Subject: RA: Girl's death highlights poor healthcare

http://www.abc.net.au/ra/asiapac/programs/s1108744.htm

EAST TIMOR: Girl's death highlights poor healthcare

As East Timor prepares for the second anniversary of independence next week, the country remains one of the world's poorest. For most East Timorese, education and basic health care - even access to clean water - are beyond reach. The situation has been highlighted by the death of a 12 year old girl.

Presenter/Interviewer: Marion MacGregor

Speakers: Dr Nurul Islam, the United Nations forensic pathologist in East Timor; Rui Arauju, East Timor's Health Minister

MACGREGOR: September 2003 in a village in the Almeira district, 12-year-old Julmira Babo was playing outside when she collapsed on the ground, unconscious. Believing she'd been struck down black magic, her family administered traditional medicine. But a few days later, on the first of October, Julmira died. The police took her body to the United Nations Serious Crimes Unit in Dili. There, an autopsy was conducted by forensic pathologist Dr Nurul Islam. He was shocked at what he found.

MUHAMMAD NURUL ISLAM: There were hundreds and hundreds of worms inside the intestine, in the stomach, in the aesophagus, in the oral cavity then on the respiratory tract that is on the trachea. So respiration stopped, so the victim died due to asphyxia.

MACGREGOR: Julmira Babo suffocated on hundreds of parasitic roundworms up to 35cm, which had been living in her small intestine. The worms travelled up into her aesophagus and then into her mouth in search of food. For several days after she collapsed, Jamila had been given only water to drink, and the worms were hungry. In sixteen years as a pathologist in developing countries, Dr Nurul says he had never seen anything like Julmira's case.

NURUL ISLAM: In my forensic experience I can't believe this, no never. In any tropical or sub-tropical country you may get some one, two three five ten worms that's not a problem But in this case, hundred and hundreds of worms, and so big, twenty to thirty, thirty-five...really, really unbelievable. And no I have never seen it in my lifetime.

MACGREGOR: Yet Dr Nurul says there's a simple, and cheap solution. A tablet costing just a few cents would have saved Julmira's life. It could prevent malnutrition, anaemia, stunted growth, and death for thousands of other East Timorese children. And this doesn't just apply to intestinal parasites. All of the more common diseases in East Timor - diahorrea, malaria, and tuberculosis, could be easily treated, says East Timor's health minister, Rui Arauju.

ARAUJU: The biggest burden of disease in this country are related to diseases that can be prevented and diseases that can be handled at the primary care level and not with sophisticated hospitals and tertiary interventions like what you have in for example developed countries.

MACGREGOR: East Timor spends about 11 percent of its overall budget on health...around 8.4 million US dollars a year. Topped up with capital investments through the World Bank, annual spending on health is about twenty dollars per person. The health ministry is planning to run a national de-worming program in schools, beginning with a pilot program. But without extra funding, it can't afford even this, says Rui Arauju.

ARAUJU: Yes we do need money, we do need money. Just one example, we are now working with the World Health Organisation's office here in Dili, to start the piloting program that I mentioned to you. And our preliminary estimate is talking about 1.4 million US dollars. But that is only a preliminary figure. The current system that we have in place will not be able to conduct mass campaigns without extra input of resources.

MACGREGOR: But more money isn't the whole solution. While pathologist Dr Nurul Islam has told the government, the World Health Organisation and UNICEF that a nationwide school de-worming program is the only way to stop thousands more deaths, he admits getting the message across won't be easy. In villages like the one where Julmira Babo lived, most people still have a lot more faith in black magic than they do in western medicine.

14/05/2004


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