Friday, June 21, 2013

Finish Line


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.


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!


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.


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.  

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