Hello!
It has been months since we last wrote about our work here. This is not because we had nothing to write about, quite the contrary in fact! We were just too busy to make a decent post. The following will attempt to fill in the gaps but we look forward to catching up soon in person or by phone when we are back stateside.
 |
| At a party to celebrate Stephanie's family visiting in May and our engagement! |
It has been months since we last wrote about our work here. This is not because we had nothing to write about, quite the contrary in fact! We were just too busy to make a decent post. The following will attempt to fill in the gaps but we look forward to catching up soon in person or by phone when we are back stateside.
Speaking of which, tomorrow we
wake at 5am to run the Dili marathon then immediately board a plane heading
home. Thank you to all of you who
have supported us and kept us in your thoughts during this journey!
Community Health Project
Now,
back to the project followed by several other stories. As you have probably long forgotten by
now our main project while in Timor was to reformat, improve, and expand Bairo
Pite’s mobile clinic program. What
follows is a summary of the work we have been engaged in that I wrote for a
different purpose:
 |
| Community visit in Osolia, a remote community in the interior of Timor Leste. |
“The Bairo Pite Hospital Community
Health Program has undergone significant change over the past 6 months. For many years it operated as a pure
mobile clinic, visiting 11 sites spread throughout Dili and Bobonaro Districts
on a weekly or bi-weekly basis with a team consisting of a driver, Timorese
nurse (who provides consultations), Timorese volunteer (to register patients
and hand out medications), a foreign doctor or medical student, and a Timorese
volunteer translator. Patient
volume depended on site and season but averaged 10-30 people. Very ill individuals would be brought
back to Bairo Pite for more definitive management. In three communities Bairo Pite employed Tuberculosis
monitors to facilitate detection and treatment compliance concerning this
disease. While the mobile clinics
were held in high regard by participating communities it was felt the program
could be improved upon.
The new program was instigated in
order to re-focus the visits in a more prevention-oriented direction and to
empower communities to take charge of their own wellbeing. The first major change was to create a
program coordinator position. The
prior mobile clinics were managed by a number of clinic staff with other
responsibilities while the new position is dedicated entirely to the community
health program.
Each site visit now commences with
community education on topics such as hygiene, nutrition, diarrhea/dehydration,
tuberculosis, malaria and more.
Education is delivered by three program staff each teaching a separate
small group and is designed in this manner to maximize community
participation. With the focus now
on prevention the team now visits communities only once per month instead of
weekly but will send an emergency vehicle when the need arises. After education, consults are carried
out as normal with the one change being that visiting medical student are no
longer allowed to conduct consults on their own and may only assist the
Timorese clinical nurse or visiting doctors.
Several changes have evolved from
the intent to build a stronger partnership between Bairo Pite and participating
communities. Key contacts were
identified early on and include village leaders, teachers, as well as other
community members. Coordinating
with these individuals has been invaluable in organizing one of the more
exciting aspects of the new program, identification and training of community
health workers and lay midwives at each site. The curriculum is currently being finalized and communities
have been guided through how to choose individuals for training. The CHWs and midwives will provide
community education, deal with minor health issues, help identify and triage
ill patients (for example malnutrition and TB), conduct home deliveries
(midwives), and coordinate with both Bairo Pite and local government health
facilities to meet the needs of their respective communities. This aspect of the program is in the
initial stages of implementation but holds great promise for the improvement of
community wellbeing.
Lastly, in the overall evaluation
of sites visited several communities were determined to have quite good access
to health services. The goal of
the Bairo Pite Hospital community health program is to serve those communities
most remote, most in need, and most willing to engage in a productive
partnership. Thus, so far, one
site has been discontinued and one new site in the Bobonaro District has been
opened. The current total of
communities visited by the program stands again at 11 but will likely drop to 9
or 10 in the coming months.”
In
addition to the above work we also traveled to and evaluated two remote
communities in the interior of the country for potential collaboration. These sites were indeed remote; one
being over 8 hours from Dili much over atrocious roads that at times become
impassable due to heavy rains causing flooding. These communities were also facing many health
challenges. For example, in one
site in a population of 1,300 they lost 9 children to diarrhea/dehydration in
2012 and 11 women to child-birth complications over the two year span of
2011-2012. We determined that the
most useful contribution we could make being so far away was to empower the
communities and assist in the prevention of disease by assisting the
communities to vote on community health workers and lay midwives who we would
then train.
We
returned to both sites and helped facilitate the selection process (for
choosing the midwife students only women were allowed to vote but men kept
trying to butt in – we had to eventually tell the men to sit down and shut it
or they would have to leave!) The
first two lay midwives have almost completed their intensive 3-month training
course at Bairo Pite (one week left as I write this!) where they will have
participated in close to 300 deliveries by the end of their training.
 |
| Voting for the community health worker trainees in Osolia. |
 |
| Training CHWs in Osolia with good old chalk and chalkboard! |
 |
| Adese with Professor Marcelo the community leader who petitioned for assistance to improve the health of his people. |
For the
training of the community health workers we developed a curriculum based off
the book “Where There Is No Doctor,” work by Partners In Health, and other
sources. I traveled to one of the
sites with a Timorese colleague, Adese, to conduct a 4 day training for two
health workers in late May. The
road had become impassable due to heavy rains causing small land slides to
deposit boulders in the road and we thus had to hike in the final 6km with our
gear. And of course it rained:) Future trainings are being planned as
additional communities select individuals for training.
While
sad to depart we leave the program in good hands as our dear friend and
colleague Lourenco (previously misspelled as Lorenzo) has been selected as the
new coordinator of the program – we are very proud and excited for him!
 |
| Professor Marcelo and his wife in their home with a breakfast they got up at 2am to spend 2 hours preparing so we could eat at 4am and start walking out at 5am in order to catch the bus in the distant town. Thank you. |
Yoga!
Stephanie’s yoga truly blossomed
in Timor. She taught a total of 42
classes, creating a new theme each week complete with quotes and moves to
reflect the topic. Her classes
were extremely well attended and a few times people had to be turned away! I was able to attend as well on an
almost weekly basis and know it helped keep me centered and rejuvenated my
stores of empathy.
Perhaps even more exciting, a
goal since coming to Timor, was Stephanie teaching yoga to Bairo Pite Clinic
staff! She taught 5 classes with
3-6 students per time and after each class the students emerged refreshed and
glowing. Stephanie was grateful to
share the power of yoga and see how it affected their lives – many students
espoused the desire to continue practicing in the future as it made them
breathe easier and feel better.
 |
| Stephanie teaching yoga at the clinic! |
Community
Timor has astounding natural
beauty but the true riches as we came to see lie in its people. The warmth and kindness we experienced
from our Timorese friends and colleagues was unlike anything either of us had
previously encountered.
 |
| Stephanie leading a yoga session at the home of a good friend from the clinic. Yolanda's (our friend) kids got a hold of the yoga magazine stephanie had brought for Yolanda and started flipping through imitating the poses as best they could. Stephanie eventually joined in to provide some guidance:) |
 |
| My "host mom" during my week in Osolia making a Tais. |
 |
| Close up view. I later purchased a completed tais from her and she gave me a different one at no charge for helping the community. |
Walk with kids
We took numerous walks and hikes
all around our community. One of
our favorite destinations was an old semi-abandoned road leading up into the
mountains. We hiked it so many
times that the local children came to know us well and would accompany us on
our adventures. On our final hike
we attracted a group that numbered 20-30 strong and at several points they all
burst into song in unison. It was
moving and beautiful experience.
They joy of children and their ability to be fully present in each
moment is remarkable and something we are working on incorporating more into
our own lives.
 |
| Walking up the hill, hand in hand with singing children. They seem to like Stephanie more:) |
Mana Lou
During our final week we finally
made a long awaited trip up into the mountains surrounding Dili to meet Sister
Lourdes, aka Mana Lou. Called a
modern day Mother Teresa for her work in Timor she strives to improve the lives
of those with less. From
healthcare (she was an original and continues to be an avid supporter of Bairo
Pite), to farming, to business she works to empower her fellow country-women
and men. All are welcome to join
her cause and her popularity among the common people for a time engendered fear
amongst the ruling elite that she had politicial aim. She told them this was ludicrous and since that time has
formed working relationships with the president and prime minister. When the Ministry of Health (MOH)
wanted to shut Bairo Pite Clinic in 2007 she met with both the president and
prime minister, explained her side, and in the end the an agreement was made
where the MOH would provide the clinic with a $15,000 per month operating
budget that continues to this day!
 |
| Us with Mana Lou in her flower garden, one of many small businesses she has started. |
We expected to see Mana Lou
briefly and thank her but were pleasantly surprised to find Lourenco (a former
student of hers) had told her about our work at Bairo Pite and Mana Lou took
over an hour on two occasions during our stay to talk with us, ask us about our
lives, and explain her work. An
inspiring woman indeed, we hope to support her cause in the future.
Goodbye
The day before we left we
received certificates of appreciation as well as hand-woven “tais,” traditional
weavings of great cultural significance. Saying goodbye was difficult but this
reflected to us just how important our new friendships had become. The question everyone posed to us was, "when will you return?" We do not
yet know what the next few years will bring but we most definitely plan to
return. Our experience in Timor
has been pivotal for us professionally but just as importantly, if not more importantly, it has
helped create the foundation of our partnership together.
 |
| Receiving Tais with our friend Lourenco. |
