16th July 2016
Dili, Timor-Leste
I am settling into work slowly. With the operating theatres out of action we have managed to configure an alternate makeshift theatre. It was quite amazing to see a 24 hour transformation from a library/meeting room filled with bookcases and tables and chairs to a fully functioning theatre. We have no running water or plumbing in the new theatre so scrubbing is done with sterile water into a large plastic lined rubbish bin. We are however only booking patients with cataracts that are causing significant reversible blindness and most of our patients have vision that is ‘Count Fingers’ or ‘Hand Movements” , that is, they cannot even see the largest letter on the Snellen (eye) chart. Surgical case numbers are significantly down at the moment anyway due to an overall decrease in the total number of patients presenting to the clinic. According to the clinic staff there are a lot of police roadblocks in the east of the country and people are simply not travelling around the country like they normally would.
From a clinical point of view I have already seen some very interesting cases. I saw a case of Gyrate Atrophy on my 3rd day here of which I haven’t seen a case in 4 1/2 years of being a registrar. I have also seen a patient with a large carotid-cavernous fistula - impressive in that there was a cephalic bruit and the biggest superior ophthalmic vein I have ever seen, almost the size of my little finger on CT scan. We are lucky that the CT scanner is working at the moment as it is intermittently out of action. Thankfully this patient was accepted to travel for neurosurgical intervention in Indonesia from the referral committee at the hospital. This committee meets once a week and medical and surgical teams can present patients they feel would benefit from receiving treatment outside of Dili due to the service not being available in Timor-Leste. This is normally in Surabaya, Indonesia but can also include Singapore if the case requires.
I have been reading some books on Timor-Leste to try and understand a little more about the history of this small Island nation. Currently I am reading Shirley Shackleton’s account of her husband Greg Shackleton who was one of the Balibo 5 journalist who was killed on 16th October 1975 in the early stages of the Indonesian invasion. She then took up the fight for truth and justice for the events surrounding the death of the five news and camera men and ultimately became involved in the Timorese resistance movement and long struggle for independence.
I have not ventured too far out of Dili yet this trip as I have largely been on my own but I did make the trip up to Dare on the weekend. It is a small town in the Fatunaba hills around 10km south of Dili which houses a small war memorial, museum and cafe. Many of the pictures are supplied by the Australian War Memorial and it is a beautiful setting to sit and contemplate and escape the heat of Dili. It was originally built by the Australian Commandos of the 2/2 Independent Company who were present on the Island between 1941 and 1942 and waged a guerrilla style warfare against the Japanese, despite Portuguese Timor declaring its neutrality in WWII. The Australian soldiers were greatly assisted by the local Timorese who were called Criados and many owed their lives and success of the campaign to these Timorese. Unfortunately with the withdrawal of Australian troops, the Timorese suffered significant reprisals and it has been estimated that approximately 40 000 Timorese lost their lives in WWII.
The road further South of Dare heads up to Aileu and Maubisse and then on to Hatubuilico, which is the base for climbing Mt Ramelau. I had visited Timor-Leste 10 years previously and at that time made the trek up the almost 2963metre high mountain. At that time, we overnighted in Hatubuilico
A very large Superior Ophthalmic Vein
The view from Dare, north towards Dili
The top of Mt Ramelau
Market Day In Hatubuilico
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