As we headed out for a health-focused field trip in Timor-Leste’s central highlands, we were treated to almost all the geographical delights of the country. Along the coast road, the dry season winds were whipping up the sea into the biggest waves I’d seen since I arrived in Timor-Leste. As we turned inland, the brown fields among the rising hills attested to the end of the harvest. Driving ever higher—along narrower and narrower roads—the altitude brought back the green of forests.
We were headed through the district of Ermera to the “sub-village” of Hatugeo, tucked just below the peak of Timor-Leste’s highest mountain. This district has some of the country’s worst health indictors:
- Infant mortality is 70 babies per 1,000 births, far higher than the national average of 45/1,000, and higher than in neighboring Indonesia (34/1,000).
- Only 3 percent of mothers deliver their babies in a health care facility, compared with 22 percent across the country.
- A higher percentage of children show signs of malnourishment and illness than in the rest of Timor-Leste.
Why is that? I’ve been told there are four main reasons (and I suppose that there are more). First, the district is very mountainous; second, there are few roads; third, there is a shortage of professional health staff; and fourth, this district is known for its festivals and parties—people spend what little money they have on these, not on nutrition and health, so says the Deputy Director of the District Health Service Florindo De Araujo. This is a big problem, and Mr. De Araujo and his staff are wracking their brains to figure out what to do about it.
We drove higher into the mountains and, after a couple of bumpy hours, we arrived in tiny Hatugeo, where we would sleep in the school that night. The sub-village chiefs and several women that we met spoke of the great need for health care in the area, and they thanked USAID for the training it provided to local health workers. Health Alliance International (HAI), our USAID-funded partner in the area, regularly shows its films on pre- and antenatal care to residents here and throughout its project areas. HAI brought a generator and a screen to mount between long pieces of wood in the schoolyard. As darkness took hold that evening, the audience, mostly women and children and a few men, concentrated fully on the screen.
The next morning we accompanied the volunteer community health workers to visit the home of a mother who gave birth three days earlier to a little girl. The mother, looking malnourished and inattentive, sat in the dark, one-room, cone-shaped dwelling, while her husband and two other daughters looked on. The small room was lit only by a wood fire smoking in the center. (Timorese custom has it that a fire should burn in the home for the first 40 days after birth without going out.) The HAI volunteer, with perfect animation, drew the complete attention of the parents. The volunteer explained about breastfeeding, about cleanliness, and about child spacing. These were very basic and simple messages, but they were effective, and, as I watched this exchange, I thought to myself: What if USAID were not funding this training? Who would be giving these messages in a way that people understood? How safe would the delivery of the next baby be?
We also visited with a young woman who was pregnant. She already had the HAI brochures about prenatal care on a table in her room. She and her husband asked lots of questions and said that they were planning to go to the maternity clinic—the nearest one is in Letefoho, about 20 kilometers away—to have the baby. As it comes time for the birth, they said they will arrange for someone to go to the closest place that has a cell phone signal. That person will call the maternity clinic, which will dispatch a four-wheel-drive ambulance to pick up the mother and hopefully get her to the clinic in time. The parents-to-be were also making alternative preparations in case there is not enough time to get to Letefoho. This expectant mother and father really do understand the benefits of better health care.
I hope that they are the sign of better things to come.