my care, raced down the driveway on a trike more times than I can count, been peppered by Nerf guns, I’ve set up (and then packed up) the Marble Run two dozen times, played Chuggington, Ninjas. Fireman Sam, been wailed at, screamed at, vomited on, and generally humiliated on X-Box. Going back to work comes as sweet relief. I don’t know how you mothers do it.

A mother’s skills: Bethany’s painting for ‘Pin the Wand on the Fairy’ for Miri’s birthday

So let’s hope the calm is not followed by a storm. The best predictor of civil unrest and violence in a country is how recent the last coup or outbreak of violence was. Every year of peace that Timor-Leste can add to its history at this time is golden, and means that within a handful of years the majority of the country’s population will never have known war in their life time. May the elections be quiet, fair, and effective in appointing a government that can continue to take this country forward.