East Timor and Australian Dental Volunteers

The seven year old Toyota Prado began the first of a dizzying array of hill climbs and, from the front seat, Ross glanced over his shoulder, and smiled.

No straight roads once we leave Dili.

He was right. Dr Ross Brandon is the Chief Medical Advisor for Clinic Café Timor (CCT), the health care division of Cooperativa Café Timor, a member owned coffee processing and marketing cooperative. He has been working in East Timor for more than 11 years, and he is the key architect and manager of the Cooperative's health programme.

Over the week that we travelled together, Ross demonstrated a caring and focussed passion that is quite imperfectly camouflaged by a light veneer of ironic understatement. Travelling over, arguably, some of the world's worst roads provided me with an immense amount of respect for Toyota's 2003 marque - and also for its owner. As we traversed the countryside the high axled car frequently bottomed out. Often literally centimetres from precipitous, and clearly deadly, sheer slopes, the vehicle made it through in one piece - and so did we. More importantly the land of East Timor (Timor-Leste) has passed through its own "bottom out" of civil unrest in 2006.

East Timor is one of Australia's closest neighbours. The capital, Dili, is as closer to Darwin than Sydney is to Brisbane. It is one of the world's newest nations and is also one of the world's the poorest. It needs our help ... now.

Australians have had deep historical and cultural links to East Timor which were deepened when Australia stood with the emerging nation in 1999 and lead the peacekeeping troops of the International Force for East Timor (INTERFET).

It is now safe to visit. It welcomes - and needs - our help. For Australian dental volunteers, East Timor is attractive, close, safe and a place where short term trips focusing on support and education of the local dental profession can make a real and lasting change for good.

A real and lasting change for good is great - but why East Timor?

In the rural Emera district I spoke to Paolo Amaral, a government "Dental Nurse." In the middle of a busy morning this well spoken, obviously intelligent young man told me that he was the only dental practitioner in the district. He had recently completed a three year training course in Indonesia and now he was directly responsible for the care of a staggering 95,000 people. His most advanced piece of equipment was a slow speed contra angle hand piece driven by a lab motor.

Clearly the needs are immense. In this country of just over one million people, the infant and maternal mortality rates are amongst the highest in the world.* This means that right now - and for at least the next five years - it is expected that the East Timorese government will, quite correctly, worry mostly about babies and mothers dying and very little about teeth. Priorities are necessary after all. This is where the Australian dental profession comes in.

We can offer a programme that has a finite life, a real outcome on the ground and a catalyst for change at all levels.

What our East Timorese colleagues need, and ask for, is to have assistance in areas that are off their nation's priority list for now. Clinical help, mentorship and education of the few existing personnel are what the Australian profession can offer. But not forever. We can offer a programme that has a finite life, a real outcome on the ground and a catalyst for change at all levels. They need our help and are asking directly for it. Two weeks in East Timor, or even one week, has the potential to improve many lives and make changes that will have many positive outcomes. This is one of those moments in time when we can make a significant and lasting difference.

The winding roads continued as we toured the mountainous interior for the duration of the journey that visited all but one of the CCT medical clinics. Crossing a ridge, high in the Emera district, it was possible to look out either side of the vehicle and view a 500 metre drop on both left and right of the one lane track - both less than one metre from the road edge. We were on a knife-edge and it caused me to reflect that so too were the people of East Timor. The difference was that the knife-edge road soon came to an end on our short journey. For the people I met in East Timor, their whole life is a knife-edge journey that is too often cut short.

East Timor's journey is one marked by Australian involvement. In 1942 a part of the small Australian army "Sparrow Force" contingent were assisted by East Timorese in guerrilla warfare against the invading Japanese. Australian forces have been stationed in East Timor virtually without a break since the Indonesian withdrawal in 1999. While the history is both rich and recent, it is a real reason to consider this professional involvement as a valuable and ongoing process of engagement to our mutual benefit. While driving through the same hills where East Timorese helped to hide our Diggers in World War II, I decided that in our vehicle was the face of the new Australian presence in East Timor - Dr Ross Brandon.

Since April 2006, Australia has provided more than $25 million in humanitarian aid including food, water and medical supplies. The Timor Gap oil and gas resources will ensure that Australia and East Timor continue to engage at many levels. The complex myriad connections between our countries make an involvement in aiding the dental health of this nation a natural choice for Australians wanting to make a difference. Making a real difference must be the key reason for contemplating any aid work. The need is clear and the links are logical.

That week, as we drove up through a 'coffee jungle' of ripening Arabica coffee beans, I went through all the reasons why this initiative should have a clear expectation of achieving the goals it would set:

  • Cooperativé Café Timor is amongst the major positive reasons for our involvement. Clinic Café Timor is the health arm of this independent, fully East Timorese entity. They have an existing, high quality, infrastructure in terms of their rurally situated health clinics. The on-the-ground logistics are managed by enthusiastic, involved and cooperative partners who welcome and invite our involvement.
  • Equal Health is an overseas aid fund of Australian health professionals. The author is currently the Chair and it has a long, successful overseas aid history in dental health provision in other countries. Equal Health has tax deductible status and proven logistical skills in managing overseas aid trips. (www.equalhealth.org.au)
  • The needs of the initiative are essentially simple. The local personnel will benefit from the practical and direct mentorship, training and assistance that can be provided by general practitioner dental professionals coming for a short stay. The needs are not complex or high-end at this stage. Small, easily made improvements will make an enormous difference.

But to make a real difference requires real people to volunteer.

Can you imagine yourself spending one or two weeks in East Timor?

Equal Health will arrange travel via Darwin or Bali for a one or two week period that fits with your schedule. Usually the Equal Health teams will be small and consist of a dentist and an assistant (nurse, hygienist or therapist.) The field work is in the countryside at CCT clinics. Volunteers will be working alongside the East Timorese team - helping in every way useful. Accommodation, translators, transport and meals are organised by Equal Health and CCT.

The experience leaves an indelible impression on your own, and others, lives. It will be a lasting legacy in the place that still needs Australians to go to help - a place that deserves our help.

East Timor is truly a life changing appointment, so watch this space for your chance to volunteer and make a difference to so many lives.

Dr Ross Brandon

  • MBBS from Brisbane University in 1979
  • Worked for Queensland Health in northern Queensland and two stints in the Northern Territory in the late 80's and again in the late 90's
  • Arrived in East Timor in January 1999 to head the Cooperativé Café Timor health service and has worked there ever since.
  • Originator, implementer and overseer of C.C.T. health programme - literally designed the physical buildings, the health programme -even their logo.
  • His vision is as a 'strategic driver', not hands on. It is important to step back and allow mistakes to be made and lessons learnt independently.
  • Currently managing a shift in focus to community outreach to give health access to more remote rural populations.
  • States that dental services (along with optical) are practically almost completely absent in his region and is certain of the need for aid work to assist in filling the gap and leading the way to encourage expansion of service delivery.

Health statistics for East Timor

  • For every 1000 live births, 4.4 babies die in Australia each year while in East Timor, 83.5 babies die.
  • Maternal death (Maternal Morality Ratio) is even worse - 660 per 100,000 live/births in East Timor versus approximately 10 per 100,000 births in Australia.
  • The average age is very low especially in the remote rural regions (Ermera, Ainaro and Manufhai) where to live past 60 years old is still rare.
  • Maternal death (Maternal Mortality Ratio) is even worse - 660 per 100,000 live/births in East Timor versus approx. 10 per 100,000 births in Australia.

Reference: Ministério Do Plano E Das Finanças Direcção; Nacioal de Estatistica. Timor -Leste Census of Population and Housing 2004. Dili: Gráficia Pátria, December 2005