6. East Timor, 1.5 years on: environmental and occupational health.
Impressions from working there with the NZDF and the Timorese health service.
Not necessarily the views of the Army, UNTAET or the Government Elect…

8. Ministry Impressions
The main health health problems at the moment are Malaria, TB and malnutrition.
The main Ministry health programmes are to:
Support service delivery- (mainly) primary care.
Improve range and quality of services.
Develop and implement health policies and management.

9. Primary Care Health care programmes-
This encompasses the range of preventive and treatment services normally found in NZ health districts.  Three levels:
1. Mobile clinics.
Health care programmes-
Health education and promotion
Maternity and reproductive health care
Primary care (lab available)
Referral.
Staff: One nurse, one midwife.
2. Fixed location clinic without beds.
The same as the mobile clinic with an after hours service
3. Fixed location clinic with beds.
At present, Suai hospital falls into this category- the aim is to be able to treat acute cases of malaria, TB and gastroenteritis.

11. Lack of diagnostic facilities

12. Secondary care.
Aim is to rehabilitate 6 Hospitals with Surgical facilities- already planned for Dili, Maliana and Bacau. These are what we would recognize as District general hospitals. They are also looking at the concept of a community Health Center with surgical facilities. This may be an option for Suai Malvesi and Ainaro.

13. Comment:
There should be at least a “health post” in most villages, and this should be regularly manned by a nurse and midwife. The perception in Dili is that this is not so (for whatever reason). We could find out from District Health Officers what facility should be available and what is in practice on the ground.

14. Perinatal problems Infant mortality Maternal mortality 60/1000
300/100,000

15. Access to acute services

16. Midwifery
Should be one of the focus areas, but no lead person in Ministry.
Pers.
645 midwives pre 1999, now 169 positions filled.
Plan.
The plan is to implement midwifery standards for “safe motherhood”. At present this is through training sessions (22 days) followed by an audit of practice.
Problems.
Not taught controlled traction.
Not using syntocinon.
Needs.
A midwives Act and registration.
Upskilling of traditional birth attendants.
Give a delivery pack at OP attendance.
Family planning manual.

17. Environmental health. Water. Problems Sewage. Refuse.
70% of water samples in rural districts are faecally contaminated.
30-50% of urban samples likewise, despite being chlorinated.
Problems
Urban: Poorly maintained water supply with intermittent low pressure.
(Inadequate staff to monitor.)
Poor hygiene in villages: contamination is via buckets. Should be working pumps.
Sewage.
Poorly developed system compounded by poor absorption of soils. Main method is by septic tank/long drop.
Refuse.
A problem in many areas- provide excellent mosquito breeding sites.

18. Diarrhoeal Illness
Prevalence?
7 deaths from Cholera in last month…

23. Malaria Endemic! Both falciparum and vivax.
5 hospital deaths- cerebral malaria- during tour.
Chloroquine resistant.

26. Prevention Drainage Larviciding Fogging- incl ULV Nets
Personal protection
Vaccination??

27. Occupational health
Whats up, doc?