Dr Tani Brown : Atauro Island, Timor-Leste

26th September 2015

I am always amazed at the scope of clinical cases that walk into our Eye clinic on a daily basis. Even relatively routine things like pterygium, which is a growth over the cornea normally caused by exposure to UV light, often take on extra significance in Timor-Leste. This week a gentleman came down from the districts with both eyes affected by very large pterygia, on both sides of the cornea. On one eye he only had a very small window of clear cornea from which to see. As such his visual acuity was worse than 6/60 (20/200) and he had considerable astigmatism (distortion or warping of the shape of the cornea from the pterygia). I have never seen such extensive pterygia in Australia and I booked him for surgery the next day to at least try and improve his vision in one eye. As expected the surgery took considerable time and required a very large autoconjunctival graft however thankfully his vision even one day after surgery had considerably improved.

I have also seen a patient this week with presumed chloroquine induced maculopathy. Malaria is quite widespread in Timor-Leste outside of Dili, and I was informed by the registrars that many patients self treat themselves with Chloroquine whenever they have a temperature or feel unwell. This patient was in in their 60’s and had been taking large doses of self prescribed chloroquine, up to 2g/day for many many years. They had reported that their visual acuity had started to decline in both eyes over the previous 2 years. Normally in Australia I would confirm diagnosis with electrophysiology testing however this is of course unavailable in Timor-Leste. While we can never prove definitely that Chloroquine was the cause, we felt that the clinical history of significant longitudinal exposure to chloroquine, in conjunction with the changes seen at the macula, was likely consistent with chlorine toxicity

We are now currently on Atauro Island for the weekend. Atauro is a small island to the north of Dili, accessible by an hour long fast boat ride or 4 hours on the old ferry (or 2 hours in an outrigger as the last time I did it 10 years ago). It is a wonderful tourist drawcard for Timor-Leste with world class diving, hiking and a unique cultural experiences and as someone mentioned to me ‘jurassic park’ like - obviously minus the dinosaurs.

While on the Island we stayed at Barry’s - a Timor institution, near the main jetty of Beloi. Barry runs an eco-resort on the Island with beach bungalows and a central dining room serving 3 local meals a day. The kids love running around the resort with the other kids and Barry’s kids are very gracious in letting the visiting children play with toys, trampoline and swings. As my daughter says “we love it here because we can run around without the adults” .

For the adults, there is wonderful snorkelling just off the beach as well as fantastic diving, particularly around the other side of the Island. Fishing is also a predominant activity on the Island for both locals and tourists, although my husband had no luck on his early morning fishing trip. The small nearby town of Vila, has some lovely Portuguese style buildings and currently a big draw card is the local NGO called Bonecas de Atauro, which handmake dolls, bags and soft toys and provide employment for local women. If nothing else, Vila has lovely wide, shady streets on which to walk around and just enjoy the atmosphere. Again, a lovely relaxing weekend away to escape the heat of Dili.

A very big Pterygium!