“Timor is part of our family story now” by Robin Osborne At various times many GPs have no doubt questioned the workaday side of practising… the stream of patients requiring scripts for statins or blood pressure meds, the need for referrals to diagnostics or specialists, the lifestyle advice that we all know but find hard to follow. However, few practitioners decide that a better way to use their skills might be to pack up their large family and move to a country where patients are generally poor, often traumatised by violent events in the recent past, and where an underfunded healthcare system struggles to keep up with demand. Jeremy Beckett was a GP (anaesthetics trained) in Western Australia. He had visited Timor-Leste (East Timor) twice, liked the place and its people, and felt he could be of some help, a view reinforced by his Christian faith, although unlike most Timorese he is not Catholic. His wife Bethany (Nelson), also a GP (obstetrics), came to agree but not before they had done their due diligence. “Although we’d travelled before we hadn’t done any lengthy stints abroad, and we knew that to have any real impact in a traditional society takes some time,” Dr Bethany told NorDocs. “So we felt we’d need to be away some time. We spoke with doctors who’d served abroad and were told there are three main things that might bring you back, if need be in a hurry. “These factors are having parents back home, or grandparents, and the need for children to start high school. Basically, this means not being too far away. So East Timor ticked that box, although the kids were well short of high school. Moreover, we knew it was a country in need.” In 2017 the Becketts bundled up their four young children and made the move of a lifetime to a country where “Community health care centres and rural health posts experience regular interruptions to electricity and water supplies, and rural patients sometimes must walk an hour or more to access a clinic.” Now they’re back in WA with a raft of experiences, medical and cultural, under their belt. They have generously shared 12 | NorDocs
these on the open blog they have posted online In Dili, a capital more in name than in practice, they began work in a 55-bed general hospital that provided conventional acute care as well as dedicated wards for tuberculosis and malnutrition. Dr Jeremy’s role was clinical oversight of the hospital’s staff, while Dr Bethany, badged as the Director of Medical Training, employed her O & G experience in a largely consulting role and in upskilling local midwives. Although Timor-Leste’s birth rate is falling, it remains high, at up to four births per woman, almost twice that of neighbouring Indonesia’s and three times PNG’s. Concerningly, nutrition levels tend to be low, with protein deficiency all too common. “You see lots of animals wandering around the place, but animal husbandry is not well established,” remarks Dr Bethany who comes from a WA farming family. We both note how small-framed are the majority of East Timorese, even compared with, say, people on the eastern Indonesian islands. While carrying some benefits, not least the generous funding component, a major challenge for Timor-Leste’s health system is the significant role played by doctors from the Cuban Medical Brigade, part of a longtime aid program funded by the Caribbean country. A key aspect of the Cubans’ work
is running Timor-Leste’s medical school. They do a great job, Dr Jeremy says, but their first language is Spanish while the country’s official languages are Portuguese and the local Tetun, with Indonesian still widely understood, and English creeping in. “So aspiring doctors must first learn Spanish before taking up medicine. This is obviously quite a challenge for them. It can also create translation issues in clinical settings.” The situation is ironic, as one of Indonesia’s justifications for its 1975 invasion of East Timor was to prevent the supposedly leftist independence leaders creating a ‘Cuba on our doorstep’. Australia went along with this rhetoric. Another challenge is the limited opportunity for post-graduation study by doctors or nurses/midwives, Dr Bethany explains, “so there’s limited ongoing medical education. This is something we became focused on after we left hospital work and helped set up the Maluk Timor organisation.” One collaborator in the training is the Royal Australasian College of Surgeons. In local language Maluk means ‘your people, kinsfolk, family, closest friends’, an apt description for the not-for-profit supported by a range of mostly-Australian benefactors, including NGOs, that has a well-focused board of governance and a
