Reuters January 13, 2000

Doctor slams UN on East Timor tuberculosis

DILI — From his ramshackle clinic in one of Dili’s backstreets, Dr Dan Murphy says the easily preventable disease tuberculosis is killing too many East Timorese.

And he blames the United Nations administration. Murphy is the longest-serving Western doctor in the territory and worked without official permission from Indonesia until East Timor’s de facto independence in September.

"The UN is afraid it doesn’t have the perfect program, but it won’t have," he said. "This is a poor country which has just suffered a major trauma."

Murphy says the bacterial disease has reached epidemic proportions and is baffled why a UN program will not be in place until February or March to combat the disease, which has become East Timor’s number one killer.

"I would estimate that it kills one fourth of those who die in East Timor every day, which is anywhere from 50 to 100. I would say that almost every Timorese person since September has been closely exposed to TB.

"When families were forced from their homes into crowded conditions together with TB sufferers no longer receiving treatment, they were all sleeping together on the ground. In a crowded room with no circulation of air, that’s great for TB."

An estimated 250,000 East Timorese fled or were forced from their homes to Indonesian West Timor in the maelstrom of violence that followed the August 30 vote for independence.

The UN praises Murphy and his tuberculosis treatment program but maintains it is delaying for good reason.

"I don’t think it’s UN bureaucracy and I don’t think it’s lack of resources," said UN’s Director of Social Services in East Timor, Cecilio Adorna.

"If we want to hand on to East Timor a good, functioning world class TB program then we need to start it off as well as we can—we definitely don’t want to hand them drug resistant TB or a chaotic mixture of different agencies providing different drugs and different protocol, we want to hand on something that will keep working," Adorna said.

"We need to have laboratory services, we have to have drugs available in the country and we have to have people who can actually manage the programme...you can’t abandon treatment because it’s very hard to get them back on the treatment and there is a huge worry about creating drug resistance so we have to get all these things in place."

The UN disputes Murphy’s claim that tuberculosis has reached epidemic proportions.

At Dili’s International Red Cross hospital, Health Co-ordinator Dr Kevin Kelly said he has seen more than 260 patients in the past three-and-a-half weeks who are likely to have tuberculosis.

"I’ve been screaming like everyone else, ‘Let’s start,’ but you do need to have the right program in place, if you don’t follow the treatment through, you risk resistance," Kelly said.

Most independent medical organizations had agreed to delay treatment where possible until the UN program was in place, he said.

"If we see people who we think are going to die before the program starts then we’ll start treating them but otherwise we treat secondary ailments of TB.

"The UN has ordered the drugs, it has the money but TB programs are very difficult to run."

Difficult or not, Murphy cannot see why the UN still does not have a dedicated program in place four months after the violence.— Reuters

"The UN knew TB would be the worst health problem in East Timor so they could’ve been prepared, the first week they came here it should’ve been the number one priority. This is the number one killer here," Murphy said.

"I see people all the time who are not going to last even a month, they’re on their last legs, adults weighing 20 kilograms [44 pounds] and people coughing up blood, but you give them treatment and they come right back to life, it’s beautiful."

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