Gavin Doolan spent his elective in East Timor. Here he explains how he felt being part of a nation recovering from war, feeling that he was making a bit of a difference

Earth's newest nation has much to offer your medical elective. A recovering war zone, Timor Lorosae (literally "Timor sunrise" in the local language, Tetun) proclaimed independence on 20 May 2002. Only two and a half years before then, East Timor was embroiled in a frenzy of militia mediated violence, leaving most of the country's infrastructure in ruins, and 100 000 people dead.¹

East Timor's brutal past is apparent as soon as you step off the slightly dodgy 13 seater plane and on to the tarmac at Dili International Airport. Burnt out and decrepit buildings still make up about two thirds of Dili; home to an estimated quarter of a million people, crowded into an area no larger than an average Australian suburb. Despite their apparent hardships, the East Timorese are some of the friendliest people I have ever met. Australians can just turn up in East Timor. You tell them how long you want to stay, and no previous arrangements are needed.

Key facts

• Population--800 000
• Capital--Dili
• Currency--United States dollars
• Languages--Indonesian, Tetum, and Portuguese
• International code--+670

The past

East Timor was colonised by the Portuguese in the 16th century and was prized for its exotic spices and heavenly scented sandalwood. The colonialists took much but did little for the country's development. After a coup by the Portuguese army, Indonesian troops crossed the border in 1975 claiming East Timor as Indonesia's 27th province.²

Australia--the only country ever to recognise the annexation--conspicuously overlooked the condemnation of the illegal invasion by the United Nations. During Indonesian times it is estimated that hundreds of thousands of East Timorese people died as a result of the occupation--due to starvation, disease, or direct military action.³

Once Soeharto lost power in 1998, the new Indonesian president, Habibie, announced a referendum for East Timorese independence. Many feared violence around the lead up to the vote, which was observed by the United Nations. However, it was not until the results were known that the Indonesian militia became active. Despite promises to the contrary the United Nations left the East Timorese to the mercy of the militia soon after the violence started. Not until two weeks later, and countless people dead or missing, did the Australian led international force in East Timor step ashore to restore order.

The United Nations transitional administration in East Timor oversaw the country's redevelopment until Xanana Gusmau won the presidential elections by a landslide to form a government in May 2002.

Culture in East Timor

I was lucky enough to live with a local family (one of the most important entities in East Timorese culture) for the early weeks of my elective. My colleague, Sandy, and I were accepted as part of this typically large East Timorese family. We ate together, kicked the soccer ball around with the kids, and played cards by candlelight when the power was off; it was fantastic for improving my language skills in Tetun and above all helped me integrate straight into East Timorese life. Over the remainder of the elective period we would drop by for the fantastically strong and sweet East Timorese coffee whenever possible.

Day to day medical work

Most of my elective was spent at Bairo Pite clinic, which is run by a fluent Tetun speaking American, Dan Murphy. The number of local doctors in East Timor can be counted on one hand. Dan has worked in Dili as a doctor since before the hostilities broke out in 1999. The clinic is busy--hundreds of outpatients are seen each day. The clinc has wards for obstetrics, tuberculosis, other inpatients, plus a literal emergency room.

The day usually started with a round of the inpatients. Dan was keen to teach and liked to get students to make management decisions, which meant that I felt a bit more useful than I usually do at hospitals in Australia. We would then either sit in with Dan while he saw outpatients, look after critical inpatients, run the emergency room, or see patients ourselves. Visiting doctors, medical students, and other health staff were in constant flux, so our role would change from day to day. Sometimes Sandy and I were the only "doctors" available. Clinical medicine was our method of working--malaria films, tuberculosis smears, and Gram stains were the only investigations at hand.

The burden of disease is heavy in East Timor. The Bairo Pite clinic is one of only a handful in Dili, and many patients prefer the clinics to Dili National Hospital. Consequently, the clinic sees a broad range of illnesses, particularly infectious diseases including tuberculosis, malaria, pneumonia, and leprosy, as well as heart failure, kwashiorkor, and marasmus. In the emergency room, I saw lots of trauma ranging from motorcycle accidents to nasty machete wounds. And, of course, there were countless abscesses to be drained. With a national health budget of only $A16m (£6.5m; $11m; a9.5m) each year, resources were scarce, so making do with simple equipment and being inventive was an essential part of the job. During my stay, East Timor's central pharmacy ran out of intravenous fluids so we had to be particularly careful about giving fluids to only those who really needed them.

Extracting teeth and animal surgery

One of the best aspects about my time in East Timor was the variety of things to do. I met an Australian volunteer dentist, Peta. She took me to Dili jail where she taught me to give local anaesthetics in the mouth and extract teeth. In one day we got through about 50 patients (number of extractions unknown). Now, unlike many interns in Australia, I would be happy to anaesthetise and extract teeth if I needed to.

I also worked with two volunteer veterinarians, Eva, a Norwegian and Jenny, an Australian, who were setting up the first veterinary practice in the whole country. I helped out with a number of small animal surgical cases, which were performed on the tailgate of a borrowed Toyota pick up truck. Other activities included attending medical and surgical teaching rounds at Dili National Hospital, a visit to the Australian military medical evacuation airbase, and speaking to Timorese university students about drugs and sexual health. They were particularly eager to know whether the actors in pornographic films were married to one another or not.

Tourist delights

East Timor is absolutely beautiful. Rugged mountains run from the east coast to the border with West Timor. In some places, the mountains bypass the narrow coastal plane and plunge straight into the sapphire blue sea. Just outside Dili are stunning beaches, with good snorkelling only 10 metres off shore. It is easy to hire four wheel drive vehicles, and a visit to Jaco Island on the eastern tip is a must. At Jaco we slept on a deserted beach, were greeted by a pod of dolphins in the morning, and local fishermen caught us fish and cooked it for our dinner. Dili is a lively city with good cheap restaurants, colourful markets, and even an internet cafe. You can spend hours wandering around Dili just watching its goings on and chatting to the locals. The East Timorese are welcoming and curious, and all of them want their photo taken.

The bottom line

You will not often have the opportunity to be part of an emerging nation like East Timor. I could not recommend a medical elective in this beautiful country highly enough. The people are friendly, the food is good, you will learn some medicine, you will be given a fair chunk of responsibility, and you might even feel like you have made a bit of a difference. What more could you possibly want from an elective?