What's up Dili?

So, what’s up in Dili, Timor Leste?

You may or may not recall the revolution that came to a head here in the late 90’s-early 2000s when Timor Leste gained it’s independence from Indonesia.  It probably didn’t outshine the O.J trial or the Monica and Bill show at the time.  It seems that when Indonesia finally got its freedom from the Dutch, they assumed that Timor Leste would want to go along.  But, they didn’t

Way, way back the Portuguese controlled the eastern part of this island and so, the island is now some 90% Catholic compared with the rest of Indonesia which is 85-90% Muslim. They still speak Portuguese here, as well as a language called Tetum and some Indonesian and some English, but they strongly identify with their Portuguese roots.   Kind of funny, I think.  Inflating one colonial power’s roots to rebel against another’s but there you are.

Timor means “East” in Indonesian.  Leste means “East” in Portuguese.  So, we’re in East East today.  The Tetum word for the country is Timor Lorosae.  Which also means East-East. Linguistic creativity is limited.

So, the country has 200,000 people, or 2 million depending on who you ask.  I’ve asked several locals and haven’t gotten the same answer twice.  Wikipedia says they have nearly 1.2 million people. From what I’ve gathered, there has been a downturn in the population after the UN pulled out of its peacekeeping and development projects.  All the accompanying people have moved on as well. It’s a pretty quiet place.

Young children swim naked on the beach after school.  They really have a blast. Men row or wade out into the surf and pull in some fish, haul them up to the beach road and sell them strung off coconut leaves by the side of the road. Those that they can’t sell they roast over a fire at the market down the street.  A poor man’s carry out. Mom’s and children fan off the flies in the evening sun.

One of the first things you notice on the road on arrival is the taxis.  They’re yellow, just like many places in the world, but the similarities end there.  They are garish and amateurishly decorated with day-glo green painted wheels and all manner of external accessories. Spoilers seem popular, as do parking mirrors affixed to the roof.  Most comical are the decals/sunshades, like “Suck on it” and “F(*k  it” and “Awesome”.  Very few have working A/C and all through the town they troll looking for customers with a toot of the horn and a yell out the open window.

Met a man in a bar who is involved with helping this young government set up its medication procurement and logistics.  Figuring out why they have a 15 years’ supply of medication that is going to expire in 2 years’ time.  Figuring out how best to ensure the population is getting true medication and not just some knock-off because it was cheaper or because the supplier was a friend of somebody.  Figuring out how to convince the people in charge that the real issue is patient health and not just a well stocked supply cupboard.  He says, “I often go into meetings  and let people know that I make decisions based on three words.”  and he writes them on the whiteboard, “Will, ‘Patients’ ‘Die’? and I’m often looked at with a perplexed look.  What do patients have to do with anything?”

He’s done this sort of work for several countries in this neck of the woods and tries to guide governments toward the decisions that make the best sense for the general health of the population.  He has come to accept a rather disheartening conclusion that “It is the right of any sovereign nation to kill its people in any way it sees fit.”  This was a couple beers into the night, but a rather sobering thought.

Made the rounds of the local hospital.  Met one of three psychiatrists in the country.  One of them is leaving next month to return to Portugal.  So, if there are 1.2 million people, he’s one in a million. He did some training in PNG and Australia, but he’s fiercely proud of his Timorese heritage.  

“Send them all.  If any person needs me here, I’ll see them?"

There is a psychiatric nurse in each of the districts and they all consult with him if they have problems. Most of the GPs like many in the world are too uncomfortable seeing psychiatric patients.

He tells me they don’t see much in the way of behavior disorders in children, perhaps they’re the ones out swimming naked in the surf. But, later he said he’d received complaints from teachers and asked for referrals, but hadn’t seen any yet.  Mostly when he sees children, they have autism or developmental problems.  He doesn’t find there are eating disorders here either.  We’re all too hungry.

Depression is a problem, as are marriage problems.  Schizophrenia rates have been rising in his office. Some patients have had problems for years, but only now have come forward.  Curiously this coincides with the newly instituted government policy where patients with severe mental illness receive an allowance for care.  They can only get the money if they are certified by a psychiatrist, and so they all come to him to get their paper signed.  

He offers them treatment, but “they just want the money.”  The families take the patient back home and do what they’ve done with them for the past 10 years, which is shackle them to a wall or keep them in a cage to keep them out of trouble. It is sad, but one consolation is that family support is something many in the US don’t have, so homelessness and victimization of the mentally ill is less.

He’s a very spiritual man.  There are a stack of New Testament bibles on his desk and there may have been talk about asking for forgiveness when I walked up to his office.  There are only 7 psychiatric meds available in the country, all of them antiquated. And it will be some time before there are any more, so there would be an urge to turn to the spiritual, I suppose.

There may be some hope.  Plans are on the drawing board for a new acute care psychiatry wing. My colleague though has yet to be consulted for any input.