HEALTH AND ILLNESS IN EAST TIMOR

East Timor has often been in the news over the past 23 years but, despite this, most Australians have little idea about the island or its people. Perhaps most of us would prefer not to know too much. We are frequently reminded that Australian newsmen were killed at Balibo as Indonesian troops crossed the border to annexe the eastern half of the island in 1975. More recently, the 1991 Dili massacre drew world attention to the plight of the 800,000 East Timorese people living under an oppressive Indonesian military regime.

Without doubt, Australia’s strained relationship with Indonesia has been a preoccupation of our foreign affairs bureaucrats. In the 1960’s and 70’s, we were inordinately scared of offending the U.S. In the 80’s and 90’s our nervousness was refocussed onto Indonesia with the result that successive Australian governments have bent over backwards to avoid treading on President Suharto’s toes. Through fear of Indonesia and over-eagerness to please its regime, Australia has been an accomplice to genocidal policies and actions in East Timor.

Perhaps if we knew more about Timor, we may be more inclined to support its people and their struggle.

Geographically, Timor is a tropical, semi-arid island situated 600kms north west of Darwin. Its central mountain areas are used for grazing and coffee plantations, while the lowlands are heavily wooded. People on the coastal plains are of Malay origin, having pushed those of Melanesian ancestry into the mountains.

Until 1975, East Timor was an overseas colony of Portugal, which began trading in sandalwood with the islanders in the early 16^th century. During World War 2, Timor was occupied by the Japanese, who conducted bombing raids to Darwin from airfields on the island. Several hundred Australian guerillas located on Timor were strongly supported by the Timorese people, 50,000 of whom were either killed fighting the Japanese or died of starvation as a result of Japanese policies. During 1974, political change in Portugal resulted in a hasty decolonization of East Timor with a brief period of independent rule by a leftist Fretilin government in 1975. This situation was unacceptable to both Indonesia and Australia. On 7 December 1975, Indonesia moved in, dropping thousands of paratroopers to take the capital, Dili, following an intensive naval bombardment.

Since then, hundreds of thousands of Timorese people have died as a result of conflict with Indonesian armed forces. Many Javanese transmigrants have arrived, forcing the Timorese off their land into resettlement camps. The post-Suharto regime apparently has no intention of relinquishing its hold on East Timor, despite the condemnation and disapproval of the international community.

In view of the situation in East Timor, it is not surprising that detailed information about health services and health status is hard to come by. Nevertheless, some information is available based on reports from people who have visited the area recently. Among these were two final year British medical students who travelled widely throughout East Timor in 1997, visiting clinics and talking with staff and community members. They reported that health services are provided by a combination of Catholic mission clinics and Indonesian government health centres (Pukesmas). There is some degree of collaboration at a local level between the mission clinics and health centres, but all resources are short. The British students painted a disturbing picture of widespread malnutrition, tuberculosis, malaria, gastroenteritis and respiratory infections. The recent drought has almost certainly aggravated the situation. Furthermore, they found that many Timorese women had been forced or tricked into receiving Depo Provera contraceptive injections. There is also distrust of the Pukesmas clinics because lethal injections had been deliberately administered in Dili hospital to some of those wounded during the Dili massacre. On the positive side, it seems that the Indonesian government has upgraded infrastructure (roads, bridges, health centres and schools) since the 1975 takeover. Portugal did very little in this respect for East Timor during its 450 year rule.

The two medical students felt that many government clinics had been built for show rather than service delivery; as they were generally ill-equipped and understaffed. Many of the Indonesian doctors in East Timor are new graduates on 3 year tours of duty. They are not acquainted with local customs or language and poorly supported. Pukesmas staff are under some pressure to meet family planning targets based on percentage of local women who are contraceptive acceptors, and the Indonesian family planning service (Keluarga Berencana Nasional) is vigorously promoted. Injectable contraceptives are favoured with the Pill being seldom prescribed and the rhythm method rarely taught. Since many East Timorese are Catholic, this approach is culturally inappropriate.

East Timor will remain in the world spotlight as the democratisation of Indonesia proceeds. It is also likely that East Timor will eventually become an independent nation and one of our nearest neighbours. Although AUSAID supports some projects on the island, the Australian government ought to be more active in attempting to repair the relationship with the people of East Timor. We should not hesitate to advocate strongly in favour of East Timorese independence, offer increased support for development of infrastucture and expertise, and immediately accept as legitimate the claims to refugee status of 1,650 East Timorese currently living in Australia.

References:

(1) Aarons M, and Domm R. East Timor. A Western Made Tragedy. The Left Book Club, Sydney 1992.

(2) Inbaraj S. Malnutrition,TB Plague Timorese. The AustralAsian. September 27, 1997.

(3) Encyclopaedia Britannica, Britannica CD 98