Tuesday, February 19, 2008

A few photos. . .

Yesterday was an 18 hour day and today was too. Every day from here on out we’ll be busy. Glad I had that swim yesterday AM. We started the surveys today and there has been so much preparation. Now I’ll be doing lab work.

We have been collecting blood samples in the community at a school today. Very full on. We are having to enter the data into these Personal digital Assistants (PDA ) for the Gates survey and it is quite laborious, especially since the names are all like Funagaliliou Papakavatu or along those lines. Then at night we are doing lab work. We could use at least 10 other people.

It's nice for me to be just helping out and not worrying about getting data for my PhD. There are mozzies, which seem to be mostly of the aedes genus, I’m not sure which species. There is not a lot of wildlife. I’ve seen a rat, a few geckos, no birds, a few cats. Pigs are penned up. There are lots of dogs running around and most of the females seem to be in heat.

Our team, striding purposefully off to work. . .
left to right: Kim, Sandra, Hayley, Rick, Sonia and Petrina

Sunday, February 17, 2008

Getting to Work. . .

Despite a few logistical problems after arriving, we will begin working tomorrow. I will be assisting with each of three surveys.

The surveys consist of:
The Tuvalu National Lymphatic Filariasis Survey being done by the Ministry of Health here.

The second is a Gates Foundation Global LF Elimination survey to compare diagnostic tools in low prevalence countries. Tuvalu is one of nine countries in the survey.

The third is a PhD study by Sonia Harmen of JCU, checking out the incidence of skin diseases, worms and LF amongst school children.

This pm we will have a mock run through of how we are going to run things. Tomorrow we will begin the work. Despite my lack of technical expertise, I’ve been asking lots of "what if" questions about the logistics of it all to make sure all the bases are covered.

I had a GLORIOUS early AM swim in the lagoon, about a km out into the TURQUOISE. The clouds were magnificent and almost like N. C. Wyeth’s Giant painting.

Helen

Tuvalu Facts:

Capital: Funafuti
Population: 11,992 (July 2007 est.)

Polynesian 96%, Micronesian 4%
Islands: 9 coral atolls

Area: 26 sq km

Highest point: 5 m
Airports: 1

Roadways: total: 8 km
Monetary unit: 1 Tuvaluan dollar, or 1 Aus dollar = 100 cents
Main exports: Copra, handicrafts
Life expectancy: men: 66.38 years women: 70.99 years
Languages: Tuvaluan, English, Samoan,

Kiribati (on the island of Nui)
Religions: Church of Tuvalu (Congregationalist) 97%

Seventh-Day Adventist 1.4%, Baha'i 1%

Tuvalu. . .

Tuvalu is made up of an archipelago of nine coral atolls located in the South Pacific just south of the Equator and west of the International Dateline.

Helen arrived there today as part of a research team working on a survey of lymphatic filariasis, which is a parasitic tropical disease responsible for elephantiasis. Elephantiasis causes a thickening of the skin and underlying tissues, especially the legs and genitals.

Helen and the team are on the main island of Funafuti, where they are being housed in a guest house she described as being ". . right on the airport runway which also doubles as the soccer field. . " The power supply and internet access is "patchy", so she'll try and get something written and perhaps some photos out over the next few days.

A Tragic Day for Timor. . .

I am writing now from Brisbane, picking up the tale from the previous posting:

After Megan received the phone call about East Timor’s President, Jose Ramos-Horta, being shot, we were out the door in less than five minutes. Per her instructions I hastily packed my gear, my passport pouch snugly tucked away under my shirt. Megan grabbed her "go" bag, complete with a two way radio, clean underwear and toilet paper, among other essential items. As we departed her house, it seemed as though the neighborhood was exceptionally quiet for a Monday morning and Fernando, her faithful gardener/friend, seemed to already know that something was awry. He said that he would look after her place and for her to be careful. Our adrenaline was pumping.

As we drove to the WHO office at the UN compound in Dili (about a 20 minute drive), life on the streets appeared normal... children going to school, shops opening and the police academy cadets lining up for training. We pulled over and bought some Timor Telecom cell phone credit from one of the ubiquitous guys on the side of the road who are constantly fanning the vouchers in their hands like a hand of cards. Communicating was going to be vital. Her two-way radio was squelching and the messages coming through were to proceed to work, with caution.

We arrived at the UN compound and they waved us through without requiring me to show any ID (which they had done previously). A group of Timorese UN employees (mostly drivers) were huddled in conversation and texting with their cell phones. When we greeted them, they all had looks of anguish and terror on their faces, having heard the news. Most all of them have suffered losses of family members and homes in the previous crises and were extremely worried about how the day could unfold.

We checked in at the WHO office and then alerted our families that we were safe and sound, anticipating that the phone lines would soon be jammed. We then rendezvoused at the cafe with Megan's friends who were arriving in for work. The text messages were flying and the cigarette smokers were feverishly lighting up. People were beginning to get messages from worried family and friends from all over the world as the news about the assassination attempt spread. Everyone was calm, but sweating bullets, the tension was exacerbated by the extreme heat too. Rumours were flying "out in the world" and details were already being skewed, a classic case of Chinese whispers.

One of Megan's friends was visibly shaken as he related the story from friends who lived in the neighbourhood of Ramos-Horta's residence. who had witnessed the assassination attempt with bullets flying past their window. The extent of Ramos-Horta's injuries was unclear. News then came through that the rebel leader, Alfredo Reinado had been killed in the encounter and also that Xanana Gusmao (the Prime Minister) had been attacked. This was all very big news indeed. Everyone was just very concerned that the shootings would trigger widespread unrest in Dili, erupting into uncontrolled violence. Security reports were coming through however, that the streets were calm. People were anticipating that violence might occur after Prime Minister Gusmao's press conference at 4:00. It did not seem as though the news of Reinado's death had hit the streets.

We decided without much hesitation that it would be wise for me to depart Dili that day in anticipation of a potential "lockdown" and possible civil war. I was due to depart the next morning anyway. Megan dealt with my flight booking with her usual efficiency and competence and succeeded in getting me a seat on that afternoon’s plane. It was very reassuring and felt luxurious to be under her wing.

The day continued with more juice and coffees as the expats gathered for personal stories and television updates from the BBC news. It was all very interesting to be at this epicentre of activity. One of her friends was getting calls from the New York Times in Jakarta, while another was in a special meeting with Gusmao instead having lunch. The whole time I felt safe, though the constant "Thwack, Thwack" of the helicopters overhead was slightly unnerving.

After consulting the head of security for an update on the streets, Megan decided that it would be OK for her to deliver me to the airport instead of my going with a UN driver. She would drop me off and then continue home. En route, the streets still seemed calm, though the presence of Aussie and NZ troops was very evident. A few tanks going past escalated the impression that "this is the real thing."

Megan is an expert ‘Dili driver’ and avoided the usual array of roving dogs, pigs, goats and children very well and we made it the airport in fine time with a quick stop to pick up some DVDs. She was anticipating being housebound under curfew restrictions in the days to come.

I was the first in line for check-in which was a bit delayed due to the simultaneous arrival of Ramos-Horta in an ambulance for his medical evacuation to Darwin. Megan and I had a hasty goodbye. It was all happening! Proceeding through the security after immigration was interesting, as the machinery was apparently not functioning but the people go through the motions anyhow.

The plane was an hour late in departing from Dili, otherwise all was normal. It was quite surreal to arrive into Darwin only an hour and a half after leaving the tense drama in Dili. Returning into the brightly lit, clean, fast lane of the developed world, I felt as though I had been in an intense 12- hour movie marathon. The reality of "globesity" was a sudden punch of instant culture shock, despite my having been out of Australia for only three weeks.

The whole day was a sad and tragic day in the history of Timor-Leste and its fragile young democracy. Fingers crossed it can withstand these events. I am thankful for my three weeks there and hope to return again one day in order to try making some worthwhile contributions and to see all my new friends once again.

Helen

Return to Atauro. . .

The last week I was out on the island of Atauro again with the Australian Aid International (AAI) team. It was great to return to such a lovely place and work with a great team, especially as I was more familiar with their routine and the general lay of the land. We did five days of mobile clinics, two of of the villages we accessed by the little outrigger boat. We also were able to go to Makadade in the more remote and mountainous region of the island via 4WD. The road had been closed for the past month or so due to slides and heavy rains.

Once again we saw people with a variety of conditions. Malaria, scabies, fungal skin infections and other bacterial skin problems, conjunctivititis, parasitic infestations, muscle pain and upper respiratory infections were most prominent. We were able to dispense basic medications to them which will hopefully help resolve these problems. Unfortunately, the real issues relate to clean water, sanitation and lack of education. There is alot of effort being put into these issues and there's hope that sometime soon these basic health problems will ease up.
















We also learned more about the local customs, particularly pertaining to marriage and dowry. The men must fork up the dowry which, depending on the district and general affluence of the area, could range from a buffalo, goat and pig, to many animals and much money.

Each morning in the village of Beloi (where we stayed) began with the blowing of a conch shell to call all the fishermen out to sea to fish en mass. Prior to Easter, they all fish for the church as a fundraiser. The women go to the fields and work together and pool their crops with proceeds going to the church as well. It was lovely to witness the boats in the predawn light heading off with the mainland as their backdrop.





















After arriving back to Dili on the weekend I spent a relaxed time with Megan and many of her wonderful ex pat friends. Always interesting to listen to their conversations as they analyze the current situations in the country.





















Monday AM rolled around and I was half packed, anticipating an early departure on Tuesday to Darwin. We were sitting outside her house having a cuppa when her mobile rang. Within a few seconds I could tell it was something serious. Her only words were "f__k! ... OK... thanks". She hung up and said ..."pack your bag, make sure you have your passport and let's go!". We were out of the house within a couple of minutes.

The president of East Timor, Jose Ramos Horta had been shot and wounded in what was (so far) a failed assissination plot, which also targeted the prime minister who was not harmed.

It was a day to remember. Check the BBC news online for updates.
I am writing this from Darwin and heading to the airport to fly to Brisbane soon. More later.

Love, Helen

Robert here. I'm just writing a quick one to say that Helen is in Darwin and fine.

There was an assassinattion attempt on East Timor's President and Prime Minister yesterday morning. She spent the day in the U.N. compound with her friend Meg who helped get her on a plane out of Dili a day earlier than she was planning. There is still a lot of uncertainty about just what will happen now, but things were rather tense and Helen described it "like being in a 12 hour movie".

Helen will write something soon, but I just wanted to post this to let people know she was alright.

Cheers, Robert

Monday, February 4, 2008

The Cycle of Life. . .

This past week was spent up at 1200m elevation in the Emera district, roughly 35 km as the crow flies to the southwest of Dili, twice that on the winding mountain roads. This is a lovely and verdant area up in the mountains where much of East Timor’s fine quality Arabica coffee is grown and ends up in Starbucks cafes. Driving up the very twisting one lane road beyond the town of Gleno was particularly beautiful with the coffee trees on the mountainsides getting shade from enormous acacia trees planted during the Portuguese time.

I stayed at Bakhita, a Timorese operated Catholic centre, which trains Timorese in computer skills, English language and sewing. A health clinic which opened in 2005 and sponsored by the St. John of God group is also there. This is run by Timorese personnel too and coordinated by Anders, originally from Seattle. He is extremely dedicated to this area and its people and has integrated himself fully into all aspects of the community. Anders was invaluable; showing me around, teaching me some Tetum, as well as local customs and culture. As a result I was able to learn a lot, gain new perspectives and be part of a whole side of the culture which many malae (foreigners) would usually not have an opportunity to experience. All of the people at Bakhita were extremely hospitable and friendly. Upon departure they presented me with a tais, the traditional Timorese weaving, which was very touching.

I helped some in the clinic, but had to make it clear a few times that I was not a doctor! For two mornings I accompanied the volunteers doing home visits for the mass community de-worming programme. This was another way to pick up some Tetum, meet locals and see quite a bit of the community. By the end of the week, I felt as though I “knew” quite a few locals by name.

The second morning I was there a woman arrived early at the centre very distressed, saying that her brother had fallen and was unconscious. Anders, Ade (the midwife) and I took off in the “ambulance”. Our driver, Dora, drove fast considering the very rough road conditions. When we arrived at the house there was a large gathering of people out on the road. We were promptly escorted through the gate past many more people and finally into the very dark house, through a rabbit warren of rooms filled with more people.

In a very small back bedroom lay the patient, an elderly man, with several close family members in attendance at the bedside. I put my stethoscope to his chest and heard no heartbeat, felt for pulses…nothing, no respirations either. It was obvious that he had died, but I felt very awkward to be the one to announce the death and gave my stethoscope to Ade who also examined him. A family member sitting on the bed tentatively asked, “mate?”(dead?) and Ade nodded. Instantly the word was passed and the bone chilling wailing began. We departed quite readily after some condolences.

Anders later explained about the rituals surrounding death in Timorese culture. All family members are expected to participate in the rituals when someone passes away. On the night immediately following the death, family members gather to hold an all night vigil with the body, including a midnight meal. That evening a group of ten of us piled into the ambulance to go to the family’s house. An envelope with money and a packet of candles were presented upon arrival in the front room where there was a coffin. It was obvious that much activity had occurred since our departure that morning. We joined a group in the main room that was chanting the rosary and singing around the body. A shrine/alter had been constructed for the deceased and his body was laid out with tais. Fresh and plastic flowers, interspersed with lit candles, were surrounding him. After an hour we went outside to a newly (that AM) constructed addition to the house, made of corrugated iron and bamboo trunks tied with twine. Coffee and cookies were served by young girls and a feast of goat was being prepared out the back. Since it was so late we didn’t stay for the feast. The whole scene was amazing to witness, not only the spectacle, but the gathering of the community to pull off such an “event” at such short notice.

“Lutu” (mourning) traditions are closely observed as the week/year continues. The day following the death is “aifunan moruk” which is the graveside service with a priest. A week later is “aifunan midar” when the family visits the grave and lays more flowers and has another feast. For the first year after the death, close family members are expected to wear metan (black) until the first anniversary. Women wear black head scarves, men pin black cloth swatches to their shirts and babies and children have black string tied around their wrists. During this time, no dancing can occur. At the end of the mourning period, there is a huge celebration/feast called kore metan “untying the black band”. Now that I am aware of the significance of the metan, I realise that many, many people are in mourning.

The next morning I accompanied Ade and Anders on a home visit to few hours old baby who had born breech. The mother was thirty and this was her 9th child. Mother and baby were in a dark, windowless bedroom with a fire burning on the dirt floor to keep the baby warm (it wasn’t that cold and the baby was wrapped in several blankets). Her brood of children was all peering in the bedroom as we did assessments in the almost dark, just a few slants of light coming in through the gaps of the corrugated iron walls. There was absolutely no ventilation and the smoke was thick. The custom of fire burning after a birth is hard to fathom and apparently impossible to alter. No wonder many are ailing with respiratory problems.

The cycle of life is very apparent and right on the surface in East Timor and I was fortunate to be on the fringe of death and birth. Now I just need to attend a wedding.

Next week I return to the island of Atauro with the Australia Aid International team. Lucky me!