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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