Subject: Dr Murphy on
serious health problems in East Timor
Date: Sun, 3 Oct 1999 08:01:58 -0700 (PDT)
From: tapol@gn.apc.org (TAPOL)On
27-28 August, Dr Dan Murphy paid a brief visit to London. After having spent nine months
working as a doctor in Dili, he had just been refused entry into East Timor by the
Indonesian authorities and was on his way to Washington to seek support to get the
Indonesian exclusion order reversed. Now with Interfet operating in East Timor, he is back
'home' with the East Timorese.
The following are points from an interview he gave to
TAPOL, which I have only now had time to transcribe. The information is urgent, in view of
the extreme vulnerability of hundreds of thousands of East Timorese still in the mountains
of East Timor (with the rainy season due very soon) and in West Timor.
Dr Murphy worked for nine months at the Motael Clinic which
is an out-patient clinic, not a hospital. But when atrocities were committed, it received
many people with serious gunshot and stab wounds and had to treat them as in-patients,
although space was extremely limited, there were no laboratory facilities, qualified
surgeons or anaesthetist. It some cases, all the medical personnel could do was to ease
the dying patient's pain.
With regard to the thousands of people who attended the
Clinic for treatment, Dr Murphy said that most diseases he saw were easily preventable and
easily treated, as long as the resources are there. In his estimation, 50 to 100 East
Timorese people were dying daily of preventable diseases.
* The Number 1 killer in East Timor is tuberculosis. As a
doctor with much experience of disease in third world countries, Dr Murphy said he had
never seen such a high incidence of TB as in East Timor. He gradually came to the
conclusion that his first line of diagnosis with almost every patient was to consider that
TB might be the ailment.
Practising in East Timor had compelled him to deepen his
knowledge of all the varieties of TB. It is a highly contagious disease and his fear even
then was that it would take a heavy toll among Timorese living in insanitary conditions in
refugee camps; at the time some 50,000 people were thought to be in camps controlled by
the TNI/militias. TB is a disease caused by social and economic factors. Poor nutrition,
housing, sanitation exacerbates the problem. Camp conditions are very likely to intensify
the incidence of TB, he said.
* According to Dr Murphy, HIV is now spreading in East
Timor, having been introduced through prostitutes used as part of a racket run by members
of the armed forces. People who are HIV positive are difficult to treat for TB because of
their low level of immunity. The Indonesian authorities refuse to acknowledge the
existence of HIV.
* Tubercular-meningitis is a condition that develops when
TB germs enter the brain tissue. Extremely dangerous unless diagnosed early when it is
treatable. When he was forced to leave Motael, there were sixteen people being treated for
this condition.
* Ideally, people with TB need to be kept under treatment
and observation for eight months, which is hardly likely for the people living as
refugees.
* Dr Murphy visited the General Hospital in Dili which had
a 40-bed unit for the treatment of TB but found it empty, clear proof that East Timorese
were not willing to go to an Indonesian hospital for treatment.
* An additional problem with treating TB is the development
of multi-drug resistant TB which often results when the treatment a patient undergoes is
incomplete. In the course of uncompleted treatment, the stronger germs subsume the weaker
ones. Once a patient reaches this stage, treatment is no longer possible and the disease
will prove fatal.
* The Number Two killer is malaria which is prevalent
particularly in coastal areas. Dr Murphy thought that as many as 10 per cent of child
deaths were caused by malaria. Many people have malaria in their bloostream and it will
flare up at moments of high vulnerability, such as during pregnancy.
* In Dr Murphy's opinion, the best way of dealing with
malaria is with community-based health care. There is a pressing need to train para-medics
to diagnose malaria and to be able to treat the condition, in particular the under-fives.
He said there was a pressing need for a Total Malaria Eradication Programme in East Timor.
* From the visits he made to refugee camps in Liquica, he
concluded that 75 per cent of the patients he treated had enlarged spleens, a symptom of
malaria. They had been forced down to coastal regions which had made them very susceptible
to malaria.
* Regarding birth control, he was very keen to encourage
mothers to breast feed because this inhibits ovulation and helps better spacing of
child-bearing. In his experience, bottle-fed babies did not do well and were usually
under-nourished. He felt that Timorese mothers usually stop breast feeding far too soon.
* He had not been able to undertake any investigation of
the extent of infant mortality but could only say that most mothers he had treated had
lost quite a few of their children. He once did a spot check of 200 infants for signs of
malnutrition, measuring the thickness of their arms and found that 44 per cent were
malnourished and hence at high risk to all kinds of illnesses.
* While he described the heath situation as very bleak, he
said that most of the diseases were easily treatable and could be helped by public health
education. It was in this sphere that he hoped to devote much of his energies once he
returned to East Timor.
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