Dili, Timor-Leste

25th October 2015

A momentous occasion this week with three ophthalmology registrars sitting the Postgraduate Diploma in Ophthalmology (PGDO) for the first time.  These registrars have been training for a minimum of 18 months with no previous ophthalmology training. All three passed so a big congratulations to the next cohort of Timorese ophthalmologists.  The exam ran over two days with external examiners from Australia and was made up of a written component, an OSCE style clinical examination and short answer written question.    Hopefully the will be able to graduate with a PGDO from  the National University of East Timor (UNTL) at the end of the year.  

This week also saw a difficult case load of patients present to the clinic.  We had our second baby under 3 months present with a preseptal abscess requiring surgical drainage.  I can honestly say  have never drained 8mls of pus from an upper lid of a 5kg baby (and perhaps I never will again). Unfortunately the collection re-accumulated and we had to take the child back to theatre to drain the upper and lower lid and leave very small drains in situ (modified from latex gloves that have been rolled up to act as a pseudo drain).  The child proceeded to improve after a week on intravenous antibiotics and one month later at follow up it was difficult to determine which eye had been affected apart from the very small scars.  I am always in awe of the power of antibiotics given the rapidity, severity and potential consequences of periorbital cellulitis in children and infants; never more so than in a country like Timor-Leste.  

I haven’t really written much about eating out in Dili - it is surprisingly good and an unimaginable variety.  Our favourites with the children are Osteria Italiana - homemade Italian mostly pasta and pizza.  This is down on the waterfront and we would probably frequent at least once a week.  The spaghetti bolognese is always a big hit and easily feeds 2 hungry children.   Our children’s other favourite is the Turkish restaurant which is now on the waterfront approximately 2km west of Dili.  The menu is rather limited to kebab, salads and dips but everything is home made and it is a good source of hummus to take home.  The staff are very friendly and alway finish of the meal by giving my kids a Kinder surprise, so of course they alway want to go there.   There is also a variety of Thai, Chinese, Indonesian, Portuguese and Brazilian on offer so there is always plenty of options.  One of my little favourites is the Portuguese Bakery Padaria Brasao - really yummy bread and pastries.  

One of my other favourite things to do in Dili (aside from eating) has been my regular Sunday morning 10km run from Areia Branca up Horta Hill, around back beach and then up and down Christo Rei.  There is a wonderful group of women (and sometimes men) who meet up early to do the walk/run and then have coffee afterwards.  Even starting at 6.15am means that it is still very ‘steamy’ by the time we finish.  I think it is probably one of the hardest 10km circuits I have done but it is certainly one of the most scenic and crossing over Horta Hill down the other side is just a beautiful way to start the morning.

Medical Staff at the National Eye Centre, Dili Timor-Leste

Modified drains, from latex gloves

Dili waterfront, just opposite from Osteria Italiano

Early morning Sunday run, Back Beach, Dili Timor-Leste

Early morning run, no crocodiles to be seen

Atauro Island, Timor-Leste

17th October

The previous three days we were conducting another surgical outreach program, this time on Atauro Island, focusing on refraction, prescribing glasses and treating surgical conditions such as cataract and pterygium.  We were fortunate to have two visiting international faculty however due to unforeseen local political forces we found ourself without any patients to operate on.  This was unfortunate given the remoteness and inaccessibility of medical care to many people on the island, quite simply a trip to Dili for them is not an option for ‘elective’ surgery.  For many people, particularly on the remote West coast of the Island, it is either a 4-6 hour walk to Beloi to then catch a ferry/boat to Dili or a 4 hour boat trip either around the Island to reach Beloi and then find transport into Dili. 

There is a purpose built eye clinic and operating theatre on the Island and it was disappointing to see the under utilisation of these facilities.   We hope that some of these issues will be resolved for next year.   We did manage to do some rudimentary screening at the primary school next door to the eye clinic while we were waiting for patients.  We set up a three step process of cover testing (looking for squints), examining for a red reflex (to identify cataract or other opacities) and examination of eyelids (mostly for trachoma).  We screened 3 classes of approximately 30 children and only found one with a red eye and eyelid changes - probably more indicative of an acute infection rather than trachoma.

 We also managed a trip into the centre of the Island to the village of Macadade, with stunning scenery along the way - again reminding me in part of North West Australia with barren hills dotted with Eucalyptus with beautiful white trunks.  There were small grassfires burning, which as an Australian well educated in bushfire danger, freaked me a little when we drove right through it!   We got some great vistas down to the West coast and beyond to the surrounding Indonesian Islands .  There is a local group trying to establish community garden’s/planting near one of the major villages as malnutrition is reportedly a concern amongst the community with limited access to fresh food, aside from fish.   Earlier in my time in Dili, I had seen a terrible case of Xerophalmia in a very small infant with severe malnutrition/Vitamin A deficiency who was from this area of Atauro Island.  I have never seen a case before and it is due to extreme dryness of the cornea which progresses to thinning of the cornea and in extreme cases corneal scarring, perforation and ultimately blindness.  Unfortunately the poor child had already perforated one cornea and the other was extremely scarred.  Such a terrible start to life. 

After three days, again staying at Barry’s, we headed back to Dili via a very small speed boat this time - while quicker, I certainly was glad we all had life jackets!

Bushfire burning Atauro Island

View towards the West coast of Atauro Island

Screening at the primary school in Beloi, Atauro Island

Schools Out

Talking to locals, Macadade, Atauro Island

Barry's, Atauro Island

Heading home for Dili