Dr Tani Brown : 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