Interesting clinical cases continue to present to the National Eye Centre. We have a case of presumed severe cicatrices conjunctivitis secondary to TB. Unfortunately TB is endemic in Timor-Leste. The National Hospital is lucky however to have the new Xpert MTB/RIF machine which is is able to perform PCR on a sputum sample in 2 hours and also determine resistance. This is vital to enable rapid diagnosis and commencement of tailored drug therapy thereby avoiding both the spread of disease as well as multidrug resistance TB strains. In Timor-Leste traditional testing such as a mantoux (skin prick test) is expensive and difficult to interpret. Chest XRAYs are readily available but are often inconclusive and must be interpreted in the clinical context e.g. in conjunction with the patients symptoms and signs.
We have been lucky to hire a ‘proper’ 4WD to take a weekend trip through the Ermera and Bobonaro districts which is the regions South-West of Dili heading towards the border with Indonesia. People have been recommending the rough trip through Gleno, Ermera, Letefoho, Bobanaro and then on to the market town of Maliana. From Maliana, a loop can be taken back through Balibo and then the easy coastal road back to Dili.
It is a little daunting setting off with two small children but I am very much looking forward to getting out of Dili. Obviously we need to make sure we are self sufficient for 3 days including drinking water, food and money - in case of breakdown or emergency. After ~ 10-15km along the coast heading East, the road then head almost due south and begins to climb immediately. The road is initially bitumen but then turns to a graded but rough track. Ermera and Letefoho townships are situated in the heart of one of the major coffee growing districts of Timor-Leste and indeed in both towns there is evidence of coffee production with drying of beans and bags of coffee. The drive up to Letefoho is a bumpy and steep 2 hour drive from Ermera but is well worth the effort. Situated at the top of a ridge I can appreciate the mountainous surroundings from where were have come from and also where we are heading down to the South as well as the steep peak of Mt Ramelau off to the East . It is completely stunning scenery and at times very hard to determine where you are.
The road then continues along a very bumpy track towards Atsabe. There are lovely waterfalls in this area but given we are in peak dry season they do not have a large volume of flow at present. Astable is a picturesque town on the side of a hill and I am surprised by the, larger than expected, population density. I never feel as though we are in the middle of no where although people living in these areas, without reasonable access to private vehicles or public transport system, are still incredible isolated. Everyone is exceedingly friendly and we have to stop many times to ensure that we take the correct ‘fork’ in the road. The road to Bobanoro is very beautiful with tall peaks, rocky outcrops and vegetation in hues of green and yellow which is a contrasting relief from the heat and dust of Dili. The track at times is only the two tyre widths and I am sure we got lost trying to direct ourselves to Bobanaro. We have managed to get this far in good time without rushing however we are quite conscious of needing to find accommodation for the night and get our children fed. They have been incredibly easy to travel with, I am always astounded how adaptable little children can be. They enjoy spotting pigs, chickens, goats and cows and of course waving at everyone going past.
We eventually head over the last pass and down into Maliana. We have been told not to expect too much from the Pousada Maliana which unfortunately has seen better days. The grounds are beautiful though and there are grand fig trees slowly reclaiming the site. Rooms are incredibly basic but there is a toilet as well as a bath to give the children a quick wash. We head down into Maliana to have the staple dinner of Nasi Goreng which was surprisingly delicious and we managed to have a quick walk around the market while we were waiting for our food. We all slept well despite sharing a shaggy mattress with the kids and had fried eggs and bread rolls that seems to be the standard breakfast at accommodation in Timor-Leste. We head off early to Balibo, keen to explore the town as well as the new hotel which has been developed from an old fort.
Severe Ocular Cicatricial Conjunctivitis presumed secondary to TB
Letefoho
Coffee - one of the major agricultural economies in the districts
The hills around Atsabe
Small cemetery in Atsabe
My young daughters pictorial representation of our day's driving!
Market Day in Maliana
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