Dr Tani Brown : Bacau, Timor-Leste

13th November 2015

I write this from the tail end of a week long outreach to Bacau. Bacau is the second largest city in Timor-Leste and is~ 120km East of Dili although with the state of the road, the drive takes approximately 3 hours. Some parts of the road are simply about trying to avoid doing a tyre in while avoiding potholes and the sharp edge of the road while other parts are narrow winding paths along steep but coastal scenery. The contrast of the red, brown soil on the steep cliffs which then descend down to the turquoise water is truly spectacular. The scattered acacia’s with their white trunks and green foliage is a little reminiscent of North-West Australia. One of the lovely things to do on the way to Bacau is to stop of ‘fish sticks’, local road sides stalls of grilled fish - all on a stick for your eating convenience.

Bacau is mix of the new town, on top of the hill, and the older town about 2km down the hill. At times it appears the town is built into a small cliff. The hospital was a myriad of small pavilions and connected walkways at an elevated but central point in town. There is a new hospital being built but currently the old one served our outreach team very well. As like most outreach visits we screened patients early in the morning for surgery that day or later in the week. Priority is always given to bilaterally blind patients. Both myself and the head of outreach were surprised by the complexity of cases that presented. Antidotally, one in two patients had evidence of pseudexofliation. Usually combined with white or brunescent cataract and small dilating pupil - the triple tyranny of ‘terror’ for any cataract surgery. We also had multiple patient present with presumed open angle pseudo exfoliation glaucoma, already blind in one eye and very high pressures in the other eye (again, usually with a dense cataract, poorly dilating pupil and some degree of zonular dehiscence). After battling our way through these cataracts for three days we came to the conclusion that in an ideal world outreach to Bacau should happen twice a year to try and screen and thus treat such patients earlier. Of course, this would be in an ideal world of endless resources, funding and outreach program.

We also managed to catch up with a paediatric patient known to the eye team in Dili with significant orbital tumour. In conjunction with the general surgeon we were able to proceed with a diagnostic biopsy in the hope that we may be able to refer her outside of Timor-Leste for treatment.

In total we did around 40 cataracts and 3-4 pterygiums. Given the stuttering delay with theatre and screening of patients earlier in the week we thought this was a reasonable outcome for the visit. Along with the principle surgeon and myself, one of the Timorese registrars was also operating. It was very encouraging to see her manage outreach cataract on her own and very encouraging for the future of ophthalmology in Timor.

Operating Theatre Bacau, Timor-Leste