East Timor is one of the poorest and most disadvantaged countries in the world. There are only 11 eye care nurses, one ophthalmologist and no optometrist to attend to the eye care needs of its more than one million residents. Alito Soares de Araugo and Bernardino Pires are two of the eye care nurses who live and work in East Timor. At the recent SRC, mivision had the privilege to meet these two miracle workers.
Picture this: over the last decade your eyesight has been getting increasingly worse and you have no idea why. You used to work hard every day to support your family, but now you can’t see to work… and you rely on your grand-daughter to guide you everywhere.
So why didn’t you go to the optometrist before it got to that stage? Because you live in East Timor… and you don’t even have access to running water, let alone eye care.
These are the sort of patients that eye care nurses Alito and Benardino have been trying to help. And while they are performing miracles every day, they are concerned that there are many, many more people in desperate need of care but without the means to reach a clinic.
People have to walk as there is no transportation. It takes many hours because there are a lot of mountains in East Timor
East Timor Eye Program
The East Timor Eye Program (ETEP) commenced in July 2000 as a response to a request from the World Health Organisation. At this stage, no eye care was available anywhere in East Timor and the damaged country was in desperate need to re-establish health services. Optometry Giving Sight began directing significant funds to East Timor Eye Program in 2007, through the support of ProVision Optometry Teams who provide primary eye care services and training for local staff. The ProVision Optometry Teams work in conjunction with ophthalmology teams to provide all aspects of vision care.
The aim of the program is to build a comprehensive and sustainable eye care system in East Timor that will make the region self-sufficient in the provision of eye care whilst delivering eye care services to meet the immediate needs of East Timorese. ETEP is working to achieve this mission through a combination of service visits, training and mentoring local eye care professionals, providing affordable supplies of spectacles, as well as building and infrastructure development activities. And while by sponsoring nurses like Alito and Bernardino to come to Australia for continued eye care education and training, there is a dire need for further development/support and a greater number of eye care professionals in order for Timor Leste to make the transition to complete self sufficiency.
ProVision Optometry Teams make six visits each year to different regions of East Timor. Each trip is made by two volunteer optometrists and each trip is usually as least a week. Twelve volunteer Australian optometrists provide 60 days annually working alongside East Timorese eye care workers.
Alito and Bernardino were both very humble as they introduced themselves; shy and friendly, and a little embarrassed that so much fuss was being made over them… Because, whilst they are doing an amazing job for the East Timorese people, their focus is not on themselves, but on the huge need before them.
Alito works in the town of Maliana and Bernardino works in Suai. Both towns have populations of approx. 22,000 people and are many hours travel by car from the country’s capital, Dili. The nurses work out of referral hospitals and travel to the surrounding villages where the conditions are often makeshift away from the hospitals.
Alito painted a picture of the desperateness of living conditions in East Timor:
“In Timore Leste, people are not educated; they live in the rural areas where it is difficult to get access to proper care. That’s why they live with blindness as they don’t know where they can go. I enjoy being an eye care nurse as I want to help the people who cannot help themselves. When I examine their eyes, I can see that they have refraction problems and then can give them glasses so that they can return to their jobs and daily activities.”
“People are very happy now to receive eye care from eye care nurses because at the time of independence there weren’t any eye care nurses,” said Alito. “Now, people can come to the clinic and have an exam, and get glasses if they need them. As a result of our outreach work, even people in the very far away, rural areas have access to much needed care.”
When asked how his patients reach the hospital Alito replied, “People have to walk as there is no transportation. It takes many hours because there are a lot of mountains in East Timor. So people have to travel a long way for eye exams and often they cannot come at all…. That’s why it is important that we can come to them.”
Still In Need
Although the situation has improved over the last few years, there is a need for more people power in order to progress further. “In Timor there are very few eye care nurses. In total there are only 10 or 11; so in some districts there are no eye care nurses at all. But even if there is a nurse in a region, there are so many people it is hard to serve them all. Like in my district there are 90,000 people, but there is only one eye care nurse there and that’s me…
“We hope that in the future maybe (the number of) eye care nurses in the eye program will grow and the quality of service will improve. We need good quality service, and we also need more eye care nurses because at the moment only one (or none) in each district is not enough.”
Michael Knipe, Director and Deputy Chairman of the Optometrist Association Australia (OAA); National Committee Member of Optometry Giving Sight in Australia and volunteer Project Manager of the East Timor Eye Program said of the visit from Alito and Bernardino: “We are very grateful… to the eye care nurses that we work with in East Timor. Their commitment to helping give sight to their people has been instrumental in the progress that has been made in developing sustainable vision care for a country so devastated by civil unrest and war.
“I have visited East Timor five times since 2003 and in the beginning most of my time, and that of my fellow volunteers, was spent examining patients. More recently however, whilst still providing basic eye care, our volunteers are extensively involved in supporting the establishment of an East Timorese eye care system staffed and run by local people, such as Alito.
“I would also like to pay tribute to my colleagues, the volunteer Australian optometrists, who give freely of their time and expertise to help their neighbours. Over the life of the program there would be too many to list here but I would like to mention Andrew Maver the co-ordinator of volunteer optometrists, Peter Lewis the equipment and supplies manager and Sib Verma the education manager.”
The Road Ahead
East Timor has a long way to go to become self-sufficient in terms of eye care. It is still one of the world’s poorest nations with 40 per cent of its 1.1 million people living below the international poverty line of AUD$1.25 a day.
Living in Australia it’s impossible to imagine the depth of such poverty. Here we feel hard done by if our new barista hasn’t poured the creme just right on our first flate-white of the day. We spend AUD$1.50 on a newspaper then toss it away.
We don’t think twice about digging around in our pocket for loose change for a coffee or a paper and yet our neighbours depend on this amount of money each day to live on. The concept of abject poverty is a huge leap for us.
East Timor is one of our closest neighbours and shares our interests in regional economic development and security; as such we have a responsibility to assist our neighbour with aid.
Since the mid-1980s the Australian Government has provided aid in East Timor, initially it was focused on humanitarian aid but quickly moved to broader development assistance. For the last ten years Australia has provided around AUD$940 million in Official Development Assistance (ODA) to East Timor and will provide an estimated $103 million in ODA over the next two years to ensure gains in stability are not lost and development and growth can progress.
Nearly two-thirds of East Timorese live in rural areas which are reliant on subsistence agriculture. However, a lack of infrastructure after East Timor gained its independence from Indonesia in 1975 meant that that only a quarter of crops were sold, and farmers had to walk for many hours to reach markets.
One of the things Australia has done to try and help the East Timorese is to mend its roads and infrastructure in order to enable people to work and to enable trucks and medical supplies to reach people who were previously inaccessible.
Donations from eye care professionals and their colleagues in industry have transformed the lives of thousands of people of East Timor.
Alito and Bernardino were sponsored by Optometry Giving Sight to come to Australia in May in order to continue their training in eye care and to receive additional training and mentoring from Australian optometrists. They visited optometry practices in Melbourne and Hobart, were hosted at the Australian College of Optometry, the Eye and Ear Hospital in Melbourne and attended the Southern Regional Congress (SRC).
For more information or to support the East Timor Eye Program and other projects, please visit www.givingsight.org.