Diseases, malnutrition, and serious illness is emerging in East Timor. Photo / Wayne Drought
A major health crisis is emerging in East Timor as the impoverished nation's few doctors, hospitals and clinics are overwhelmed by endemic diseases, malnutrition, and serious illnesses they have no hope of treating.
Specialist services for conditions routinely treated in Australia and New Zealand, such as heart disease, do not exist. For many the only hope of survival lies abroad, at exorbitant - and impossible - cost.
Western Governments advise their nationals to arrive armed with comprehensive travel insurance policies that include the cost of medical evacuation by air to Australia or Singapore.
They are also warned that there is only limited emergency medical care in Dili, the nation's capital. Options for even routine medical care throughout the rest of the country are extremely limited.
"Medical facilities are extremely limited and evacuation, at significant expense, is often the only option in cases of serious illness or accident," Australia's Foreign Affairs department says.
For the bulk of East Timor's 1 million people there is no escape.
The World Health Organisation (Who) says the nation has one of Asia's highest rates of deaths during pregnancy and childbirth.
About three-quarters of deliveries are home births, without midwives or other skilled attendants. Most women do not receive follow-up visits to monitor their health or the well-being of their child.
Malnutrition is endemic. More than 45 per cent of children are underweight, especially in rural areas.
Malaria, dengue fever, acute respiratory infections and diarrhoeal diseases afflict the nation, claiming most of their victims among the young.
Tuberculosis remains a curse, with about 8000 cases a year. Leprosy is endemic.
High rates of sexually transmitted diseases also take a heavy toll.
East Timor has little to fight back with. It remains one of the poorest nations in the Asia Pacific region, with few resources outside the large oil and gas reserves in the Timor Sea, making the economy one of the most oil-dependent in the world.
Although gaining significant revenues since winning independence from Indonesia, East Timor remains locked in a battle with Australia for a more equitable share of the reserves.
In the meantime its overwhelmingly poor and youthful population - more than 40 per cent is aged under 15 - is living with a growing health crisis beyond the resources of scant health services.
There is one major hospital, Dili's Guido Valadares National Hospital. It has emergency room services and radiology facilities. These are mostly x-rays and ultrasounds, with only one CT scan that is frequently out of service.
Throughout the nation there are 67 community health centres with limited inpatient facilities, 114 health posts, mobile clinics and five district hospitals providing only basic services.
The most recent available estimate, made by Who a decade ago, put medical staffing levels at just one doctor, 18 nurses, four midwives and 20 community health workers for every 10,000 people.
In Australia there are 25 doctors per 10,000 population; in New Zealand there are 22.
Doctors are now appealing for help. Dan Murphy, an American doctor who has lived in East Timor for 16 years, faces a daily round of wards packed to overflowing with cases of malnutrition, tuberculosis, and other serious conditions.
"There is really no access to anything near adequate healthcare," he told the ABC's Foreign Correspondent programme. "In every category in health, their numbers are worse than most of Southeast Asia.
"We don't have very many medications.
"We don't have very many diagnostic tools, so mostly we're going by smoke and mirrors. You can't do as well as you could if you had all the right tests."
This year Australian Foreign Minister Julie Bishop said foreign aid in the immediate region would be a top priority. Australia is East Timor's largest aid donor.
"We are focusing on alleviating poverty, we are focusing on economic growth and empowering women and girls, better educational outcomes and better health outcomes in our region," she said.
But aid to East Timor has been slashed by A$15 million ($16.6 million), to about A$96 million. New Zealand will this year spend $7 million on aid to the country.
World Vision had planned to launch a new nutrition and child health programme there next year. After the Australian Government cut its funding for the organisation by A$7 million, the plan was shelved.
"When we are cutting funds in a place like East Timor it's a very bad message," chief executive Tim Costello told Foreign Correspondent. "After all, Australia is still the second wealthiest country in the world on a per capita media basis."
Other agencies have stepped in, sending seriously ill patients to Australia for treatment for heart conditions and other problems that would otherwise have killed them.
Toll Remote Logistics, a major corporate sponsor of the East Timor Heart fund that sends patients to Melbourne, has flown 15 patients to Victorian specialists in the past four years. All have recovered and returned home.
But they remain a drop in an overflowing bucket.